Gaia Series 66: Regenerate the Hospital - Towards Medical Care for Citizens

Otsu Municipal Hospital embarks on a challenging journey of reform, blending innovation, local engagement, and unwavering dedication to regain public trust.

In this powerful instalment of Japan Hour, we follow the ongoing transformation of Otsu Municipal Hospital in Shiga Prefecture, as it struggles to recover from a crippling scandal that threatened its very foundation. Two years ago, Otsu Municipal became embroiled in a high-profile staffing controversy, revealing an entrenched “medical office” system, where local universities sent doctors to municipal hospitals. Tensions ran high between physicians from Kyoto University and Kyoto Prefectural University of Medicine, creating a divided workforce that ultimately left critical departments understaffed. Neuroscience was left without a full-time doctor, and the hospital faced a real risk of service collapse.

As the episode begins, viewers are introduced to Akihiko Hino, the hospital director appointed specifically to restore order and trust. Known for his resilience in handling difficult situations, Hino was transferred from Saiseikai Shiga Prefectural Hospital with a clear mission: To stabilise Otsu Municipal’s troubled operations. “They told me, ‘You like tricky situations, Hino,’” he says with a modest smile. His journey has been anything but easy, marked by repeated attempts to reestablish staffing and morale, particularly in departments like neurology and radiology, left vulnerable by the crisis.

The underlying tension is explored in the documentary’s coverage of the power struggles between Kyoto Prefectural University of Medicine and Kyoto University, two institutions whose rivalry has simmered for decades. Toshiyuki Senda, a medical journalist featured in the programme, remarks, “It’s a place for a clique from university medical departments to one-up each other. The citizens are just tossed to one side.” Otsu Municipal became a stage for competing medical factions, with hospital leaders requesting one university to cut staff from the other. As a result, crucial departments were often short-staffed, and patients were left in limbo.

With a population of 340,000 in Otsu City relying on the hospital, the need to restore stability has been pressing. Early in his tenure, Hino reached out to his alma mater, Kyoto Prefectural University of Medicine, requesting a new roster of doctors to fill the vacancies left by the scandal. Yet, as Professor Naoya Hashimoto explains, “There are people who think that there are plots at the hospital… and malevolent forces behind the scenes,” alluding to the lingering distrust within the community.

Hino’s efforts have, however, borne some fruit. Dr Noriatsu Ichiba, a highly-regarded radiologist and top-ranked in Japan for diagnostic imaging, chose to stay despite intense pressure to leave, citing Hino’s sincerity. “He doesn’t lie,” Ichiba says of Hino. The two share a mutual respect, with Ichiba likening Hino to a coach who came in during a crisis season. “I wanted to give him a win,” he adds, highlighting how individual loyalty is helping to rebuild the hospital’s infrastructure one department at a time.

Among Hino’s reforms is the innovative “doctor car” system, an initiative allowing doctors to respond directly to emergencies outside the hospital, treating patients on-site before transferring them. Led by Hiroya Chiba, the hospital’s emergency and ICU lead, the “doctor car” initiative has already saved lives. Chiba explains, “The purpose of the doctor car is to enable action that’s vital 10 or 20 minutes prior to getting to the hospital.” This new service embodies the hospital’s renewed commitment to proactive healthcare, ensuring that residents of Otsu can access timely, life-saving assistance.

Beyond emergency care, Hino’s vision for a “hospital for the residents” extends to home visits for patients who find it difficult to travel. This outreach initiative, led by Dr Ryo Omachi and a team of 50 medical professionals, includes doctors, nurses, and dieticians. Dr Omachi is shown visiting 91-year-old Takeyoshi Nishimura, a resident of Otsu. Nishimura, visibly grateful, says, “I never imagined they would come out to my home. I am really grateful.” The home visitation programme not only addresses the needs of the elderly but also alleviates pressure on local clinics, many of which have been forced to cut back on house calls due to an ageing workforce.

The documentary also highlights the contributions of female doctors, who are breaking new ground in Otsu’s traditionally male-dominated medical community. Kanako Kawaguchi, head of breast surgery, is introduced as the hospital’s first female deputy director, a role she balances with a demanding commute from Osaka and a busy family life. “Things would be much easier if the hospital were closer, but I make it work,” she says. Kawaguchi is dedicated to making breast cancer treatment approachable and humane, expressing her hope that patients will feel comfortable sharing their concerns with her. “I try to make it easy for patients to tell me what is troubling them,” she remarks.

Despite positive strides, financial challenges continue to loom over the hospital. The mass resignations two years ago plunged Otsu Municipal into unprecedented debt, and the recent reclassification of COVID-19 as a Category 5 illness has reduced government subsidies for hospitals that were previously on the front lines. Hino acknowledges, “We are significantly in the red,” underscoring the financial instability that threatens to undercut the hospital’s efforts at reform. Yet, the episode also captures Hino’s determination to keep going, driven by the unwavering goal of restoring the institution’s reputation.

The hospital’s journey, as Japan Hour presents it, is far from over, yet the dedication of individuals like Hino, Ichiba, Kawaguchi, and Hashiguchi suggests that Otsu Municipal is finally beginning to shed its turbulent past. Through innovative programmes like the doctor car, home visitations, and partnerships with local clinics, Otsu Municipal is evolving into a true “hospital for the residents,” a beacon of trust in a community that once doubted it.

As Hino poignantly states, “The patient doesn’t care what university someone went to; it doesn’t matter. You just need to carry out your duties to the best of your ability.” This simple, powerful message captures the hospital’s new ethos, dedicated to patient care above all else. The episode closes on this hopeful note, leaving viewers with the sense that, even in the face of ongoing challenges, Otsu Municipal Hospital’s transformation is indeed possible, one step at a time.