Strategising for improved hospice patient outcomes in Japan

Categories: Leadership.

Members of our team visited Australia and New Zealand in 2003, and saw the palliative care network of these two countries with our own eyes. We were convinced that for the development of Japan’s palliative care, the enhancement of home-based palliative care was essential. Therefore we began to prepare to start a home palliative care services in Tochigi Prefecture located in the eastern part of Japan.

When DHH was established in 2006, there were three staff members, including a doctor, a nurse and a medical clerk. Between 2009 and 2010, six nurses were employed. However, one after another they began to leave their jobs, we believe, due to the huge gap between the toughness of the actual work and the image that they had initially had in their minds.

Defining a mission

In 2011, we started an innovation period. The team defined a mission and set goals for palliative care, nursing care and ethics. Further, we considered a necessary new position and human resource after we had reviewed the all business contents. To measure our progress, we compared the number of patients that had been introduced, preparation of discharge in cooperation, dying at home and home mortality before and after the innovation.

The goals

We defined our mission as: ‘to help cancer patients to be able to live at home oneself until the last moment’. We set the goal of palliative care to protect the rights to be cared for by those who can maintain a sense of hopefulness, however changing this may be, following Kessler. We set

the goals of nursing care based on ‘The Notes of Nursing’ by Florence Nightingale, and we set out the goals of ethics based on ‘Bushido: The Soul of Japan’ by Nitobe.

As a result, we decided that we needed a hospice aide, to carry out tasks such as driving a car, article management, and managing the office. We also set up a new position of hospice manager, with responsibility for necessary collaboration with multidisciplinary team members inside and outside of DHH.

In all aspects, the number of patients that have been introduced, preparation of discharge in cooperation, dying at home and home mortality increased after this innovation. 

Results of the innovation

The DHH has grown more rapidly in the last two years. Once the mission and the goals were all set, doctors, nurses, hospice aides, and a medical clerk began to throw themselves into their respective roles and also tried to improve their own ability and skill.

The skill of the hospice manager has had a significant impact on the speed and timing of multidisciplinary cooperation. Consequently, all the multidisciplinary team members, both inside and outside of DHH, sharing the same goals of providing high-quality of palliative care to the patients, came to work closely and cooperate together.

The more they experienced gentle death of patients at home, the more they were deeply moved. Thereafter, a sense of accomplishment was born, which led to enhanced motivation and further improvement of respective ability and skill (PDCA cycle of plan-do-check-act started to function).

We feel that we are better able to care for our patients, now that the team is running more smoothly under the guidance of a skilled hospice manager.


Miyashita, M. & Moritani, Y. The present condition of palliative care to watch by date of Japan. Palliative Care White Paper. Japan Hospice Palliative Care Foundation. (Japanese)  pp: 64-81. 2014

Drucker, P.F. Managing the nonprofit organization. Principles and Practices. Harper Collins Publishers. New York. 1990

Kessler, D. The Rights of the Dying: a companion for life’s final moments. Harper Collins Publishers. New York. 1997

Nightingale, F. Notes on Nursing. Dover Publication. New York. 1969

Nitobe, I. Bushido: 92ed. Iwanami Shoten. Tokyo (Japanese): pp41-44, 2007.

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