**7. Outlook for the future**

#### **7.1. Standardization of methodology**

We believe that it would be useful to standardize the methodology for carrying out the ser‐ ies of operations that was constructed for this study. Some reasons are suggested below.

Because each institution and each ward has different attitudes towards individual patient characteristics and tasks, and different methods of executing tasks, it is difficult to calculate universal quantities for essential nursing tasks that can be applied in any institution. In ad‐ dition, there are cases in which it would be dangerous, or lead to the loss of desirable quali‐ ties, if a fixed value were applied to all institutions. It is desirable to go through the following series of operations. Having considered the task management appropriate to the ward, while preserving the ward's characteristics, a time study of the ward should first be carried out, then a virtual environment simulating the actual ward should be created, mak‐ ing use of existing cumulative information, and test experiments should be conducted using that virtual environment.

#### **7.2. Combination with other information**

#### *7.2.1. Relationship to incidents and accidents*

We believe that it is possible, on the basis of information derived from incident and accident reports, to explore the relationship between medical errors and task times from a number of viewpoints. As medical malpractice suits have increased in recent years, consciousness of medical errors by nurses has increased and the number of nursing departments that make it a requirement to write near-miss incident reports has grown. Protection of patient safety re‐ quires maintenance of minimum standards in all medical jobs, including nursing, and is of the utmost importance. Fujita et.al. have pointed out that there are errors that are related to busyness and errors that are not related to busyness. It is possible to extract from the analy‐ sis results the answers to such questions as: 'What kinds of incidents and accidents increase with an increase in task time?' 'What amount of task time elapses before the number of cases reported begins to increase?' and 'After how many hours of overtime work over how many days in a row does the number of cases reported begin to increase?' These analysis results will also provide important material for the investigation of task allocation and assignment of nursing staff with a view to minimizing medical errors.

#### *7.2.2. Patient satisfaction*

It is possible to explore the relationship between nurse's task time, particularly 'time de‐ voted to patients for whom the nurse is responsible,' and patient satisfaction. We believe that this has great significance for the improvement of nursing care. We are entering an era when patients are expected to draw sharp distinctions among hospitals. As a result, more and more hospitals are increasing the number of their private rooms, where pa‐ tients can spend their hospital stay in privacy, and are giving thought to the appearance of the hospital's interior and the richness of its amenities. But we believe that what is more important to patients than the physical elements of the institution is that they should be able to receive care that they are satisfied with in an atmosphere based on a re‐ lationship of trust with the medical personnel. Sickness is a special condition, and pa‐ tients need warm-hearted support at all times. The nurses, who spend more time in contact with the patient than any other medical personnel, have a particularly large role to play, and are at the forefront of ensuring customer satisfaction.

### *7.2.3. Level of fatigue*

committing large amounts of effort and funding, as required for time studies at present, this

We believe that it would be useful to standardize the methodology for carrying out the ser‐ ies of operations that was constructed for this study. Some reasons are suggested below.

Because each institution and each ward has different attitudes towards individual patient characteristics and tasks, and different methods of executing tasks, it is difficult to calculate universal quantities for essential nursing tasks that can be applied in any institution. In ad‐ dition, there are cases in which it would be dangerous, or lead to the loss of desirable quali‐ ties, if a fixed value were applied to all institutions. It is desirable to go through the following series of operations. Having considered the task management appropriate to the ward, while preserving the ward's characteristics, a time study of the ward should first be carried out, then a virtual environment simulating the actual ward should be created, mak‐ ing use of existing cumulative information, and test experiments should be conducted using

We believe that it is possible, on the basis of information derived from incident and accident reports, to explore the relationship between medical errors and task times from a number of viewpoints. As medical malpractice suits have increased in recent years, consciousness of medical errors by nurses has increased and the number of nursing departments that make it a requirement to write near-miss incident reports has grown. Protection of patient safety re‐ quires maintenance of minimum standards in all medical jobs, including nursing, and is of the utmost importance. Fujita et.al. have pointed out that there are errors that are related to busyness and errors that are not related to busyness. It is possible to extract from the analy‐ sis results the answers to such questions as: 'What kinds of incidents and accidents increase with an increase in task time?' 'What amount of task time elapses before the number of cases reported begins to increase?' and 'After how many hours of overtime work over how many days in a row does the number of cases reported begin to increase?' These analysis results will also provide important material for the investigation of task allocation and assignment

It is possible to explore the relationship between nurse's task time, particularly 'time de‐ voted to patients for whom the nurse is responsible,' and patient satisfaction. We believe

is an approach that must be investigated.

**7. Outlook for the future**

242 Advances in Discrete Time Systems

that virtual environment.

*7.2.2. Patient satisfaction*

**7.2. Combination with other information**

*7.2.1. Relationship to incidents and accidents*

of nursing staff with a view to minimizing medical errors.

**7.1. Standardization of methodology**

In the present study we analyzed only the day shift, but we believe that by constructing a virtual ward environment that takes other shifts into account and carrying out simulations, it would be possible to show the relationship between task time and nurses' fatigue. It has been pointed out that symptoms of fatigue among nurses are greatest after the evening shift and that where the night shift is concerned there is considerable fatigue before the shift be‐ gins. There is concern that the physical and mental fatigue of nurses on the night shift has a negative effect on their work. Attempts have long been made to reduce the burden on nurses and to establish an efficient nursing system. One notable example was the introduc‐ tion of the two-shift system, but no reference has been made to investigation of specific as‐ pects of this working system, such as how its merits and demerits are related to the characteristics of the ward. It is important to re-investigate nurses' work systems, including conditions such as these.

#### *7.2.4. Link between patterns of change in nursing intensity and clinical path*

In this study we chose pattern of nursing intensity as the clinical path and, having fixed pa‐ tient severity as a definite condition, it was possible to make a preliminary calculation of ac‐ tual nursing task times. In recent years, much has been made of efficiency of treatment, and an increasing number of institutions have introduced the clinical path as a specific method‐ ology. Among city hospitals and privately run general hospitals, there are institutions and wards that have almost completely adopted clinical paths, and that have been successful in the management of planned admission with almost no variance. We believe that in hospital institutions like this, it will be possible to effectively apply patterns of change in nursing in‐ tensity to items such as preliminary calculations of nursing personnel costs, which have a great influence on hospital management.

We feel that a combination of the experimental results derived from virtual environments as described in this study and other information will be helpful in the management of nursing tasks suited to various goals.
