Dysfunction of the Clinical Path: A Case of the Japanese Medical Service

1. Background to the study:Studies of target costing in the manufacturing industry have so far reported that while there is progress on the accumulation of success cases and sophistication of methods, dysfunctions such as “designer exhaustion or burn-outs,” “supplier fatigue,” “intra-organizational conflicts,” “technique-dependent syndrome,” and “loss of pricing power” exist. Here, “dysfunction” refers to the evil that sometimes manifests and its usefulness is inevitably latent. As a result of their inability to respond appropriately to dysfunctions in product development, many manufacturers face problems such as low profitability, scandals related to quality, as well as the malfunction of the business system that supports the industry. Meanwhile, in the service industry, the usefulness of target costing has been attracting attention since early 2000’s. In particular, the use of “clinical protocol” in the medical service industry has been advancing as a groundbreaking method that aims to improve both the quality of medical care and the dramatic reduction of costs and expenses. However, at present, the focus is only on its usefulness, and studies on the dysfunctions are insufficient. This study derives the dysfunctions of the “clinical protocol” and confirms their existence through an interview survey with persons in medical care services.2. Main research objectives and research questions:This study tries to derive the dysfunctions of the “clinical protocols” and confirms their existence through an interview survey with persons in charge of medical care services.3. Research methodologies:To identify the existence of dysfunctions of clinical protocols, 12 interviewees were selected and interviewed about an hour for each. Interview protocols are carefully prepared. Information gathered are systematically coded and documented with grounded theory approach.4. Results:Five dysfunctions, 1) method-dependent syndrome, 2) intra-organizational conflicts, 3) problems caused by the progress of systemization of medical care service, 4) limited application of clinical protocol to acute care phase, and 5) never-ending cost reduction activities of clinical protocols were identified. Some dysfunctions were expected ex ante and others are unidentified prior to the study. What is impressive is the efforts of doctors and hospitals to overcome dysfunctions for better medical treatments and patients’ satisfaction.5. Discussions:Based on the literature survey of target costing dysfunction in manufacturing sector, authors hypothesized dysfunctions of medical services, as in the manufacturing sector, will exist in the medical treatments with clinical protocols. As we hypothesized, various dysfunctions are observed along with the merits of using clinical protocols. Efforts of doctors and hospitals were worth noticing to minimize the negative effects of using clinical protocols.6. Contribution and Conclusion:This paper made the first examination of dysfunctions of clinical protocols, target costing in medical care service. We confirmed the existence of dysfunctions. Also, we noticed that observed efforts of doctors and hospitals would be beneficial for the better management of hospitals and satisfactory treatment of patients.