Using a Systems Approach to Understand Quality Improvement in a Nursing Home in Japan

Abstract As one of the most rapidly ageing economies, Japan currently faces a shortage of care workers and a relatively low intake of migrant workers. Faced with increasing demand, rising expectations for better care, and a declining number of care workers, there is the opportunity to rethink and analyze how care can and should be provided in residential care homes, including through the support of technology, such as robots. This chapter explores a nursing home in western Tokyo where robotics-aided care has been introduced and has previously been shown to improve standards of care. Although evaluations of socially assistive robots (SARs) and safety monitoring system suggest a positive impact, the mechanism through which the technology-driven system improves care and residents’ quality of life remains unclear. Using a systems approach, the authors sought to uncover this mechanism. They found that key factors for the successful implementation of robotics-aided care stem from within the organization, with a particular focus on the concepts drawn from resilience engineering, key attributes of which are anticipating, responding, monitoring, and learning. The chapter details some of the tools that pre-dated the introduction of these technologies in the care home and use a resilience framework to analyze interview data with care staff. Using a systems approach, the researchers unearth considerations (i.e., opportunities and challenges) for the future of care delivery in an institutional setting and highlight the characteristics of a context in which technologies can be effectively introduced and successfully implemented in nursing homes.