[Abolition of Physical Restraints Accelerated by Medical Fee Revisions] Reaching Zero Restraints in 4 Years and Its Essence
Yokohama Hospital presented its 4-year journey to achieve 'zero physical restraints' at a nursing training session, aligning with the government's push to minimize restraints.
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- 📰 Published: April 15, 2026 at 23:00
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In the basic policy for the medical fee revision in FY2026, "promotion of the minimization of physical restraints" is listed as a specific direction for promoting safe, secure, and high-quality medical care. Amidst this, Genkikai Yokohama Hospital (Location: Midori-ku, Yokohama City, Chairman/Director: Akiyoshi Kitajima) presented its "zero physical restraints" initiative and the trial-and-error process leading up to its realization at the 2nd Nursing Training Session of the Kanagawa Nursing Association Central Branch for FY2025.
■ Social Background
In the basic policy for the medical fee revision in FY2026 by the Ministry of Health, Labour and Welfare, "promotion of the minimization of physical restraints" was explicitly stated again as one of the specific directions for "promoting safe, secure, and high-quality medical care." (*1) Previously, in the FY2024 revision, penalty rules such as deductions in basic hospitalization fees were introduced, but the current revision policy evaluates the systems and actual results for minimizing physical restraints, demanding further promotion. However, according to the latest survey by the Ministry of Health, Labour and Welfare, some form of physical restraint is implemented in over 80% of wards. (*2) Furthermore, among restrained patients, the proportion of those continuously restrained "every day" over the past 7 days is higher in chronic care wards, reaching approximately 90% in medical care wards, indicating that physical restraints have become the norm. (*2) Thus, while the minimization of physical restraints is promoted as a policy, challenges still remain on the frontline.
Sources:
*1 Ministry of Health, Labour and Welfare, "Basic Policy for FY2026 Medical Fee Revision," December 2025
*2 Ministry of Health, Labour and Welfare, "Central Social Insurance Medical Council General Meeting (623rd) General-2 Regarding Hospitalization (Part 3) Chronic Care Hospitalization Medical Care & Physical Restraints," p61, October 2025
■ What is Physical Restraint?
First, the purpose of physical restraint is a temporary safety measure. However, in the long term, risks such as a decline in physical function (ADL) and worsening of cognitive function, as well as an increase in accidents due to patients trying to escape the restraints, have been pointed out. Furthermore, it can also lead to a decline in the morale of the caregiving staff.
According to materials from the Ministry of Health, Labour and Welfare, "physical restraint" is defined as "the restriction of actions that temporarily constrains the body of the patient and suppresses their movement by using some kind of tool that touches the patient's body or clothing, such as a restraining belt." (*3) Specific examples include tying the trunk or limbs to the bed with a string to prevent falling, or tying the limbs with a string to prevent the pulling out of tubes such as those for IV drips or tube feeding. Also, as a broader concept including the use of bed rails and medications, the idea of defining "restricting the freedom of action of the person" as "physical restraint" has been presented. (*3) At our hospital, we are also working on releasing restraints targeting this broader definition of physical restraint, not limited to the use of tools.
Sources:
*3 Ministry of Health, Labour and Welfare, "FY2025 13th Survey and Evaluation Subcommittee on Inpatient Medical Care, etc. [Attachment] Material Compilation ⑤," September 2025
*4 FY2024 Health and Welfare Project for the Elderly, Investigative Research Project for Promoting Initiatives to Abolish and Prevent Physical Restraints in Nursing Care Facilities/Offices, etc., "Guide to Abolishing and Preventing Physical Restraints for People Working in Nursing Care Facilities/Offices, etc.," March 2024
■ Zero Physical Restraints at Yokohama Hospital
The Journey to Zero Physical Restraints
In April 2012, our hospital declared to all staff that we would reduce physical restraints to zero within 5 years. However, things did not go smoothly from the beginning. Rather, for the first few years, we fell into a vicious cycle where "the more we tried, the more exhausted the frontline staff became."
At the beginning of the reform, we attempted a phased release through the textbook approach of "risk assessment," but as a result, the number of physical restraints did not decrease at all. The frontline conflict of "We want to remove them, but we are afraid of unlikely accidents" and "We have no choice but to tie them up to protect their lives" was deep, and the initiative stalled. In this way, relying on sheer willpower alone could not dispel the "anxiety about safety" on the frontline.
After that, what broke the stagnation was the decision "not to make removing physical restraints the goal." We stopped arguing about "how to untie the restraints" and decided to explore the root causes. By switching this perspective, we realized that the clues to a solution lay within the medical and care customs we had given up on as "unavoidable." And as a result of implementing new approaches, we achieved zero physical restraints in 2016, 4 years after the conception. Even now, it is not a prohibitive rule that "physical restraints are bad so we stop them," but the pride as professionals providing care that protects the dignity of the patients that supports our current medical and nursing care without restraints.
Changes After Realizing Zero Physical Restraints
By realizing zero physical restraints, patients regained a peaceful expression
■ Social Background
In the basic policy for the medical fee revision in FY2026 by the Ministry of Health, Labour and Welfare, "promotion of the minimization of physical restraints" was explicitly stated again as one of the specific directions for "promoting safe, secure, and high-quality medical care." (*1) Previously, in the FY2024 revision, penalty rules such as deductions in basic hospitalization fees were introduced, but the current revision policy evaluates the systems and actual results for minimizing physical restraints, demanding further promotion. However, according to the latest survey by the Ministry of Health, Labour and Welfare, some form of physical restraint is implemented in over 80% of wards. (*2) Furthermore, among restrained patients, the proportion of those continuously restrained "every day" over the past 7 days is higher in chronic care wards, reaching approximately 90% in medical care wards, indicating that physical restraints have become the norm. (*2) Thus, while the minimization of physical restraints is promoted as a policy, challenges still remain on the frontline.
Sources:
*1 Ministry of Health, Labour and Welfare, "Basic Policy for FY2026 Medical Fee Revision," December 2025
*2 Ministry of Health, Labour and Welfare, "Central Social Insurance Medical Council General Meeting (623rd) General-2 Regarding Hospitalization (Part 3) Chronic Care Hospitalization Medical Care & Physical Restraints," p61, October 2025
■ What is Physical Restraint?
First, the purpose of physical restraint is a temporary safety measure. However, in the long term, risks such as a decline in physical function (ADL) and worsening of cognitive function, as well as an increase in accidents due to patients trying to escape the restraints, have been pointed out. Furthermore, it can also lead to a decline in the morale of the caregiving staff.
According to materials from the Ministry of Health, Labour and Welfare, "physical restraint" is defined as "the restriction of actions that temporarily constrains the body of the patient and suppresses their movement by using some kind of tool that touches the patient's body or clothing, such as a restraining belt." (*3) Specific examples include tying the trunk or limbs to the bed with a string to prevent falling, or tying the limbs with a string to prevent the pulling out of tubes such as those for IV drips or tube feeding. Also, as a broader concept including the use of bed rails and medications, the idea of defining "restricting the freedom of action of the person" as "physical restraint" has been presented. (*3) At our hospital, we are also working on releasing restraints targeting this broader definition of physical restraint, not limited to the use of tools.
Sources:
*3 Ministry of Health, Labour and Welfare, "FY2025 13th Survey and Evaluation Subcommittee on Inpatient Medical Care, etc. [Attachment] Material Compilation ⑤," September 2025
*4 FY2024 Health and Welfare Project for the Elderly, Investigative Research Project for Promoting Initiatives to Abolish and Prevent Physical Restraints in Nursing Care Facilities/Offices, etc., "Guide to Abolishing and Preventing Physical Restraints for People Working in Nursing Care Facilities/Offices, etc.," March 2024
■ Zero Physical Restraints at Yokohama Hospital
The Journey to Zero Physical Restraints
In April 2012, our hospital declared to all staff that we would reduce physical restraints to zero within 5 years. However, things did not go smoothly from the beginning. Rather, for the first few years, we fell into a vicious cycle where "the more we tried, the more exhausted the frontline staff became."
At the beginning of the reform, we attempted a phased release through the textbook approach of "risk assessment," but as a result, the number of physical restraints did not decrease at all. The frontline conflict of "We want to remove them, but we are afraid of unlikely accidents" and "We have no choice but to tie them up to protect their lives" was deep, and the initiative stalled. In this way, relying on sheer willpower alone could not dispel the "anxiety about safety" on the frontline.
After that, what broke the stagnation was the decision "not to make removing physical restraints the goal." We stopped arguing about "how to untie the restraints" and decided to explore the root causes. By switching this perspective, we realized that the clues to a solution lay within the medical and care customs we had given up on as "unavoidable." And as a result of implementing new approaches, we achieved zero physical restraints in 2016, 4 years after the conception. Even now, it is not a prohibitive rule that "physical restraints are bad so we stop them," but the pride as professionals providing care that protects the dignity of the patients that supports our current medical and nursing care without restraints.
Changes After Realizing Zero Physical Restraints
By realizing zero physical restraints, patients regained a peaceful expression