Motivation
Since my job is advising management and employees of the hospital organization about the way that training and coaching can contribute to improve organizational processes, I was particularly interested in the Japanese Human Resource Management. I was also anxious to find out if Japanese healthcare organizations have corresponding professions with mine. If that be the case for whom do they work: the board of directors and executive staff or all employees. Further, I wanted to participate in the GSE Tour to Japan because it would enable me to get in touch with unconventional point of views, feelings and emotions and, above all, it could help me gain experiences which might prove useful in my daily work.
Besides, Japan was an unknown yet fascinating country to me (and still is) with its many contrasts. It is a land of leading international technology and old traditions, such as the tea ceremony. That is why I expected this trip to be a learning process about what the Japanese people expect from life, what is important to them, what they are striving for at work and in the private sphere of life.
After a thorough selection process I got invited to join the GSE-program. I think everyone can imagine my exitedness about the idea of visiting Japan. Therefore, I would like to start my personal report by thanking the Rotary Organization for giving me the opportunity to participate in the GSE-program 2000 / 2001. As promised, I will try to keep this report as brief and personal as possible. I will tell something about the healthcare system in Japan, and subsequently give my personal reflection on the program.
Healthcare organisations
I started my vocational days with a visit to the Japanese Medical System and Hospital Management of the Osaka Prefectural Government. In about 3 hours they managed to give me an excellent overview of the Japanese healthcare system. They even took the effort to make comparisons between the Japanese and the Dutch situation concerning such figures as primary death causes. Their presentation provided me with a good preparation for visiting the hospitals during the next days.
Japan is the world leading country on longevity. The average life expectancy of females is 84 years and males is 77 years (in the Netherlands respectively 80 and 74.5) The three biggest causes of death are malignant tumour, heart diseases and brain vessel diseases. This is the same big three as in the Netherlands, however in the Netherlands the number of people dying of a heart disease is as twice as big as in Japan (114.300 people in Japan versus 227.200 in the Netherlands). The official reason for this difference is that Dutch people eat more fat food than Japanese people do. After experiencing the food-culture in Japan I fully subscribe to that opinion. The food is healthier there and contains more natural ingredients. Yet, it has one major drawback, it is much saltier. This appears to be one of the major causes of deaths. The rate of brain vessel disease is much higher in Japan (110.000 in Japan versus 80.300 in the Netherlands).
Since people live longer and fewer children are born, the rate of the senior citizens in Japan becomes higher and higher. The estimate for the year 2015 is that 25.2% of the population will be over 65. This means that fewer people can contribute to ensuring the healthcare system. In Japan everybody is covered by a public insurance system. This system helps to support the livelihood of the Japanese people, although how to cope with the increasing security burden is an important matter of concern. Due to changes in the socio-economic structure such as the population aging and more working women, the people's awareness and sense of values are undergoing a modification. There is a call for reforms in the social security system in response to those changes. This means, for example, introducing a maternal leave system and taking measures for the care of the elderly. Given the fact that the financial situation of the healthcare system is far from optimistic, reforms are necessary and inevitable.
As a result of the financial crisis, hospitals have to cut back their expenses. By shortening the length of the hospitalisation (average is 33 days, compared to the situation of my own hospital, 8 days, this seems a lot), centralisation of the procurement of medicines and supplies and, seeking for outsourcing possibilities. Other considerations are setting up one Risk Manager per hospital, conducting satisfaction surveys under patients and developing an electronic medical record. Surprisingly enough, I discovered that despite some differences, both Japanese and Dutch hospitals use similar solutions to cut costs. In short the problems of the Japanese healthcare system bear many resemblances with the Dutch. The Dutch healthcare system is also struggling with financial problems. Medisch Spectrum Twente in Enschede has choosen for the improvement of procurement of medicine and outsourcing of cleaning and catering facilities.
Later on, during my vocational days I visited several prefectural hospitals and nursery homes for the elderly in Japan. I was able to talk to the management of the hospitals as well as to nursing and medical staff. Their information gave me, amongst others, more insight in the organization and management of Japanese hospitals and the education of nurses and doctors. I found out that the approach of Human Resource Management (HRM) in hospitals and other healthcare organizations is slightly different from the Dutch one. The profession of an educational advisor does not yet exists. The personnel who work for the prefectural government carry out most of the HRM tasks. I was surprised about the fact that one of the HRM-instruments, namely job rotation, is highly established in Japan. I wish we could compel healthcare organizations to use job rotation in the Netherlands. In Japan I had an unique opportunity, to talk to the people for whom it is perfectly normal to switch jobs every three years. Employees seems to have little influence determining their careers. In the Netherlands we strive for the opposite: maximum responsibility to plan your own career. This difference was a real paradigm shift.
I want to end this part of the report by describing some experiences and particular memories I have from each visit:
Osaka Medical Center and Research Institute for Maternal and Child health:
the superb ability of this hospital to be able to keep alive a neonate of 21
weeks and weighing only 400 gram. Kansai Medical University:
the neonatology department and the enormous collection of skulls in the room
of Professor Kawamoto.
Matsushita Memorial Hospital:
the fact that the founding father of Matsushita was a patient and the founder
of this hospital and the fact that the director of the hospital is able to continue
operating patients while being manager of the hospital.
Himawari and Inoue hospital:
a fantastic day in which I have seen a nursery home for the elderly, a haemodialysis
unit and a hospital. During lunch we talked about many, sometimes difficult,
subjects. I very much appreciated the management meeting at the end of the day
and the photo-book I received later.
Sumitomo hospital:
a brand new hospital with a lot of new technology and architecture. The physical
check-up facilities for working people and the outstanding facilities for the
wealthy people are very impressing.
Osaka Medical Center for cancer and cardiovascular diseases:
a very interesting and informative evening. I liked visiting the radiotherapy
department and valued the discussion with the young staff (nurses and doctor)
at the end of the day.
Thanks to the excellent job of the translators who accompanied me, I have learned more from my vocational days than I can describe in this short report. Many thanks to them.
Personal reflection
Everybody is asking me: 'What did you like most about Japan' or 'What was the most impressive about Japan?'. I cannot answer that question. I gathered so much impressions from these five weeks that it is hard to select the most important one. I wish to describe several impressions:
Host families
It was a new experience for me to stay with a host family. It was wonderful. The bedroom, study facilities, laundry-procedures, travelling to and from host families: it was all well organized. They taught me how to eat Japanese food, which is very different from the food I ate in the Netherlands. Due to their friendliness and openness I felt at home there. I can best describe it by saying that I felt like a princess. Therefore, I like to thank the families of Mr. Rikimi, Mr. Ishiyama, Mr. Mori, Mr. Matsumoto and Mr. Tokieda for being my host family in Japan. I also appreciated the stay in the New Otani hotel on Saturdays very much. The hotel was helpful with storing luggage during the week. Returning to the same hotel was very comforting and relaxing. It was a steady base in a kaleidoscope of experiences.
Family life
I learned also a great deal about family life in Japan, especially about the roles of husband and wife. From a Dutch point of view these roles seems very traditional. The wife stops working when she gets married and she is fulltime busy with raising children. It is the role of the husband to take care of the family and provide them with sufficient income. A regular working week seems to have at least 60 hours. It is not widely accepted yet to delegate care tasks to a nursery home for children or to hire someone who cleans your house so you can focus on your job. When the children become adolescents, women re-enter the working force. It was also surprising to find out that young adults live with their parents until they marry. It is possible to live on your own (but mostly with relatives) during your study, but after graduating the student goes back home. The major cause of this situation seems to be a financial one: the high standard of living in Japan but also its culture, norms and believes. In the Netherlands family culture has shifted towards a more individual perspective and towards changing roles. In general, the wife is having a working career of her own, the husband is also responsible for taking care of the children and is working less. Adolescents are leaving home for study or when they find a partner with whom they want to live together but not have to marry him or her. The Dutch family life seems more modern but it is not necessarily better!
People and surrounding
The first thing that struck my attention was the total absence of scratches of paper and garbage on the airport ground. Osaka is a very clean city. It is a habit to use the garbage can instead of throwing things on the ground. Amazing, considering the size of the city: 2.6 million people. I even saw a homeless man sweeping his fag ends before moving to another spot.
Landscape
The part of Japan which I visited has limited free space. From the seaside up to the mountains, it is an endless strip of buildings, houses, apartments and industries. Roadsigns are the only physical evidence of entering another city, which makes recognizing the boundaries between them difficult. I expected more natural boundaries like forests and grass lands. If you want to walk in the woods you have to drive in the direction of the mountains.
Driving habits
In this rural area with a lot of traffic jams driving a car is not always a pleasure. However this is not due to the driving habits of the people of Osaka. Everybody is driving extremely correct. Filtering in and out goes naturally and bumper-clinging is rare. Maximum speed is limited, even on highways, and everybody seems to abide these regulations. After some inquiry I found out that the perfect driving habit is not only a matter of good manners but that of the hidden camera's alongside the roads.
Hiroshima
Hiroshima had a deep impact on me. The museum with its stories of survivors, the aerial views and the schoolchildren with their festoons of crane birds. Due to a catastrophy in the area I live (a firework explosion destroyed a complete city area in Enschede), I can now better understand how devastating it was. It made me feel humble and sad.
It is obvious for me that it is difficult to find a job in my area of interest in the coming five years in Japan. So, instead of emigrating to Japan (I would love it), it is 'back to life and back to reality' now. This is not easy because thanks to the perfect organisation by the Japanese Rotary-clubs and the host families I felt like a VIP for five weeks. Looking back at the things I learned and experienced I feel very fortunate to have participated in this GSE-program. A big THANK YOU to all of the people who contributed to the GSE-program.
Renate Bergman
