The more regular readers of the Japan Postcard will be familiar with my observations of the Japanese Hospital Management System. This feature of a specific area of the economy and how it is managed
always fascinates, everything seems so sensible, everything seems to work well and leaves the English observer with the obvious question: Why are we so incompetent?
Before I hasten off to my latest observation of Hospital detail I would like to relate an incident in the Musashi-Koyama subway station. As you will remember, this is the subway line which only three years ago ran on the surface. The transformation is now complete and all work finished. The new line, built beneath the old one (as you could see when standing at the station as the rails were on props revealing the massive engineering going on below) has now been "dressed" on top with a smart taxi rank, bus station and state of the art and design toilet facilities whilst below a fantastic and spotlessly clean station has been completed.
Note: remembering that this construction project along 10 miles of railway did not once effect the train timetables and the transition was accomplished from above to below by the flick of a junction point last August.
On my journey to inspect the hospital facilities (and satisfy the Takayama clan that my heart is sound by being the subject of extensive checks) I came down the escalator into the new station to be greeted with a sight that was of the most shocking proportions. There on the platform before me I saw a discarded plastic coffee cup randomly abandoned. My first instinct was that this was some sort of error, perhaps someone had dropped it through accident or rush for a train. I walked over to this alarming departure from the required standards of hygiene and went to point it out to Takayama.
As I raised my accusatory finger and aimed it at the offending object a man in a smart uniform whisked past me and in a swift and deft movement flicked the wanton container with a brush into the open mouth of a dustpan mounted at the end of a handy length pole. One moment social disgrace the next order re-established.
All I can assume is that in the control room above there is a monitor system and it scans the platform with certain regularity for any deviant waste disposal. On being spotted a man is dispatched with the appropriate tool to apply corrective strategies. There was one down side to this moment and that was that I suddenly realised that I was the only foreigner on the platform. Surely no Japanese person simply threw their coffee cup to the floor!
On to the Hospital detail which I know is eagerly awaited by the medical readers of this postcard. Over the years the observations on the Japanese Health Service have drawn an enthusiastic audience from various doctors and design fanatics who frequently comment on how amazing the simplicity of the management is.
Myself, I love the Japanese Health Care experience, so much so I feel that I might have developed a bizarre form of hypochondria, a psychological need to manifest symptoms of illness so that I have the chance to study the fascinating workings of the Tokyo Hospital. Fortunately I am spared this obsessive condition as my very honourable wife is fastidious in keeping me alive and insists on extensive health checks whilst in Tokyo because: "You simply can't trust the NHS not to kill you."
So down to business and I first have to apologise. The system I am about to describe has been present at all other visits but for some inexplicable reason I lacked attention to this particular detail. I shall now correct this oversight.
As previously explained the architecture of the Japanese Hospital works as a sort of jigsaw. from the moment you walk in you are in a space that is for the "public patient". This space is threaded into the "medical professional space" in such a way that interaction between the applicant for services and the professional providers is managed in very specific locations and purpose built spaces. I know, I know, this sounds hopelessly difficult to imagine so here is a simpler description. Take your hands and place the fingers in between each other, interlace them so to speak. One hand is the public space and the other is the medical professional space. In such a structure it is possible for the doctors to come to work and move around the hospital all day without actually meeting a patient! On the other side patients simply can't wander about the professional space.
Now the entry point for this space is the front lobby which is a long corridor, a finger, with equally long and well staffed counters either side, two more fingers! I have written extensively about the speed of service and this recent experience was no less impressive. By my timing, a practice I insist on upon entry, from the minute we arrived at the general reception to the moment I was being dealt with by the cardiac testing department for my pre-arranged appointment was exactly six minutes and twenty three seconds. That included the lift journey. All in all from arrival to departure, including bill payment, I was in the hospital for twenty two minutes and fifty three seconds.
As I have said, all this efficiency is previously well documented but I do hope to release a book entitled "Timetables of Health Care, a detailed study of hospital appointments and their progress in Japan" sometime in the near future, no doubt a best seller! On this visit my key observation was of the management of the filing system. What brilliance, what design, what outstanding efficiency!
Everywhere in the hospital there is a railway track on the ceiling. This has three tracks, one for one direction, one for the opposite direction and another as a holding sideway into the administration desk of each department. On arrival at the main reception desk the clerk logs you in on the computer system. Your records are then placed into a document box which stands inside the reception area rail track. Along the bottom of the box is something akin to the holes in a cribbage board, two sets, A to J and 1 to 10. Pins are inserted into the relevant combination, say D7; cardiac testing department, and the box then begins its journey as you leave for the department of choice.
Above your heads all over the hospital dozens and dozens of boxes containing records and x-rays etc., are traveling in numerous directions to their exact and precisely required destination. Small junctions direct and re-direct, boxes pass each other, some halt in sidings, some jog on into administration centres, there is a veritable computer waltz of data going on above the heads of all concerned.
By the time that you reach the payment machines, all payments are through automated units much like cash point machines (and there are plenty of them) your detailed account awaits the swipe of your credit card or the injection of cash into the requisite slot. The thing is that everything is done immediately, by the time you leave your cardiac monitoring stats are already on the way to the relevant doctor for assessment and possible diagnosis, your bill is paid or credited to the relevant social security account and no-one has lost your records! More importantly the corridors aren't cluttered with trolleys full of lever-arch files and folders with bits of paper sliding off onto the floor here and there.
So as I left the hospital amazed by having spent most of my brief visit watching the comings and goings of data boxes I was left with one more observation: Does the fact that the floors are so highly polished and clean create a reflective index that saves on the electricity bill through not needing so many light bulbs?
Hmmm, perhaps another study is required!
As I entered the subway there was a man with a portable hoover strapped to his back in the style of a rucksack patiently and diligently hoovering the stairs from the main road to the ticket lobby. On his shirt across his shoulders was the legend "Clean Staff" and I bet they are!
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