Karoshi & Inemuri

First principles

There are many things in Asia that seem fascinating, mysterious and incomprehensible. Such is the case of the concepts of Karoshi and Inemuri, which are idealized by Japanese society and which have been associated with great work devotion. These concepts, although you don't know the words, are not alien to the healthcare personnel of any place. Professionals with chronic exhaustion, who get sick as a result of work stress and who even die at their work sites.

The term Karoshi, the most extreme aspect we will explore today, is to die from overwork. It happens to people who exceed 80 hours of work per week, that is, 16 hours a day if working from Monday to Friday in an average week, for periods longer than one month. It is literally "dying from exhaustion", although it also applies to people who, in the context of overwork, die of myocardial infarction or cerebrovascular disease.

The second term, the least extreme aspect of this spectrum, is to fall asleep in inappropriate places, such as in the bus, subway or park benches. Even falling asleep in the workplace.

Western translation

In both cases there is a deformation of the role that a person plays in the workplace, that is, instead of "working to live", one "lives to work." In addition, the inability to determine how much has been sufficient and in some way an implicit labor exploration that perpetuates this kind of behavior is also experienced.

In healthcare, these concepts have been used very frequently as positive concepts that are in direct opposition to the effort that personnel invest in training. Young professionals who have traffic accidents due to fatigue, deterioration of their family relationships, physical and mental illnesses directly related to work stress ... and the list could continue.

The root of the problem is that these seem to be concepts worthy of a neoliberalist capitalist economy, such as "every man for himself" or "survival of the strongest," but it is the exact opposite. In a liberal economy, there is no restriction on the free supply and demand for services, just as there are no restrictions on the price requested for such goods. A person will work hard enough to meet their needs and aspirations, but not more beyond that. They are not required to remain in a job, without producing, increasing the risk of making mistakes, to satisfy the ego of a superior or the owner of the company.

The sad reality

This is increasingly relevant for health, particularly in our country, given two phenomena that we have experienced in recent years: Negligence and Burn-out.

Before ... a long time ago, in what appears to be a different country, healthcare workers were almost revered as individuals, not as a team, and negligence was something that should be tolerated by patients, swooped under the carpet. Over time, society has evolved to demand compensation from those who provide a damaged service that in turn causes greater injuries to patients.

Many acts of negligence are the product of the exhaustion of healthcare personnel. An error can be understood by a patient, but a series of errors lead to unwanted results and it is these series of errors are what's considered negligence.

On a public or private level, it's the professionals, not the institutions or employers, who must compensate the patients, so that each one watches over their own well-being, taking care not to fall into negligence. Yes, errors will continue to exist as long as human beings remain human, imperfect and incomplete, but most of us try our best not to fall into neglect.

The burn-out or exhaustion crisis, is one of the reasons why health workers become disenchanted with their profession. Chronic stress leads them to abandon everything for which they've worked so much, leading them to seek occupations other than healthcare, even paid less, where they can find greater personal satisfaction.

The solution?

If you have been readers of our many other entries on healthcare management, you will know that we do not advocate for one chosen solution. We don't believe in sticky acronyms, or numbered advice to possibly avoid something.

However, in these entries we will make a list of what we believe may be the tips of icebergs of more complex topics.

1. Teamwork. Families have centers or pillars, usually a parent. Everything is forgiven and attempts are made to keep all its members afloat, even those who do not "roll." In a team there can be no pillars.

This does not exclude team leaders, but each member has a valuable contribution, in work and vision. Each member is to obtain a benefit, to provide something that no one else on the team can, but at the same time monitor why others do not make a series of mistakes that result in negligence.

2. Vaca-time! You have to know the limits of what one is capable of doing. It is true that to know them you have to try them, which represents a risk, but everything in life is. If you are very close to the limit you should take a step back, take a breath and consider taking a break or leaving everything.

3. Mirror, mirror. There is nothing more valuable, and more underestimated by healthcare personnel, than self-criticism. Crises have the courage to reveal vulnerable points, but only giving yourself an objective look will allow you to know what those vulnerabilities are. In Panama we like to slap each other on the back and gratify ourselves for a job well done, even if it's a real crap.

The simplest way of self-criticism is to ask dissatisfied customers, why they are dissatisfied, and the most objective way to do it is to try to measure our performance to see it embodied in numbers. This is what others call "quality control."

Other perspectives Not always, if you are very immersed in the culture itself, it is possible to have a clear vision of what is happening. Sometimes you have to bring other eyes that see things differently to understand not only if there is a problem, but what it is.

Karoshi, Inemuri, burn-out, Over work, exhaustion, neoliberalism, social darwinism, negligence

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