| A key element of Japanese business culture is the business card. This has been a difficult part of business for me to master. I tend to leave the
 cards in the office at key times. They just aren't an important thing for
 me to consider. To alleviate the problem, I purchased a business card
 holder. The sole purpose of this mini-wallet is to hold your business cards
 for distribution and give you a place to store cards. I wanted to have a
 card holder to assure that I would always carry the cards with me. This is
 critical to operating in Japan. Going without cards is like forgetting to
 put on pants.
 
 There is even a subtle ritual to giving and receiving the cards. When you
 give a card, you hold it with both hands, assuring that the lettering on the
 card faces the recipient. You slowly extend the card toward the recipient.
 When you receive a card, you accept the card with two hands. You carefully
 read the card, nod your approval, (an interesting process when you can't
 read many of the cards) and hold onto it throughout the meeting. You must
 be careful not to simply place the card in your pocket, since that is
 considered extremely disrespectful.
 
 It's a fascinating social phenomenon. Foreigners in Japan must be very
 careful to observe this ritual to assure they don't alienate the people they
 deal with. I believe I have it mastered now, but I am sure that I will
 learn an addendum to this procedure in the near future. With many of the
 social rituals here, the more you go through it, the more details emerge.
 
 Business ettiquette in the US is much less complex than it is here. The
 same type of formality exists, but in Japan, it's much more structured and
 rigorous. Every tiny move you make has some significance. As an American
 here, I find myself examining every little thing I do under a microscope. I
 am sure that I am still making some mistakes, but foreigners are _generally_
 given some freedom from the social rigors that are so important to Japanese
 society. Still, I would like to master these rituals so I can feel fairly
 confident when dealing with Japanese businesspeople.
 
 With preparation I had in these forms of etiquette, I set out for my second
 round of tours in Tokyo. On the agenda today were a visit to St. Luke's
 Hospital and Johnson & Johnson. Again, the train left Kamogawa at 7:38 AM
 and arrived in Tokyo around two hours later. Chiaki accompanied me on this
 journey to serve as guide and interpreter. We arrived at St. Luke's around
 10:00. From the outside, St Luke's looked very different from other
 Japanese hospitals. Foremost, there were lots of plants surrounding the
 hospital, giving it a more comfortable feel. There was also a giant cross
 on top of the hospital, clearly showing the organization's affiliation.
 
 The inside of St. Luke's was also atypical of Japanese hospitals. The lobby
 was large, open, and like a hotel. The hospital elements were hidden away.
 The rooms were all private. Most Japanese hospital rooms house two to four
 people. This difference has some important implications for infection
 control. Each room at St. Luke's had a TV, which is often not the case in
 Japanese hospital rooms. At Kameda, you check out the TV by the day and pay
 a fee for its use.
 
 St. Luke's also lacked the clutter in the hallways and sterile, white walls
 that typify Japanese hospitals. It looked like the best American hospitals.
 It was clean, modern, and gave visitors a feeling of comfort. Mr. Ishiyama,
 the Public Relations director, who gave me the tour, was a very pleasant man
 and was a strong advocate of the organization. It didn't need much
 help...the place did a good job of selling itself.
 
 St. Luke's also owns a tower next to the hospital which contains a variety
 of offices and restaurants. On the 46th floor, there was an observation
 deck. You could look over central Tokyo and see much of the city. It was a
 breathtaking experience. It also underscored the enormity of the city and
 the activity within. It is really something to think of a city where 12
 million people live and work. When you look down into it, it's even more
 meaningful.
 
 The tower had some other significance. Since Japan has socialized
 healthcare, it is difficult for hospitals to make enough money to improve
 their facilities. St. Luke's bought the land for the tower long ago and
 built on it. They spun off a company to rent the office space for the tower
 to companies in the area. With Tokyo's notoriously high rent, a 45+ story
 building provides a lot of opportunity for money-making. This money is
 invested back into the hospital. They also make money from health
 consultations. Patients can pay to talk with a physicians for an hour or
 so. This is a significant opportunity. In Japan, people usually wait one
 to three hours in the waiting room for a five minute meeting with their
 physician. Only top physicians are involved in this program. With this
 extra money, along with some other endeavors, St. Luke's has been able to
 provide the best facilities and hire the best physicians. This puts them in
 a very strong position among Japanese hospitals.
 
 After a spicy ramen noodle lunch and cup of Starbucks coffee (purchased in
 the St. Luke's tower), Chiaki and I went to Johnson and Johnson. The
 presentation was by Mr. Horio, the director of materials management. He did
 a Power Point presentation about his company, highlighting the diverse
 product line and inventory management. The latter topic was extremely
 interesting. They have an extremely powerful database program run on IBM
 AS/400 servers that uses a multiparametric equation to determine the amount
 of inventory needed at any given time. It is over 99% accurate. Data is
 put into the system daily, allowing the projections of inventory need to be
 as accurate as possible. This system is shared with J and J's Japanese
 partners and has resulted in decreasing labor costs in inventory management
 with increasing volume. The system completely blew me away. It's the kind
 of thing a computer nerd dreams of: using a computer to eliminate the need
 for labor and perfecting a process. Amazing!
 
 Mr. Horio was quite a delightful host. He spoke excellent English and made
 many jokes (and, yes, I am sure that he was making jokes and not making
 mistakes in speaking). Upon explaining how hot the meeting room was, he
 said, "If you get too hot, you can take off your pants. We are very casual
 here." He also announced that he was heading out for a "cancer break"
 halfway through the presentation. He had an unusually good sense of humor
 and went out of his way to make sure I understood his company's work.
 
 Overall, Mr. Horio was an excellent host and did an excellent job of
 explaining his work at Johnson and Johnson. I also was intrigued by Johnson
 and Johnson's labor composition compared to Baxter and Pfizer. I didn't see
 a single American in Johnson and Johnson. In the other companies, I saw
 many Americans. I am under the impression that the lack of Americans is a
 consequence of the autonomy of individual J and J offices.
 
 I wrapped up the day with a quick trip to the Ginza neighborhood of Tokyo.
 This neighborbood is home to the Sony Show Room. This eight-story building
 is filled with new televisions, Walkmans, computers, stereos, video games,
 car audio systems, GPS, and every other Sony product. They had some glasses
 with TV sets inside. I tried them on, but they were not designed for gaijin
 noses. I guess the term "long-nosed foreigner" has some real weight. I
 also beheld the wonder the Sumo on HDTV. I must get an HDTV! They look
 better than real life. DVDs look EVEN BETTER on these sets. I am going to
 have to wait a while, but when I get my HDTV, it will be WELL WORTH IT! A
 quick dinner at an Italian restaurant, followed by the train ride back
 capped the day. All in all a good day and a fine experience in Tokyo, once
 again.
 
 In other news:
 
 There is an interesting case of food poisoning here. A company called Snow
 Brand has been distributing milk that has been causing staph infections in
 their customers. Apparently they didn't clean one of their tanks and an
 infection in the tank tainted the milk and yogurt drinks. In addition,
 there is news that after the milk was recalled, they poured it into a bucket
 and sent it back out. Boy...that's responsible.
 
 As is typical in this country, the CEO resigned to take responsibility. So
 much from learning a lesson from your mistakes and taking responsibility for
 FIXING the problem. I guess that would make too much sense.
 
 Over the weekend, I went to another get-together at Chiaki and George's
 house. Nick, their British friend was there. He and I tried to think of
 the words with conflicting pronounciation or a different word choice in our
 two dialects of English. Here is what we came up with:
 
 British: American:
 Aluminum Al-oo-min-yim Uh-loo-mih-num
 Police Bobby Police Officer
 Potato Chip Crisp Chip
 French Fry Chip French Fry
 Missile Miss-EYE-l Miss-ul
 Elevator Lift Elevator
 Television Telly TV
 Garbage Rubbish Trash/Garbage
 
 Nick particularly enjoyed the discussion about missile. I told him of the
 fine Cold War-era movies, where Soviet sea captains would instruct their
 crews to "Fire a miss-EYE-l." He found that amusing. Both of us were
 pretty amazed by the number of differences between the two versions of
 English. Finding them made for a fun game.
 
 George and I also discussed the history of his home country, Romania. He
 gave me an interesting perspective on their 1989 revolution. I knew some of
 the story, but it's always interesting to hear a view of a situation from
 within. Fascinating stuff for a history buff, like me.
 
 As for work, I finally got a demonstration of the electronic medical record.
 It really has everything. The doctor from India that I went through the
 demonstration with liked the patient care implications. I was more
 interested in the technical aspects of it, like screen layout templates for
 every user. It was really remarkable. The rest of this week will be spent
 on getting work done on some of my ongoing projects. I have been away from
 the office so much, I may have a hard time getting going again.
 
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