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Dan's Adventure in Japan

Fun in Tokyo again

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

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

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.