Nemawashi essential for conducting research in Japan

Nemawashi is a semi-formal but systematic and sequential consensus building procedure in Japan by which the approval of a proposed idea or project is sought from every person in a significant organizational position. For foreigners planning research in Japan, this concept has important implications since the project approval process is more obscure than in many Western countries. In this paper, I discuss observations as an outsider the research environment and culture in a Japanese hospital as seen from the inside, and draw conclusions for conducting research in Japan. From May to July of 1992, I was supported by the Japan-United States Educational Commission (the Fulbright Program) to interview physicians about end of life decision-making in Japan. The proposed project sought to obtain information on the way Japanese physicians use family and patient preferences in clinical decision-making. As I initiated the project, my Japanese advisor took great pains to explain the need for nemawashi to gain approval in my host institution. He underscored the importance of carefully informing every clinical and administrative person who might be affected by the proposed project, as well as the steps necessary for obtaining their endorsement. This process alone took three weeks and personal negotiations by my advisor at six levels before final project approval was granted by the dean. For actual data collection, my advisor made personal introductions to a high ranking physician from each department which greatly facilitated the scheduling of subsequent interviews with other faculty members in that department. The personal introductions by my host professor ensured 100% participant cooperation.(ABSTRACT TRUNCATED AT 250 WORDS)