The Japanese people place a high value on maintaining social harmony and they are likely to comply with hospital rules and conform to expected behaviors, with-out any significant objections, except in the most extreme circumstances [52].Other characteristics of the Japanese healthcare sys-tem include factors such as relatively long hospital stays and a low number of physicians [53]. Japan’s physician to population ratio has been lower than that of most other OECD countries for the past decade. The issue of physician shortage [54] in conjunction with imbalanced distribution of healthcare resources [55] has resulted in the continuous long-hour work of the medical staff in Japan. The introduction of diagnostic procedure combination (DPC) reimbursement system in 2003, which encourages hospitals to shorten the average length of stay, further increases workloads of medical staff [56]. Against this background, the indicators related to workload were more important for the hospital management in Japan. These can also partially explain the meaningless for indicators of employee competence, i.e., academic papers written and scientific projects.