Atsushi Nakanishi

Tokyo-based Atsushi Nakanishi, 38, has an academic background in business and global business management. After graduating from Keio University in Tokyo, he worked for a consulting company for a few years before spending two years as a volunteer for the Japan International Cooperation Agency in the Philippines. He then spent a year studying at the University of California, Berkeley, where he got the idea to develop DFree, a wearable device for urinary incontinence. With this idea in mind, he established Triple W in the United States in 2014 and in Japan in 2015.

What was the inspiration behind setting up Triple W and launching DFree?

I was in the United States in 2013 and I had a terrible experience. Due to uncontrollable diarrhea, I soiled my pants on the street. If I had known that I would need to use the bathroom, that terrible experience wouldn’t have happened. That year, I also learned that sales of adult diapers exceeded that of baby diapers in Japan due to the country’s ageing population. In Japan, 78% of elderly people have urinary problems, such as frequent urination or loss of bladder control. I thought we could provide a solution to address these problems for seniors and nursing homes and hospitals, to support rehabilitation and toilet care. I do not have any medical background, but I felt inspired to create this product.

How did you feel about going into entrepreneurship?

From a young age, I’ve always envisioned starting a company. When I was in the fourth grade, I got inspiration from people like Bill Gates. I also grew up in a time when not everyone had to work as an employee in a big company. I’ve always been thinking of when and how I would start a company and, after my incident in the United States, I thought this is what I should do. That was my eureka moment.

What early difficulties did you face in the business and how did you overcome them?

We were trying to develop a product that did not exist; it’s the world’s first ultrasound wearable device. In the beginning, we had to collect a lot of data and even tried the device on ourselves. Then we collaborated with nursing homes and experimented even more. These were the procedures of the early stages of our R&D. I’m not an engineer, so we had to hire engineers. That was one of the biggest challenges for us. Hiring more people meant we had to fundraise. We had several angel investors but most of the investments came from friends. Once we developed a prototype, I contacted some venture capitals in Japan, and some invested in us in a seed round. Now that we are selling the product, we have to continue to invest in the next generation device, so we’re still not profitable.

What has been the best decision that you’ve made with the business?

Getting feedback from users of the device. I learned about one user who had sustained a brain injury after a stroke. For a year and a half, he couldn’t go to the bathroom on his own and had to use diapers. With our device, he was able to get back to his normal routine of going to the bathroom. Also, I learned about a seven-year-old boy with a disability who had always used diapers. With our device, he was able to do toilet training and transition to using normal underwear, which made him and his family very happy. I realized that our device has a positive impact, not just on the user but also on their family. The device is giving people who had lost hope or felt useless an opportunity to live a normal life.

With no background in healthcare, what steps did you take to help you in the business?

Especially in Japan, the healthcare field is heavily reliant on the government in areas such as nursing insurance, medical insurance and healthcare regulations. To understand the way the system works, I spent a lot of time studying. I worked directly with people who were involved with the regulations to collect information and sometimes even shared my insights and ideas. I dedicated a lot of time to understand the technology behind the device because, although I didn’t make the device myself, I needed to understand the product in order to determine future milestones and motivate the company to keep going.

What things do you today for continued success?

I go to the nursing homes and spend time with people facing urinary problems. I talk to them and try to understand their struggles and think of how I can help them. I know what I am capable of and what I’m not capable of. If I determine that I need help on something, I usually delegate to experts. This also fosters teambuilding and helps me accomplish my goals.

How did you find your early team and what values do you look for now?

My early team members were mostly my classmates from junior and senior high school and university who wanted to contribute to social issues using their skillsets. For specialised roles, like engineers, I recruited them based on introductions and recommendations. Making hardware in the healthcare field takes time. I consider it as one of the most difficult fields to tackle as a start-up, so I want to make a team with a sense of mission that will continue to work with passion until we succeed. If you work in a big company, you tend to do whatever you are told. I try to hire people who like challenges and want to learn new things. I also look for people who want to approach issues and try to address them on their own.

How do you foster teambuilding in the company?

Twice a month, the team goes out on Friday evenings for happy hour to have drinks or to have an informal party with dinner and drinks. Once a month, we also head off camping as a group. We even take our families with us. Socialising together is a great way for us to better work together as a team and I also make sure I have time to spend with team members, to foster my relationship with them.

You set up the company in Berkeley first. Why did you choose Tokyo as the headquarters and how does its culture benefit the business?

Yes, I started the company in Berkeley, but I decided to make Tokyo the headquarters because of its highly skilled and affordable engineers. At that time, I knew a lot of great people in the city who shared my passion and would be great to work with. Also, the first investment in the company came from Tokyo and the device was targeting the Japanese market initially.

Tokyo is also a really convenient location to meet with people working in the government, the law and healthcare industries, which was essential for developing the product. Also, the city has one of the biggest—and growing—start-up ecosystems in Japan, so I’ve been able to gather around me a lot of great people who are working hard to make the company successful.

What habits do you have that help you in your work?

I think it’s important to have first-hand information, so I often go out to fact-find. I value speed, so I always try to respond to situations and people as fast as possible. I never say no to going out to have a drink with the team because I value that time with them. In the morning, no matter how tired I am, I will make it to the office for the start of the workday and, on weekends, I go out to exercise. I also walk instead of taking the train as it gives me time to think.

Looking to the future, what are your biggest challenges?

We have two big challenges – the market and the product. We will continue to focus on devices that monitor the bladder and bowel movements. We are also developing a much smaller and thinner product that can be worn more comfortably.

We know that ultrasound is the only viable technology to monitor organs noninvasively. It is also safe and affordable. Our next step is to work on monitoring other organs like the stomach. We also plan to integrate our device with a remote healthcare platform, like a tele-medicine system. We want our devices to be used to monitor organs during rehabilitation, especially in the home.

Regarding market expansion, we already sell our products in Japan and the United States, but we want to move into other markets like China.

What professional advice would you give someone in the early stages of starting up a company?

One advice that I can give is that you never know if you can do something until you try, so always approach without fearing failure. Also, once you start doing something, make sure you finish it. In terms of specific advice, if a start-up runs out of money, it will mean the end, so in the early stages it’s important to gather as much money as possible while you can.