148th Blog Entry for 2008

This is the last day of 2008. In fact, the last 2 hours...

On Jan 15, 2008 I started this blog after my sinus surgery. I heard about blogs, read a few blogs but could not tell it apart from normal websites. Inspired by Paul Levy, the CEO of Beth Israel Deaconess Medical Centre after I met him at the Harvard Advanced Management Programme in May 2007 and learnt about his popular blog www.runningahospital.blogspot.com, I decided to give it a shot. My main motivation was to write about my experience before, during and after my sinus surgery. Being rather uninventive and thoroughly excited about my recovery (i.e I can smell and breathe again), I named my blog www.icansmell.blogspot.com. Yes, I can smell!

It is liberating to write and express my thoughts, my encounters, my learnings and yet I had to be careful about what I write least I am taken out of context. My blog is a conversation with myself but now I have come to know that many of my friends and colleagues are following it - perhaps just for the heck of it. My wife and kids read my blog. They liked what they read and as a result know even more about me and my days. In a strange way, we communicate via my blog as well.

I close 2008 with this 148th blog entry, satisfied that I have not just started something and left it uncompleted but am confident of following through with it.

2009 will be an exciting year for me. I plan to document my journey as I lived it along with many ramblings and rants. Hopefully, in my own little ways, I will make healthcare in Singapore an even better one, where the needs of the patients come first.

Happy new year!

Reflecting 2008

It is the eve of the eve of the new year. I can't help but feel a sense of nostalgia for 2008.

As it is customary for me, I cleared all work from my desk for the new year. There was a pile on the left side of my table that i consider my "procrastination pile" - things that i convinced myself that i will soon find the time to do but... by the time i got to them today, guess what - they have all (but one) been overtaken by events and don't need further action. That one, I will start to do tomorrow because i have been saving it as a personal milestone :-)

Lots happened, some bad, lots more good.

At work:

I missed working with a great boss who left, but gained working with another great boss.

I lost a few good staff but gained a bunch who stayed and who became even better.

I was worried about how rising oil and commodity prices was going to affect the savings that we could achieve for our patients, but now we recapture planned savings and more.

At home:

I have a great wife who has become "better-est" (in the words of Minister Lim Swee Say's Better, Better-er, Better-est), she is not only an excellent helper but a source of encouragement as well.

My eldest daughter learnt to cycle yesterday.

Melody my No. 2 kid, moved on to the next grade in ballet and can now read well using phonics.

My son is chatty and is very cute!

Personally:

My nose is now as clear as KPE after a surgery (it used to be as congested as CTE).

I have been consistent with my exercise and covering greater distances with better ease. Fitness has improved.

My relationship with my family and with God has improved significantly.

I had my first real holiday in a few years with my family to Japan in November. I have so much to be thankful for in 2008.

What do I want for 2009? Let's start with divine protection and favour upon my family and friends...

My Daughter Brittney Can Cycle!!!

Brittney, my eldest daughter finally managed to cycle at the Pasir Ris Park today!

It is with the help of the lady at the bicycle rental shop at Carpark C of the Pasir Ris park. She really loves to teach children to cycle, and I am happy that Brittney had the good fortune of her teaching.

My wife and I are so so so proud of Brittney and the sight of our daughter finally being able to cycle is unforgetable! Watch the video to see why.

Hurray!!!!!!!

Year 2009 will be The ACCEPTABLE year of the Lord

Amidst gloom and doom predictions about 2009, I heard good news at my church service today that I believe will set the tone for next year.

The message today is that year 2009 will be the Acceptable Year of the Lord!

Jesus, in Luke 4:18 -20 was asked to read the scripture. It "happened" to be a passage from the book of prophet Isaiah. He read:

"The Spirit of the Lord is upon Me,
Because He has anointed Me,
To preach the gospel to the poor;
He has sent Me to heal the brokenhearted,
To proclaim liberty to the captives
And recovery of sight to the blind,
To set at liberty those who are oppressed;
To proclaim the Acceptable year of the Lord."

Then he closed the book and said to all in the synagogue "Today this scripture is fulfilled in your hearing."

In hebrew, "Acceptable" is the word "Ratson" which means Delight, Favour and Acceptable.

In Greek, it is the word "Dektos" which denotes the most blessed time where salvation and the free favours of God profusely abound.

For 2009 to be The Acceptable Year of the Lord means that it will be year filled with Delight, favour and acceptance where salvation and free favours of God profusely abound. My family and I said "Amen" to this!

The question is, why is 2009 the acceptable year of the Lord, when it has been written 2000 years ago. My pastor explained that the passage that Jesus read out in Luke was taken from the book of Isaiah Chapter 61, which took its context from the previous passage Chapter 60. Going back to Isaiah 60, the context described was one where "darkness cover all the earth, and deep darkness over the people..." - the same context today (2008) of doom and gloom that surround the world with the financial meltdown and economies of the world brought into deep recession (often compared to the great depression in the 1930s) and lifes of many are affected as jobs are lost. Hence, the acceptable year described in Isaiah 61 is for 2009!

Year 2009 may not be so bad afterall if we believe in our hearts what God wills for us...Delight, Favour, Acceptable and the year will be one where the free favours of God PROFUSELY abound!

I will this to all believers and to me and my household. Afterall, the scripture is fulfilled in our hearing - have you heard?

Lessons from Riding the Bicycle

I tried to teach my daughter how to ride the bicycle today.

There are 3 lessons that I receive from the lesson that I attempted to give.

Firstly, balance is personal. As much as I would like to help my daughter find the balance while riding the bicycle, she has to personally discover that balance. How true it is in life too isn't it?

Second, the more you concentrate to avoid an object while learning to ride the bicycle, the greater the chance that you will hit it. That was exactly what happened to my daughter today. My friend who went to Yosimite to ski recently crashed into something that he consciously told himself to avoid. His ski trainer subsequently told him that the way to avoid something while skiing is to look ahead and not think about the object. Again, how true it is in life?

Thirdly, learn to let go. I could not bear to let my daughter fall and hence at every opportunity I held on to her bike. She was largely unsuccessful as a result. Then came the bicycle rental lady. She told my daughter that she should only remember 2 things, look ahead and cycle continuously. With that she gave my daughter a push and instructed her to cycle. That was the first time I saw my daughter balance and cycle for some distance. Instead of holding on tightly to the bicycle for my daughter, I gave her the push and off she went. She made major improvements and i think she is close to finding her balance when we return the next 2 days. Any resemblance to life's lesson about letting go?

Balance, look ahead and let go... this is how we cycle through life's journey!

Robinson Christmas Sale - No sign of Recession

Robinson has outdone itself sale after sale. Her Christmas sale held on the 25th and 26th December 2008 where there is storewide 20% discount, with card holder getting another 10% attracted huge crowds. No wonder, Robinson calls it the Traffic Stopping Sale!

I was there on both days with my wife and particularly enjoyed watching people doing their shopping. Based on the amount that I see people buying, I can't tell that we are in recession. Maybe Singaporeans are heeding SM Goh Chok Tong's call to "shop our way out of recession"? Or, perhaps, people are capitalising on the better prices to buy their 'stock' for 2009 and aim to spend less for the rest of next year.

I must say that I got some very good deals - paid less than half for similar items that I was looking out at Robinson during non-sale seasons. Being someone who do not particularly enjoy shopping, I am very happy with the savings I've got.

The Singapore Flyer Outage... let's take it in the spirit of christmas

The various media today were flooded with news about the Singapore Flyer power failure with over 170 people stuck for more than 6 hours. It must have been quite a ride for the people stuck up there, and one where many will remember for many years to come. The bright spark in this "storm" is many will continue to talk about Singapore back in their own country, and hopefully the better part of their visit as well.

As I watch snippets of the media conference, I saw a tired General Manager of Singapore Flyer with ruffled hair trying to explain various aspects leading to the flyer failure. True, there are many questions that need to be answered, improvements that can be made, service recovery to be done. However, I am concerned that in the Singapore culture that we have come to know of, he may have to take responsibility and resign. I hope that I will be proven wrong, provided no wilful neglect is uncovered in the investigation. Can we be a society that is big-hearted enough to accept that something can go wrong and learn to be better?

It is Christmas time, let the spirit of the season show.

Untimed break from Blogging...

For more than a week now, I have been taking a break from blogging.

It is the time of the year that things are "forced" to slow down because colleagues are clearing leave, patients are putting their non-urgent sickness "on hold" and we all enter a time of reflections for the coming year.

I have been catching up with readings, clearing things that were repeated overtaken by urgent and more important matters, putting things in their correct places (will try though), and taking deliberate time to think and organise key milestones for 2009.

One thing that has come up as top priority is my own health. For 3 months now, I managed to stick to my fitness regime of running at least 3km 3 times a week followed by weights training. I am definitely physically fitter now and i have started to enjoy my runs. Last week, during one of my runs, I decided to try something new that I read - smile when i run, and found that the smile helped with conditioning my psyche and I ran my fastest 3km ever...still raring to go on at the end of the run!

I enjoy receiving Christmas and Season greeting cards very much, especially those who takes the time to pen a few words. There is a special feeling about being remembered, being able to keep in touch. This is the reason why I have continued with card sending as a year end routine even though I am told that this practice enlarges my carbon footprint. E-cards just don't mean the same. There is a nagging feeling that those cards could have been keyed in by somebody's secretary! So i will keep sending the cards and find other ways to compensate my carbon footprint...

Today, I attended a funeral. My brother-in-law's mom who is 82 years passed away, having suffered parkinson disease for the last 22 years. Her entire family came back to Singapore, including my brother-in-law who lives in Holland. Although it was a sad occasion, I am told that this is the first time that the whole family unite after so many years. Hence, it was a time of bonding, of healing and of restoration of ties that have gone sour. Now, I visualise her looking down from heaven and pleased that her family is together. I missed my church christmas celebration so that i could attend the funeral with my mom and dad and feel that this is time well spent!

It will be Christmas next week! My favourite time of the year! In fact, I think I enjoy the journey leading up to Christmas than the day itself. Of course, Christmas is of significance to me and my family. It is the day that Jesus, our saviour was born to die for all my sin (past, present and future), so that I may live a life more abundantly. That I may have Hope to know that I am Greatly blessed, High Favoured and Deeply Loved.

I have many things to be thankful for, and among them are many of you who read this blog. I pray that you will have a joyous christmas with family and friends, and may your 2009 will be filled with love, peace and joy that surpasses all understanding!

http://www.icansmell.blogspot.com/

US$25 a barrel of Oil?

Price of Oil has dropped from a peak of US$150 to about US$40 and then to US$25?

A week ago, OPEC president Chakib Khelil said there is no "floor" for the price of a barrel of oil. "Prices can drop to a very, very low level."

Is this good news or bad news?

Education during the Financial crisis

The impact of the current financial crisis is very real.

Huge companies crashed, the stock markets tanked, major car makers in US looking for govt help (even Toyota sliced jobs!), COE dived, Commodities - the darling of the season slide, oil prices at all time low, spending reduced, loans are harder to get.

By the Grace of God, I am generally out of the market and can afford to watch how the crisis unfold. I am taking time to educate myself about the financial crisis so that I can side-step any obvious landmine.

There are many points of view about what to do in this crisis. Many compared it to the Great Depression in the 1930's where the impact will be depression and deflation. Our PM said in a latest interview that he does not think that deflation is on the cards, the economy will recover in about 3 quarters and then followed by a long period of slow growth. When compared to the other predictions out there, this is a good scanario and I wish that this is the outcome for Singapore.

Follow this link to an article discussing the prospect of depression and deflation. An interesting read but anybody's guess.

Why do you do what you do?

My daughter asked me this question as we were having dinner at IKEA Tampines yesterday.

I was tempted to give the "brush-off" answer such as "because I've got to earn money to...", when something within me told me that it was a teachable moment and that I should use it wisely.

I told her "Papa has found his calling to help people who are sick and I like what I do and i think I am also quite good at it." I proceeded to tell her to consciously seek out what she loves so that when she grows up she will be able to find a job that she likes and that she will be able to express her talents through her work. She looked at me in my eye and said, "oh, now I know papa" and she proceeded with other facinations at IKEA.

Her question did not leave me even though she was satisfied with my answer. I truely wish that she too will find her calling and find the satisfaction of her contribution through her job when she grows up. This she will have to find with quiet facilitation from her parents.

How did I "find" my calling in Healthcare? For me, it was by observing the "giants" in my midst and be inspired. I was fortunate to work directly with Mr Liak Teng Lit (now CEO of Alexandra Hospital) and Mr Chua Song Khim (was CEO of national University Hospital and now Group CEO of ChinaHealthcare). Both of them taught me much early on in my career that we do what we do because of the Patients. They taught me, whatever it is, keep your eyes on the patient and you will know that you are heading in the right direction. I saw through their works that it is possible as healthcare administrators to make a difference to the care, service and experience of patients. Patients' lives are touched through the work that we do. Through both of them, and chiefly Professor Tan Ser Kiat (now Group CEO of Singapore Health Services), I was inspired to learn more about the contributions of other giants in healthcare such as Mr Khaw Boon Wan (now Minister of Health) and Dr Kwa Soon Bee (longest serving Permanent Secretary for Health) and the difference that they have made to Singapore Healthcare. One does not need to be a doctor to be able to make a difference for patients. I see that I too could contribute towards the ideal that Hippocrates said in his famous quote, "To Heal Sometimes, to Treat Often, to Comfort Always" by partnering other healthcare providors.

My last 15 years in healthcare afforded me the opportunity to work with other giants whose work and effort revolves around patients and their wellbeing. I like what I do... sure I have the occasional moments that leave me frustrated as well, but when I refocus on the patients, all is worth it!

Patients. At the Heart of All we Do! - SGH's Tagline...

The Return of the US Dollar?

The greenback was given up for dead just a few months ago, until the financial crisis hit its peak.

With prices of almost everything going down...oil, property, commodity, cars, etc, investors shun risks and rush to the safety of cash.

Read this article from Money and Market about the Triump of the Dollar.

6 Months of life is worth SG$34,125

"Everybody should be allowed to have as much life as they can," said Joy Hardy, who has kidney cancer but the British NHS has refused to pay for the expensive drug Sutent that he needs to delay progression of the disease.

The National Institute for Health and Clinical Excellence, known as NICE, has decided that Britain, except in rare cases, can afford only £15,000, or about $22,750 (SG$34,125) to save six months of a citizen’s life.

In an NYTimes article "British Balance Gain Against the Cost of the Latest Drugs", it appears that although the British authorities are reconsidering their decision on Sutent, many other countries are looking towards NICE for suitable applications of cost effective studies as a method to control escalating costs of drugs and devices. In fact, NICE has been so successful that it is know that large pharmaceutical companies are willing to package special pricing or consider other special arrangements (eg pay only when medication is proven to work on patient) just to get NICE to nod for the UK market.

The application of cost effective studies in medicine is bound to create strong responses not only from the pharmaceutical companies but also patients who are "denied" access. Doctors who "profit" by prescribing expensive drugs will also likely raise ethical discussions as the oblique approach.

The health budget is NOT infinite in any country, to support ALL new medication and devices necessarily mean that money will dry up and proper access to care WILL eventually be denied to segments of the population. Evidence-based cost effectiveness approach looks like the way to go, unless a better method is in sight.

So, even at the political level, a price is being put on lives. At a different level, it begs the question "Whose Life is more precious?"

Singapore is 118!

My daughter asked me about which is the most populous country in the world today.

I rattle off the obvious, i.e. China 1st, India 2nd and then I was lost. I promised that I will check. Here is the list that I googled from the US census Bureau for 2008:

Countries and Areas Ranked by Population: 2008
--------------------------------------------------------
Rank Country or Area Population
--------------------------------------------------------
1 China 1,330,044,605
2 India 1,147,995,898
3 United States 303,824,646
4 Indonesia 237,512,355
5 Brazil 196,342,587
6 Pakistan 172,800,051
7 Bangladesh 153,546,901
8 Nigeria 146,255,306
9 Russia 140,702,094
10 Japan 127,288,419
11 Mexico 109,955,400
12 Philippines 96,061,683
13 Vietnam 86,116,559
14 Ethiopia 82,544,838
15 Germany 82,369,548
16 Egypt 81,713,517
17 Turkey 71,892,807
18 Congo (Kinshasa) 66,514,506
19 Iran 65,875,223
20 Thailand 65,493,298
21 France 64,057,790
22 United Kingdom 60,943,912
23 Italy 58,145,321
24 South Africa 48,782,755
25 Korea, South 48,379,392
26 Burma 47,758,181
27 Ukraine 45,994,287
28 Colombia 45,013,674
29 Spain 40,491,051
30 Argentina 40,481,998
31 Sudan 40,218,455
32 Tanzania 40,213,162
33 Poland 38,500,696
34 Kenya 37,953,838
35 Morocco 34,343,219
36 Algeria 33,769,669
37 Canada 33,212,696
38 Afghanistan 32,738,376
39 Uganda 31,367,972
40 Nepal 29,519,114
41 Peru 29,180,899
42 Iraq 28,221,181
43 Saudi Arabia 28,146,657
44 Uzbekistan 27,345,026
45 Venezuela 26,414,815
46 Malaysia 25,274,133
47 Korea, North 23,479,089
48 Ghana 23,382,848
49 Yemen 23,013,376
50 Taiwan 22,920,946
51 Romania 22,246,862
52 Mozambique 21,284,701
53 Sri Lanka 21,128,773
54 Australia 21,007,310
55 Cote d'Ivoire 20,179,602
56 Madagascar 20,042,551
57 Syria 19,747,586
58 Cameroon 18,467,692
59 Netherlands 16,645,313
60 Chile 16,454,143
61 Kazakhstan 15,340,533
62 Burkina Faso 15,264,735
63 Cambodia 14,241,640
64 Malawi 13,931,831
65 Ecuador 13,927,650
66 Niger 13,272,679
67 Guatemala 13,002,206
68 Senegal 12,853,259
69 Angola 12,531,357
70 Mali 12,324,029
71 Zambia 11,669,534
72 Cuba 11,423,952
73 Zimbabwe 11,350,111
74 Greece 10,722,816
75 Portugal 10,676,910
76 Belgium 10,403,951
77 Tunisia 10,383,577
78 Czech Republic 10,220,911
79 Rwanda 10,186,063
80 Serbia 10,159,046
81 Chad 10,111,337
82 Hungary 9,930,915
83 Guinea 9,806,509
84 Belarus 9,685,768
85 Somalia 9,558,666
86 Dominican Republic 9,507,133
87 Bolivia 9,247,816
88 Sweden 9,045,389
89 Haiti 8,924,553
90 Burundi 8,691,005
91 Benin 8,532,547
92 Austria 8,205,533
93 Azerbaijan 8,177,717
94 Honduras 7,639,327
95 Switzerland 7,581,520
96 Bulgaria 7,262,675
97 Tajikistan 7,211,884
98 Israel 7,112,359
99 El Salvador 7,066,403
100 Hong Kong S.A.R. 7,018,636
101 Paraguay 6,831,306
102 Laos 6,677,534
103 Sierra Leone 6,294,774
104 Jordan 6,198,677
105 Libya 6,173,579
106 Papua New Guinea 5,931,769
107 Togo 5,858,673
108 Nicaragua 5,785,846
109 Eritrea 5,502,026
110 Denmark 5,484,723
111 Slovakia 5,455,407
112 Kyrgyzstan 5,356,869
113 Finland 5,244,749
114 Turkmenistan 5,179,571
115 Norway 4,644,457
116 Georgia 4,630,841
117 United Arab Emirates 4,621,399
118 Singapore 4,608,167
119 Bosnia and Herzegovina 4,590,310
120 Croatia 4,491,543
121 Central African Republic 4,444,330
122 Moldova 4,324,450
123 Costa Rica 4,195,914
124 New Zealand 4,173,460
125 Ireland 4,156,119
126 Lebanon 3,971,941
127 Puerto Rico 3,958,128
128 Congo (Brazzaville) 3,903,318
129 Albania 3,619,778
130 Lithuania 3,565,205
131 Uruguay 3,477,778
132 Mauritania 3,364,940
133 Liberia 3,334,587
134 Oman 3,311,640
135 Panama 3,309,679
136 Mongolia 2,996,081
137 Armenia 2,968,586
138 Jamaica 2,804,332
139 Kuwait 2,596,799
140 West Bank 2,407,681
141 Latvia 2,245,423
142 Lesotho 2,128,180
143 Namibia 2,088,669
144 Macedonia 2,061,315
145 Slovenia 2,007,711
146 Botswana 1,842,323
147 Gambia, The 1,735,464
148 Guinea-Bissau 1,503,182
149 Gaza Strip 1,500,202
150 Gabon 1,485,832
151 Estonia 1,307,605
152 Mauritius 1,274,189
153 Swaziland 1,128,814
154 Timor-Leste 1,108,777
155 Trinidad and Tobago 1,047,366
156 Fiji 931,741
157 Qatar 824,789
158 Cyprus 792,604
159 Guyana 770,794
160 Comoros 731,775
161 Bahrain 718,306
162 Bhutan 682,321
163 Montenegro 678,177
164 Equatorial Guinea 616,459
165 Solomon Islands 581,318
166 Macau S.A.R. 545,674
167 Djibouti 506,221
168 Luxembourg 486,006
169 Suriname 475,996
170 Cape Verde 426,998
171 Malta 403,532
172 Western Sahara 393,831
173 Maldives 385,925
174 Brunei 381,371
175 Bahamas, The 307,451
176 Iceland 304,367
177 Belize 301,270
178 French Polynesia 283,019
179 Barbados 281,968
180 Netherlands Antilles 225,369
181 New Caledonia 224,824
182 Samoa 217,083
183 Mayotte 216,306
184 Vanuatu 215,446
185 Sao Tome and Principe 206,178
186 Guam 175,877
187 Saint Lucia 159,585
188 Tonga 119,009
189 Saint Vincent and the Grenadines 118,432
190 Kiribati 110,356
191 Virgin Islands, U.S. 109,840
192 Micronesia, Federated States of 107,665
193 Aruba 101,541
194 Jersey 91,533
195 Grenada 90,343
196 Northern Mariana Islands 86,616
197 Antigua and Barbuda 84,522
198 Andorra 82,627
199 Seychelles 82,247
200 Isle of Man 76,220
201 Dominica 72,514
202 Bermuda 66,536
203 Guernsey 65,726
204 American Samoa 64,827
205 Marshall Islands 63,174
206 Greenland 57,564
207 Faroe Islands 48,668
208 Cayman Islands 47,862
209 Saint Kitts and Nevis 39,817
210 Liechtenstein 34,498
211 Monaco 32,796
212 San Marino 29,973
213 Saint Martin 29,376
214 Gibraltar 28,002
215 Virgin Islands, British 24,041
216 Turks and Caicos Islands 22,352
217 Palau 21,093
218 Wallis and Futuna 15,237
219 Anguilla 14,108
220 Nauru 13,770
221 Cook Islands 12,271
222 Tuvalu 12,177
223 Saint Helena 7,601
224 Saint Barthelemy 7,492
225 Saint Pierre and Miquelon 7,044
226 Montserrat 5,079
--------------------------------------------------------
Note: Data updated 6-18-2008 (Release notes).
Latest U.S. projections not included.
Source: U.S. Census Bureau, International Data Base.

Whose Life is More Precious?

The engineer from Oberoi Hotel in Mumbai decided to take the bullet for the guest... why did he consider the guest's life more important than his (at that time)?

If the boat with your wife and mother is sinking, and you can only save one, who will you choose?

In a burning building, a firefighter only has time to save one life, how will he choose?

In a crisis situation where a hospital only has enough blood to save either a VIP or a commoner with similar condition, who will be saved?

Compensation for kidney donation...is one life worth less than another?

Euthanasia - can we choose to end the life of another who is suffering?

Tough questions... but no easy answers. Our answers will depend on which side we are on, our answers will put us in extreme ethical dilemma, our answers may make us sick, our answers may be right for the society but wrong for the individual, and our answers may make us live with regret for the rest of our lives.

... we hope we do not have to make these decisions, but sometimes they become the inevitable. Eventually, I guess we will step out of intellectualisation, into the domain of our gut and hopefully our faith.

How will you decide?

The Husband Song...

Enjoy... I'm the Man...

The Dilemma of Measurement in Healthcare

Those of us who clocked enough time in healthcare know that whenever we get to a discussion on indicators ranging from aspects of quality, operational effectiveness, financials or even workload, the debate can be quite interesting, to say the least.

This is not surprising because healthcare, quite unlike manufacturing processes, has its product (ie the patient) as a variable. Two human beings with seemingly similar medical conditions may have symptoms that manifest differently due to different genetic makeup, different environmental factors and different predispositions. Treatment may thus produce different results, take different amount of time and may require different level of intensities. Even modalities and medication can vary. Such differences, as it is commonly argued, will affect quality, render operational processes less effective, consume different amount of resources and hence different financials and quite different outcome. So, the "natural" conclusion is that measurement in healthcare is not ideal and may not produce the kind of insights and improvement that we see in other industries.

The truth is somewhere in between. At the case level, the arguements set forth above are true. However, when we adopt a "population"/ statistical approach, one will NOT find it difficult to discover that there are lots more similarity among patients than we make it out to be. We can develop insights for improvement when we measure, and are courageous enough to test ideas for improvement that those insights suggest. Often, this distinguishes between the great healthcare organisations and those that are mediocre.

Paul Levy, the CEO of a Boston academic medical centre, wrote in his latest log entry "relentless determination" that healthcare organisations often get carried away with the notion that the science to measurement in healthcare is imperfect and let themselves live with arbitrary sense of security that they are providing healthcare as best as they can. It is only when we measure that we will soon find out that nothing is further than the truth.

When we are not careful, we soon find ourselves confronted with the "dilemma of measurement in healthcare"...damned you do, damned you don't! In such cases, only courageous and strong leadership counts.

The next time when we have the occasion to discuss an indicator, learn to refrain from asking what's wrong with this indicator. Instead, ask what is right about this indicator that can help me make better decision. When we seek, we inevitably find.

Learning to Let Go...

Today, I am reminded of a quote from a poster - "If you love something, set it free. If it comes back to you, it is yours. If it doesn't, it never was."

The problem with individuals like me is that sometimes I hang on to a task too tightly because I feel responsible for the outcome and the wellbeing of people involved . However, in doing so, it can stifle the team's effort, creativity and morale, without possibly improving the outcome. Moreover, one becomes a better leader getting done through others than always trying to get things done ourselves.

Today, I fell into this trap. But, fortunately I manage to catch myself trudging into this vicious cycle. I stepped back, apologised for my folly and told the team the quote above. They looked visibly relieved and encouraged.

I am sorry for doing this sometimes, but yet I am human. Tell me next time and I will appreciate it.

A New "Champion" has been uncovered in Singapore - "The Rudest Motorist of the Day"

Ladies and gentlemen, I am ashamed to introduce to you the winner of "The Rudest Motorist of the Day" award - Ms Nissan Blue Cefiro of Holland Village!

I have been a driver for many years, heard about many many experiences of inconsiderate, rude and dangerous motorists, personally experienced some of the worst myself, been guilty of some chaff myself... BUT, today I met the motorist that epitomises the worst attitude.

My wife and I headed to Holland village for lunch to use a voucher that is close to expiration. Parking was full and instead of spinning round the carpark, we decided that we will wait for other drivers to leave and then take our lot. We stopped our vehicle along a lane patiently waiting for our turn. After some 10 minutes, we saw a vehicle preparing to leave. I signalled my intention to take the lot. At that time, Ms Nissan Blue Cefiro approached slowly from the opposite direction, overtook another vehicle who was also waiting and stopped close to my car. She turned, looked at my car, saw my signal to take the lot, mumbled something and reversed her car into the lot as the parked vehicle left the lot.

I tapped my horn at her, gesturing to her that I was waiting for the lot (in case she need any reminder on basic road courtesy)... she looked at me, mumbled some more and continued her way into the lot. Figuring that car language is not something that she understands, I got out of the car and approached her. I told her that it was clear that I have been waiting for the lot and she should not have taken it as a matter of courtesy. Her remarks astounded me.

She said, "You don't own the carpark, I can park as I like, I don't care if you are waiting." What was even more amazing about her remarks was that she said all that in front of her 5-year old child who was in the car with her! What she also did not realise was that she also does not own the carpark, and basic courtesy needs to be practiced and respected.

Exercising, a supreme version of self control learnt from my recent trip to the "holy" Mt. Fuji, I was reminded of a book that I read before "Don't Fight with Pigs - You get dirty and they enjoy it." I walked away, least I become reduced to a lower being.

I am appalled by the absolute lack of basic courtesy and the total disregard for others. Fortunately, Ms Nissan Blue Cefiro form the minority amidst the civilised population in Singapore.

Congratulations, Ms Nissan Blue Cefiro - you won... BUT, really?

No "Good Bye"?

This morning, at a promotion review meeting, I found out that a good new staff has tendered her resignation and today would be her last day. Even though she does not report to me, I was disappointed that I have only come to know of this so late but even more disappointed with losing a good staff.

Interestingly, by the time I returned to my desk, I still received a few fresh emails from the staff trying to settle some meeting matters. I thought to myself, I will swing by to say "Thank you" and wish her well in her new job. I took out a "Thank you" card from my drawer, wrote a note of appreciation in it, inserted it into an envelope and wrote her name on the outside. I walked to her desk, but she was not there. I left the card on her desk and walked off, thinking that she would still be back.

By the afternoon, I am told that she already packed and left in the morning. What I am curious about is why was there no Good Bye? Maybe, there were just too many to say Good Bye to... and perhaps I am one of those best to avoid?

I just hate losing good staff!

Never Drive with Your Wife!

After posting about death for the last 2 days, here is some comic relief that I received today...

A police officer pulls over a speeding car. The officer says, ' I clocked you at 80 miles per hour, sir.'

The driver says, 'Gee, officer I had it on cruise control at 60, perhaps your radar gun needs calibrating.'

Not looking up from her knitting the wife says: 'Now don't be silly dear, you know that this car doesn't have cruise control.'

As the officer writes out the ticket, the driver looks over at his wife and growls, 'Can't you please keep your mouth shut for once?'

The wife smiles demurely and says, 'You should be thankful your radar detector went off when it did.'

As the officer makes out the second ticket for the illegal radar detector unit, the man glowers at his wife and says through clenched teeth, 'Dammit, woman, can't you keep your mouth shut?'

The officer frowns and says, 'And I notice that you're not wearing your seat belt, sir. That's an automatic $75 fine.'

The driver says, 'Yeah, well, you see officer, I had it on, but took it off when you pulled me over so that I could get my license out of my back pocket.'

The wife says, 'Now, dear, you know very well that y ou didn't have your seat belt on. You never wear your seat belt when you're driving.'

And as the police officer is writing out the third ticket the driver turns to his wife and barks, 'WHY DON'T YOU PLEASE SHUT UP??'
The officer looks over at the woman and asks, 'Does your husband always talk to you this way, Ma'am?'
I love this part.... :

'Only when he's been drinking.'

Dying with Grace...

In memory of Ho Hwei Yen...

I do not know you, but yet your untimely death has struck an emotional cord with me and my family. The danger of terrorism has been personalised and the message brought home.

The heart of a terrorist can never be fanthomed because what can bring someone to the point where the heart and mind is fully separated. That killing the innocent can become a virtue, and taking away another's life not longer mean anything?

But, when innocent lives like that of Ho Hwei Yen is taken, it helps to unite the minds and hearts of Singaporean that we need to stay vigilant and be part of the fight against terrorism. Hwei Yen, you now represent the face of our resolve.

My condolence to your husband and your family. I feel the pain of your husband Michael when he wrote "My beautiful angel Yen, without you my life has no meaning and no purpose. You were everything to me and the time i spent with you was the happiest of my life. Your family misses you more than words can express. We love you so much and pray that God has you in His loving Arms."

The hearts of Singaporeans are with you... God Bless

I am so Happy to be Back Singapore!

I touched down Singapore at 5.50pm today via Singapore Airlines, and as I was driving home, my wife and us both experienced the sweet feeling of homecoming. The sense that this (Singapore) is where we belong...

Don't get me wrong, my family just had one of the best vacation ever in Japan. It was a time of bonding, of having fun at Disney, of marveling at the beauty of nature especially at Mt Fuji and Hakone, and of delighting our palette with the wonderful variety of beautiful and "Oushi" Japanese food. The experience was truly extraordinary, but yet it was different.

I want to write about the many things that I get to experience and learnt...but I guess it will have to wait till I get my much needed dose of sleep. We have many things to be thankful for in Singapore. Everytime I take a trip out, I come back developing a deeper affection for this Lion City that we call home.

Otherwise, I just want to drop a note that I am back!

Documenting Japan Brand of Service...

For the next 8 days, I will be at the "Happiest Place on Earth" - so goes the tagline by Disneyland, and visiting various places of interest in Tokyo for my family vacation.

Japan is a place known for many good things. It is the land of Toyota, their cars invading all corners of the glode for economy and quality. Coming out from Toyota came is LEAN manufacturing or the Toyota Production System (TPS) that is now finding its way into healthcare - transforming healthcare process and improving care delivery. Japan is also the land where everything hyper organised and gifts are wrapped so nicely that one would wonder whether to forgo the content at risk of spoiling the gift wrap. When one thinks of politeness and courtesy, the bowing Japanese certainly comes first to mind. These coupled with the reputed service from Disneyland delivers a quite prompting in my heart that I should carefully observe as I travel through the land and see what I can learn about the Japan brand of service.

I hope to document my learning (and my enjoyment too) daily...

For now, the blackberry is switched off, and my vacation psyche switched on.

Creating Awareness about Extreme Drug Resistance to TB via Photography

Photographer James Nachtwey's picture depiction of the suffering around the world due to TB...

Watch the video on Youtube...

I will never be able to look at the White tiger at the Singapore Zoo the same way again...

On 29 October 2008, I visited the zoo and posted a video of one of the 3 white tigers pacing up and down a set of rocks. I reflected about them being a source of power or a heap of bones and meat...

Today, a malaysian contract worker, apparently in a suicide bid jumped into the White Tiger exhibit and was devoured by the 3 tigers. He died apparent from bites sustained on his neck and I dare not imagine the condition of his body after the attack. The pool must be filled with blood and the white fur of the white tigers stained with red deep especially around the mouth. I certainly hope that there were no children there during the incident because it can leave a deep emotional scar.

Indeed, the tigers are a source of power but as of now their beauty has been tainted by the image of murderers. I am now less sympathetic when they are reduced to heaps of bones and meat!

Laughter the best medicine...

What's the difference between a STAR performer and an AVERAGE performer? Plenty...

1000% is the answer for complex jobs and responsibilities - reported the Businessweek in their article "Obama First Proirity - Hiring the Right people". Here is the article by Claudio Fernández-Aráoz:

With Barack Obama moving to take charge as the President-elect of the U.S. in the middle of the worst financial crisis since the Great Depression, Job No. 1 for him is to make great people decisions when picking the members of his team. No other single, controllable factor will have a larger impact in the coming years over the U.S., and to a significant extent, around the globe.
Why is this so important? One answer is because the jobs at those upper reaches are so complicated. This may sound obvious, but consider the following. The more complex the job, the greater the spread between average performance and outstanding performance. On average, a "star" assembly line worker is 40% more productive than his or her peers. But when it comes to a high-complexity job such as a computer programmer or an account manager in a professional services firm, a star performer may be as much as 1,000% more effective than an average performer. What does this suggest about, say, an average Secretary of Treasury vs. a stellar Secretary of Treasury?

Unfortunately, finding great people isn't easy. The late Peter Drucker believed that the typical executive bats no better than .333 when it comes to making hiring and promotion decisions. That's more than good enough for baseball; it's nowhere near good enough for running a great company—or country.

Why do we fail at people decisions two times out of three? The main problem is that we are asking an old brain to do a new job. Our hardwired brains—designed to help us survive as nomadic hunter-gatherers—don't mesh well with our current challenges. In particular, a series of emotional biases, hidden deep in our unconscious minds, work against us, and unfortunately, they bear strongly on our people decisions.

For example, because of our hard wiring, we procrastinate about people decisions. We exaggerate the risks of change and disregard the opportunity cost of the status quo. And when we do act, we are inclined toward snap judgments. Research from the neurosciences has revealed that we form an initial unconscious impression of the person in front of us at lightning speed—on the order of one-twentieth of a second—but unfortunately, such impressions are long on snap and short on judgment. On a more conscious level, we are inclined to place far too much value on brands and labels (such as educational background or political affiliation) and far too little on substance.

If I had the ear of the President-elect, I'd suggest four steps:
• Do the hard work.
There is enormous pressure on incoming Administrations to staff up and hit the ground running. The "First 100 Days" clock is ticking from Day One. Everyone is looking for results within the first months, or even weeks, of taking charge. To make things worse many people believe that, if the President fails to achieve a lot within the first 100 days, he will never be able to regain credibility. This is dead wrong. The best CEOs take significant amount of time to set up the right teams and together with these teams make the right diagnostics—before jumping into crucial change initiatives. Even when taking charge of troubled companies, the best take their time to make sure that they are fighting the right battles in the right ways. When making people decisions, they don't just bring rapidly on board the people they know—or those they owe favors. Rather, the best corporate leaders cast a wide net and conduct in-depth assessments of the strongest looking candidates. The new President and his people-finders have to approach this all-important process with the highest level of attention, discipline, and patience. Go slow to go fast.

• Use multiple screens.
Relevant experience is a good initial screen, since there's no time for on-the-job training. (Ask Ben Bernanke and Hank Paulson.) Move from there to integrity. (If they're not squeaky clean, they're out.) Then look to competence: Were they any good, as they amassed all that experience? Finally, look beyond the standard measures of intelligence, such as I.Q., test scores, class ranks, and the like. You need to scrutinize the ways in which leaders have managed themselves and their relationships with others. This is by far the most important predictor of success or failure in any senior leadership role.

• Worry about the team.
It's not all about the great Secretary of Whatever. It's also about his or her lieutenants—and their lieutenants. Remember that outstanding teams require not only strong skill sets, but also significant diversity to avoid the risks of herding and group-think. The ability to pick great people with complementary skills should be a key factor for success for the new President-elect as well as for each of his key appointments.

• Invest in the political positions as well as in the permanent professional staff.
Too many politicians overvalue the former and undervalue the latter. But you just can't build lasting greatness without staffing the Administration with competent professionals at all levels, including young staffers with potentials who will continue strengthening the country long after the Presidential mandate is over. At the time of its independence, Singapore's founding fathers realized that without natural resources or scale its only way to grow was to invest in talent. They systematically have attracted the best people, both to key political appointments and its exemplary civil service, for over four decades now. As a result, since 1965 Singapore's gross national product per capita multiplied by a factor of eight in real terms (constant dollars), while that in the U.S. multiplied by a factor of less than three.

Navigating the financial storm is just one of the many challenges the new President will face. Ensuring that the U.S. can compete successfully in a global marketplace populated by increasingly skilled national rivals is another. Yet of all the challenges, making the right decisions about people is among the most important. If President-elect Obama fails at that, his ability to succeed in anything else is severely compromised.

Claudio Fernández-Aráoz is a partner and member of the Global Executive Committee of Egon Zehnder International, the global executive recruiting firm. He is the author of Great People Decisions: Why They Matter So Much, Why They Are So Hard, and How You Can Master Them

More Healthcare Executives and Professionals will be in demand in the next few years

Channelnewsasia carried news that Minister Khaw has announced that the new Jurong General Hospital will be brought forward to capitalise on expected lower construction costs while at the same time add capacity to public healthcare.

With Parkway's Novena Hospital coming on stream by 2011, Khoo Teck Puat Hospital by 2010 and now Jurong General Hospital before 2015, demand for healthcare executives and professionals will likely escalate. This will be a great time for talents to consider a career in healthcare...but need to be patient as healthcare is a complex business and need time to learn the trade, establish credibility and grow!

Budgeting in an Academic Medical centre/ Health System

Hospitals are currently into their budgeting cycles. The issues and discussions on how to apportion limited resources to support the inter-related mission of service, education and research are interesting but difficult.

Hospitals have a duty to provide good care to their patients (service mission) but at the same time (as importantly) to train the next generation of healthcare professionals (Education) and research new frontiers in medicine and care delivery (Research).

Paul Levy, CEO of Beth Israel Deaconess Medical centre, an academic medical centre affiliated to Harvard Medical School, discusses in his blog www.runningahospital.blogspot.com his views on constructing a hospital budget. Check it out, including the comments that were posted. I find this reflection helpful.

Beginner Big Camera Education...So interesting

I think the answer to my question of my Nov 2 blog entry "Am I a Big camera Kind of Guy?" is likely a YES!

There are many photography enthusiast out there who are very keen to help. When I last spoke to a colleague in GPO, he forwarded me an email "all things photograhies" with links to review sites and where are the better places to buy DSLRs at good prices and service.

There is a site DPreview.com that is such a fabulous site for Big Camera Education. I just finished reading a page about what to look out for when choosing a DSLR. No wonder one advice that was doled out to me was "be prepared to spend lots of time and money on books and accessories!" Currently, I think I am sold on Canon but still working through the precise model. Better work fast so that I can hint to my wife about my Christmas Present :-)

Suggestions on other models anyone?

Why does my stomach growl when I am hungry?

This can be so embarrassing sometimes! Now why does that happens?

You can find the answer through a patient education video on the Beth Israel Deaconess Medical centre.

There are other interesting health questions and answers as well. Check it out!

Too many Cooks Spoil The Broth

Processes fail and suboptimise often because clarity of roles and responsibilities is missing.

Too many cooks can indeed spoil the broth. A process where many different parties feel that they are responsible often pull in different directions, result in wastage of resources, damages to relationship and worst of all the customer (or Patient in healthcare) suffers.

A useful framework is RASCI:

Responsible - Who makes it happen?
Approve - Who needs to approve this?
Support - Who provides the expertise?
Consult - Who can add value?
Inform - Who needs to know?

There should only be one person Responsible, and any more than one Approver can be troublesome and for me raises alarm bells. For the other roles it is perfectly fine to have more people.

I have been thinking about how to streamline certain roles in the hospital for better effectiveness and have found the framework to be very helpful.

One Step at a Time...

Take one step at a time... A timeless advice from my daughter Brittney when she was 4-year old. At that time, I was troubled about something at work and was wondering how I could complete my assignment on time when I turned to Brittney. She said in the melody of a song from Barney, "One step at a time, One step at a time..." How right she was and still is!

There is no need to rush nor to procrastinate, just take one step at a time.

One of my friend on facebook posted a youtube video entitled "One Step at a Time" by Jordin Sparks. The post attracted my attention, reminded me of my daughter and captivated me with a nice song... listen to it and pay attention to the lyrics. Be encouraged...

Someone needs to read this...

Got this spam in my mailbox but thought that it is a good reminder for some of us some time somehow... Get out of "downward spiral"

Do you know what it means to be caught in a downward spiral? Well, it starts with a belief. Let's say you believe you're not good at something. Now, if you expect to fail, you don't use much of your potential, do you? You don't take action that is confident, assertive, or energized. And what kind of results comes from this kind of attitude and this kind of action? Pretty dismal ones, right?

These dismal results reinforce the original belief that you're no good at it. Which in turn produces even less effort and even worse results - and down and down you go. This is a classic downward spiral in which a negative belief breeds failure, which breeds an even more negative belief, and so on.

People who are chronically unhappy and who live hopeless, helpless lives have been without the results they want for so long, that they no longer believe they can produce good results, no matter what they do. They become trapped in a downward spiral, and after a while they can't even conceive of a way out. They see others doing well, but they attribute it to luck or circumstances.

The interesting thing is, this can happen to individuals, teams, departments, entire organizations, even entire countries. And, with the media as pervasive and accessible as it is these days, it could happen to far more than one country. Look at how fast global financial markets have reacted in the last few weeks.

There are ways to interrupt downward spirals and reverse their direction. It is never too late to start.

4 Types of people in the World, who are you?

There are 4 types of people in the worlds.

The 1st Type, we all love. They "make the world go round". They just make the world a better place for everyone and are a joy to work with. You know, when you are with them.

The 2nd Type, well... They just "Watch the World go Round". As the world spins, they simply watch and marvel. They neither make the world better off nor worst off... they simply watch. Even when they see that something needs to be done, they do not take any action.

The 3rd Type, is sightly "blurr". They "dont know that the world is going around". Obama has been elected the first black President of the United States and Type 3 would ask "who is US Prime Minister?"

The 4th Type, I hate the most. They not only do not make the world go round but goes around "Cursing at the way the world is going around." When the world turns to the left, they criticise... when the world spins to the right, they mock at the right view...when others do something right, they will make them feel bad and drive others into inaction. All in, they just make the world a worst off.

What do I do...

I do as Steven Covey say, begin with the end in mind...

First FIRE the Type 4 and banish them from my universe!

Identify the Type 3, train and educate them and try to change them to Type 2

Type 2's with good attitude may be changed into Type 1 with coaching and motivation

Promote and develop the Type 1's. We all need more of them!

Which type are YOU?

Creative Mathematics...

Ready for some laughs? I received an email showing examples of actual answers provided by students. This is my personal favourite - why didn't I think of that! The could be the beginning of creative accounting when the syudent grows up...

Am I a Big Camera kind of Guy?

Deep within me, I sense there is a passionate photographer amidst a busy healthcare executive.

Great photography turns me on. Today, after church service, and I was walking with my family to the carpark at the millenia when we came across an exhibit of underwater photography. The vivid colours of the sea creatures and of the sea entralled me. I marvelled at all the details that were captured under the skillful hands of the photographers and wished i could do the same. There is a sense of aesthetics and an immense interest to be able to capture life as it happens and hold it for eternity for me.

So far, I am a small camera kind of guy. I tot a Sony Cybershot T30 - nice camera, handy and occasionally i get some nice shots. I wonder whether I should go for a digital SLR - the Big camera, but I am not sure if I am the Big Camera kind of guy. What does it take to sustain a hobby in photography? Comments and suggestions welcomed...

Healthcare Workers Do not Deserve To Be Abused

Today, I received emails from a few staff who were at their wits end.

A patient has repeatedly demanded that he be given meals of his choice, outside of the menu choices available in the hospital. Each time, he would verbally abuse my staff and ordered them to even leave the hospital grounds to go to very specific food joints to get the food that he wanted. When he asked for chicken nasi bryani and was served from the hospital kitchen, he complained that the rice was not the correct byani grade and ordered my staff to go across the road to buy from the coffee shop. When staff stood firm with him, he threatened to jump, if he did not get his way.

Every meal time has become a terrible nightmare for hospital staff. Do healthcare workers deserved to be abused like this? I do not think so, even if they are full paying patients. We will stand firmly behind our staff, so that they have all the support that they need to do a good job looking after patients who need their fullest attention.

The incidence of abuse of healthcare workers has increased sharply in recent times. During the last 15 years I've spent in healthcare, I seen all kinds of abuses staff have been put through. Patients would go to the vending machine to buy a hot cup of milo just to throw it on a staff. A next-of-kin of a patient removed a drip pole from the bed to attack staff. Verbal abuses extend to making threats of harm to staff, threats to harm their career, and repeated shouting at staff during every visit causing severe mental anguish to staff.

Such abuses to healthcare workers cannot be tolerated. No one deserved to be abused verbally or physically, let alone healthcare workers who worked hard to care for the sick among us. There are 2 problems when we decide to respond to such abuses:

1. Our staff have been very compassionate even though they were abused. Each time, they have decided that they do not want to pursue the matter and would like to let the matter rest. They would like to give the benefit of doubt to the patient, i.e. that their aggression was the result of their illness and hence not wilfull.

2. Since the restructuring of public hospitals, healthcare workers are no longer considered "public servants". Under the Penal Code, voluntary causing hurt/ grievous hurt to deter a public servant from their duties is a seizable offence under Section 332 and 333 SHALL carry an imprisonment term or fine or caning. The aggressor physically abusing a public servant may be arrested by the police and be charged in court. However, after restructuring, physically abusing a healthcare worker is an offence under Section 323 of the Penal code, but it is a non-seizable offence. In this case, the victim (ie healthcare workers) or the hospital will have to go to court to pray for a summons before taking the aggressor to court, and the offence is normally one where the police will not arrest the aggressor (ie non-seizable).

Healthcare workers working in public hospitals are performing public duties and should be better protected. Perhaps, the stance adopted by the AG when road bully became a problem earlier in Singapore should be considered. Even though road bully cases typically fall under Section 323 of the Penal code (voluntary causing hurt), the decision was taken that all road bully cases will be prosecuted in court by the police where the facts are substantiated. Not surprisingly, the problem of road bullies has decreased significantly. I can imagine that the number of cases of abuse of healthcare workers will follow a similar downward trend when similar legal stance is adopted.

Hospitals are not perfect and occasionally we goof up. Tell us so that we will improve. But, our staff do not deserve to be abused.

Won't we give way to save lives?

I read yesterday's article in the Straits Times "Heart attack outside hospital: You have 2.7% chance to live" with surprise and disgust.

My Grandaunt who recently survived a massive heart attack can surely count her lucky stars because she was among the less than 3 people out of 100 who survived a heart attack at home.

What i was disgusted about are some of the reasons why paramedics were delayed getting to the heart attack victims. Not surprisingly, people who refused to give way to ambulance even under the full blare of the siren and flashing lights. What was even more disgusting are people who refused to get out of lifts so that paramedics could get in quickly with the stretchers to reach the victims quickly! What could be people be thinking about when they do so? Perhaps, "my time is more important than saving lives?"

What can be done to up the chance of survival? I personally support having more AEDs in more public places. Personally, I am motivated to refresh my knowledge in CPR so that I will be of use when the need arise. Also what Dr fatimah from SGH said in the Straits times is a simple and practical one, "hold open the lift door in anticipation of the arrival of the ambulance and paramedics", the few minutes saved can mean the difference between life and death.

Perhaps, the best chance of survival is avoid getting a heart attack in the first instance. It starts with our diet and watch stress in our lives.

Sighted again..."Madam Transparent" at Yio Chu Kang

Tonight was melody's (my 2nd Daughter) K1 graduation night performance at Yio Chu Kang Chapel. It was a night that I have looked forward to because Melody practiced really hard for her performances.

Again, my experience was marred by yet another inconsiderate parent/ grandmother. This time "Mrs Transparent". She decided to move herself to the "best spot" to view the performance with absolutely no regard whether she is blocking other's view or not. I went up to her to tell her that she was blocking the rest of us behind and she merely looked at me, slanted her body somewhat and carried on her ways.

Mrs Transparent's behavior and attitude certainly created other reciprocal behavior. Very soon, other parents whose view was blocked also got up to catch a glimpse of the performance. Within moments, the entire block of parents were standing up.

Thanks Mrs Transparent for leading the way... and generating bad behavior from the crowd. Which part of the principal's announcement "parents, in order for all parents to enjoy the performance, please do not stand up during the performances and remain in your seats" is so hard to understand?

If you recall, earlier my eldest daughter's performance at RGPS was similarly marred by "Mr Transparent."

We really more social grace and consideration for others... maybe we should empower a "Citizen Fine"...oops, did I say we are a "fine city?"

Hollywood is now Bollywood!!

For those of us familiar with the songs and drama of Bollywood will find all elements and more in the latest Disney's "High School Musical 3." Watch the trailer and you will know why. Better still go watch the movie, which I did, and you will be bowled over!!

White Tiger...A Source of power but a heap of bones and meat?

My visit to the zoo today yielded one of the most stunning sight of the White Tiger. Previous visits only allowed me to capture the tigers sleeping under the shades. As I watch the huge tiger pacing up and down the row of rocks, the sheer size and beauty of the the animal was a sight to behold.

At some point, I thought the white tiger must be caucasian of the cat world, because the animal seems to have gleaming blue eyes :-)

I later found out that the tiger is hunted for every part of the body. The tiger skin/ covering is a luxury item coveted by the rich. Her teeth a sought after ornament with properties to "ward off the evil". Her (of his) penis is among the first body part to be cut of from the hunted tiger - it is believed to have properties similar to viagra; her flesh is reputed to go well with spring onions and builds the body... Now, it is said that there are less than 500 tigers left in the wild and heading down the trial of extinction. When I contrast this against my image of the tiger that I just saw, I can't help imagining the animal in x-ray version, ie of her parts rather than her majesty.

Like Sharks and Sharks fin, I am still rather ambivalent about protecting the tiger. But, I know that the politically correct answer is that "we must do all we can to protect wildlife". In due time, I will educate myself and steer my point of views. What about yours?

When you expect the treatment to make you better, you feel better?

A placebo treatment is defined as a treatment whose benefits derive from positive patient expectations and not from the physiological mechanism of the treatment itself.

The 23 October 2008 BMJ's article "Prescribing placebo treatments: results of national survey of US internists and rheumatologists" shows that 50% of the US doctors surveyed routine prescribed placebo treatment. The placebo could come in the form of a sugar pill and in other cases headache pills or vitamins. Research has shown that placebo treatments do work in some clinical trials for depression, hypertension and pain.

So, the common phrase that "It is all in the mind" is true after all!

However there are deep concerns about placebo treatments, one of which is ethics. At the heart of this is that the trust between patients and doctors could be undermined.

With patient expections getting higher, and many expecting to at least swallow a pill after seeing a doctor even when they do not need it, placebo treatments could well keep all parties happy!

How things are Politicised?

I received a random email today, sharing it as it carries a good moral and lessons - applicable in many present day situations as well, if we are not careful...

Older Version:

The Ant works hard in the withering heat all summer, building its house and laying up supplies for the winter. The Grasshopper thinks the Ant is a fool, and laughs & dances & plays the summer away. Come winter, the Ant is warm and well fed. The Grasshopper has no food or shelter so he dies out in the cold.

Present Day Version (in imaginary country Y):

The Ant works hard in the withering heat all summer, building its house and laying up supplies for the winter.

The Grasshopper thinks the Ant's a fool, and laughs & dances & plays the summer away.

Come winter, the shivering Grasshopper calls a press conference and demands to know why the Ant should be warm and well fed while he is cold and starving.

TV1, TV2 & TV3 show up to provide pictures of the shivering Grasshopper next to a video of the Ant in his comfortable home with a table filled with food.

The majority of the Parliament are stunned by the sharp contrast. How can this poor Grasshopper be allowed to suffer?

One MP stages a demonstration in front of the Ant's house.

Another MP goes on a fast along with other Grasshoppers demanding that Grasshoppers be relocated to warmer climates during winter.

The Government immediately passes a law preventing Ants from working hard in the summer so as to bring about equality of poverty among Ants and Grasshoppers.

Yet another MP makes 'More Special Reservation' for Grasshoppers in Educational Institutions & in Government Services. The Ant is fined for failing to share 30% of his food with the Grasshopper.

The President of country Y announces that this is part of the NEP. Every ant must not question it.

Many years later... The Ant has migrated to the US and set up a multi-billion dollar company there. 100s of Grasshoppers still die of starvation despite the 'Special Reservation'.

Losing lots of hard working Ants and feeding the Grasshoppers, Country Y is still a developing country. All because the ANTS are just doing their work .............................

Rest and relax in Japan

I head to the land of Mt. Fuji in mid-november to unwind and spend time with family. The vacation will last 7 nights and I think we will have plenty of time.

Even though I have been to Japan twice, once to visit the famous Toyota factories to see how they efficienctly produce cars using LEAN processes, and the other to see how hospitals and companies run their supply chains; it almost appears to me that I will be visiting Japan for the first time. It is actually quite different when you visit a country or a city while on business trip.

What I can vividly remember about Japan are how everything is so organised, the sense of system and processes, the extremely punctual trains, the tastefully wrapped items that are too nice to even open and how polite and courteous the people are... One of my favourite so far has been the visit to the stationery shop, all 7 stories of it at the heart of Tokyo. This was certainly a dream come true for a stationery lover like yours truely!

The first 4 nights will be at Tokyo Disney. I figure 2 days at Disneyland and 2 days at Disney Sea. The beauty of this segment of the travel has to be that we are staying right smack within disneyland, where the magic will touch every aspects of what we do... see even the adults are excited. There is something about Disney that is able to create a new experience everytime one visit the resort.

On the 5th day, the plan is to head out to Hakone to take in the view of the famous Mt Fuji. Thinking of staying in a traditional japanese type hotel (i heard something like Ryokan) with the option to sleep on tatami, be served meals in traditional japanese settings and perhaps enjoy a hot spa (onsen?). Still seraching the web on the most exotic place to stay...suggestions welcomed.
Our 6th and 7th night will be spent in the heart of Tokyo. This is where we will see cosmopolitan Japan and take in Ginza, and do a couple of visits to shrines and perhaps shopping.

All of us need to make time to rest and relax. Even machines need to regular downtime for tuning and maintenance. I will do so, but this time with perhaps the blackberry at home. I am really looking forward to a proper vacation with my wife and 2 daughters and hope that it will be a great experience where we can remember for a long time to come.

Thanks for the Visits!

Green - Pageloads, Blue - Unique Visitors, Orange - Returning Visitors

(Statcounter on 25 October 2008)
Page Loads Unique Visitors First Time Visitors Returning Visitors
3,285 1,911 869 1,042

Over the last 39 weeks since I started my blog http://www.icansmell.blogspot.com/, I am humbled by the stats showing the number of hits that I've received.

In particular, for some unknown reasons, the last 5 weeks saw the highest number of unique visitors to my blog. Perhaps, it was because I have started to intensify my blog entries with at least one entry per day since end September 2008.

Thanks for visit and feel free to leave your comments!

Will the banking system fail?

Minister Mentor Lee Kuan Yew gave his projection that if the banking systems do NOT fail, the world economy will likely turn around in 3, 4 or 5 years; and the Asian economies under this optimistic scenario will likely come out ahead. However, if the banking systems do fail, the situation will be much more difficult.

The BIG question is whether the banking systems will come out ok after this financial turmoil?

The US Treasury has committed to US$700 Bil to buy toxic bank assets... BUT many say, "too little too late"

In Europe, UK banks were nationalised, even the biggies like RBS included to the tune of 80 Bil pounds... Is this enough?

Governments in ASIA have come together to set up a pool of $80 Bil to help with liquidity of banks if necessary?

Governments around the world, including Singapore, have guaranteed all bank deposits in full to restore consumer confidence and prevent capital flights

Alan greenspan, the long-time US Fed Chief admitted in court hearing that his fiscal policies are wrong...

... are all of these enough to prevent the banking system from failure, I would like to think so...

At this time, the stock markets are still tanking. Some labeled the downward spiral in asian and european stock markets on Friday the Black Friday... Watch out for the Black Monday when wall street opens. Singapore STI will have to wait till Tuesday as our market close for Deepavali holiday.

The general sentiment is that the stock market will be heading even lower... many analysts have advised to sit out this spiral and not commit new investments. When CEO Liew Mun leong was asked on ST what will he do with capitaland's cash hoard of $4 Bil he said he is no rush..."Just when you think something is cheap, it becomes even cheaper."

I will await MM's optimistic scenario to come true. For now, I will be sitting out like most people.

Shoot the Peacock and the Seagulls...

Capitaland CEO Liew Mun leong gave a rousing presentation during the Singapore Human Capital Summit 2008 that just ended yesterday.

He made the point that CEOs are responsible to teach values to the organisation. Mr Liew does this through many forums eg. Office of the President Meeting on Mondays, CEO Council meetings and of course his regular Sunday emails to all Capitaland staff. Reading his book "Building people - Sundays Emails from a CEO", one will really be convinced that when the boss speaks with passion, conviction and consistency, the tone, values and direction is set for the entire organisation.

During the summit, he made 2 memorable points, among others:

(1) "Shoot the Peacocks and the Seagulls" - The peacocks are the individual performers who are "showy" and who are not part of the team. The seagulls on the other hand, flies from one person to another dropping "shit" on others. Leadership needs to act decisively to drive the right values and create the right culture.

(2) "Discriminate boldly between star performers and the rest". Mr Liew said that star performers in capitaland get significantly more bonus than the average performer in order to send the right signal. Promotion, rewards and other benefits for various levels of performance are made transparent to set the performance culture. For example, it is made plain that staff who makes $100 Mil for Capitaland gets to attend the Harvard's Advanced management programme! I know this is true because the Capitaland participant at Harvard AMP 172 told me while we were at the programme together before I heard it from Mr Liew. All these seem commonsense, BUT many organisations do not have the courage to do the same - no wonder many just bumble along with mediocre staff making average impact...

The boss sets the tone and the culture for the entire organisation. We need to lead with clarity, courage and conviction because what we do help to direct the energy of all staff within the organisation either towards success or failure.

Let's load up and fire...

Quotable quote...

"I embrace the values of a family business... that's why I don't fire people in my company", a successful local entrepreneur took pains to explain at a forum about creating a strong corporate culture at the Singapore Human Resource Summit 2008 at Shangri-La...

"BUT, that does not mean people do not leave the company!", he added, much to the laughter of the audience.

Corporate culture can make or break a company's ability to hire and retain talents. Companies with strong culture is palpable. Those who can identify with it stays and thrive, while those who don't, will find out quickly, stick out like a sore thumb and leave!

In a sense, through the corporate culture of a company, staff can identify (or not) with a cause that is in alignment with their own beliefs. This will increasingly be an important attraction for talents beyond compensation.

Will patients cut back on medication in the wake of economic recession?

The New york times reported that for the first time in a decade, Americans are cutting back in their medication in favour of spending on food and gas.

Could this happen in Singapore? I certainly hope not, but for patients suffering from illnesses that generic drugs are not yet available and the cost of branded drugs is still steep, this could be a real possibility.

The longer term impact could well mean that patients allow their "illness to cook" until they are really ill before they are conveyed to the accident and emergency department and receive intensive interventions that could be much more costlier - both for the patients and the nation.

Singapore Healthcare system has safety net that Singaporeans could depend on. Basic and affordable healthcare is available through the polyclinics and the public hospitals. We should not let this happen.

Should I hold my savings in cold hard cash?

Over dinner tonight, my mom told me "I have asked papa to withdraw our savings from the banks to keep at home, I heard it is not safe to keep money in the banks anymore...".

It suddenly dawned upon me that there could be lots more people who may not be as informed about all that is happening amidst the financial turmoil. The Singapore government has over the last week announced that they are putting out $150 Bil to guarantee all bank deposits in full. This is a major contrast to the earlier policy of a minimum guarantee of $20,000 per individual per account.

The coffee shop chatters have intensified. Lots of people have lost faith in the Singapore banks particularly in the wake of the savings of many retirees and other members of public who have seen their hard earned savings wiped out through the collapse of Lehman Brothers Mini Bonds. For many elderly who cannot understand the news (or those whose children are too busy to explain things to them - like me!), they take their cue from the coffee shop chatters. To many Singaporeans, how can big strong banks like DBS, Standard Chartered Bank possibly collapse? They should not, but have we not seen major financial institutions disappear overnight in US?

I am wondering how we could better communicate what members of public need to take note of in this financial crisis? Perhaps, we should target the coffee shops :-)

For me, my parents are now convinced that it is now safe to leave money in the banks. Maybe my father will be an important source of input to his friends at the Ang Mo Kio Coffee shop meeting tomorrow morning.

I dropped my finger!

... No, I actually have a dropped finger or mallet finger!

While trying to remove a microSD card from my wife's mobile phone last night, I used my last finger (pinky) to exert pressure on the tiny little slot. The next I know, I heard a loud "snap" (similar to the sound of a piece of dried branch snapping under pressure) with a sharp sensation on my pinky. The last joint of my finger holding my nail was bent downwards, and could not be straightened on its own ie a "dropped finger". The feeling while having a dropped finger is rather strange - slightly numbish and lack of control.

This morning I went to the occupational therapist. He told me that I had snapped the tendon propping up the joints to my pinky. Putting on a splint for 6 weeks will align the two ends of the snapped tendon together and allow them to fuse together over time. Most times, this is all that I will need but I have to remember to keep the splint on. He proceeded to cut out a piece of material that look very much like plastic with holes and put it into hot water to soften it. He then used the softened plastic and mould it around my pinky. With a few snips, the splint was done.

Dropped finger is actually quite a common injury. It can be quite alarming to the uninitiated but with simple treatment, the finger could be straightened - althought not back to original form.

So, when i have finger sticking out at you - I am trying to insult you, but rather have compassion on me :-)

Inspirational Message from Steve Jobs, CEO Apple

Steve Jobs addressed the graduating class at Stanford University in 2005.

His message: "Follow your heart, never settle...", "stay hungry, stay foolish"...

His quotes:

"I was rejected but still in love"

"sometimes life is going to hit you on your head with a brick, but don't lose faith"

"the only way to do great work is to love what you do"

"you got to find what you love, and as with all matters of the heart you know when you find it"

"I ask myself, "if today is the last day of my life, will i still do what I am about to do today? If the answer is No for a few days in a row, I know I have to change""

"in the face of dead, fear of failure, fear of embarrassment of doing something, all fade away..."

"there is no reason not to follow your heart...you are already naked, you have nothing to lose"

"no one wants to die - even people who wants to go to heaven don't want to die to get there"

"your time is limited don't be trapped living someone else life"

"don't let other's opinion drown out your own"

"stay hungry, stay foolish"

I hope that others will be inspired too...

Be Fearful when Others are greedy, Be greedy when others are fearful

These are the words of the world's greatest investor, Warren Buffet.

He wrote an editorial on the NewYork Times on October 17 2008 basically saying that he is seeing tremendous value in great companies whose stocks are battered badly and he is converting his personal portfolio into stocks. Previously, his personal portfolios comprise only government bonds. He is greedy now when others are fearful.

His view is that in the short term, no one can predict the direction the market will head, but in the long term, we will look back to today and marvel at the value that is available.

This is afterall Buffetology... the man who can afford to lose but kept winning.

Singapore Nursing Role Model - A/ Prof Lim Swee Hia

SingHealth Group Nursing Director and SGH Director Nursing Lim Swee Hia was conferred the position of Adjunct Professor with the Curtin University's School of Midwifery and Nursing last week. This is the first international appointment by the school and a significant honour. Concurrently, Swee Hia was also conferred a similar adjunct professor position by the National University of Singapore's School of Nursing. Swee Hia... Oops A/ Prof Lim Swee Hia has done herself and nursing profession proud with such distinguished honours!

Aspiring nurses can now follow her footsteps to a bright future in Singapore Healthcare!

Congratulations Swee Hia, my friend! I am very proud of your achievements.