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...