An Inspiring Story...

I received this via email this evening.

The story illustrates to me the power of a strong value system and spirit of generosity.

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Tan Sri Robert Kuok Hock Nien (born 6 October 1923, in Johor Bahru, Johor), is an influential Malaysian Chinese businessman. According to Forbes his net worth is estimated to be around $10 billion on May 2008, making him the richest person in Southeast Asia.

He is media shy and discreet; most of his businesses are privately held by him or his family. Apart from a multitude of enterprises in Malaysia, his companies have investments in many countries throughout Asia. His business interests range from sugarcane
plantations (Perlis Plantations Bhd), sugar refinery, flour milling, animal feed, palm oil and mining to finance, hotels, properties, trading and freight and publishing.

On the occasion of Kuok Group's 60th Anniversary 10 April 2009, Robert Kuok Hock Nien's notes on those sixty years provide an interesting insight in to how success comes about.

1) My brothers and I owe our upbringing completely to Mother. She
was steeped in Ru-Jiao, the teachings of Confucius, Mencius, Laozi and
other Chinese sages. Ru-Jiao teaches the correct behaviour for a human
being on his life on earth. Mother gently, and sometimes strongly, drummed
into the minds of her three boys the values of honesty, of never cheating,
lying, stealing or envying other people their material wealth or physical
attributes.

2) Father died on 25 December 1948 night without leaving a will.
Following the Japanese surrender, he had re-registered the firm as a sole
proprietorship. We went to court to get an appointment as managers,
permitting us to continue to manage Tong Seng & Co. The judge said that,
as there were two widows, the firm and the estate should be wound up.

(3) We decided to establish Kuok Brothers Limited. In mid-January 1949, five of us met at a small roundtable in our home in Johore Bahru. Present were my MOTHER, cousin number five HOCK CHIN, cousin number twelve HOCK SENG, my brother HOCK KHEE nicknamed Philip (a.k.a. cousin number seventeen), and myself (a.k.a. cousin number twenty). We sat down and Mother said, "Nien, would you like to start?" I said, "Fine, yes I will start." To cut the long story short, we got started, and commenced business from a little shop house in Johore Bharu on 1 April 1949.

(4) As a young man, I thought there was no substitute for hard work
and thinking up good, honest business plans and, without respite, pushing
them along. There will always be business on earth. Be humble; be
straight; don't be crooked; don't take advantage of people. To be a successful
businessman, I think you really need to brush all your senses every
morning, just as you brush your teeth. I coined the phrase "honing your
senses" in business: your vision, hearing, sense of smell, touch and
taste. All these senses come in very useful.

(5) Mother was the captain of our ship. She saw and sensed everything, but being a wise person she didn't interfere. Yet she was the background influence, the glue that bound the Group together. She taught
my cousins and my brothers and me never to be greedy, and that in making money one could practise high morality. She stressed that whenever the firm does well it should make donations to the charities operating in our societies. She always kept us focused on the big picture in business. For example: avoid businesses that bring harm, destruction or grief to people. This includes trades like gambling, drugs, arms sales, loan-sharking and prostitution.

(6) We started as little fish swimming in a bathtub. From there we
went to a lake and now we are in the open seas. Today our businesses cover
many industries and our operations are worldwide but this would not have
been possible without the vision of the founding members, the dedicated
contributions and loyalty of our colleagues and employees, and very
importantly the strong moral principles espoused by my mother.

(7) When I hire staff I look for honest, hardworking, intelligent people. When I look candidates in the eye, they must appear very honest to me. I do not look for MBAs or exceptional students. You may hire a
brilliant man, summa cum laude, first-class honours, but if his mind is not a fair one or if he has a warped attitude in life, does brilliance really matter?

(8) Among the first employees were Lau Teo Chin (Ee Wor), Kwok Chin
Luang (Ee Luang), Othman Samad (Kadir) and an Indian accountant called
Joachim who was a devout Roman Catholic and who travelled in every day
from Singapore where he lived.

(9) I would like on this special occasion to pay tribute to them and in particular to those who were with us in the early days; many of whom are no longer here. I have already mentioned Lau Teo Chin (Ee Wor) and Kwok
Chin Luang (Ee Luang) and Othman Samad (Kadir), there are others like Lean Chye Huat, who is not here today due to failing eyesight, and Yusuf Sharif who passed away in his home country India about one and a half years ago and the late Lee Siew Wah, and others who all gave solid and unstinting support and devotion to the Company. It saddens me that in those early difficult years these pioneers did not enjoy significant and substantial rewards but such is the order of things and a most unfortunate aspect of capitalism. However through our Group and employee Foundations, today we are able to help their descendants whenever there is a need to.

(10) I have learnt that the success of a company must depend on the
unity of all its employees. We are all in the same boat rowing against the
current and tide and every able person must pull the oars to move the boat
forward. Also, we must relentlessly endeavour to maintain and practise the
values of integrity and honesty, and eschew and reject greed and
arrogance.

(11) A few words of caution to all businessmen and women. I recall the Chinese saying: shibai nai chenggong zhi mu (failure is the mother of success). But in the last thirty years of my business life, I have come to
the conclusion that the reverse phrase is even truer of today's world: chenggong nai shibai zhi mu. Success often breeds failure, because it makes you arrogant, complacent and, therefore, lower your guard.

(12) The way forward for this world is through capitalism. Even China
has come to realise it. But it's equally true that capitalism, if allowed
to snowball along unchecked, can in many ways become destructive.
Capitalism needs to be inspected under a magnifying glass once a day, a
super-magnifying glass once a week, and put through the cleaning machine
once a month.

In capitalism, man needs elements of ambition and greed to
drive him. But where does ambition end and greed take over? That's why I
say that capitalism, if left to its own devices, will snowball along, roll
down the hill and cause a lot of damage. So a sound capitalist system
requires very strongly led, enlightened, wise governments. That means
politician-statesmen willing to sacrifice their lives for the sake of
their people. I don't mean politicians who are there for fame, glory and to line
their pockets.

(13) To my mind the two great challenges facing China are the restoration of education in morals and the establishment of a rule of law. You must begin from the root up, imbuing and infusing moral lessons and
morality into youth, both at home and from kindergarten and primary school upward through university. Every Chinese needs to accept the principle of rule of law; then you have to train upright judges and lawyers to uphold the legal system.

(14) Wealth should be used for two main purposes. One: for the
generation of greater wealth; in other words, you continue to invest,
creating prosperity and jobs in the country. Two: part of your wealth
should be applied to the betterment of mankind, either by acts of pure
philanthropy or by investment in research and development along the
frontiers of science, space, health care and so forth.

Is this true?

What kind of a person are you?

Inspiring Lessons from Mayo Clinic by Prof Leonard Berry

Since the day that I have been introduced to the Mayo Clinic, I have been a fan of Mayo Clinic.

The Mecca of Healthcare, as the hospital is popularly known, holds a simple value since its founding by Dr Mayo over 140 years ago - that the "Needs of the Patient come first". This simple value of putting the patient first and team-based medicine has put Mayo Clinic at the forefront of Medicine. Many patients come to the Mayo Clinic looking for miracle because they have been to many other healthcare facilities and found no firm diagnosis for their conditions and little hope of recovery. Many at Mayo Clinic did in fact receive their "miracles" and their positive "word of mouth" has helped to build trust at mayo Clinic.

There are many Mayo Clinic lessons for us at JGH. Prof Leonard Berry's book on "Management Lessons at mayo Clinic" is such an inspirational and delightful read. Today, many of us have the pleasure of listening to Prof Berry's lecture at Alexandra Hospital. The pictures below show his summary on the lessons from mayo Clinic.

Thanks Prof Berry for bringing to us the inside story of the Mayo Clinic!

JGH - URA Centre Model Perspectives

The Transformation at Jurong Lakeside that JGH will be a part of

JGH is one of the key projects at the Lakeside transformation

Located next to IMM and close to the MRT

Another perspective of the exciting lakeside development at Jurong

For staff of JGH who have yet to make a trip to Jurong East to catch a site of where our future hospital will be located, here are some pictures taken of the masterplan model at URA Centre.

As you can see, JGH will be developed amidst very interesting developments at Jurong. One of our challenges will be to figure out how we can create a restful environment within a rather urban setting. Participants at our main consultant design competition have already given various ideas how it may be done. We will incorporate greenery into patient care areas to reduce stress of experiencing healthcare and create a sense of bringing the outside indoors.

Take a trip to the site and see for yourself!!

Click here if you can see the pictures: http://icansmell.blogspot.com/2009/07/jgh-ura-centre-model-perspectives.html

Jurong General Hospital July 09 Issue of Staff Newsletter

JGH has planned various ways of communicating with our staff who are nested in various hospitals currently. One of which is a newsletter - here is the first issue (July 2009). Staff can also facebook me at www.facebook.com/heejug and here about recent happenings at JGH via my postings and status updates.

In the first tea sessions that I've had with JGH staff nested at TTSH and NUH, I have come to realise that I have such a great group of staff who is excited about the hospital and making a difference to patients.

We have now started on crafting the Mission, Vision and Core Values of Jurong General Hospital. Staff can look forward to being engaged in thsi process as well.

Cheers

Public perception could hinder healthcare reforms?

The New York Times carried an article "Forget who pays the bill, but who sets the costs".

What's interesting to me is the following excerpt from the article:

"Thus the political challenge facing any effort at an overhaul: Americans say they want change, but they also want to preserve their own status quo.

The disconnect can be explained partly by the peculiar economics of health care. Because third parties — the government or a private insurer — typically pay the bill, many people miss the fact that the money originally comes from them. They see the benefits of medical care without seeing the costs.

But trust in doctors is a factor as well. Even when doctors order costly treatments with serious side effects and little evidence of their being effective, as studies find is common, patients are loath to question the decision. Instead of blaming such treatments for the rising cost of medicine, many people are inclined to blame forces that health economists say are far less important, like greedy insurance companies or onerous malpractice laws."

Obama Health Reforms Pushing the frontier to have doctors salaried instead of fee-for-service...

Some of the most prestigous names in US Healthcare eg. Mayo Clinic, Cleveland clinic have gone the way of putting their doctors on salary instead of fee-for-service. The objective is to take out any incentive for doctors to order unnecessary tests and services for patients.

In the latest drive under the President Obama Health reform, this issue is again surfaced as an appropriate approach for the rest of US healthcare to follow in their quest to control costs.

What do doctors in Singapore think?

Mission, Vision and Values of JGH

Tomorrow is yet another milestone for JGH. We will kick-off the series of conversations of what we stand for, where do we want to be, how do we get there, and values each and every staff member at the new Jurong General Hospital need to embrace.

The JGH team is determined not to allow this exercise to become mere words on the walls of hospital but living words that we will all embrace and live out on a daily basis. Our Patients, Our Community and Our Staff must become better because of the work that we do.

When I was interviewed by 938LIVE on 20 May 2009 and asked what is my vision for JGH. I said, "I'm actually looking forward to JGH being an integral part of the community in the western region, where residents can rely on for their health and fitness needs. We will work closely with the new community hospital and also the primary care clinics in our area so that patients can expect holistic care beyond the hospital into the community." I added that "... in designing the hospital's services and processes, patients' needs will be our main focus and we hope to make it hassle free for them."

However, it is not only just the patients and the community that must benefit. We must also be a hospital where staff will flourish. That's why, in the first JGH advertisement in the Straits Times on 4 July 2009, both Chairman Medical Board A/ Prof Cheah Wei Keat and I said that, "we envision an environment that fosters excellent patient care, where staff are Empowered to Excel and Encouraged to learn and grow."

Jurong General Hospital is where the birth of a new era in healthcare will take place. We want to make it a meaningful endeavour for ALL our staff, while at the same time make a difference to our patients and the community.

To ALL the Staff of Jurong General Hospital, thank you for taking part in this journey with me. I look forward to your ongoing commitment, dedication as we plan, design and build not just an excellent hospital but a healthcare institution for generations to come!

I also thank my colleagues in healthcare for backing me up in this journey.

Prof Ng Han Seong wins the National Medical Excellence 2009 Outstanding Clinician Mentor Award! Congratulations!!

Prof Low Poh Sim, NUH Paediatrics

Prof Mike Chee, Duke-NUS

Prof John Wong, Dean NUS-YLL Medical School

Prof Ng Han Seong

Prof Ng Han Seong

Prof Ng Han Seong, Chairman Medical Board of Singapore General Hospital (SGH) was awarded the National Medical Excellence Outstanding Clinician Mentor Award 2009 this evening at CHIJME's Hall. He is a very well respected doctor who is always keen to impart his knowledge/ wisdom to the younger generation. An excellent storyteller, a fountain of inspiration and an excellent leader! Above all, a great clinician! Congrats Han Seong!!

The occasional great signs...

Found at the new ION shopping centre...

53% of flu cases in Singapore are H1N1 positive

Community spread is certainly in full swing in Singapore. The odds of someone with flu symptoms carrying the H1N1 is as likely as a coin toss!

Fortunately, H1N1 is not as dangerous as it was originally feared. But, Singapore has already seen it first death late last week. It is reported that 2 more cases are hospitalised in the intensive care unit because they sought treatment late.

For most of us, life should go on as usual. The high risk groups, namely pregnant ladies, young children and those with multiple chronic co-mobidities should take necessary precautions.

Let's take personal responsibilities in hygiene, stay fit and healthy to ensure that we and our loved ones are safe. When down with symptoms, put on a mask and head to the doctor early.

New Generation Old Generation Grandparents

This evening, we celebrated my son's 3rd birthday at Jumbo Seafood.

My mom, in particular, has been looking forward to this celebration. Not only is it her grandson's birthday but also my eldest's brother's birthday. Even though my parents try to be fair to both boys and girls in our family (and they are), you can tell the boys still feature strongly in their mind.

We had a fabulous time! For me I am just happy that my parents are happy; and everybody seem to enjoy themselves. My son in particular was very happy with his purple barney cake!

My parents in their late 60s have simple pleasures. Their way of expressing love is for family members to have a good meal and all of us could eat heartily. They are happy when they see their children each having a good family and hold a good job. Till today, my mother still wait for me to come back to have dinner, made sure that the food is hot and sit around looking at me when I eat and smiles when I enjoy the food. That's why I feel guilty sometimes when I need to attend official function and forget to tell her that I won't have dinner at home. Many times, I will not eat my fill and still come home for dinner because I cannot bear to disappoint her.

Tonight, when my father whipped out his mobile to snap a picture of my son during the birthday celebration surprised me. They are trying to keep current with the new generation, and I appreciate their effort.

For me, I am just glad that I can still play a part in my parents' lives. I am most fortunate to have a wife who is so understanding and supportive in this regard. My parents can stay as they are, they don't have to catch up with the new generation, I love them as they are.

Take care of our children...

I have a clear weakness. I can't stand the sight nor knowledge of any abuse/ hurt to children.

A moment ago, I found out about the new Boston Children Hospital blogsite (THRIVE) and read an article "The Shaken Children Syndrome". It is a real story of a father who was left to look after an infant while the wife was out, shook the kid so hard to stop her from crying that left with the syndrome - throwing up milk, shaking from one side of her body, seizure, etc. I don't think the father intended for the outcome (or at least I hope he didn't) but the impact to the child...sigh...I cringe to even to think about it.

Over the years, I have come across other situations that occasionally still give me the flashback.

I remember once I was at Hougang Mall foodcourt. A man returned with a bowl of noodles with clear soup. As he prepared to land the food on the table, the bowl slipped off the tray and the bowl of noodle with soup was splattered on his 2 year old boy who was seated there. Fortunately, there was a GP clinic nearby on the same floor... the boy was rushed there...I hope he is fine.

Another occasion was at the East Coast. A couple was jogging with a baby in the pram. As they were jogging the baby was sliding out... this time, I was glad they realised it soon enough. The baby only landed up with some abrasion on his knee, but the outcome could have been way way worst!!

You can imagine, I have been extremely careful since when I am at the foodcourt with my kids. And, I will never ever bring my kids in a pram while jogging! You can imagine, I do not enjoy going to hougang mall foodcourt.

Accidents do happen, but when it out of our own negligence, it will be regretable. So, lets take care of our children...

Taking things in stride...

It is the weekend again. Another week has just concluded. The days flew by... fortunately, this has been a great week. Not everything turned out the way I wanted it to be, but I take it in my stride because i know that there are more things that turned out well.

The first JGH Staff newsletter came out early this week. All JGH staff currently nested in various institutions received a personal copy by post. I proudly presented copies too to several other people who matter.

Our very own email domain jgh.com.sg was rolled out this week and naturally I got my new permanent email hee_jug_foo@jgh.com.sg. With this settled, my namecard went to the printers today and from next week, I will be able to hand out my JGH name cards.

We conducted the JGH consultant tender interviews today. Had a very fruitful session clarifying the proposals and we look set to award to the winning architect soon. The design of the hospital will receive very prominent mention too, so watch out for it.

Completed a ton of reading this week, more than I had expected and feeling great that my desk is clear and my bags are lightened.

Interviewed 3 important hires this week, found out that 1 candidate for a strategic position has accepted my offer. Hiring went well as expected this week!

The study trip overseas to learn about hospital designs and care models is on track and we look set to have a great trip with my management team.

... I see the sun rising about JGH and feeling proud of the founding team that I have assembled for the hospital. What a way to start the weekend!

My next reading...

"The practice of Slow Medicine has taught me that it is wise to slow down and moderate the urgent pressures of decision-making that are often pushed prematurely on elders by society, the medical profession, worried friends and family. Well-intentioned, we want to make good and humane choices for ourselves and for those we love. We are worried by guilty feelings of neglect if we wait too long to act. We often experience nagging doubts of our adequacy in these new and very changed relationships." My Mother, Your Mother by Dr Dennis Maccullough

Read this book with me...

How much is a life worth?

People, particularly those of us in healthcare, often talks about the value of a life in so many ways because we come across such situations of dealing with a patient's health (hence their lives) up close and personal daily. Nevermind the fact that not all of us are at the frontline with patients.

We cringe everytime...

The New York Times carry a provocative article "Why we must ration healthcare" today. Central to the article is whether society as a whole can afford to provide unlimited care to save a life that even when sustained is not "worth living"?

At the individual level, this often evoke a strong reaction "who are you to decide what's a life worth? Are you playing god?" ...

At the society level, when paying unlimited amount to sustain a life mean that less will be available for others, in a world of finite resources will present similar dilemma. The question that will likely be evoked is "why is your life more important than mine?"

What then usually happens is that people begin "game" this dilemma by playing a creeping game. "I know I am not god, so I will just do my best for THIS patient. Now if I only do it for this patient, I know it is expensive but society can still afford it and most of all I save a life."...then we hope that we never have to deal with this again. The truth is...someone else would.

The laws of mathematics will then apply. 1+1+1+........+ 1 = a very large number. The next thing we know, healthcare expenditure as a percentage of GDP would have crept up from 3% to 5% to 7% to 10% to 14% to 16% and this expenditure is slowly but surely crowding out money necessary for education, transportation, defence...gee we heard about this before!

Someone from the crowd will shout, "why do we spend so much on healthcare"?

So, how much is a life worth?

Too Aggressive Medicine?

The diagnosis of cancer is frightening. The most obvious reaction is to opt for the most high-tech, most advanced and more often the most aggressive treatment.

But, is this approach doing more harm than good? I chance upon the table above on 5 treatment options for prostate cancer with significantly different cost implications, side-effects without significant differential outcome.

Most people do not die from prostate cancer. Reports seems to point to the fact that most people can carry prostate cancer for rather long period of time and when they do die, the reason is seldom prostate cancer but other causes. Given such prognosis, evidence seems to suggest that "Watchful Waiting" that cost $2400 produces similar outcome to highly aggressive Proton Beam therapy costing $50,000. Think about it.

I also chance upon a "Status Update" from a fellow Facebooker this week. She updated "could I have brain tumour? How could I have headache for so long?" For most headache, we could sleep it out - cost is $0. Alternatively, we could take 2 paracetamol and the cost is $0.20. For more aggressive diagnosis, we could get a CT scan and pay $700. On average would outcome be significantly better? Guess not.

We need better evidence to support the treatment that modern healthcare prescribes...

In the World of "Fast Medicine", is there room for "Gentle Deaths"?

This is an informative video from the New York Times.

Is this just a western concept, or is this relevant for the Singapore society as well?

Lowering our "Frenetic Energy"

This evening, I had an unusual appointment with someone who made time for me.

There were a few firsts throughout the evening...

First, we started with wine - 2 bottles of wine to be precise. As I took each sip, I was delivered practical lessons on wine appreciation and found out what "structure" and "finish" actually feel in my mouth.

As we appreciated the "finish" of fine wine, I was delivered the message of "Lowering our Frenetic Energy" - it takes time to slowly appreciate what a good wine can bring and hurrying through it makes us miss the goodness. How true it is isn't is - especially in the fast pace life of Singapore. We are hurried on many things, our project, assignment, tasks and perhaps even our dreams! When we done with one thing, we do not spend the time to reflect, appreciate and learn, and move on to another thing quickly. We sometimes need to slow down to go faster - remember the last time that happened? I do, and it felt good.

Second (another First), consider what are the things that you really MUST learn and develop a consciousness and habit to concertedly do so. These "must learns" preferably should not be industry specific and portable and they include developing a wide network. When done, we can look forward to achieving independence in the future.

Third (yet another First), if we want (and mean) real breakthroughs, we need to really get out of our comfort zone...Many times we can be carried by the "waves" of life to a point in life where we are satisfice, but never realise our true potential.

Inspite of the influence of alcohol (or because of the influence of alcohol), these messages were delivered with sparkling clarity and the message struck a chord with the inner me.

The challenge is: 10 years from now, look back and see if I have indeed learnt anything or have I allow the waves to carry me through...

The Searchable me on google...

I googled myself tonight, and found many things about me :-)

I decided to tag myself for posterity...

NUS Outstanding Science Alumni Award 2007

Same Award but another article

CGH Caring Article - Leaving CGH for SGH

CGH Article - Launch of SQ

Response on Cut Waste

Jurong General Hospital to be completed by 2014

A complaint about my reply in the papers

Straits Times - Hiring for Jurong General Hospital

Helming GPO

Medical technology Standards Committee

Quote on Diversity/ SMU

938Live - Leadership at up and coming Jurong general Hospital unveiled

to be con't...

I Got my NEW iPhone 3G S!... But Why?

Finally, the latest iPhone 3G S is launched tonight at the Comcentre!

I got my Black 32G wonder amidst the queue that snaked in an endless fashion in front of comcentre. I figured that there must be more than a few thousand people in line, all waiting for the coveted new iPhone. The most surprising sight that caught my wife's attention was that of a mother with infant in arm queuing patiently. Singtel organised the event very well. Tired customers were given bottled water with launch event and music entertainment screened at various locations to help manage the psychology of waiting.

It is not hard to see the enthusiasm. Some people were sighted with their laptop and mobile broadband setting up their brand new iPhone by any corner they could fine. The excitement is too hard to contain even during the journey home! It must be set up immediately.

By now, my phone is fully set up! My 2000 songs on iTunes, 700 contacts, calendar are fully sync'ed on my iPhone and set up to be updated via the Apple Mobileme cloud on the fly. I downloaded the Straitstimes and facebook apps and found them to be amazing features. Most of all, the iPhone works so well with my Mac! I am right, getting the latest iPhone 3GS completes my transition from windows to Mac.

As my iPhone (not phone) is being charged, I am thinking about why is the iPhone so popular? To say the least, I have never seen any queue for any other phone before, certainly not the various Nokias that have come online over the years. Why am I personally excited about my latest acquisition?

I propose 3 reasons:

(1) iPhone is a indeed a beautiful phone with an almost perfect form factor

(2) iPhone is riding on the strong network effects from high ownership of iPods. Many people already have their songs ready to take advantage of the phone's feature. Plus, iTunes that is set up for our iPods is immediately ready for the iPhone.

(3) the wide variety of iPhone apps available eg. Straits Times apps, help to make ownership of the iPhone even more useful. One gets breaking news on the fly, update facebook status, view stock prices, etc etc on a very user friendly interface.

PLUS, Apple has made the iPhone 3GS even better! The voice command (it actually works), seamless synchronisation, video, sms forwarding, landscape keyboard, much more sensitive keypad etc makes this iPhone better than the 2 previous incarnations.

I am still not sure why I need the new iPhone 3GS, but owning it certainly feels good and cool!

Transparency promotes quality?

For a while now, I have been fan of Paul Levy, the President and CEO of Beth Israel Deaconess Medical Center in Boston. I studied his turnaround of BIDMC when I was doing the Advanced Management Programme in Harvard 2007, but it is how he has advocated transparency in management and quality through his blog www.runningahospital.blogspot.com that I am really a fan of.

It is not uncommon that he publishes communication with his staff on various issues. Here is one from his Director Critical Care Quality...

The good thing is, he does not publishes only the good stuff but also when things go wrong. I believe this creates direct pressure on his hospital to make the necessary improvements while they celebrate when they achieve success. It is a double edge sword that Paul Levy has used to good effects.

So far, my sense for BIDMC is that transparency does seems to promote quality... you think?

The Healthcare conundrum to avoid...

When I was last at Houston Texas, I could not help but be amazed by the medical enterprise at an entire district known as Texas Medical Centre. Brand name hospitals and specialist centres are there and the hotel where I stayed was practically filled with patients. Hotels run shuttle bus services to and from hospitals for patients and their next-of-kin.

It is in this setting that this new BBC article reports the Healthcare conundrum, ie more spending per patient in Texas is not translated into better patient outcome, and that the "business" of healthcare is inducing unnecessary demand for services that patients do not need.

Prof Christensen is right. Doing more of what we currently have in healthcare cannot help. We need to disrupt the way healthcare is being provided through coherent solution shops, value-added Process (VAP) clinics for illnesses that are already well understood and where precision/ empirical medicine may be practiced; and facilitated networks (disease management plans) where providers are rewarded to keep patients well, and patients are incentivised to comply with their therapy.

What do lawyers really do?

...well at least I call this into question for the lawyer that my wife just met!

Late last week, the lawyer's office called my wife. The assistant conveyed to my wife the lawyer's question, "do you want to settle for a 50-50" in the traffic accident claim. To which my wife replied, "No". "Then you will need to come down to the lawyer's office, because our lawyer needs to speak with you", came the reply.

This call came some 7 months after the traffic accident that my wife had the misfortune to encounter with a huge truck/ lorry while on her way to fetch my daughter along Bukit Timah. Silence for 7 full months, then a call to ask the client to "settle". What a way to earn their fees, probably wrote one letter to the other party, waited for the response, and ask the client to settle? I thought, surely they must have done more, and wife will do well to find out more by meeting the lawyer.

My wife turned up at the lawyer's office today.

The lawyer looked at my wife and the first sentence that he uttered was "I think you better settle for 50-50"!

When asked why, he said that based on the reply from the other driver, he said that because there are no witnesses, it will be very difficult to prove my wife's version of how the accident happened. Then he said, "only God knows whether you are telling the truth!" To which, the only correct reply should have been "only God knows why you are a lawyer!"

He went on to try to "scare" my wife into accepting the 50-50 settlement. He said that if she were to reject the 50-50 settlement, the case will have to go to mitigation/ court and whatever the outcome my wife would have to be responsible for his fees of $2500! The keyword emphasised was "whatever the outcome". Of course, he went on to say that "for heaven sake, this is just a road traffic accident claim, I have 1600 other cases, and you want to pursue this case?!"

I am glad my wife gave the only correct answer, "what's the point you are trying to make?"

All these prompted my question, "what do lawyers really do?"

(1) Nothing that he said or shown my wife at his office has shown that he has gone beyond the information and forms that we have completed as part of insurance claim.

(2) Based on his words and behavior, he has already given up "fighting" for the case - although I am not even convinced that he even attempted to try.

(3) Nothing that he will say during mitigation/ court hearing will be any attempt to argue the case for his client. In fact, he discredited his client by asserting without evidence that my wife had lied about the facts of the accident by his statement "only God will know whether you are telling the truth."

(4) Why should he as the lawyer be paid regardless of his effort and outcome?

My conclusion is that he has done nothing for his client (my wife) and come to think about it, we did not even appoint him as our lawyer, maybe he was signed up by the insurance company.

So, it begs the question: what does he as a lawyer really do (looks like nothing)? With his behavior and performance ANY client with a sound mind and half a kidney could do a better job.

What IS the role of a lawyer in such situations?

The Silver Tsunami - doctors in America need to learn how to treat the elderly

I was forwarded an email containing the following article that I find so interesting as we prepare for the Silver Tsunami in Singapore...

July 2, 2009
Op-Ed Contributor

The Patients Doctors Don’t Know
By ROSANNE M. LEIPZIG

AS they do every July, hospitals across America are welcoming new interns,
fresh from medical school graduation. Given how much these trainees have
yet to learn, common wisdom holds that it’s not a good time of year to get
sick. This may be particularly true for older patients, because American
medical schools require no training in geriatric medicine.

Often even experienced doctors are unaware that 80-year-olds are not the
same as 50-year-olds. Pneumonia in a 50-year-old causes fever, cough and
difficulty breathing; an 80-year-old with the same illness may have none of
these symptoms, but just seem “not herself” confused and unsteady, unable
to get out of bed.

She may end up in a hospital, where a doctor prescribes a dose of
antibiotic that would be right for a woman in her 50s, but is twice as much
as an 80-year-old patient should get, and so she develops kidney failure,
and grows weaker and more confused. In her confusion, she pulls the tube
from her arm and the catheter from her bladder.

Instead of re-evaluating whether the tubes are needed, her doctor then asks
the nurses to tie her arms to the bed so she won’t hurt herself. This only
increases her agitation and keeps her bed-bound, causing her to lose muscle
and bone mass. Eventually, she recovers from the pneumonia and her mind is
clearer, so she’s considered ready for discharge but she is no longer the
woman she was before her illness. She’s more frail, and needs help with
walking, bathing and daily chores.

This shouldn’t happen. All medical students are required to have clinical
experiences in pediatrics and obstetrics, even though after they graduate
most will never treat a child or deliver a baby. Yet there is no
requirement for any clinical training in geriatrics, even though patients
65 and older account for 32 percent of the average doctor’s workload in
surgical care and 43 percent in medical specialty care, and they make up 48
percent of all inpatient hospital days. Medicare, the national health
insurance for people 65 and older, contributes more than $8 billion a year
to support residency training, yet it does not require that part of that
training focus on the unique health care needs of older adults.

Medicare beneficiaries receive care from doctors who may not have been
taught that heart attacks in octogenarians usually present without chest
pain, or that confusion can be due to bladder infections, heart attacks or
Benadryl. They do not routinely check for memory problems, or know which
community resources can help these patients manage their conditions.
They’re uncomfortable discussing goals of care, and recommend screening
tests and treatments to patients who are not going to live long enough to
reap the benefits.

I was part of a group of doctors and medical educators who recently
published in the journal Academic Medicine a set of minimum abilities that
every medical student should demonstrate before graduating and caring for
elderly patients. Nicknamed the “don’t kill Granny” list, it includes being
able to prescribe medicines, assess patients’ ability to care for
themselves, recognize atypical presentations of common diseases, prevent
falls, recognize the hazards of hospitalization and decide on treatments
based on elderly patients’ prognosis and their personal preferences.

The 2008 Institute of Medicine report “Retooling for an Aging America”
resolved that all licensed health care professionals should be required to
demonstrate such competence in the care of older adults. But this
resolution lacks teeth. Medical resident training programs that receive
Medicare money should be required to demonstrate that their trainees are
competent in geriatric care. Medicare should finance medical training in
nursing homes. And state licensing and medical specialty boards should
require demonstration of geriatric competence for licensing and
certification.

Basic geriatric knowledge is preventive medicine. Nurses, social workers,
pharmacists and other health care professionals should have it, too, in
order to improve care for older people. But until doctors get this basic
training, we can’t even begin to give 80-year-olds the care they need.

Rosanne M. Leipzig, a physician, is a professor at Mount Sinai School of
Medicine.

Effective CEOs spend more time on less things

An article in the New York Times caught my eye today. Entitled "How to be an Effective CEO", it is a good reminder of timeless advice that need to be brought from "the back of the mind to the front of the mind."

Basically, a CEO needs to spend more time on less things. The most consistent "thing" among the few things is PEOPLE. Hire the right people to do the things that CEO should not spend his time on, spend time with good people, and counsel people who need improvement.

The article talks about 2 timeless classics, Peter Drucker and Steven Covey's 7 Habits of Highly Effective People.

Peter Drucker's advice to CEO:

(1) Find time for uninterupted work.

(2) Spend time on people

(3) Focus on allocating resources

(4) Focus on strengths rather than managing weaknesses.

Steven Covey's 7 Habits:

(1) Be proactive

(2) Begin with the end in mind

(3) Put First thing first

(4) Think win/ win

(5) Seek first to understand, then be understood

(6) Synergise

(7) Sharpen the saw

These are not new concepts, but important reminders for leaders leading others through change and challenging times.

Another important point that my chairman recently reminded us, "Work in Quadrant 2" - Work that are important but not urgent. He is really talking about spending time "Planning" and not fighting fire all the time. In fact, if we plan well, we will fight less fire! How true. The book "The Living Company" is really a great book about planning for the future...

Let's not get carried away, while we plan for tomorrow...Let's LIVE today!

Preparing for the new iPhone 3G S

SingTel will have a launch event on 10 July 2009 (Friday) for the new iPhone 3G S in Singapore.

Enthusiasts who signed up with SingTel got an email on Friday - me included!

I am not sure whether I count as an iPhone enthusiast? "Yes"...because I owned the last 2 versions of the iPhone but ... "Maybe" - because I sold them within 2 weeks! Main reasons, smallish screen keypad, inability to forward sms and slow.

My recent ownership of a brand new 24" iMac piqued my interest in many things Apple. The launch of the new iPhone 3G S cannot be more timely. You can say, it sort of "completes" my conversion from Windows to Mac.

The new iPhone 3G S took care of all my pet peeves. It is not only faster, it provides a larger screen keypad in landscape position, sms forwarding function and like all things Apple, other sexy functions and programmes such as video and a better camera.

Since Singtel's announcement of the 10 July launch, I have been making preparations for my impending ownership. I sold my Nokia E71 today and then just an hour ago, I used a programme PocketMac to transfer all my contacts from my Blackberry phone to mac Address Book. I must say that for someone who owns a Mac and Blackberry, the free PocketMac software is very neat and handy. Just remember to run the driver update as well for the new Bold, Storm and Curve handset before launching the programme. The synchronisation was flawless and effortless!

I know, yes, I am aware of the many reports talking about the overheating problem for the new iPhone 3G S. I understand that this only becomes a problem when multiple programmes are run at the same time, and for long conversations. Unless one is trying to stress-test the phone, I do not think that a normal user like me will face such problems. Afterall, my new Nokia E71 also becomes quite hot when I am on the phone for a long time! This morning, I was trading sms with a friend who is also waiting for the new iPhone. I texted him that "not bad, buy one phone and get a toaster for free", and his reply was quite humorous and telling..., he replied "Being toasted is better than getting microwaved on windows based phone."

I wonder how the new iPhone 3G S will work out for my kind of lifestyle. In any case, I am prepared to give iPhone a 3rd chance. Hopefully, this time my ownership will be much more enduring. If not, I will sell it within 2 weeks again.

Developing a conscience of being environmentally friendly...

The Inconvenient Truth by El Gore about global warming...

A recent video entitled "Home" talks about the damage being inflicted on mother earth and that mankind has 10 years to change the way we live and to avert depletion of natural resources and catastrophic damage to earth's climate. My reservist colleague alerted me to this video. He said that he watched the hour long video with his 11 year old daughter and it changed the way she thought about the importance of being environmentally friendly. Tonight, I watched the video on youtube, as I key in my thoughts on my blog.

Personally, I've observed that the weather has become noticeably hotter, especially in recent times. Has the hole in the ozone layer become bigger? Freak weather has also become sort of the norm as we tune in to the news. I am trying to reason away the changes that I am seeing before my very eyes, but I could not. The damage being inflicted on our environment and consequently the impact on our climate has become quite clear.

The last few days, I turned my attention on the vehicle that I drive. Instinctively, my love for old mercedes benz took over. I chanced upon a rare 1984 Mercedes 380 SEC and it gripped my attention. As I thought about the prospect of buying that car, I reflected on the impact it will have on the environment and evoked a self discussion on whether it is indeed a need or want. Why do I need a 3.8 litre car? The consumption of the car will be almost twice that of my current car. Other than the cost of petrol, what will that mean in terms of my carbon footprint? Obviously there was tug-of-war between my heart, which indicate the MB 380 SEC would be such a lovely purchase and would satisfy my emotional being; and my head, which question the purchase from the angle of excess and impact on the environment. My heart, gave in today (just a little bit) and I swung by to Borneo motors to look at the new 1.8 Litre Toyota Prius. The hybrid car can do 23km on one litre of petrol, a saving of at least 60% of my current car. My head was nodding but my heart hurts as I stared at the Prius - it is so ugly, so plain, so lacking in character...but most of all, so inaccessible because there is a 5 months wait for the car!

I am thinking, the new Toyota Prius will be such a statement that I can carry regarding the message of environmentally friendly to others. Maybe, it may trigger a conversation around why do I still buy a car that I know is so plain? ... not to mention to pay a premium for it!

I am positive that my conscience of being environmentally friendly is currently being shaped in a significant manner. Even as this happens, I am determined that I will be a good advocate for the environment but one who will be practical in the world that we live in. By this I mean, I will continue to ask for a plastic bag when I need one for it is not practical for me to tuck a bag in my pocket wherever I go. But where I can do without one, such as my recent visit to Ikea, I will do without one.

So, should go for the MB 380 SEC or the Toyota Prius 1.8 ?

Are we Ugly Singaporeans?

This morning, I got up really early. My wife who was up early too to get my daughter ready for school told me that the Ikea sale is on, and for "Friends of Ikea", we get to have free breakfast starting from 7.30am.

Thrilled by the idea of "free" breakfast and the prospect of spending time with my wife, we were soon quickly making our way to the Ikea at Tampines. By the time we arrived, the crowd was thin and people were only beginning to arrive. Without having to wait in line, we got our free coffee, an apple and a cinnamon roll each and made our way to the table and started on our breakfast.

Then, I overheard a conversation. Someone said in a rather cynical and almost mocking manner, "look at all these Singaporeans, got free food only they come and bring the whole family... Singaporeans." It started me thinking...

By now, Singaporeans would have heard about this phrase "Ugly Singaporeans" and perhaps used the phrase on our fellow countrymen a number of times. Unbeknown to many of us, probably the same phrase has been used on us, by others. Usually the circumstances where the phrase is used include: people forming/ joining long queues to get a good deal, free drinks/ food attracting many people to get their hands on them, people on MRT not giving their seats to the elderly/ pregnant ladies, etc; people not giving way to other drivers who wishes to switch lanes...While I personally do not condone such behavior and attitudes, I question whether such stereotypical labeling of the Singapore society and people is justified.

Take this morning experience at Ikea for example. Is it only "ugly Singaporeans" who would turn up when there is free food? I do not think so and I also think there is nothing wrong doing so. At least I think Singaporeans appreciate good value when they see one. In fact, I will feel extremely sorry for Singaporeans when they see a good deal, do not know it is a good deal and hence not avail themselves. Does turning up at Ikea for free breakfast make us "ugly Singaporeans?" I think not.

Even when we see the set of bad behavior by some Singaporeans listed above, is it justified to lavishly use the label "ugly Singaporeans" for the whole society? In my many travel overseas and having lived in the US for 3 years, I have seen similar behavior but I have never heard or heard so consistently people say..."Ugly Americans", "Ugly British", "Ugly Chinese" as we do in Singapore.

Labels when used consistently can conjure a false image of society and people. In psychology, we know that when a person for example is consistently labelled as stupid will after some time believe that his mental capacity is limited and adverse affect his development. I believe the same can be said at the societal level. An eagle will soar like a real eagle when she believes she is one, otherwise she will bump around like a chicken and never realise her full potential.

By now, I believe there are already other labels of Singaporeans that are already deeply ingrained... remember "Kia Su" (afraid to lose) ? Are we "Ugly Singaporeans" and "Kia Su"?

I implore all of us to stop using undesirable labels on ourselves. In every society, there will be black sheep (us included) but we must not brand/ label the whole society because of a few black sheep. Address the behavior, make the improvements and move on. Let us not be too hard on ourselves.

We are not "Ugly Singaporean" but like all human beings, we do fail sometimes.

We are the World

This is such a powerful song. I remember I waited to watch the live broadcast on TV when I was much younger. I am very glad in the age of youtube, I get to watch it again with such clarity.

There is a cause bigger than ourselves, our own success...

Keep this in mind as we get caught up in this rat race going nowhere. Pause...know how fortunate we are, and help make a difference in the world that we live in.

WE ARE THE WORLD...

There comes a time
When we head a certain call
When the world must come together as one
There are people dying
And it's time to lend a hand to life
The greatest gift of all

We can't go on
Pretending day by day
That someone, somewhere will soon make a change
We are all a part of
God's great big family
And the truth, you know love is all we need

[Chorus]
We are the world
We are the children
We are the ones who make a brighter day
So let's start giving
There's a choice we're making
We're saving our own lives
It's true we'll make a better day
Just you and me

Send them your heart
So they'll know that someone cares
And their lives will be stronger and free
As God has shown us by turning stone to bread
So we all must lend a helping hand

[Chorus]
We are the world
We are the children
We are the ones who make a brighter day
So let's start giving
There's a choice we're making
We're saving our own lives
It's true we'll make a better day
Just you and me

When you're down and out
There seems no hope at all
But if you just believe
There's no way we can fall
Well, well, well, well, let us realize
That a change will only come
When we stand together as one

[Chorus]
We are the world
We are the children
We are the ones who make a brighter day
So let's start giving
There's a choice we're making
We're saving our own lives
It's true we'll make a better day
Just you and me

The beginning of evidence based medicine?

The New York Times reported that a high powered panel appointed by the Obama administration as part of healthcare reforms has recommended that priorities be given to comparing effectiveness of competing drugs, medical devices, operations and other treatment for various medical conditions.

Prof Christensen in his book said that medicine as it is practiced today is largely in the realm of intuitive medicine where medical therapy is left largely to the judgement and experience of the doctor. Even where there are evidence to suggest rule-based treatment, the current system is not atuned to it.

The NYT article went on to give the example of abnormal heart rhythm known as atrial fibrillation. In such cases, a doctor may recommend drugs or a surgical procedure known as ablation, with little evidence as to which strategy works better or has fewer side effects.

Could this be the beginning of the push for evidence based medicine with new reimbursement incentives tied to it to drive the right "business models" to make healthcare more affordable, better quality and more convenient?