Sunday, May 26, 2013

Can the Public Service up its game?

Am I getting old and slow? I found myself having to read this more than once to understand it.

Good that the service wants to up its game but I think they have are stuck in a gold box problem, and there is nothing better than a golden box because it is the best box.

Easiest I just quote an example Peter Ong gave. A low hanging fruit to pluck why I say they don't get it. Much clearer this way.

Let me quote the good man.

On health care, the other day I had a consultant who came by. He heads a practice in Asia Pacific on health care and I said we're thinking through our health care. Tell me which systems around the world or even in particular in Asia Pacific would you recommend for us to study that's really good? He said seriously Singapore, you've got a very good health-care system. I was glad to hear that validation from someone like him. He studies all the health care systems around the world and recognised that actually we do have many positive features.

I met permanent secretaries from around the world and they say we wished we had Medisave. Many of them have pay as you go systems where current taxpayers pay for the health-care needs of their people. And he says, guard what you have. So I think what we're doing is trying to make sure that we guard the positive features that we have in our system but saying that, as the population profile changes, what are the new things that we need to have. So that's what my colleagues are very busy with right now.

The civil service do not understand that unless there is new thinking, health care the world over is a zero sum game.

Pay as you go, the people do not worry. Medisave? Better die than to fall ill. Pay as you go provides good service but deteriorates over time, which they like to teach my kids in school - the British NHS example.  Medisave and together the 3Ms is increasingly unaffordable, i.e., even more worry that it is better to die than to fall ill.

Now that consultant see the world from a helicopter. Is he the average health care customer? He missed the trees for the forest. 3Ms is beautiful on paper but the test of the pudding is in the eating.

Zero sum game, choose your combination. Unaffordable to the state but affordable to patients who do not worry about falling ill, or affordable to the state but have patients very worried that they go bankrupt getting treatment. Which is better? Both are good and bad but that consultant and our civil service could only see one side of it, and not the side we are looking and living.

What is new thinking? Here is a nascent example not from healthcare but education: Khan Academy. Sal Khan, I saw my daughter earlier today trying to use it to learn how to code. She gave me a quick run down of their learning model, I can see they are providing another way that is friendly to the realities of the 21st century for people to learn. Ditto also what is coming and evolving from top universities putting out their lectures on the Internet. These are emerging ground up answers to the runaway costs of paying for college. A long way to go but the journey has begun.

My point? Our civil service don't get it because they mistakenly thought they are the best even as they keep reminding themselves to be humble. Not helpful when every purportedly credible opinion they sought agrees with them. Why don't they ask us but first they must learn a language they are not used to. They must learn to hear beyond the spectrum they are familiar with, which even their politician bosses are not good at.

Update: May 27 5:15am

I thought I remember reading about such Indian hospitals not very long ago. Google helped me to locate them this morning (link). We are not doing this for the masses in Singapore. May be if we ask them they say it cannot be done here. If so, not a problem but we want to know why.

At their website, I found the following in their landing page.

Our Vision

“Affordable Quality Healthcare for the Masses Worldwide”

Our Mission

“A dream to making quality healthcare accessible to the masses worldwide”

Our Objectives

  • Provide holistic, timely patient care
  • Continually upgrade the knowledge and technology in patient care
  • Enhance customer relationships and provide an enriching experience
We could have the same vision, mission and objectives for our hospitals? The Americans as usual in a contentious manner will definitely be looking at such examples to rein in their runaway healthcare costs. It has caught the attention of Fast Company.

THIS IS A SPECIFIC EXAMPLE OF NEW THINKING I FEEL OUR CIVIL SERVICE LACKS. Something I pointed out earlier in the main post. Why should we be suffering under their zero sum thinking? You think a bean counting gold plated consultant can dream up such possibilities? Peter Ong was talking to the wrong people. Get out of your suffocating gold box. Today's true gold is hiding in lead boxes.

Bassanio: (Merchant of Venice)
So may the least deserved be most rewarded;    
The world is e’er deceived° by outer show.                                                
What says the gold?—‘ . . . shall gain what (many) men desire.’
I do not know what many men desire,    
Nor what they hope to gain by such desire--
(I only know what my heart yearns to give.)
O gold, you shine° but do not satisfy,                                               
Like golden food which Midas cannot eat.
Therefore, gaudy gold, I’ll have none of thee.
And what of silver?—‘. . . shall get (as much) as he deserves.’
Yet how does ‘getting’° mingle with true love?                                  
‘Tis not of love we speak, nay, but of business.
O silver, thou pale promise appeals
Only to those who have nothing to give,
To greedy hands that grab at passing coins.°                                    
And lead?—‘. . . must give and hazard all he has.’ 
O lead, thou threatens yet offers no gain.
Yet how° can we speak of ‘giving’ or ‘hazard’                                   
To one already lost in love’s abyss?°                                                  
      (And what of gain for one whose heart is full?)                            
One sight of her beauty fills me til dawn;
One glimpse of her glory and I'm complete;       
My heart cares not for gain—as bid by gold                                 
Neither° to get—as promis├ęd by silver°                                              
But e're° to give, as required by lead.°                                                       
    Here, here chose I—when all is done and said 
    A heart that giveth all can ne’er be misled.

Of course your counterparts in other countries envy you. You don't have their problems or citizens. But if you are truly good in your job like our first generation leaders, envy wouldn't be what you get from these other perm secs. They would be worried or even frightened by your boldness and courage. I am asking too much from your team but Singapore will eventually get nowhere without such demanding standards which brought us here.

Meanwhile we wait for others living in greater pain to get their act together because they have no choice, and then they will beat us. That Indian hospital is not staying in India. It wants to conquer the world. This should start to worry our hospital business. But you might say that is many years away and we would have retired by then? I used to have bosses that thought this way.

1 comment:

  1. Why didn't we do something like that "India no frills hospital"?

    You ask that question because you think like a citizen of a country.

    This is where "Singapore Inc." comes in. The Govt thinks like a corporate CEO. We are promoting medical tourism. We are attracting biomedical companies. We are attracting medical companies to research drugs here in Singapore specifically targeting Asian genes.

    Putting citizens first like "cheap hospitals" will immediately undermine all these work. Its like, if you want Shell, Esso to invest here, tolerate the oligopoly on petrol price thats been in existence for donkey years (while in USA, such collusion will immediately have prompted investigation by the authorities).

    Medical costs keep rising in Sgp not just because its a global trend -- but because its exarcabated by the twin goal of medical tourism. We have abundance of beds in private hospitals. Meanwhile, citizens have to make do with beds in the corridors of A&E dept.

    The Govt has invested too much in "Sgp Inc." to backtrack. BTW, 7m population is also part of Sgp Inc.