Procurement issues - a problem with competence? Surely not.

DPM Tharman Shanmugaratnam's announcement that the government will look into widely criticized e-procurement issues is timely and very much appreciated. But his comment that this was all to do with incompetence and compliance shows that perhaps he hasn't quite appreciated what the real problem is.

If indeed compliance was the problem, surely this would have been detected easily through the regular audits, and the necessary corrective action taken. If corrective action had not been taken despite non-compliance having been diagnosed, something is seriously wrong with management. To lay the blame at the level of the procurement officer is misguided to say the least.

If anything, the procurement officer is only all too careful to follow all procedures. He knows he will be caught out by the audit if he is non-compliant. I am not talking here about any intention to cheat. This can happen even if procedures are followed. That is why Minister Khaw can confidently attest in the NParks wayang that "procurement formally observed and complied with the existing rules".

The real problem is not one of incompetence and lack of compliance at the level of the procurement office. Rather it is the lack of understanding at the level of the approving officers and senior management about why the procedures are in place. It is the fallacy that being right is only about procedural correctness.

The NParks wayang - Problems with GeBIZ that everyone knows about but the auditors turn a blind eye to.

When the NParks Brompton bicycle story first broke, I daresay many had already guessed at what lay behind the procurement/tender fiasco. I am not referring here to the allegations of corruption, or the buddy-buddy relationships between procurer-approver-supplier. Simply, the GeBIZ system is kinda screwed up and pretty much every procurement officer is well aware of these problems and knows exactly how to navigate (read 'cheat') the system to get what they want. It is not as if the auditors don't know. They generally pretend not to know and are pretty 'satisfied' so long as the documentations are in order. Minister Khaw's mistake was his over-eager endorsement of the purchase of the bikes on the assurance of procedural and documentary 'correctness'.

All tenders need to go through the GeBIZ system, yet many of the small suppliers are not registered on GeBIZ. Therefore if the product depends on small suppliers, how do you open a tender on GeBIZ, and expect a reasonable response from suppliers? In the NParks case, what is the likelihood that bicycle shops will be registered on GeBIZ, and will be aware of the tender? Ultimately this will depend on some non-GeBIZ way of disseminating the tender information and hoping the suppliers will go into GeBIZ and tender. This non-GeBIZ way of information dissemination is already subjective and selective to only a limited number of suppliers. And therefore open to abuse.

Secondly, very often procurement offices already have a specific product in mind. This is not necessarily dishonest, but operational centres often have a preference for a specific product. Sometimes this is logical, but often they are not.This is not necessarily the cheapest, but is often perceived to be the most 'desired' product. What makes this product most desirable depends on many factors, most of which are not codifiable. In the laboratory for example, many researchers have preferences for certain branded products, names which they associate with reproducibility or reliability. If they open the tender for the equipment, they run the likelihood of being swamped with cheaper but less desirable products. And endless needs to justify awarding the tender to the non-cheapest tenderer. So what do they do? They word the tender in such a specific way that only one brand name matches the tender specifications. In the NParks case, the wording of the tender was so obviously directed towards a very specific product.

The above are without doubt 'bad practices' but superficially may be viewed as being procedurally 'correct'. I challenge any auditor to say that he/she is unaware of these practices but has not looked the other way in performing the audits.

Another problem contributing to this fiasco is the familiar end-of-financial year monkeying with the accounts. How many of us are unfamiliar with the regular message that comes down from senior management that there is left over money that needs to be spent? Rather than to return the money and risking a reduction of next year's budget, the instruction that comes down from senior (or very senior) management is to spend the money. It is under these circumstances that the most wasteful expenditure of public funds occur. It is under these circumstances that you see the sudden purchase of weird, expensive and poorly justifiable items. Perhaps 26 expensive Brompton foldable bikes?

Investigating aviation errors and IVF mistakes - a fair comparison?

Minister of Health Khaw Boon Wan made an interesting reference to the investigation of aviation errors while commenting or the recent IVF mistake which occurred at the Thomson Medical Centre.

He said: "Like the health sector, the aviation sector used to approach safety and errors through a largely fault-finding approach. When a plane crashed or hit a problem, the first question was to nail down the culprit: who was responsible, was the pilot at fault, was the engineer negligent etc? This used to be their approach a decade or two ago.

But they have since moved away from that approach. Instead, they took a system approach. Each time an adverse event occurs, they will conduct an objective and thorough investigation, not to witch hunt, but to identify the causes, especially if there are systemic flaws. Because they moved away from fault-finding, everyone was open in their comments, resulting in a speedy and accurate assessment of the true situation. Under the previous approach, the tendency was to protect one’s interest, resulting sometimes in cover-ups and the truth became elusive."

It's a very enlightened approach, and one to be applauded, although at some point in time there needs to be some accountability and someone has to take responsibility for not putting in place adequate measures to prevent errors. The MOM comes in hard for employers who put their workers in jeopardy by being negligent in not ensuring adequate workplace safety. In our research laboratories, the principle investigator faces a possible jailable outcome should lab safety measures be violated, or he has been negligent. Should not we expect the same rigour when medical professionals are negligent in situations such as this?

But I digress. The real purpose of this post is to explore the appropriateness or lack of, in the comparison with the investigation of aviation errors.

Avoidance of fault finding and cover-ups are two faces of the same coin. Often breakdowns in the integrity of a system/process extends beyond the party holding the smoking gun. If an error occurs in the regulatory functions, this would be less likely to be flagged out if the investigating team comes from the regulators themselves. In the investigation of aviation errors, to avoid this conflict of interests, an independent body forms the investigating team. Only thus, can the true extent of errors be discovered. If the investigating team is formed by the regulator, it is more than likely that a "fault" will be found only in the party in possession of the smoking gun.

In this instance of the IVF error, the investigating team is the Ministry of Health team. Yet it is the Ministry of Health which audits and regulates this industry. How can the Ministry then identify weaknesses in its own audit/regulatory systems covering the IVF facilities which allowed high likelihood of errors such as this to be committed? This is uncertain.

Should we not require some sort of pre-implantation diagnosis of paternity to be documented as validation of the integrity of the process before the embryo is implanted? Doing so will at least ensure that at the very least, there are no costly mistakes beyond the irreversible step of implantation.

Perhaps the Ministry of Health could consider releasing the last audit findings of Thomson Medical Centre so that the public can gauge if the audit was done with the stringency we expect, and/or the facility failed to act of recommendations.

As the Minister pointed out, this should not be to find fault but to enable everyone to correct all the deficiencies of the system. Following which, we can move on.

Thomson Medical Centre - suspension of assisted reproduction activities

Well done, MOH!! The Thomson Medical Centre has been whacked with a suspension following the IVF mix-up. Iwould have prefered that the suspension had been immediate upon news of the mistake, but better late than never.

What is further required is a full and proper audit of all IVF facilities to ensure that procedures are not only in place, but that centres are in full compliance of procedures. In addition, regular annual audits should be implemented, perhaps with a way to monitor outcomes... for example routine genetic screening of babies to ensure babies are who the centres say they are.

Lapses in audit? Suggest they check if MOE's budget for medical education has been appropriately used.

The Public Accounts Committee released its report on the MDA, MTI, MOE and Mindef showings lapses in the audit books.

It's all very interesting, but seems like chicken feed to me.

From where I am sitting, it always seems to me that whatever has been budgeted for medical education always seems like not enough. I have always wondered if the MOE budget for training of medical undergraduates, which I understand is based on number of graduating doctors, has been appropriately spent by the medical school. The number of students per graduating class has increased, so the total budget (MOE budget and school fees) must have gone up. The number of students per lecture theatre has gone up so the classroom cost per student must have gone down. The number of labs have been slashed, so the costs of providing labs must have gone down. The problem based learning platform that they migrated to some years ago utilizes 'non-expert tutors (facilitators)'....so the cost of tutoring must have gone down.

So if the budget has gone up and teaching costs gone down....how come the shortfall appears going up?

To what extent is the increasing costs due to non-teaching expenditure, such as research related ventures. I wonder if the Public Accounts Committee had looked into this?

Watch out for the next round of student fee increase.

Auditor General's Report - How did our MOH do?

From 'My Sketchbook'

The publication of the recent AG (Auditor General)'s report created quite a bit of stir. What has been refreshing has been the increasing transparency of the process and findings. What had in the past been pretty much swept under the carpet is now (since 2007) finding it's way out into the public domain. And it is fantastic improvement, I must say.

This year the MDA (Media Development Authority) got a bit of thrashing ... deservedly so I thought. And what about SPRING's fiasco with respect to Phillip Yeo's Office? That was kinda indecent the way they handled it. I hope there will be some concrete response to the report. Who will the scapegoat I wonder?

I wonder if there have been other irregularites that have been found but not made public?

Why can't the report be more substantive and complete? For example, the report on our MOH kinda fudges around the use of inadequate KPIs without telling us any details, and cites MOH's rather fuzzy remarks about internal KPIs without telling us what these KPIs are. And since we don't know what the MOH KPIs are....the whole thing is meaningless to us.

One gets the feeling that the AG Office is somehow skirting the issues and 'afraid' to point the finger at where the problems lie.

Lastly as the 'My Sketchbook' cartoon above mocks.... Where is the follow up? Is someone keeping track of remedial actions? The AG's report doesn't mention compliance and follow up actions from previous audits.

So how? I say more needs to be done.