LTA and regulatory capture? HSA are you listening?

A week ago in the Sunday Times Senior Correspondent  Christopher Tan write a nice article about the recent SMRT wayang and the LTA, raising the issue of a regulatory capture occurring between the transport regulator LTA and the transport industry.

The concept of regulatory capture is very much assocated with Economics Nobel Laureate George Stigler. It refers to the type of government failure when a public sector regulator has a cosy cosy relationship with the regulated service provider, to the extent that the regulator becomes a promoter of the regulated rather than a protector of the public needs.

Is the LTA a victim.... or are we, the public, victims of the regulatory capture between LTA and the transport industry.

This is actually not an isolated problem affecting the LTA, but can be seen to exist in many of Singapore's regulators.

The HSA (Health Sciences Authority) for example may be in such a predicament. Formed in the past from all the disparate MOH subunits in the Ministry of Health that the MOH wanted to decant from the Ministry, the functions of the various parts of the HSA range all the way from service provision, regulatory and promotional. Regulatory capture?...certainly many opportunities for this to develop in the HSA. Successive Board Chairmen and CEs have not made any attempt to deconflict all these functions, choosing instead to keep the easy and cosy relationships which made their work easier. However, unless this regulatory captures are dismantled, one has to question to what extent public needs are sacrificed to meed the needs of the industry.

By the way, George Stigler was also well known in medical circles for his attempt to optimize the daily recommended diet. Like all economic solutions, the result was totally unpalatable.

Experts disagree with NEA

I read with interest the recent disagreement between an expert panel of drainage experts and the National Environment Agency (NEA) with respect to the annual rainfall trends. No discernable trend, sez the NEA. But the expert panel disagreed. You can almost see Prof Lui Pao Chuen shaking his head in disbelief. According to the panel, the annual rainfall has actually been increasing at about 15mm per year between 1968 and 2008.

And it's my turn to shake my head in disbelief. How can something so fundamental be in dispute? I mean, I can understand differences in scientific perspectives and theories, but the interpretation of hard numbers?? There is either a trend or not. How can there be such a fundamental disagreement about whether the rainfall is going up or not?

Intuitively, and not having access to the detailed data, I am more inclined to believe the expert panel. Global warming has been melting the ice caps. There is just so much more water circulating in the environment. Sea levels are rising and projected to rise even more. Surely more rain is cycling through the atmosphere. The increasing spate of ponding, oops, sorry, flooding says a lot about how much more rain has been falling.

It kinda makes me question what's happening at the NEA. How are they, and have they been examining the data they have been collecting? Can we trust their projections for the future? And can we trust any assurances that they are adequately preparing for the future?

This is just one of the indications that we really need our agencies to provide more publicly available information. Hitherto, the public has been trained to accept sanitized proclamations from our public agencies that all is well with the world, and Singapore, and that we should trust only their interpretation of fragmented and cryptic data shown to the public.

This is not acceptable any more.

This episode speaks volumes about why we need data to be made available to the public so that they can be scrutinized independently. More eyes are always better. French philosopher Henri Bergson said, “The eye sees only what the mind is prepared to comprehend.” How true.

In this case, the NEA mind appears to have been conditioned to comprehend a rather fixed set of reality based on historical weather models; models which are not applicable in today's world anymore.

If it appears I am picking on the NEA, I am not. This problem exists in all our government agencies. They need to break free from historical models, and look at their data/stats with fresh sets of eyes. Today is a very different  world. Importantly, my plea to all the public agencies is that Singapore's interest is best served by placing much more institutional and government data in the public domain so that independent conclusions can be drawn about what is happening, so that more independent options for the future can be contemplated.

Happy New Year!

Happy New Year all! 

Have a blessed Christmas all :The doctor never reported that the angels sang....!

One of my favourite books in the Bible is Gospel of Luke. Luke, as well as the Acts of the Apostles are supposed to have been written by the Greco-Syrian physician, Luke. Although not an eyewitness to the many of the events he reported on, he drew heavily on eye witness accounts about the life on Jesus as well as the events which took place around the early church. His accounts all carry the trademark attention to personal details and emotions.

His account of the night of Jesus birth has provided many of the inspirations for the celebration of Christmas. Unfortunately they have been pretty much distorted by romantic notions and more recent commercial interests.

"Hark!" The herald angels sang. Or did they? The romanticized accounts all have mass choir of angels celebrating proclaiming "Peace on earth, goodwill to men!". Fireworks in the sky even!

But careful reading of Luke's account actually shows us a very different reality. The angels appeared to shepherds in the darkness of the fields. Their appearance was not at all comforting. In fact they were a terrifying spectacle.The angels had to reassure the shepherds. They had a simple message. Luke documented that the angels spoke the message rather than sang. There was no musical performance in the sky. Yes, the angels were praising God, but praises can be uttered and not sang.

It was a terrifying spectacle. And an earthshaking message. There was to be a major paradigm shift in the affairs of men. Their Messiah had been born.

It is like that for other aspects of life, isn't it? Major paradigm shifts are often terrifying events. The mistake Management often makes is to ignore how unsettling and terrifying paradigm changes are to the workforce. There is often no peace on earth and goodwill to men, other than to those in political alignment. The angels did make it clear, "...and on earth, Peace to those on whom His favour rests."

Nonetheless, Gigamole would like to wish that you all have a very blessed Christmas.

We need a major rethink of our educational system.... and please do so outside of the box.

One of the areas that Singapore can be very proud of is how we have been able to make education so available to our kids, to the extent that we can say that no child will be denied a chance to go to school. In the previous generation there many capable people who had limited opportunities simply because they did not have access to education. But not anymore. Education has indeed been the great leveler for this generation. Because schooling is now accessible to every child regardless of his/her  socioeconomic background, career opportunities are limited more by abilities and skills rather than the individual's socioeconomic stratum. Likewise for gender and ethnicity.

But sadly this appears true only to a certain degree.

The Ministry of Education (MOE) should be congratulated for making examination data available to the public. One wishes though that they would put up more detailed data, and not only cherry picked information for public consumption.

The recent data is quite instructive. They are really quite similar to previous years' data and therefore really doesn't say anything new. True, there are some wiggly movements in percentages, but they are relatively small changes. Over a long period one can see that the performance data is relatively stable. Boringly stable. This stability is actually both comforting and alarming. Comforting because it means the MOE has done an excellent job in providing education. Not much more to do. Alarming because despite all this effort, fixed disparities in educational performances between ethnic groups are apparent.

If we look at the performance at the Primary School Leaving Examinations,we see more than 90% of students pass the exams. But only the Chinese outperform the national average. The Malay students, as a group, under-perform everyone else.

This ethnic ranking not only persist at the O-levels, but the differences are markedly accentuated. And this is for 5 O-level passes. I am quite sure if we set more stringent criteria, even greater differences can be demonstrated.

This is alarming because the data is not improving despite what the amount of resources the MOE has put into the school system. I am sure the MOE is aware of this problem. But I hope they are not ignoring it. Something drastic needs to be done because the current models are not working.

To an outsider, looking at the data, such 'fixed' differences suggest a number of possibilities:
a] Our delivery of education has ethnic biases;
b] Our way of assessing has ethnic biases;
c] Ethnic biases exist in both instruction and assessment; or
d] There are real ethnic related limitations in abilities.

Since I do not subscribe to there being biologically and ethnically related limitations in ability, it must be that the first three are valid.

The MOE must spare no effort to get to the bottom of this problem. It must not rest on the laurels of its past accomplishments. There are unintended ethnic biases in how education is delivered to the public as well as ethnic biases in how the examinations are set. It is not adequate to congratulate ourselves on the performance at a national level, because this is invariably defined by the performance of the largest and most successful ethnic group. This is unfair to the minority groups who may have unaddressed special needs and considerations.

We need to remodel our educational paradigm to level the playing field for all ethnic groups.

Should the finger be pointing at the CEO? A moleview of the SMRT saga....

image from here

All of sudden there seems to be deluge of bad news for SMRT. The latest involves a woman who fell and and sustained a head injury. Apparently she remains in coma. Gigamole wishes her well.

The public outcry against the SMRT is both understandable and justified. The hounds are now baying for the head of the CEO, Saw Phaik Hwa. The mass media has been particularly unkind, I think, and has dug up as many photos as they have on  file that portray her in the most unflattering light.

However, Gigamole somehow feels this antipathy against the CEO has been somewhat misplaced. Yes, because she heads the SMRT, the responsibility for all the mishaps falls squarely on her lap. Bt we should not forget that as CEO she acts upon the guidance of the SMRT Board. It was also the SMRT Board who examined her credentials and appointed her to the post. It was the SMRT Board who crafted up the directions and strategies for the CEO. By appointing Ms Saw to the post, the Board obviously prioritized the retail agenda above operational and service needs. Whether they did this as a conscious strategic  decision is unclear. It may well have been it seemed like an OK thing to do at that time, and only now shown to be inappropriate.

It seems clear at the moment that the SMRT CEO did all she could within her capabilities. Unfortunately though her experience was principally in retail and marketing. Was she someone who had a good insight into the technical/engineering and operation needs of the SMRT? Should we blame her for  lapses in areas outside her expertise. Yes, as she is CEO; but not entirely, as the Board should account for why they did not think operational/service skills were critically important for a train and transport company. Transport Minister Lui was spot on when he picked up the phone to speak with Chairman SMRT. This is a problem squarely shared by the Board and Management.

So for those who are happily shooting off arrows at Ms Saw, hold your fire a bit, and see if perhaps some of the arrows need to be redirected towards the SMRT Board.

The Singapore Medical Council Physician's Pledge - What motivates doctors nowadays?

Pointing the finger at the SMRT for their Freudian slip prodded me to think about what motivates our doctors nowadays. Or at least what should motivate our doctors nowadays.

It seems to me that many doctors nowadays are quite happy to regard their practice as a business. Quite understandably so since every other aspect of health care has become such a business. Ever since the mid 1980s in Singapore, when Medicine became defined as one of the pillars of our economic growth, the practice of medicine has become increasingly premised upon a business-like quid pro quo relationship between doctors and patients.

Yet the very ethos of Medicine is not built upon any kind of a business model. In fact the Hippocratic traditions de-emphasized the rights (pecuniary or otherwise) of the physician and instead focused on the duties of the physician. The Hippocratic Oath was really all about the duties of the physician. Likewise, our SMC Physician's Pledge is heavy on duties and does not even mention payments for services rendered.

In fact the very first line of the Pledge reads: "I solemnly pledge to dedicate my life to the service of humanity". Some will of course argue that this is wholly unrealistic, and that doctors do have to make a living, and perhaps even to live in the lap of luxury. But they forget that this was the pledge they took. Theirs was to dedicate their life to the service of humanity. If this was unrealistic, perhaps they should not have taken the pledge.

The great Canadian physician Sir William Osler, made it equally clear - “The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.”

In today's world, this calling is so easily brushed aside in favour of the allure of "Income Opportunities". I do not mean to belittle the sacrifices of many doctors who do have their hearts in the right place. Indeed there are many of them. Many I have had the privilege of knowing as teachers, friends and colleagues. But I think even they would not disagree that the practice of medicine in Singapore has to a large part, degenerated to a mere trade or business.

What is the purpose of the Physician's Pledge if we are not to take it seriously?

On another note, I wonder why hospital CEOs are not expected to take a similar pledge of service and duty to patients. After all, it is their management performance indicators that compel doctors to behave after a certain fashion. Can we expect a doctor bound in service to a hospital to put the patient's interest first, and disregard the clarion call to seize the hospital's "Income Opportunities"?