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Sakmongkol ak 47

Wednesday 11 November 2009

IJN: Privatization and Taking It Private

The evils of privatization and making IJN private are similar. In the former, an outside entity wants to take over and do whatever it wants. Sell assets, cannibalize it( the sanitized term is widespread asset unbundling) and make more money. Taking it private is usually done by those people already inside eager to protect its assets from being shared by the public. If you look at the proposal by the doctors, it means just that- hiding behind the concept of physician led organization and center of excellence, what they are doing really is, to ensure that IJN remains within their control. But the cost and outlay needed to run the institution plus even the volume of referred patients- these they depend on the government. So how can any doctor claim, that it's because of them IJN is what it is now? If IJN was founded using these doctors' money, who cares if they want to take it private or otherwise? Precisely because, IJN belongs to the nation, it becomes a matter of public interest.

I think this debate on IJN must be looked it its proper perspective. The debate should centre on whether the management and governance model proposed by the doctors (actually pushed very hard by the 13 head of departments within the group of 33 senior doctors) serves as the better model than the one proposed to the EPU in 2005. This should be the starting point of debate.

It's not about whether doctors are better human beings or not greedy and so on. To lay such claims would only open you up to retorts perhaps within your own organization as many of the anonymous comments on my articles show.


Did these people who presented the doctors' proposal on 27th October back their proposal by hard numbers? Unfortunately, it appears they didn't. How will MOF then decide the issue rationally and scientifically?

For example, it's almost certain; the presentation wasn't supported by full financial analyses appropriate for deciding on the future of an institution which costs the government a lot of money.

Because its money from the government (MOF AND COMMISSIONER OF LANDS), makes this debate a PUBLIC INTEREST DEBATE. The doctors didn't come up with the seed capital to set up IJN- the government did. True, IJN became what it is today is partly due to the doctors work, but is also due perhaps on a greater scale to the skunk work of administrative support system consisting of non clinicians, managers, nurses, general workers etc, and patients referred to by the government. Yes sirree- if Mr G didn't refer patients to IJN (from whom IJN gets paid), IJN will go down under.

Consider the comments from anonymous fellows below which I have reproduced verbatim:-

Anonymous said...

Sak, sadly to say, in the docs presentation on the 27th Oct, there's NO mention wat-so-ever about turning IJN into CENTRE OF EXCELLENCE.

I wonder why? Maybe the good doctor Azlan care to explain. After all he's spokesman for the lot. (Look back at his comments from the SD failed take-over days)

Do check also on the role of Dr Ismail Merican, the sitting DG of MoH, in this soap-opera. He sits on the Board of IJN SB & is fully aware of the present business model of IJN. It's no secret that there's no love lost between IJN & him!

Oherwise how do one explain the 10% reduction on the patients number this year alone. He's pushing patients to Serdang Hospital instead of IJN. Mind you, IJN have been receiving "nyawa-nyawa ikan" patients from Serdang Hospital!

What you have probing of late is bigger that you think. Do probe further. PM Najib must be made aware of this scheming & put a stop to this nonsense.

RAKYAT Didahulukan bukan DOKTOR Diutamakan


08 November 2009 20:43

Anonymous said...


The doctor's presentation to the EC comprise a 7-slide presentation.

There's no financial numbers to back-up their proposal for a single structure organisation.

No pro's and con's between the present and their proposed structure.

No nothing..except air-liur & gusi!!

And yet, in a matter of couple of hours, the EC decides that the single structure organisation is the BEST option for IJN.

Who's d sucker now??

Dr DoLittle

09 November 2009 10:06

Anonymous said...

1) The doctors have no say at all in the building. We are only asked on what equipment we need to to function, period.The design, funding and project management are entirely managed by IJN Cooperate, not IJN Clinical.
(It is delayed by more than two years, btw)

Ye ke..?? The matter for the expansion project was mooted way back in 2003 by the then CEO. In case you forget, she's among your peer i.e. a Doctor too.

You guys tortured her emotionally, remember?

When the project finally kick-off the ground, the doctors were involved all the way. The doctors participated via the user-interaction. Not only on what equipment you need to function, but also the processes as well. Even up to the four-wall drawings.

To say that the doctors have no say is not true isn't it?

2) Our shareholders include MOH and MOF. They define our salary structure( fixed amount, btw) and we have no say AT ALL how we much pay we get.

The shareholder of IJN is MOF (99%) and The Federal Land Commissioner (1%). MoH only involves itself in policy matters. The salary structure is defined by a two-way negotiation!

To say that the doctors have no say AT ALL on how much the doctors gets every month, it's very MISLEADING. Are you trying to say that you guys are being paid peanuts??

Take a look at the LG (doctor's parking bays) and it's like Naza's showroom.

You are portraying as if you are the VICTIM here.

4) If doctors in IJN are all interested in feathering their nest,then IJN is the least place they want to be. Private practice is where you want to be. You can make more in a week working in private than a month working in IJN MINUS ALL THE HEADACHES !

You sure or not? Are you implying that if you are in private practice you will make RM70,000 a week?? Woww!! if that's the case you are definately in a wrong place. Furthermore, your headache will be gone too!

But, who pays for the doctors overseas trip, business class and all the trimmings? The courses you attend? The speaking engagements? I bet it's definitely not from the doctor's own pocket right?

While the doctors in the private practice have to rely on the available bodies to maintain their lifestyle, the doctors in IJN have abundant of bodies.

Therefore, in comparison, while the doctors in the private practice is experiencing a low-season in terms of pay, the doctors in IJN is still able to maintain, as the patients numbers remains constant.

09 November 2009 10:45

These comments should be the basis for MOF advisers to exercise caution and prudence over this matter. In the next part, I shall try to debate on the more substantive issues raised by DR Azlan such as the concept and practice of physician led organization and so forth.

If this is a hospital owned by DR Azlan in which he invested his own money, or if IJN is a just a private clinic, this issue would not raise an eyebrow. Mayo Clinic started life with money invested by the doctors Mayo. Uncle Sam didn't give them money.


Prihatin,  11 November 2009 at 12:55  

Pak Sak, Tak mau kah buat artikel tentang bagaimana nak memperbaiki taraf perkhidmatan hospital kerajaan.

La ni hospital kerajaan dah takda wad klas 2 dah. 2 dan 3 campur jadi satu klas.

Perkhidmatan mencakupi juga attitude misi-misi (nurse), jaga security yg saya tengok sebagai pelawat melayan pesakit dan pelawat pesakit macam klas kambing aja.

Lain kita minta, layan cara jawap. Nada yg kasar dan tidak bersopan santun. Apa kata buatkan KPI jugak kepada dorang2 ni. Pasang kamera ke, rekod tengok bagaimana mereka layan pesakit, Tak pun buat kan score card macam bila kita keluar hotel tu, baru la boleh org2 tertentu dapat balas maklum tentang kepincangan.

Fikiran terbuka la skit hendaknya. Dunia dah ber globalisasi, dimana advertisement atau cerita dok cakap2 pasal. Tapi hendaknya, laksanakan atau punyailah attitude seperti mana diwar warkan.

Anonymous,  11 November 2009 at 15:14  

if govt really want to privatize IJN and don't want to use any rakyat money to support it then conduct a bidding tender.
Put IJN on ebay. highest bidder wins!

After that winning bidder is on his own. No referral from govt hostpital, no govt support, no losing money then come back for bail out. It has to be a private enterprise that take their own risk.
no need more argument, just put IJN on ebay.

DingDong,  11 November 2009 at 19:18  

Salam Dato,

You make me trust UMNO again knowing there are plenty of good people still in it.
I sure hope that IJN in the end of the day will be the best affordable centre of excellence for healthcare and not a profit oriented entity.

Anonymous,  11 November 2009 at 20:11  


I wholeheartedly agree with you. The issue you are fighting is not about doctors vs non-doctors, or the prima donnas doctor or the business savvy corporate bosses. It's about the rakyat well being. It's about the normal man able to seek first class cardiac treatment at an affordable price. There's only ONE IJN in this country. Focus on the objective of IJN. Leave the business side to the experts.

Finally..Please don't gamble with our lifes!

Lesu deh,  11 November 2009 at 22:44  

Dato', risau memikirkan, dulu masa Dr. Rob jadi MD,cartel 13/33 ni tak dapat dikawal. Mereka nak mengamuk, nak biadap, ponteng kerja buat locum dsbgnya nampak gaya macam boleh saja. Semua Dr. Rob telan bulat-bulat. Sekarang dia jadi CEO, adakah cartel 13/33 akan buat perangai lama atau mengikut tunjuk ajar?? Macam mana dengan pekerja-pekerja lain. Takut nanti jaga cartel, pekerja-pekerja IJN lain diabaikan.

nxforget 12 November 2009 at 00:41  

Salam dato,

Sorry, whatever the plan to privatize IJN is still piratisation. They want things on a silver platter and wants the free fuel to keep going. What a bunch of robbers that trying to fool the public.

Look at MAS. I came, I saw, I rip the company apart, then I sell off for profit. Never recovered until today.

Anonymous,  12 November 2009 at 01:26  

1. After reading your latest post I have to admit that NOT ALL OF US is in sync with what our CEO put forth to the EC. Somehow I suspect you already knew that!

2. I know what I am about to say or write, might put me at loggerheads with the other 'side'. But all this public bickering must ceased as its hurting the morale of the entire staff of IJN which will ultimately makes all our good efforts thus far to a nought. IJN is an INSTITUTION set-up by the Rakyat for the Rakyat. And it must be defended at all cost!

3. We have lived under a medically trained CEO for the first 12 years since IJN's inception in 1992. We have reached a plateau in terms of progress as the CEO then was a 'part-time' as he/she was still expected to see through their patients.

4. Internal bickering among doctors then was rife & to certain extense bordering madness. As one commentator put it correctly, the CEO's during that period was 'emotionally tortured' by our more aggressive colleagues pushing through the doctor's agenda which is always 'Doctor's First'.

5. Then came a period of calmness when the shareholders decided to put in place a non-medical CEO. The CEO basically clean up the house, tightened the screws where its needed and makes us all toe the line. Its all fine with some but not to others.

6. We were all rewarded accordingly and all seems fine at first. But as the numbers starts to improved, so is the expectation of the others. It seems nothing is enough.

7. This latest episode, sadly to say, is the culmination of such expectation. We are aware of a meeting between one of our colleague with a blogger whereby a supposedly private & confidential information was passed on to this blogger. Unfortunately for them, but fortunately for us, some people just couldn't keep their mouth shut.

8. In the EY report date the 13th October, there's no mentioned anywhere in the documents of any privatisation proposal or sell-off or canniballising of subsidiary companies. It merely outline the current organisation structure & ways to strengthened it to meet future challenges. That's all to it!

9. But, why was it distorted in the manner it was published on that Monday that is beyond comprehension. We couldn't understand it then & even now. Was there a hidden agenda by this group? What's the end game? Maybe to create strong public sentiments against any form of 'privatisation' or 'wide-spread asset unbundling'. We are just doctors!

10. Somewhere along the line, we have lost our objectivity. I can deny that the financial rewards is there & I'll be a hypocrite to say we don't want to be rewarded. And we don't need to re-invent the wheel just to achieve our financial goals.

11. Our objective is the patients. During those glorious days when a doctor is just a doctor, when we used to do everything ourselves, patient comes first. Sadly to say, I see some of my colleagues is pushing everything to the junior team member. Getting appointment to see us is still a major issue. We tried our best to fulfill our patients' need but to be perfectly honest, we are short handed.

12. IJN must re-chart its course. But not the way our CEO is doing it. They think by reverting to the single structure things will be better than the current one. I see no flaws in the current structure & can understand why it's being done this way. I sincerely hope my other colleagues can see it too. But it has got to be seen without any hatred, revenge and only with a clear mind.

13. I do not wish to be known as I know the kind of treatment I will received from my colleagues. All tjese years, my colleagues and me, managed to keep our sanity by staying at the sideline. And we will remain there for as long as it takes.

One of the 33 BUT not the 13

Anonymous,  12 November 2009 at 07:00  

Finally, someone among the rank speaking out! Well done Doc!

How about this?

Once upon a time, there's this good doctor in IJN. Not only he's an excellent surgeon he also possessed a certain level of knowledge about business & corporate acumen. And a likeable person too! (unlike some who thinks highly of themselves)

He can considered a pioneer of sort, having initiated the Heart & Lung Unit in IJN. But, because of internal politics, he resigned! He just couldn't stomoch it anymore. He left together several members of his team & ply their trade elsewhere. And successfully too.

Last year, attempts were made to bring him & his team back onto IJN. Letter of Offer has even been given to him & his team to start another pioneering unit in IJN.

Somehow he did not except the appointment. Although he did not spell out the reason(s), we were made to understand that for as long as the 'cartel rulez' in IJN, he's not coming back. What a waste!!

And to the DCEO, watch your back! They are out after you. You will be marginalised. Just take a good look again at the org chart. You will know what I mean.


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