IJN- What’s up Docs?

Doctors are the kindest people on earth. I cannot imagine any other reason for any person wanting to become a doctor other than having the wish and obsession to help out the sick. They are also smart people. They can be smart and still help people. They can do and achieve this under the proper environment. So when an eminent lady doctor asked in a meeting- as if setting the tone for that meeting, what do we want to become, we can only give one answer. That IJN becomes the centre of excellence.

How will it achieve  this? By organizing itself as an entity with a vast support system, not found in a family like business structure. In business the family owned business structure has given way to the professionally run business organizations by people who are neither the owners nor founders of the business. These outsider professionals run the business while preserving the core values of the owners as best as possible.

If they chose to go back to an organizational structure based on a command centre kind, the move will surely be a retrograde one. Imagine now, the pioneer doctors who started with the founding of IJN as owners and founders. 15 years ago, a simplified structure with one command centre was sufficient to carry out work. One person and a close circle were able to function the hospital. He assumes ultimate responsibility, hire and fire, procurement (where the money was). On the flip side, one person can also screw the system and people up. But the organization thugs along.

Today, as new patient demands emerge, as new challenges emerge, that simplified structure cannot sustain IJN's quest to become a centre of excellence. The only way, I can think of for IJN to remain on its course to becoming a centre of excellence, is to duplicate or replicate the templates of such esteemed health institutions as Mayo and Cleveland. That is, you must have the right organizational structure. That right structure isn't the one promoted by some doctors at IJN presently. They are proposing to go back to pre 2005 of one command centre organization. You can't run an institution on the work ethics of a single general practitioner's clinic. That doctor in particular may be good and even outstanding, but his clinic isn't an institution. You need a support system.

The only interest is for the government to insist that IJN remains as a premier institution of medical excellence. It can only achieve this aim, if IJN remains as an entity that supports and promotes excellence. Further, that can only be achieved if IJN re-structures along the proposal made in 2005. That is, it organizes itself, in substance to the lines on which Mayo and Cleveland Clinics are organized. Basically these institutions are organized along a business structure that allows professionals do their best in their chosen vacations- doctors and clinicians concentrate on medicine while support staff creates the environment in which doctors thrive and prosper.

In 2007, for example, Mayo Clinic had some 2700 doctors and medical scientists. But it had almost 36,000 administrative and allied staff and some 3000 residents, fellows and students. To me, what makes Mayo great isn't because it privatizes but because it has the organizational structure that allows doctors and medical scientist blossom and proper financially and professionally. It's the support system that consists of 36,000 non medical people. With that Mayo made USD622 million profit.

I am not at all belittling the intellectual capacity of a single doctor or a small group of doctors , but surely a single command center system can't provide the supporting environment established along the lines of a Mayo.

There's even a more fundamental reason to reject a proposal to go back to a command centre kind of arrangement. It's to avoid concentration of power and tyranny. The basic principle to avoid tyranny (used in the widest sense possible) is to champion a dispersal of power. Milton Friedman the Nobel Prize winning economist wrote, if power is to be exercised, better in the county than the district, better in the district than in the state and better in the state than in Washington. What he meant was, we had better avoid concentration of powers in one person or one small group.

That principle finds expression in a more contemporary form in management theory – that of concentrating on the clock and not the clock builder. The institution is exceedingly more important that the personalities involved in building the clock.

Here's the deal. When Sime Darby wanted to take over IJN ( the clock), the idea was resisted on many fronts. Although, many different people resisted the idea, through representations, though joining forces ( soliciting the support of our eminence grise Tun M for example), through our writings- we were actually united for a purpose- that of preserving the barely 20 year old IJN as an institution. It was also directed at the attempt to concentrate power in a small group.

Hence this idea (being mooted by some eminent physicians at IJN) is doing exactly the reverse. First, they are attempting to concentrate power in a cartel like club whose membership perhaps number 12 or 13. Imagine the possible effects. One, it will have the immediate effect of closing membership of the physician's cartel. The club of 13 has absolute discretion and powers to limit entry into the cartel and it will determine who, how and when any other physicians not currently belonging to the club, can become a member. This will stifle the advancement of those physicians outside the club and will definitely reduce morale. Second and more important to me, the members of the physician's cartel alone have the power to decide on the application of the RM411 million cash or near cash which IJN has. Or maybe RM100 million or so if one takes into account the seed capital given by the Government and other capex outlay. What's to stop one decision maker( the boss of the company) deciding how to spend the RM 100 million or so. Divide RM 100 million among 13 people for example.

This idea is inherently flawed and contain within it, the seeds for the future destruction of IJN as an institution. What's the emotive of the doctors? Why do the doctors who agreed to a 2005 organizational structure, abandoned this management idea which can turn IJN into a centre of excellence agree to revert to a management organization which was abandoned in the first place? Why must IJN go back to the pre 2005 to turn IJN into effectively, a general one person general practitioner's clinic? Its back to the Yahya Awang days with a management system, the doctors themselves disapproved. What's up docs?

If the PM agrees to this idea, he is ill advised.