The medical profession's way of organising people

As I continue to journey through the medical profession as a student, now in the wards, it is interesting to ponder how this profession has learnt to organise itself in a way that it sees as the best for managing the stressful tasks thrust upon it. Unlike corporate organisations this is a group of people who have come up with a organisational structure unseen elsewhere. Interestingly, it fails to catch the attention of the media compared to the likes of google's organisational structure, and I associate that with how the hospital comes across as a rather exclusive place where esoteric activities occur in the sterile environment, seemingly void of any room for creativity. But as different organisations continue to search for ways to manage their human resources, I feel that this is a wonderful alternative that everyone should bear in mind.

Merits of the Singapore hospitals' organisational structure

In Singapore hospitals, which I would assume to be highly efficient given how highly the healthcare system is rated internationally (last I heard from a professor, it was 6th). Not only that, this is a system which has continuously trained and produced highly skilled individuals respected locally and overseas for their clinical acumen, in short, a workplace that develops its members. From there, many individuals have gained enough recognition to migrate to foreign countries and continue practicing there as outstanding physicians. Aside from tangible results, I have also seen firsthand how teams are able to bond well and work through tough working conditions. What more could we want from an organisational structure?

How hospitals go about it

Undoubtedly, hospitals have presented themselves as exclusive groups and understanding them requires some insider insights. And of course, there are differences in culture within different hospitals, and between different departments in the same hospital. By my observations, specialties that require and emphasize on teamwork seem to have a higher level of synergy and team spirit, while certain specialties known to take in "type A personalities" are known for fuelling some form of unspoken competition between members. Hence, while we try to generalise on what the system does, let us not forget that, like all theories, this is an oversimplification and there are always exceptions (how ironic that these 2 words go together) to what will be written on this.

Creating a culture of team bonding

Imagine if you were in a company that hires and fires all the time, would you give your all to the TEAM of people you are working with? I mean, I don't even know if I'll be working with them next year, or next month at that. And given that you never know when you're going to be fired, how can you invest much, if at all, on the welfare of those around you? Will they backstab you one day because they can't lose the only job feeding their family of 4 + 2 elderly parents? Will YOU backstab the same people you invested your time and friendship with for the same reason?

In the healthcare industry, everyone knows they are all in it for the long haul, hence it is easier to coax people to be invested in not just individual needs, but those of other members and even the system itself. Also, the medical community is rather small and tight-knit, given the small number of healthcare professionals. Many of them went to the same schools together, or received training in the same hospitals at a certain point in their medical education. Otherwise, mutual friends and similar experiences are relatively common and form a good basis for conversations and establishing rapport. This allows for strong team bonding to occur, and I believe almost everyone is agreeable that this will produce better satisfaction at work and better outcomes for the organisation as a whole.

But doesn't the comfort of a "long-haul" career that is "recession proof" create an environment of individuals contented with maintaining the status quo? This is the common American logic propagated by American multinationals. I guess they do imagine the world to be populated by hedonistic creatures, to which I agree to a large extent. But this just brings me to my next point.

Continuous improvement

In the healthcare industry, there is a strong culture of learning being propagated as well. Everyone within the healthcare system knows that healthcare is dependent on technology, and is hence ever-changing, for the better of our patients.

Being on the ground, seeing the state of our patients, few would be so lacking in empathy as to turn a blind eye to the suffering of such individuals. And for those, there are mandatory learning points to clock so that everyone is kept up to date with the most recent approaches/management plans etc. that are present.

If we were to explore even further, one would notice that conducting research is a common practice in many Singapore hospitals, and from these sprout the new management approaches and knowledge used in clinical decisions by various healthcare professionals.

All these come together to create a system where individuals have both the purpose, incentive, and the avenues for continued skills development throughout their career, forging an organisation that is driven to continuously innovate and improve itself.

Investing in every individual

Hospitals see every member as an asset. Maybe aside from medical students. Every doctor/nurse/allied-health professional is seen as someone adding value to the group and the patient's welfare. Add that on to the fact that this group of people have been rather "recession proof" and you see how it comes together to give the administration the confidence to invest in its people. This is a stark contrast to the corporate world where a corporation would simply fire one of its own and replace that member with someone who has already been trained or has already proven himelf/herself in a particular field, which makes companies hesitant to provide training given the ease of getting replacements, and the uncertain loyalties of those it trains.

In the local healthcare scene, every doctor (and though I have never asked, I'm quite sure every nurse too) is required to teach their more junior members in the team. Everyone is well looked after by every other member of the team, who continuously provide them with the learning opportunities present. This is aside from courses organised by the hospitals to provide staff with opportunities for growth. Healthcare professionals also regularly go on conferences overseas to learn the best practices or soak in the latest results from research going on in other countries. If that is still insufficient, doctors would go on fellowships in other renowned hospitals overseas to observe and learn on the job what other healthcare professionals elsewhere are practicing.

Beyond the more serious side of hospitals, they are also known to invest in individuals in other ways. For example, weekly welfare buffets, comfortable rooms for doctors who are on call, as well as lounges for resting or some peace and quiet are present in all hospitals. Team bonding activities are organised by departments, and some teams are known to have drinks together at certain points of the day (some overlap with the first point on team spirit here)

Not a panacea, but probably worth considering

As mentioned, such are the merits of the system, and how hospitals go around it here. While it is an overgeneralisation of what hospitals are doing, those are some notable points which I feel are the strengths of the system. After all, recent surveys into people's attitudes with regard to jobs have shown that individuals now rate certain characteristics of jobs, such as opportunities for growth, future job opportunities and good working culture rather highly, as contrasted to the age old thinking that money controls the world. While it may still be true that money does keep people in check, let us not forget that the healthcare industry is not slavery, and healthcare professionals are paid decently if we were to look at their monthly pay, instead of their average per hourly pay. Of course, we could say that the motivations of medical personnel are rooted in the fact that many of them were selected via stringent interview criteria, or point to the incredibly high rates of substance abuse and health complications in medical professionals in certain fields, and those are indeed an extremely negative reflection on areas of improvement in the system. But it is still a unique culture that I feel other industries should explore.

LKY's passing: the final piece of his work

For 1 week, this nation shall mourn, and for 1 week, this nation shall reflect.

The passing of Lee Kuan Yew is indeed a saddening event that weighs heavily on the hearts of every Singaporean deserving of a place in this country. Here in this glorious country lies a man who has turned the tables around when the odds were against the nation. In chinese, there are 2 sayings. One saying has it that heroes are made by the era they were born into, and a contradicting saying that heroes are the ones who usher in a new era with their efforts. 时势造英雄, 英雄造时势. Here, he has, I believe, achieved both, and it is to this idea, that I dedicate this article to him, if that even meant anything given the readership of this blog (readership, as those who know me would understand, was never my concern compared to anonymity).

Reflecting on LKY's deeds and accomplishments, I doubt there are any who would challenge his position in history as a legendary statesman. Personally, despite my respect for the man, I was always skeptical when my parents, who visit China all so often (due to my father's work there) would speak of the admiration the world, especially Mainland Chinese, have for LKY. I had believed that his deeds would only have been appreciated by locals, and maybe in Southeast Asia, due to the size of this country. It is only during the past week, when international leaders all turned their attention to his passing, that I am truly astounded by the respect that he has gathered in the global community. After all, how many world leaders are capable of having the leaders of the US (led by Bill Clinton himself), China, Japan, India, SEA, among others, coming to accord them their last respects? Few but the legendary leaders like Mahatma Gandhi, Nelson Mandela, and few other names that even the man on the street half the world away would be familiar with. 

Indeed, while the President is the highest representative and ambassador of Singapore, Mr LKY has been the most important diplomat for this nation, not by the nature of his post in the government, but by the immeasurable respect he is accorded.

Locally, as a professor mentioned, a country not known for being emotional has shown an outpouring of emotions. Although I would despise to make such a comparison, I would say that this showing by Singaporeans has totally put to shame the display of grief and mourning by even the N. Korea. Although the exact figures on the numbers who paid tribute to him in 8-10h queues are not out yet, I doubt they are anything less astounding as the legacy he has left behind.

This, is in relation to what I wish to write about today. Sorry for the long introduction.

I don't claim to be old and wise, or to be weathered by stormy times, but looking back to the timeline of Singapore, to a time way before the birth of myself or my parents, Singapore has been through much, all of which LKY had a great influence on. The existence of the nation itself owes its birth to him. Yet as times passed, and the world changed, so did all of us in Singapore, as it is only right to do so. But deep under, we always knew one thing to be true. No matter how hard Singaporeans tried, we have failed, in all these years, to establish a Singaporean identity. It was right that we tried, but almost inevitable that we failed. We were a people forged by tough times. We did not band together as a nation because we stood for something, but because we stood with nothing. 

Today, the Americans can proclaim themselves as a nation where everyone stands for freedom. In Singapore, it seems, no one can point to one such value. It seems no matter how hard LKY tried, no matter how wise his policies, no matter how noble his vision, or how innovative his approaches, he has solved all but this problem. He gave the people housing, one of the world's highest per capita income, global recognition, access to almost every country, good jobs, and enough nutrition and clean water. That is aside from clean streets, clear waters, green environments and sparkling city centres. He had given this country everything material it could want for. You could even say that he fed the people's spiritual needs by promoting freedom of religion, and taking a staunch stance against press freedom with regard to religion. Yet he has failed to give people one last spiritual need - an identity as a nation.

With his passing, he has completed his work.

With his death and the 7 day mourning period, Singaporeans are forced to wake up to the idea of a Singapore without LKY. For too long, this nation had taken his presence for granted, and every National Day celebration our complacency is being reinforced. I had hardly heard anyone discuss about a Singapore without LKY more than 2 weeks ago, when on hindsight we should all have been prepared since a long time ago.

Now, as Singaporeans are forced to carry on without him, the people - I believe - are starting to fall back on the thoughs, "what would LKY have done?" They would also revisit the times when Singapore was this young, bold nation, diving headfirst into all the problems as they presented themselves before us. And as those thoughts fill their minds, they will finally think, "what does Singapore stand for?"

That is the magical moment when the nation finally learns to rethink what its identity is. As I once told an audience, "I cannot give you a reason to __________. I can only tell you mine. But you will need to find your own". I quote myself not because of some misplaced narcissism but because I believed in that strongly enough to say it in public. For years, numerous events in our history had given us reason to band together. Sometimes, they were from beyond the country, sometimes from within. But there were at best failures, meant to move only the emotional for but a few days, and at worst, jokes. Finally, with LKY's passing, we will have the best reason to think on our own feet as to what this nation stood for, so that we know how we can carry on without the shoulder of this giant to lean upon. 

As for the government, his passing should also bring about some reflection as to the workings of the government and the state of affairs for the past few years. As my brother had rightly put it, Singapore had started out as an innovative, and might I add, bold nation. We always strived to do things better than others, in ways never before employed by others. 

When housing was a problem, we had a public housing programme that churned out 10,000 housing units before the feasibility report was completed. 

When water was short, we bought water, processed it, then sold it back to Malaysia for a profit. 

We even reprocessed the water that our people flushed down their toilets. 

When national defence was a problem, we used National Service which, though not a novel idea, we still did better than Malaysia. 

Policy after policy, it was either an innovative approach, or an adaptation with a high benchmark. Then there were the forward looking policies. 

LKY was known for being a supporter of greening the nation even while its economic development was still in progress. And today, we could argue that the government has done it better than anyone else. Which other metropolis has a single tree taller than 4m in the middle of its shopping district? Well guess what, we have more than a handful and they have been there for as long as I can remember. I do not for a moment believe any Singaporean can imagine an Orchard Road (how fitting the name is) without trees. 

The transport network could almost be world class if it hadn't been for the recent breakdowns.

Where had all that ambition, all that boldness, and those far sighted visions gone to? How could the housing market had gotten out of control under the government's watch? And how could the transport system have become so overloaded, so poorly maintained? Weren't those caused by the implementation of pro-immigration policies which was spearheaded by this same government itself? What about the balance between the manpower shortage and the aspirations of Singaporeans, which would require innovative approaches?

Perhaps, with the passing of LKY, we will all - citizens and politicians - begin to ponder over our identity. What do we stand for and how should it guide us moving on from here? What were the values that forged this nation into what it is today? 

Thank you Mr LKY, even in death, you have contributed greatly to this nation. Now, it is up to the Singaporean who have been awakened by it to take it from here, for you have given us the only thing we lacked all these years. Unity through a common identity - and hopefully - common purpose.

Power: a short(?) analysis

Power. Throughout history, men have waged war over this more so than any other causes, in the form of wars between tribes, nations, and might I say, religions. Today, many of us have acknowledged that it is time to leave such uncivilised ways of attaining power behind, but the lust for power prevails. In place of expanding empires, we see ever expanding corporations. In place of conquest, we see aggressive diplomacy, and in place of crusades, we see aggressive mission trips (at this point I must ask that all who have religious views understand that I see the expanding power of religions as a result of missions and not the primary goal).

Even at the level of individuals, we each have some form of "power", however minute, as we continually influence the decisions of friends and family members around us. We do not think much about such issues, perhaps because some of us see it as a natural result of our daily minimum dose of interactions with others, humans being social creatures. Yet some of us would beg to differ, to think that power is something that can be nurtured and cultivated by taking the appropriate steps in a series of manoeuvres.

In this post, I hope to briefly (though I expect it to be long) go through my views on a "model of power relations" that I personally use in aspects of my life where I wish to build up my influence gradually.

What is power?

First of all, I would define "power" as the ability to influence the outcomes of events in other individuals' lives. This can be done either directly by wielding something of value to the individuals involved, such as a boss threatening to fire his subordinates and thereby depriving him/her of income. Otherwise, it can be done indirectly by influencing the actions of individuals, such as friends putting peer pressure on each other to perform certain acts, such as smoking, studying harder, or choosing one hangout over another. The eventual objective is to have the ability to dictate the course of another individual's actions or fate to align with your personal interest, be it detrimental or beneficial to the individual.

Properties of power

We should note that there are certain peculiar properties of power. First and foremost, power is finite. It is limited by the number of people in this world, and the number of activities in their lifetime that can be influenced. The latter can be influenced by numerous factors, such as the nature of an individual's work, the number of waking hours he/she has, and the activities he/she participates in. These factors come together to define the extent of "man-made" influence that can be exerted on a particular individual.

The second property of power is that it can be transferred from one individual to another. Of course, how else can people rise to places of power, given that amount of power in this world is finite? This is to say, for any one individual to gain an increasing amount of influence on the course of a group of individuals' lives, another individual's influence on the group must be proportionally decreased. This can most easily be seen from the shifts in power from one leader to another in countries, religious organisations, and corporate companies, where major decisions are made by the highest ranking office bearer, of which there can be no equivalent of within the organisation. In the everyday lives of individuals, we could use the example of a new student faced with 2 rival camps of friends in a school who would try to influence him to come over to their side. We can assume that the 2 rival camps initially hold the same amount of power over the same child, but the moment the child joins 1 camp, he has just transferred some influence, and hence power, over his life from the losing camp to the winning camp. The net result is that the losing camp has a decreased ability to influence how he would spend his time, while the winning camp would have an increased ability to do the same.

Types of power

Power can be divided into 2 broad categories, as seen in the section above. They are namely hard power and soft power. Hard power is achieved when one is able to cause other individuals to perform an act or be involved in an event against their will. That is to say that an individual who is being manipulated by hard power is fully conscious of the acts or experiences he is going through, and will indeed bear negative feelings against it and the perpetrators. Such power is most obvious in terms of national relations, where larger states with stronger militaries are capable of exerting pressure on their neighbours or other states on the basis of the possibility of military aggression. Within societies, this is mostly found in hierarchical organisations, such as the workplace (or at least, 99.99% of the time, or you wouldn't be hating your bosses, would you?), schools, the military, police force, or the civil service. In such places, the hierarchical structure confers upon individuals in higher ranks or positions in the organisation the ability to withhold something of value from subordinates (e.g. salary), or to dish out disincentives such as punishments.

Soft power, on the other hand, is more discreet or subtle. This is the power that motivational speakers, influential political personnel (especially during rally speeches) hold. Soft power is the ability to make individuals perform an act willingly, in other words, to bend the will of other individuals to align them with your own. It is most evident when we look at the relationship between individuals in society. Many individuals are susceptible to peer pressure. In fact it has been shown that for the majority of individuals, our decisions are affected by those around us to a certain extent, a reason why introverts are usually the driving force behind novel ideas and inventions. Another example is the use of advertisements to change the mindsets of individuals, to build up momentum leading to a new fashion trend in the fashion industry. In politics, candidates use various media to affect the decisions of individuals on the polls. Every festive season, corporations use decorations to foster a mood that is conducive for promoting spending within their compounds. In the above examples, it is seen that soft power is used to cause individuals to perform a certain action which they believe they are in control of (and in many cases, they actually are, logically speaking).

Here is an interesting form of power (that inspired me to write this post):

How do we gain power?

Since the above shows that there are 2 forms of power, it is possible to gain power in 2 ways. However, in most situations, we would assume that the power discussed is a combination of both. In this section, we will discuss on how the total power of individuals can be increased by utilising both an increase in hard and soft power. For the purpose of our analysis, I'll use a JC economics style graph.

First of all, I will make an assertion that power is initially gained in the form of soft power. This is because the majority of us will not be able to command the wealth of resources required to form the basis of hard power when we first start out gaining power. Also, there will always be a dependence for trusted individuals around us who should be best gained when we are not endowed with enough resources to attract the wrong attention that hard power often brings us. Hence, at the beginning, soft power is of utmost importance as we seek to establish ourselves in society with whatever little resources or reputation we possess. However, as a person gradually gains a certain amount of power, he/she would now have built up enough resources or reputation to exert control over another individual who might give in to his/her demands on the basis of fear of antagonising him/her or prospective gains from being able to gain favour and tap on the power base of an established individual. Finally, as an individual continues to gain power, he/she will find that increasingly, soft power becomes more relevant again. There are 2 reasons for this. The first is that as an individual gains power, he/she moves up the hierarchy where further gains in power will probably come from power transfers from other prominent individuals who possess similar amounts of influence. Hence, they will not be enticed by the same things they have in excess, and hard power loses its lustre. Also, as an individual gains power through expanding hard power, he/she should have already tapped on much of his/her available resources, enough to comfortably meet the needs of most normal individuals. Anymore motivation from his/her subordinates will have to come from ideals or loyalty that is strong enough to put them out of their comfort zone, to overcome the inertia of a stable, routine life, into one that is likely to carry certain risks and discomforts.

To gain soft power would be much more difficult than hard power. It usually requires forming an emotional connection with other individuals so that they are not swayed by the environment, or the incentives in it. These can be done through friendships forged with others, such that people remain loyal in face of temptations by other individuals. Charisma is also one important means by which soft power can be obtained. This is the ability to capture the hearts and minds of individuals one interacts with such that the words of the speaker is transformed into the actions of the listener. For example, planning a speech to have a strong build up to a climax, where the most important point/argument is delivered is a technique that can build up the emotions of those around an individual and finally bring it to a "high" that implants the idea into the audience. Finally as an individual gains power, his ability to obtain more power rises in a non-linear fashion (note that I have held back from using "exponential" as it still may not be to that extent). Once an individual has gained power, he/she will have gained a reputation among a sizeable crowd. This increases the chances of him/her gaining the attention of others (e.g. becoming a topic of discussion among the common folk), and along with a base of people willing to spread the good word to other individuals, he/she gains a new platform to gain power. Also, with the good follower base, there will be some form of peer pressure on some individuals to conform and subject themselves to the wills of others in order to seek the acceptance of those they are well acquainted to.

Otherwise, it could be in other ways such as running personal errands or taking up responsibilities within a team. This, in the simplest sense, makes individuals increase their involvement in the activities of the group or a particular individual. With this increase in involvement, individuals increasingly exert their presence on others

Hard power is gained by using resources available to us (e.g. a position in a hierarchy, financial ability to procure services, etc.) to alter the actions of individuals such that they fit one's will. Gaining hard power is relatively straightforward, by rising up the corporate ladder to gain a position high in the hierarchy or/and commanding a greater amount of financial resources. Do note however, that individuals need not necessarily need to use hard power just because they have such resources at their disposal. It is possible for soft power to be borne from such excess of resources, as other individuals idolise such an individual as a role model, or that knowledge of an individual's high social standing automatically commands a high amount of respect from other individuals due to assumptions and societal biases.

It is interesting to note that some, if not most professions seem to carry with them more of one type of power over the other. For example, businessmen, bankers or other corporate high-flyers, tend to command more hard power due to their job being much more financially rewarding. However, societal stereotypes tend to hold that such individuals are of poorer moral grounding, which prevents many of them from wielding soft power. Professions like doctors and judges, on the other hand, tend to carry with them an "angelic glow" which confers them respect, trust and all the basic necessities of soft power. While the abovementioned professions are indeed well-paying, by societal standards, it is also notable that it takes many years of training and much work to achieve much less than what people in the corporate world might be achieving at a younger age, much less aspiring towards.

Maintaining power

As mentioned, power is finite, and hence can be eroded by the presence of other individuals gaining power. Therefore, individuals who wish to stay in power need to continue performing certain actions to maintain power. These are mostly similar to those involved in gaining power, but to a less extreme end as the motive now is no longer to expand but to maintain what already is. It should however be noted that at this stage, individuals who have depended on hard power should begin to convert over individuals' loyalties using soft power as soft power forms a more secure basis for his/her power base. After all, there are many duplicates of large organisations with hierarchical structures, all of them headed by individuals commanding great financial resources, but there are few who can use soft power to exert their influence on others around them. It is in fact compelling to make an argument that soft power is the pinnacle of power as it is the best means to ensure loyalty at any point in time.

And the informal section...

Finally, a long post at the end of a long hiatus. Med school hasn't been cutting me much slack, or maybe I'm just a little too caught up in the rat race. Typical Singaporean huh. I'd like to believe that I'll be working myself to death whichever faculty I'm in, so I'm not particularly affected by the workload. 

I've recently started learning calligraphy, building on the specerian script (aka cursive) I learnt to write previously. I've expanded out to gothic as well and it's now gaining momentum. It was... strangely satisfying, turning something so mundane like writing the letters of the alphabet into something worthy of more appreciation than a glance. Especially when I know that it gives me the basics of transforming any word into something aesthetically appealing. Maybe I should do a post on it some day, just a brief introduction to calligraphy. How odd that a "doctor-to-be" is learning to write for aesthetics, when half of society assumes we can't even write legibly in the first place.

Calligraphy is an example of the skills I feel that people should learn for more than mere entertainment, something that does not require much of a large tool or prop, which can be used at almost any event (I mean, words are everywhere). Just another way to look smooth at social events and a good, respectable way to answer the question "so, what are your hobbies?" without stuttering, or saying something less politically-correct. "I like to go clubbing with friends" - does not go well with middle aged conservative people, e.g. your S.O.s' parents, especially on a first meeting. "I like k-pop" - does not go well with some people with strong views on music/drama genre. Still, singing is a good place to start but I'm not particularly fond of using my voice, even for normal talking, so... nope. Next up I was thinking origami. Paper is everywhere too after all. Problem is it takes forever to get something interesting done up. Just try searching "ryujin 3.5". Hemoptysis + syncope. Bad for my mental health too. That thing is reserved for the OCD, of which I might just count as.

On a side note, t'was the ORD season that just passed, and to all those who just ORDed, good job! Now to take up the books again, or to face the world, for those who are headed straight for work. As for those finishing up their last few months, hang in there! Your pink IC isn't too far away! For the regulars... I just hope you don't feel like you made the wrong decision, or turning back might be a little difficult at this point.

Time to hit the books again. Medicine exams are just round the corner for second year NUS medical students.