SingHealth COI: About keeping your head down

So I asked the doctor if I could send my mother to Changi General Hospital for physiotherapy instead of Singapore General Hospital. Closer to home, I said. But no, she would have to go to the polyclinic to get a referral to a doctor at CGH and then proceed from there.

What about a letter from him for CGH? Cannot. Aren’t they part of the same cluster and have all our medical data on electronic databases? Yes, but still cannot. Then can I use his medication prescription for later at a polyclinic pharmacy, rather that buy them now at the hospital? He doesn’t think so.

But why? His answer was to go ask Health Minister Gan Kim Yong.

I rather thought he should go and ask him himself but maybe, there is such a thing as separation of the political and public service. Maybe this was what National Development Minister Lawrence Wong meant when he said that public officers should engage the public and “co-create’’ solutions. I thought to myself that there doesn’t need to be an engagement ‘’exercise’’, but merely a question of being alert to interest of citizens and bringing up improvements to the powers-that-be.

I am reminded of the encounter after reading the summation to inquiry panel on  the SingHealth hacking incident. There are 16 recommendations including technical ones about adding security filters and no-brainers such as using a more complicated password than P@ssw0rd. But we all know that whatever SOPs are in place are no good if the people can’t be bothered to follow them. Or worse, people follow them to the letter rather than hark to the sentiments behind them – which is for efficient and effective problem-solving. (Like banning the sale of rum and raisin ice cream after hours because it contains alcohol.)

If anything, the COI hearings illustrate the depth of complacency pervading the environment of those in charge of our health data. I called it bo chup culture in one column but I think I should also add that it’s about not wanting to rock the boat, or the worry about getting blamed or being singled out as a troublemaker.

I thought about how the employers were more intent on punishing an employee who wanted to move out, rather than consider the helpful advice from the vendor he courted about lapses in the system. I thought about the kiasuism in making sure there was really, really a breach before sounding the alarm. This is to avoid having bosses breathing down their necks and working with “no day, no night”. 

I thought about the guy who discovered the breach and was credited for alerting his boss – who did nothing. I think credit should be given if that same guy took his suspicions elsewhere when he realised his boss was sitting on the problem.

Our standards have become so low that we praise people for doing their duty and earning their salary. The flip side is: we lay no blame on those who don’t.

Plenty of wags have commented that this attitude of keeping your head down is more pervasive than we think. It is an organizational culture that breeds silence and consent, not one that encourages initiative and action. If this is true for big public sector agencies, then we are in big trouble. The private sector has the profit-making imperative to kick employees out of their complacency so as to gain market share, or to get a lead on rivals. Their bonuses and sometimes, even their continued employment, depend on it. The public sector has what? Random audits by the Auditor-General? A complaints box? A rehearsal or drill that they are prepared for because they know when it’s coming?

We’ve been hearing a lot about cultural issues lately. SMRT Mr Neo Kian Hong, made a remarkable declaration two weeks ago that  the “deep-seated cultural issues” of human error or failure characterised by his predecessor Desmond Kuek do not exist within the SMRT. That was a bold move, and he must hope that no major lapses occur on his watch or he would have to put it down to the usual excuse of “technical issues’’.

I don’t think Mr Kuek made himself popular with SMRT staff with his comments, because it tarred everyone in the organization. But I think he was brave to actually blame “people’’ because we are so averse to making people feel bad. So if a few people let down an organization, should we dismiss the whole barrel? Of course not, but it would be good if the rest of the apples realize that they too had a part to play in letting the bad ones rot to such an extent.

I happen to think that this approach of keeping your head down and not attracting attention is something that is embedded in our psyche. I see it all the time when I ask my class of undergraduates if they have any questions and I get no response. I’m sure it prevails even among those whose job it is to ask questions. Either because we’ve lost the art of asking questions or we simply don’t think we should do any asking because it’s considered so, so rude.

Taking initiative, like interrupting a class with questions, is even worse. You’ll be accused of wanting the limelight and “spoiling the market’’. You’ll be accused of adding to other people’s workload and raising expectations. No one wants to stand out and be noticed. It’s not Singaporean to be ambitious, not even for politicians.

However “smart” we are as a nation, it’s the people who are the source of good and bad. If people don’t take pride in their work, or in whichever organization they belong to, then they really just are cogs in a wheel. At a national level, we see it everywhere. We live our own lives and do our own thing. We think nothing will happen if we speak or take action – and we don’t even want to try.

It’s depressing.

I want to say that the encounter with the doctor was just a blip on an otherwise very good day at the hospital. I have always been impressed by the service and civility of the staff in SGH, from the security guard to the receptionists to the front-line nurses. This is one organisation with a culture of excellence and professionalism. Its record might have been marred by high-profile incidents, especially by senior people, but its rank-and-file have much to be proud of.

I guess Mr Neo feels the same about SMRT.