The logo from 1987 to 2006. "Evolution of...

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The way to gain a good reputation is to endeavor to be what you desire to appear.

Kodak is gone.  The once mighty company that produces photographic films has filed for bankruptcy.  Kodak moments will now be a thing of the past as the world embraces the emergence of digital technology to capture cherished memories.

Yes, technology continues to evolve in dramatic ways.  Established companies like Kodak may disappear, new products like digital cameras emerge, and competition in the world of business is more ferocious and ruthless.

However, as technology evolves, so does the service business.  Most new jobs today are generated by services.  And contrary to what is popularly perceived, service positions are well-paid and require highly specialized skills.  The health care industry, for instance, demands significant training, and its employees are well-compensated.

Unfortunately, a number of health care professionals see themselves as overworked and underpaid.  This translates to poor customer service and declining patient satisfaction outcomes.  Even non-health care service professionals need to be reoriented as to the nature of their profession.  This is because, as is frequently mentioned in customer service training, “If you make customers happy, they might each tell a couple of friends.  If you make customers unhappy, they might each tell  20 friends and acquaintances. 

So what does it take to succeed in the service business?  In a nutshell, the essential characteristics of a service professional can be summarized by S.E.R.V.I.C.E.

S – Smart.  A smart person has the academic competency in the chosen service field.  He or she must show an ability to make good decisions.  Education in the classroom is handy, but even more important is real-life experience.  A true service professional learns to utilize both education and experience to provide world-class service.

E – Energetic.  Intrinsic motivation is essential.  It would be difficult to relate to someone who seems lethargic.  How would you feel if someone communicates with you, but is noticeably tired or just desires to see you off?  You might as well talk to a computer terminal if you are served by a stone-faced human.

R – Reliable.  Service professionals must be dependable, and they must deliver more than is expected.  When they promise to finish at a certain time, they must do so.  When a customer has a problem, they must exhibit a sincere interest to find a solution.

V – Values-driven.  God-fearing and ethical employees are a gem.  They will always act in accordance to their religious beliefs, and will consider their God as their Boss.  This would translate to a service experience that is respectful and caring.

I – Innovative.  Effective frontline service providers can adapt to difficult situations even under pressure.  For employers, this means that employees must be given free reign to decide how to resolve conflicts.  Creativity in customer service is severely limited by company policies that are too restrictive.  Don’t be too quick in punishing an employee who means well.

C – Courteous.  A pleasant demeanor is always welcoming.  Calls are answered politely, and there is an air of friendliness in every engagement.

E – Empathic.  A real professional empathizes with the customer’s needs and sees himself or herself in the position of the customer to meet the customer’s needs.  Personalized attention is provided, and the firm ensures that operating hours and service areas are convenient for every customer and employee.

So don’t be a grouch.  Master the art of interpersonal relations.  It can be the key to success in your chosen career – no matter what industry you’re in.  After all, you wouldn’t want to end up unemployed or bankrupt because you didn’t evolve.  Just ask Eastman Kodak.


Transactional Model of Communication

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"The future belongs to a different kind of person with a different kind of mind."

–  Daniel Pink

An emerging healthcare-related field is something called a medical science liaison or MSL.  The MSL is an expert who has advanced scientific training in the medical field. MSL’s are not sales representatives, and their functions are very different.  The main purpose of the MSL role is to provide scientific data and establish relationships with doctors and Key Opinion Leaders or KOL’s.  T

MSLs were first established when Upjohn Pharmaceuticals saw the need for professionally-trained field staff that would be able to build rapport with people who prescribe their products.  Over the years, pharmaceutical companies have used various names for their roles, including Medical Liaison Officers, Medical Managers, Regional Scientific Mangers, Clinical Liaisons, and Scientific Affairs Managers.

Few people know what an MSL does, and little is written about it.  But it does not rule out an MSL’s significance as a bridge between the Medical Professionals and the non-medical Professionals in business.  Consider some of the roles of the MSL:

1.  Communicates highly scientific concepts while relating them to clinical objectives and business opportunities.

2.  Introduces and builds product and service awareness

3.  Speeds up the time in communicating the value of a product to key opinion leaders

4.  Initiates and maintains relationships with health care customers

As such, the following skills are essential for an MSL:

1.  Business skills.  An MSL must understand the inner workings of the business environment and the different metrics by which his performance will be measured.

2.  Creative skills.  Communicating with thought leaders and non-medical personnel, an MSL must be able to have confidence in his ability to pave the way towards goals that have never been ventured into.

3. Leadership Skills.  Competence and integrity are required to foster trust among an MSL’s clients.  Both are valued traits of a leader.

4.  Intellectual ability.  The credentials of an MSL must reflect a certain expertise.  Being a PhD or an MD is an essential competency.

5.  Communication Skills.  While intelligence is important, even more crucial for the MSL is the ability to deal with people.  This is not learned in school, but it must be developed by the MSL throughout his or her career.

Most hospitals may not be ready to add an MSL to their overhead costs.  However, with the increasing complexity of medical management, most marketing and sales professionals may not be equipped to fully explain the intricacies of the various machines and treatment modalities employed in a hospital.  MSLs can bridge this gap and create the kind of interaction between a hospital and its physicians that will be mutually profitable for  both the administration and its medical professionals.

It may be time for hospitals to learn this concept from the multi-billion dollar pharmaceutical industry.


the human atmosphere

The Human "Aura"

“I didn’t want my body to be opened…I didn’t want to be violated in that way.”

–  Steve Jobs on his decision to pursue alternative treatment

I just read an article which claims that Steve Jobs regretted his decision to undergo alternative medicine treatment for his pancreatic neuroendocrine tumor, which resulted in his death a few weeks ago.  According to Walter Isaacson, who has written a biography on Steve Jobs, by the time the former Apple CEO made a decision to discontinue alternative treatments, the tumor in his pancreas had already spread to surrounding areas.  Thus, from a supposedly good prognosis, his condition deteriorated and proved to be fatal.

The relatively new revolution called Alternative Medicine  has evolved over the past few years.  Just like Steve Jobs, there are individuals who opt to try alternative treatments to cure common and not so common illnesses.  The claim of alternative medicine practitioners is that it is safe and it works. While most people accept that conventional medicine is essential for emergency treatments, some sectors believe mainstream treatment is less effective when it comes to disease prevention, chronic disease management, and even in cancer therapy. These are the realms where alternative medicine is usually practiced, and it has supposedly earned millions of dollars for its business proponents.  In fact, a number of large tertiary hospitals, both public and private, have started to offer alternative medicine services.

So how does alternative medicine claim to differ from allopathic or conventional medicine?

First, alternative medicine practitioners claim that their practice is more holistic, treating patients as a whole individual instead of breaking them down into organ systems.  According to them, too much specialization has crept into allophathic medicine practitioners.

Secondly, alternative medicine says that it is less aggressive in treating disease, which means that it does no rely on a “quick fix” approach.  They claim to rely on more gentle modalities, and allow the body to heal on its own.

Third, some sectors maintain that allopathic medicine is based on too many strict rules.  To some, it seems as if the guidelines of allopathic medicine practitioners cannot be violated or interpreted in any other way, for fear of malpractice suits.

Fourth is the assertion that conventional medicine seemingly views the body as a machine, and most disorders are best treated with drugs. Alternative medicine claims to assert that the body is “a network of channels” involving simple energy transfer mechanisms. Impediments in the flow of energy through these channels lead to ailments, and the goal of the healer is to remove these impediments or “energy flow blockers”.

Lastly, alternative medicine alleges that it is more open to participative and coordinated treatment with patients, while conventional medicine is more paternalistic in approach, with patient opinions not listened to or dismissed as unscientific.

How do we resolve these differences in mind-set?  The key is to incorporate the best characteristics of alternative and allopathic medicine in order to enhance health care.  The ability to establish scientific evidence is a strength of allopathic medicine, but some of its practitioners truly pale in comparison to alternative medicine proponents in terms of patient interaction – the “art” of medicine, so to speak.  By combining the science and art of medical management, incorporating both ideologies into the education of future physicians, an integrated and complementary approach would benefit everyone.  Alternative treatments must be researched in order to establish their effectivity through evidence-based studies.  In turn, conventional medicine practitioners must see the whole person and be more  open to conversation to establish a more trusting relationship with patients and their families.


Extraction of Whale-Oil, image from a 18th cen...

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“The incorrect supposition that we live in a world of scarce resources … has been responsible for wars, revolutions, political strategies, and human suffering of unfathomable proportions.”

–  Paul Zane Pilzer

In the 1800’s, before electricity was invented, the whaling industry provided most of the energy for lighting and heating.  Demand was high for whale byproducts, and it came to a point where whale oil became scarce.  During that time, dire predictions were made about the economy as whale stocks went down.  Just in time, however, an oil well was discovered in the United States, heralding the start of the petroleum industry.  Today, whale oil is rarely used, and commercial whaling is no longer used for energy production.

For the past ten years, petroleum prices have been increasing at alarming proportions.  Doomsayers are saying that once the oil wells dry up, we will have a full-blown energy crisis with dire consequences to the economy.  Must we be scared?  Perhaps.  But looking through the annals of history, I am confident in the creativity and resourcefulness of men.  Sooner or later, new energy sources will be found to supplant petroleum.

Inspite of the scarcity of natural resources, the fact is that our world has adequately accommodated an increasing population.  According to Paul Zane Pilzer, the global population has increased six times over the past 260 years, but the wealth of the world has multiplied 1,700 times over that same period.  Someone Up There has given us unlimited resources.  As stewards of creation, we have been given the ability to master technology and resources for the good of many.

In medicine, the scarcity mindset has sadly been propagated.  Some medical societies limit the clinical practice of doctors in certain areas “in order to preserve the share of the pie”.  This has resulted in monopolistic practices, resulting in the deterioration of medical care.  Competition breeds an upgrading of skills on the part of the clinician.  Without this competition, one becomes complacent and fails to better his or her craft.  The community, left with no choice because of the “monopoly”, is forced to make do with what is available.

Must we be scared of things that take away our share of the pie?  Perhaps we have to analyze our own motives to answer this.  The desire to learn new things may initially be due to selfish reasons.  But in the end, it results in the betterment of society.  Drug manufacturers may initially benefit from patents for new drugs that they create, and they make a lot of money out of it.  But once the patent expires, society stands to benefit more when drug prices go down.  At the same time, this inspires drug manufacturers to do more research and find better cures for prevailing ailments.  Is it intrinsically wrong to allow pharmaceutical companies to have patents on their discoveries?  As long as the competition is healthy and it fosters creativity, the freedom to cash in on one’s intellectual property must be preserved.  It is only when greed overrides the desire to do good that safeguards must be put in place.

The world is an abundant place.  I believe that God wants all of us to be rich.  But money must circulate.  It must be shared.  The ultra-rich people of society have learned this by sharing their wealth with their philanthropic deeds.  Medical knowledge is no different.  It must not be monopolized.  Its quest must be promoted.  And ultimately, it must be shared.


A patient having his blood pressure taken by a...

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After reading my last post on “How to Add Patients to Your Hospital”, Dr. Jet Comia sent me this reply to air his sentiment on the referral system here in the Philippines.  Here was his comment:

Based on my personal experience of running a primary care hospital for the last six years, there is not much support or “gratitude” coming from Tertiary hospital giants. Worst is instead (of) thanking (you for your) referrals, you have a greater chance of getting comments like “This is a wrong diagnosis”, or “The treatment that should have been done is…”, or they don’t even read referrals anymore, and doctors just to win patients would not care to explain the life saving measures you have done. Where is the refer back slip thanking you or (saying) “This is what we’ve done”, etc… Anyway,  I guess doctors, not all of them, once they reached the status of the rich and richer, (are) more concerned (with) the payback fee…So primary care doctors are very much overlooked and ridiculed.

Most of the hospitals who desire to have a higher market share would try to invest in sophisticated machines and employing medical specialists.  They would increase bed capacity and add new services.  They spend a lot on improving brand identity, image, and customer satisfaction.  While there is nothing wrong with these initiatives, the bottom line is this: the general public does not think about which is the best hospital – until disease strikes.  And who do they go to when this happens?  Chances are, most people would choose to go to their trusted primary care physician.

According to an article published in The New Zealand Medical Journal, only 14% prefer to see a specialist first when they need to see a doctor.  This phenomenon does not only happen in the Philippines and New Zealand, but in a good number of other countries as well – even if primary care physicians are not mandated as gatekeepers.*    Thus, for hospitals and specialists, it is crucial to exert effort to maintain an ideal relationship with local primary care physicians.  As a Family Physician and Palliative Care practitioner in a tertiary hospital, I actually get to be a primary care provider and specialty physician at the same time, so I  have an idea on how to work on both ends of the spectrum.

So what must a specialist or a hospital do to attract referrals?  Here are some suggestions.

1.  Treat primary care providers with respect.  Never show superiority of knowledge to a primary care physician when they refer patients.  Instead, view them as partners in the health care continuum so that they would refer more patients to you.  And make it a point, if possible, to teach them and add to their knowledge and competence.

2.  Know the referral practices of primary care physicians.  Find out where and how they practice, and ensure a smooth transition when they send patients to you.

3.  Acknowledge the referrals and provide feedback.  It is unprofessional not to return a referred patient to the primary care provider.  Being rude may put your livelihood at stake.  Word of mouth spreads fast, and you may find yourself staring at the ceiling and salivating at the clinic of the EQ-laden physician or hospital next to you.

Peter Drucker once said that the prime directive of a business is to acquire and keep a customer.  And it is still the referral of the primary care provider that enables specialists and hospitals to succeed.

* Patient Preferences for Care by General Internists and Specialists in the Ambulatory Setting by Lewis, et. al.  J Gen Intern Med. 2000 February; 15(2): 75–83.


Health care systems

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In my last blog, I talked about the “natural history” of hospitals in the country, and whether they are profitable or not.  As a continuation, I’d like to explore the health care delivery system.  Specifically, I would like to expound on how a person seeking medical care ends up in a hospital.  Then I’ll give a suggestion on how to drive traffic towards your hospital.

In the Philippines, 49% of health care spending still comes from out-of-the-pocket expenditures.  Thus a sick patient tries to defer medical consultation for financial reasons.  Let’s say Juan suffers from a severe headache.  Juan will most likely try  to self-medicate initially by purchasing over-the counter drugs.  If that does not work, he might ask his neighbor Pedro, who also suffers from occasional headaches, for tips.  Only when the pain becomes unbearable will Juan seek consultation.

Juan then has several options.  He can go to a hospital on his own and see Dr. Jose Pital.  Or, more likely, he goes to a nearby health center and consults a primary care physician named Dr. Mac Inigo.  It is the latter, which is more likely to happen, for a number of reasons.  First, a health center or clinic is less intimidating.  Second, the consultation fee is often lower than a hospital consultation fee.  And lastly, a primary care physician often spends more time on patients compared to specialists.  Dr. Mac Inigo usually listens to his patients unlike other specialists, according to Pedro.   After reading a blog by Dr. Bernard Lown on the internet saying that we need to retire many specialists and train more primary care physicians, Juan is convinced that Dr. Inigo is the right choice.

This brings me to an important point.  Because most patients would rather go to a primary care practitioner than to a specialist, it is not a good idea to invite too many specialty care physicians while neglecting generalists.  The true driver of dominance in market share among hospitals is the number of primary care physicians affiliated with the hospital.  In the final analysis, it is still the referrals of primary care doctors that will enable hospitals to succeed.  Dr. Inigo will see more patients, refer more patients for utilization of hospital diagnostic tests, and will feed referrals to the other hospital specialists like Dr. Pital.  Therefore, instead of inviting high-profile sub-specialists, it would definitely be wiser to look for the Dr. Inigos in the community and allow them to practice in the hospital, or to at least create a relationship with Dr. Inigo to make your hospital his hospital of choice for referrals.

Is your hospital today geared towards attracting primary care physicians?


Cancer Hospital in final stages of constructio...

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If the success of a business is based on capturing and retaining market share, hospitals and invasive specialty physicians are poorly positioned to do so.

–          Marc D. Halley, MBA

One of the biggest challenges hospital administrators face today is how to increase profit.  People would rather spend their hard-earned money on food, entertainment, or flashy gadgets.  Hospitals are visited only when people get sick.  Is there anything wrong with this general mindset?

Let’s start off with the strategies hospitals do in order to increase their market share.  A small hospital takes off by taking in primary care physicians.  They may do this by selling shares of stock.  As the number of practitioners increase, and with income on the rise, they find the need to acquire more equipment.  This also compels them to attract more specialists to man the equipment.  With these developments, operating costs increase, together with the need to attract more medical practitioners and patients.

A few things may happen after this.  First, the primary care practitioners who initially allowed the hospital to prosper may get displaced by the influx of specialists.  Disgruntled, they may bring their patients elsewhere, and the hospital loses its patients.  This leaves the hospital with unused equipment and specialists without referrals.

Second, patients may become attracted by the hotel-like atmosphere of the hospital.  They decide to try it out.  Bearing a card from a Health Maintenance Organization, they are led to a doctor’s clinic.  A battery of tests are requested.  Seeing that the results are normal, the patient is satisfied that nothing is wrong with him.  So he never returns again, till the next illness or the next executive check-up.  Meantime, the specialists, and the expensive equipment, remain untapped.  After a while, investors are turned off by the low return, and they bring their money elsewhere.

Eventually, the hospital simply relies on its emergency room admissions to recoup its losses.  However, with the ER being a highly chaotic area, no new relationships between the hospitals and its patients are created.  Stress escalates, and dissatisfaction ensues.  When the patient is sent home, he or she tells 5 people, each of whom pass on the negative experience to an increasingly exponential number.  Negative word of mouth propagates.

Finally, with escalating costs and rising inflation, the hospital decides to bite the bullet.  It spends more on PR and marketing, in an effort to attract patients.  It works!  Patients come, the hospital gains its market share, and profits once again.  Then management says: the formula works!  Let’s get more machines!  Let’s attract more specialists!  We’re the toast of the industry!

And they live happily ever after.

Do you agree?

Let’s talk about it on my next post!


It is the age of information and technology.  For health care services, the race is on to grab a share of the market.  Hospitals are also sprouting here and there, trying to attract practitioners to invest, and positioning themselves for the booming population.  I am quite engrossed with the varying strategies of hospitals and clinics to attract customers, ranging from establishing the expertise of its staff to showcasing its equipment and facilities.  However, with scarce resources, it would be difficult to have a good return of investment from traditional marketing.  What then could be done to acquire market share without spending too much?

One cost-effective strategy that can be used is word of mouth marketing.  With the widespread use of social media sites, positive or negative comments regarding products and services can spread readily.  There is the belief that word of mouth can be generated by painstaking interior design of buildings and offices, procurement of cutting-edge technologies, or employing rock-star executives to jumpstart sales.  While these could create interest in the short term, sustaining the gains consistently for years is another story.  Just think about it: are you inclined to be a rabid fan of a service whose only claim to fame is based on a beautiful office, a brand-new costly machine, or a well-known personality?

One aspect that is often neglected in order to generate good word of mouth is the interpersonal experience of customers with employees.  While most firms recognize the value of customer service, they fail to do more than creating systems and process flows to minimize and address customer complaints.  Some executives even say that if only they could automate and control their staff, business would soar.  This may be good for manufacturing firms, but never for health care services.  The sad part is that the culture in most health care firms is passive-aggressive, and this translates to below par satisfaction ratings(1).  Is there anything that our leaders from the health care industry can do to reverse this trend?

In order to delight patients on a consistent basis, we must make sure that the health care staff are truly happy and delighted to serve.  This positive culture starts from the firm’s leaders.  If a leader shows that service is more important than profit and demonstrates it through action, employees will be inspired to follow.  It is also important to employ people who are not only competent in their field, but also show high empathy scores.  Once the ideal person is identified, all effort must be exerted to keep him or her happy and satisfied.  Though this may be easier said than done, the effort is worth it.  After all, the competition is fierce.  And in the final analysis, a dedicated and service-oriented work force is something that cannot easily be copied or cloned.



Cover of "Extraordinary Measures"

Cover of Extraordinary Measures

The pill. Most people consider it as a life-saving substance. Ask any patient who comes to a physician with a symptomatic complaint, and 9 out of 10 times, the doctor would be inclined to prescribe at least one drug. Sadly, more often than not, symptoms disappear spontaneously without taking a drug. So why do we always expect a prescription each time we come to a clinic for medical treatment?

In the film “Extraordinary Measures”, the circumstances behind therapeutic drug development is elucidated and exposed in an interesting narrative. It takes money, not just smarts and research acumen, in order to formulate a new drug. The best ideas may never come to fruition because manufacturing the drug may not bring with it the return on investment that would make it economically worthwhile. We are a society that is too dependent on businessmen – from our politics to the products we apply and take into our bodies – and thus we become manipulated as such.

Drugs are meant to reverse an acute situation. All of them are xenobiotics – foreign substances that must not remain in our system for a considerable period of time. No matter how convincing research findings are about the efficacy and safety of the pill, never discount the possibility of the drug being marketed for the fattening of one’s pocket. Don’t get me wrong – I believe in research and the inherent goodness of scientific discovery. As a matter of fact, I know that a lot of today’s drugs prescribed by doctors are truly life-saving. However, when economics starts to come into the picture, facts can be altered to favor the desire for profit. And I am particularly cynical about medications that are being hyped as “miracle cures” that need to be taken for life. I’d rather push for lifestyle modifications, knowing that they will establish permanence in one’s routine and provide more positive outcomes long-term.

So the next time someone prescribes you a drug to take for a lifetime, try to figure out whether it is truly a magic pill – or someone is just trying to play magic tricks on your finances. With the internet at your disposal, all information is just around the corner. While doctors know best, it’s still your body at stake. You wouldn’t want to be victimized, would you?