Category Archives: Business

The Lean Startup Conference 2018 – Las Vegas

We came to the startup movement through Steve Blank: he really has it canned, this how to build a business from nothing. It is almost like it is too easy, except he does tell you, whatever else you do, starting a business to scale will probably be the hardest endeavour you can ever do, and by the way, coming from a dysfunctional family helps if you are going to be a founder. In fact in a panel discussion at the 2018 Lean Startup Conference in Las Vegas, Eric Ries the author of the bestseller The Lean Startup expressed his wish that if he could do it all over again, he would have not made it sound too easy, which has become an entry point of criticism for the book in recent years, especially now that corporate America is trying to implement and learn from Ries and his team.

Eric Ries’ The Lean Startup book and company we can say are the crystallization of Steve Blank’s initial ideas as taught in his classroom and initial blog essays, combining it with the engineering methods and management systems of Toyota, thus transforming the concepts and anecdotes to a combination of Steve Blank and Toyota into a digestible language that has graduated into the world to consultants and annual conferences.

First off, in spite of the criticism the Lean Startup concepts and simplifications have received in recent years, our company is a testament that the ideas of Steve Blank, and the iterations of his ideas in the works of people like Eric Ries do work. We of course are no brand name in the startup movements that have sprouted all over the world in the last decade, especially those that have emerged from Silicon Valley. But we have grown from our beginnings of just starting as a scrappy two-people team, to a health care trading company contributing to health care solutions in the Philippines. Nearing our one-decade birthday anniversary in the market, to pull back and understand startups, to be reminded of our roots, to also take a break from the intensity of work for eight years: we decided to join the Lean Startup Conference in Las Vegas.

Largely, the venue of having it on the Zappos Campus is very interesting, because startup movements are always seen to be innovations in technology, and Zappos is a testament that innovations can come from business models, service orientation, to management styles. Zappos is the largest company to practice holocracy, which we find to be too utopian but nevertheless seems to be working for this Amazon subsidiary.

The conference did not disappoint: the plenary sessions were mostly of very high quality, and the breakout sessions we thought were revealing of the limits of the Lean Startup concepts when extended to philanthropy or big business. GE previously was touted to be the company that was using the Lean Startup methodologies, and the difference of just two years in the covers of Bloomberg below should be enough to summarize what had happened in 24 months since celebrating the transformation of GE to some kind of a Lean-agile-digital company.

March 21, 2016 Bloomberg cover versus February 18, 2018 cover

The big incentive for us to travel was also Reid Hoffman being part of the culminating plenary session, and he had approached business ideas previously with his background in philosophy, and his success in business and philanthropy made him a much sought-after speaker.

So with what Steve Blank’s ideas have contributed to our start and growth (we got to meet him and even had him autograph a book in 2016), thus the interest in Lean as a concept, Reid Hoffman attending to join a discussion on blitz scaling, and going to Las Vegas to visit Zappos: we were on our way.

Reid Hoffman is too big, and too present in youtube, to be interesting because what he said in the conference is basically out there already. And since he is a certified billionaire, he is likely very calculated in public discussions. This was all confirmed in seeing and listening to Hoffman on the last day of the conference. But in conferences like this, it is not the big name one is likely familiar with that makes attendance worth the effort. The discovery of new names not in our radar is really what makes these conferences worth the trip.

What we said about Reid Hoffman we can say the same about Tony Hsieh, what he had to say had been said by him many times, and easily can be found on the web, in articles and videos.

Hands down, Holly Liu was the best speaker for us, plus an education on the world of online games. She was articulate, staggering in achievement, and generous with her ideas. In fact, listening to her explained to us the weak breakout sessions or even one of the weaker plenary sessions. She basically says that there are abilities and ingredients to innovate and disrupt that are unique to startups. Some of the reasons are: nobody cares about your startup, nobody knows or likes your startup. This frees you up to be sharp, to be adventurous, and to dare to be different and exciting to rise above the rest. She did not exactly say large companies are hopeless in the areas of innovation and disruption, but that somehow the outlook will be different, or the ingredients just cannot be duplicated, and by implication, likely will need a whole different set of ingredients. In breakout sessions of the people in government who are currently tasked to bring in the spirit of the Lean Startup movement into these mammoth organizations, one does hear some of the speakers say they were hired because they did a startup and failed, so one qualification was they have tried out the startup world. There is much that has been said of being unafraid to fail in Silicon Valley, but the ability and the experience of those who have succeeded, like Holly Liu, are the reasons the gravitas to talk about innovation and persistence amidst the sea of failures is so convincing and more importantly, realistic.

Holly Liu in the conference

The other great speakers were Matt Johnson of the Frontier Project and Stephen Robert Morse of Observatory, on the importance of a compelling story, even biological and psychological reactions to it were discussed, with a powerful preview of a possible Netflix project by Morse on Colin Kaepernick. Liz Jackson of The Disabled List (she was even more compelling here than in New York last year with her 99U talk on design as she argued not for design this time, but for how business is doing it all wrong in approaching this segment of the market). Joel Spolsky of Stack Overflow did not only have a great story of making it in the world of online business, but more importantly he talked about countering a web business that monetizes what should be an online space that allows programmers to have a free and open discussion to help each other. In short, not everything should be monetized in the web, even if it is possible to monetize it: and Silicon Valley is under the microscope these days precisely because of this issue (Facebook is monetizing you).

The discussion titled Lean Startup Where You Least Expect It was well moderated by Hisham Ibrahim, and the founders Malcolm Handley of Strong Atomics, Jaya Rao of Molekule, Greg Piefer of Shine, and Claudia Recchi of EdSights were all articulate, and have been going through the hoops of running a startup. These are founders who are beginning or have attracted funding, but are still grappling with issues of how to scale. You could see and hear their passion and struggle to get not only proof of concept, but beyond, the struggle to scale in the area of nuclear fusion to software to help universities track students at risk of dropping out. This is in contrast to the Real-World Lessons in Scaling Innovation Inside Large Enterprises with Keith Berry of Moody Analytics, John Buhl of Liguori Innovation, Julie Foy of Proctor and Gamble, Jean Vernor of Munich Reinsurance America, and Lisha Davis of Vanguard. The most memorable anecdote here was how Procter and Gamble innovated with what is a leading sub-category product in the diaper category: the environmentally friendly disposable diaper, which is certainly important, but also maybe says a lot about the limits of what is possible in giants like Procter and Gamble, which certainly is known globally to aggressively recruit some of the best talent available out there, but is also being questioned in media outlets for how competition from smaller companies may be beating it in the area of innovation and in delighting customers.

Forms were given to those who wanted some time with Eric Ries, founder of the Lean Startup Conference. It was told to us that those who will get some time with him will be announced, but no announcement ever came, so some of us wondered if this did push through. Our question written in the form was: How do we bring this to the Philippines? It was a shot at having the Lean Startup team really connected to Philippine giant companies (with paid fees of course, and we would have helped in the legwork to get them connected), and to the small but real startup scene in the Philippines. Telecom conglomerate PLDT for example had Guy Kawasaki previously, and we think other conglomerates are also trying to understand the startup DNA. Metro Pacific and Ayala Corporation both have startup funding ventures looking for the next Alibaba. It will not be as exciting as say trying out the methodology and the Lean Startup team in say Procter and Gamble, or even GE for that matter: but with the efforts in non-profit, I think to launch this in a Third World country, in Asia, will add to the coffers and glamour and usefulness of the Lean Startup ideas, extend concepts, ignite new movements. But the Lean Startup team will need to be willing to see this market as worthy of its time (China and its cities like Shenzhen should be disqualified from the Third World category), as it tries to extend its influence way beyond the Startup world of say San Francisco, New York, and Berlin. The future of this movement and the Lean Startup team of Eric Ries can be found outside the centers of startups and innovation.

A full disclosure: we got to attend simply out of the kindness of the Lean Startup Conference rules, that allow participants who find the fees too prohibitive to go at a much reduced rate in exchange for a blog review of the conference. The conference is worth the trip and the time for anyone who wants to know how people are using, innovating, extending the Lean Startup concepts. Eric Ries did proudly say at the beginning that this conference had none of the PR-machine-polished talks, and except for two of the biggest names that had the feel of a PR polisher having done work already long ago, Ries was largely correct, and this made the weaker parts of the breakout conferences all the more obvious, but at the same time it was what made the strong plenary sessions so fresh and compelling.

Interview: Arturo Dela Pena, MD (Surgeon, Administrator, Educator, Academic)


Arturo Dela Pena, MD is the Medical Director of St. Luke’s Global City. He is a man of many hats, being an active surgeon, administrator, academic, and educator. Contrary to the serious demeanor, it always does not take long for him to crack a joke. Yet, underneath the good humor, the man is complex in a positive and interesting way: you enter his room and on his table is a Michael Cacnio sculpture of an anonymous every day man kneeling and kissing the ground to give respect to a crown of thorns. He has Ricardo Semblar’s book Maverick, which is on the radical transformation of a company in Brazil, also on his table, and this is for Dela Pena the management man. Yet under the book is The Teaching of Buddha, and only a pile of papers separate Facility Management and Safety Manual and the book Moments with God, together with the latest bulletin and journals of his medical specialty. This self-professed fan of Rod Stewart and the Beatles is deadly serious when talking about medicine and St. Luke’s Global City.

You wear many hats: educator, administrator, surgeon, academic. Which one is the more prominent one right now?

The answer of course is administration takes up most of my time, and as a consequence I have to cut down on my clinical practice, yet I cannot say it is less prominent in my life, because I give the same time to each of the patient, and without a clinical practice, I will not be in touch with the patient, which is important to my work as an administrator, and without my role as an educator in PGH, I will not be up-to-date not only with what is happening in my field, which is rapidly changing, but I will also not be up-to-date as to the kind of residents and training they are getting . The explosion of data is just incredible, and if you are teaching in front of these young people, you just have to digest the data in a way that you are unlikely to do unless you are there in front of them. All these hats are important, and I cannot say one is less over the other, as administration must constantly be informed by all these.

Yet in research, which is very important, and I am involved with the team of Dr. Adriano Laudico, I cannot say my involvement now is significant, unfortunately. But let me say Dr. Laudico and his team are doing good and significant research on the relation of female hormones to breast cancer. That is the advantage of the younger generation physicians is their training recognizes the importance of this integration of the many aspects that make a good physician. Their academic subjects even in freshman medicine are already being connected to the clinical practice. I have a daughter in 2nd year medicine, so I can see the difference.

What do you tell your daughter who is a doctor? What is the most important thing that you tell your residents that will make them good doctors?

I tell them to learn from the patient: see the patient for what is actually there. Do not just have preconceived notions of what should be or what is said in the book. This is what distinguishes a good clinician from the rest. My father is a farmer, and it is my great misfortune that I did not keep the brown bags he was sending me with his notations about his referrals. He would write in Filipino, for example, “Arturo, apologies, but this patient is asking for help. Please help and see what you can do, as she is complaining about excessive bleeding.” Later on he will ask me what was wrong with the patient, and I will say it was ectopic pregnancy. After many people have come to me through him with his brown paper bag notations, his notation would suddenly say: “This patient is having problem with excessive bleeding, please see if she needs a D & C immediately.” For some patients, later, he will have a note like; “Please see if this is appendix, and it might explode soon.” So I keep telling young doctors, keep examining patients, no matter even if you think it is a simple case of pneumonia, because the more patterns you see, the better off you are in seeing patterns, and yet you also learn that solely relying on patterns is not good, as you also learn that each patient is unique.

How did a son of a farmer become the Medical Director of St. Luke’s Global City, become a leading educator and surgeon?

You know, I recall it now and I still get goose bumps. I remember helping my father in getting copra in Talisay, Batangas, when I was a boy and I tripped: I literally found myself falling face down on horse manure. I remember the anger I had because my father could not stop laughing at me. I was so angry and crying, I said he should not laugh at me. My father said, and I still remember this very clearly, when he said: “Arturo, if you do not study hard, you will just be like me and you will have to work with manure. If you do not want to be like me, only by doing well in school can you become different from me. Or else you will be like me, and your son will be like you.” You know, that turned my life around, and I am convinced, if my father had the privilege of having studied all the way in school, he would have been a great intellectual.

Thankfully you were still able to study in FEU for medicine. How were you able to afford it?

I got to use the education benefits that my father had because he was a guerrilla during the war. My father had a town mate who was the college secretary of FEU and so we decided I should go there. The youngest sister of my father also married a lawyer, and they helped and housed me. They were my parents here in Manila.

What is exciting you in the medical profession right now?

Everything excites me. The opportunities in medicine right now are quantitatively and qualitatively very different from when I was a young surgeon. We are now in a position to improve patient care.

So this is the about the generational change in leadership?

Yes and no. Yes, Dr. Edgardo Cortez our President and CEO is a real visionary. He is really implementing brave and innovative changes in the hospital. But aside from the generational shift, there is more competition, so everybody has to shape up, at the same time there is more data available, so there are real metrics from which you could measure the performance of an organization. This is all changing medicine and hospital administration in the country, all to the betterment of the patient.

Yet it is not just the generation shift in leadership that excites me. The developments in medicine, the speed at which we are beginning to understand diseases, it is astounding. The time may really come when we can predict diseases in a person long before any manifestation is apparent.

There are those who are saying, the competition, due to the entry of conglomerates in the hospital business, are also escalating prices for the patients. What do you think?

Yes, that is true, they are escalating their prices, because they are in health care for profit. That is fine, but also, because you want them to put money in health care to improve health care. Yet we also realize, doctors’ owned hospitals, non-profits, religious-owned hospitals, public hospitals, they also provide another vision of health care, not just the bottom line and excellent service, and I am proud and happy with St. Luke’s Global in that our vision is not just profit, although I have to say, any hospital that is not profitable, except for a government hospital, is not sustainable as the expenses are big and constant. Doctors have, I would like to believe, a different take on running a hospital, compared to, for example, a finance man, or a banker. We have I think over a thousand nurses here in St. Luke’s Global, because we have to allocate a certain number for many departments and functions for three shifts, and you also have to have a backup for the holidays and leaves that are part of the package for employment in a hospital. If you are not profitable as a hospital, it will not take long for you to close down. To say we give the highest standard of care is very easy to say, but many ingredients come into play when you want that to be a reality, from doctors, to geographic location, to the culture of the country. Finance is a big part of that mix as well, we have to admit.

Speaking of location, how are we compared to for example the United States in terms of health care?

Well, it is the most expensive health care system, and we should have learned by now that expensive doesn’t necessarily equate to quality, especially in relation to health care. It is not a question of money for me, because even if you have all the money in the world, are you using it efficiently, wisely, and logically? Because of defensive medicine in the United States, where they ask you to take a battery of test just to protect themselves from lawsuits, when in actuality you do not need the test, it is not necessarily good for you, never mind the waste in your finances. You requests these test for academic reasons? Yes, if there is a reason, but academic reason is vague and has been a blanket rational to just getting the patient to go through all the diagnostic equipment available and I don’t agree with that.

Now going back to your question about going to the United States for your health care; unfortunately health care is not like building a bridge where engineering can compute for you up to the last bag of cement that will be used. The hospital you can standardize the process, the physicians let us say we can even standardize the quality, but the patient, each patient is different from another, and how that disease will develop or evolve you cannot predict with standardization. Maybe you can predict 85 percent of the patients, but how will you know your patient is the 85 percent? For example, you can operate on a patient for breast cancer, and in your research you can do comparisons based on age, economic standing, and yet not all of them will fall into the data; yet your patient is not only not a statistic, but you don’t know which part of the statistic she falls into. Of course if the statistic says the survival rate is this, it doesn’t also mean you will die of cancer. You may die of something earlier or later for a reason totally not related to cancer that you have, so I will study the data, but I will be careful in extrapolating conclusions from the data.

The simple standard should be: there should be the same standard care you get, in the best hospitals in the United States and in the best hospitals in the Philippines, except their culture is very different from our culture. For example, in many clinics or doctor offices, you cannot just show up without an appointment. For example, our hospitals are adjusted to our culture in accommodating watchers or relatives staying overnight with the patient. In many private hospitals, we have the facilities, up to a common pantry that watchers or relatives find useful.

No doubt the United States has one of the most cost ineffective systems of health care, but with the case-rate payment scheme, it is shifting to an opposite extreme in reaction to the excesses of the past, and this has an impact on the decisions of many medical doctors. The most important is what is necessary for you to get well, and I am worried doctors may begin deciding on what is only possible based on your case rate.

Steve Jobs: did his wealth and access to the cutting –edge treatments extend his life?

Maybe. But I really don’t know the specific treatment. Difficult to answer: what measurements do you use as to the reactions of his immune system to the disease or the drugs? How can you quantify this? I know it is not a simple adenocarcinoma of the pancreas, it might be some slow acting tumor, since a neuroendocrine tumor is slower. Is it secondary to the treatment that he received? We don’t know. There is a lead time bias that is important. The latest issue of Time magazine , there is a mention about ductal carcinoma in situ ( DCIS )where it used to be treated with radiation and a removal of the breast, now no treatment is being advised, because it is now seen to be only a premalignant lesion. The disease process now is better understood, and that is also what I meant earlier that the opportunities in understanding of diseases are simply different now, and as a result better treatments are also improving rapidly.

What have you realized now as an administrator you did not know as a doctor?

When you are not part of administration, sometimes you just think of your needs, so you request for the best and latest and most branded equipment, not realizing the fact that the hospital has to spread out its income to many other needs and expenses. Running operations means more than just toys for doctors. Running a hospital also means running things efficiently and as economically as possible without compromising on the patient’s health. And this again is where metrics for service, finance, treatment outcomes all come into play.

Are you saying we have the data?

We will get there. The CEO of St. Luke’s, Dr. Cortez, made a decision of acquiring a data gathering system that will put the data in our hands. We have been going around the world looking for the best system, and we are beginning to narrow it down to only a few vendors. Of course having the best and most accurate data gathering software doesn’t mean anything if it’s too complex or tedious, then we won’t get the cooperation of doctors and nurses, and the whole thing becomes useless. We already tried to do it ourselves and to develop our operating systems, but you realize, the best hospitals and system developers took 20 or 30 years to finally get it right, so you go out and try to find a well-developed system that you can purchase.

Who are the most influential doctors in your career?

Dr. Antonio Limson and Dr. Adriano Laudico, who I always call the best chairman we never had. He was a visionary, like Dr. Limson. They had the vision to develop sub specializations in our field. They sent me to Toranomon Hospital for further studies. Of course in a way I have the best of both worlds, because PGH has the research and training, but there are limitations as well; and the opposite is what we have here in St. Luke’s, which has the private sector need for optimum efficiency, speed, and cutting-edge equipment.

Maybe this is changing? PGH has a big budget for equipment purchases.

I am not sure if a big budget necessarily equates with using your budget efficiently. In the area of purchasing for example, usually government hospitals allocate funds on the basis of democracy, when the more efficient way really is to define your strategic objective as an organization, have the whole organization buy into the vision of the leadership, and the purchases will be based on that strategic objective. I am not sure if you can run PGH on the basis of getting a wide consensus as to strategic objectives. This is not about democracy. Before you can do all that, you have to know your core competence, and you must know where you want to distinguish yourself as an organization. Strategic intent is the most basic for management to decide on purchases. But no doubt PGH has a very strong faculty.

I guess the next question will have to be what distinguishes St. Luke’s from the rest?

The leadership. The President and CEO here, Dr. Cortez, is a real innovator, and his direction is towards building a culture where people can be creative in solving problems. We have invested, through his efforts, on something that changes the treatment and chances of anyone who comes to us with ovarian cancer. Adenocarcinoma of the ovary, for example, we do chemotherapy intraoperatively, heat it up to 42 degrees and we find that the survival rate increases. Many hospitals are looking to wet lab and animal labs, but we went to Israel and bought a simulation system that helps our doctors have more opportunities in training. We are into robotics now as well.

How do you deal with death as a medical doctor?

With the patients, I think it should always be with sincere empathy, and with honesty. I have experienced the loss of my only son when he was only 21 years old, and experiencing something like that changes you in very definite ways: it is never the same anymore after something like that.

It is cruel for a doctor to give people a false sense of hope. It is unethical and immoral. One of my most memorable patients was brought to me by a friend. She comes from one of the rich families in the country. When I saw her, from her workup, I knew she had advanced liver cancer. I gave her the objective clinical diagnosis. She was stunned. She asked for her chances, and I told her the truth that short of a miracle, she did not likely have a lot of time in this world anymore. She thanked me. She said she was wondering why she was not getting well and all doctors were telling her she had this or that, like diagnosing her with hepatitis: nobody wanted to tell her the truth. So, after seeing me, she made her plan to go Lourdes in France, and she asked me for the necessary medical certificates, and she made her pilgrimage, made side trips to relatives living abroad. In fact I remember she asked me what she could get me in her trip to Europe, and I jokingly said one of those famous shirts that has a crocodile as its trademark. That was July. December, on a Friday, on her birthday, she kept calling me because I was the guest of honor for her birthday party, but I was too busy. That was the last time I had talked to her. March she was brought to the hospital for hepatic coma and she died. After two weeks, her two kids came to visit me. They informed I was in her last will and testament: it said that as long as they can afford it, I would get 12 Lacoste shirts every year. I started getting them every December, because she knew December is my birth month, and in fact, I still get them but I had to request, if they insist on giving me the shirts, they do it bi-annually or quarterly, so I don’t end up with the same sets of shirts every year.

Are you religious? You have spiritual books here on your table?

I came from a Catholic family and went to questioning the existence of God and becoming rebellious and wanting immediate social change, and I believe I have come full circle. I have come to believe that when there are no answers to questions, the answers maybe with something higher than us.

What books have you enjoyed that you would like to share with our readers?

Few people can write with social science data like Malcolm Gladwell. I have read Blink, Tipping Point, What the Dog Saw, Outliers. I would encourage people to read him. The very interesting book I always remember is by Captain Michael Abrakoff. His first book is It’s Your Ship, and he relates how he turned one of the worst-ranked US navy ships to become the top ship in the navy in efficiency, cost control, gunnery score in his two years of commanding the ship. It is an amazing book, on how he got feedback from the sailors on how to avoid the rusting of the metal, and he implemented it, and because of that, it meant less time for people devoted to repainting the ship and the time was allocated for some more productive endeavours. It is a simple management book but very good. I am looking forward to this book on my table, Maverick by Ricardo Sembler. It is another leadership book.

Are you a maverick?

No, I don’t think so. I would like to believe my leadership style is to always work within the rules. I think a maverick goes outside the rules. But more than anything, I hope to be remembered as a doer, that I do things that are assigned to me. That I get things done, and not just talk about them.

What is your definition of a good leader?

A good leader must first be a good follower. A good leader must be able to motivate people to get things done and to aim for higher things.

What we give our clients/partners

We mean the title of this entry in two ways: we are giving out books all the time to our friends (most of our clients are considered good friends, or serious business partners; or both). Below is a photo of a stack of the book Antifragile by Nassim Taleb, which is our gift book of choice for 2015. It is a good book, if only for its concept; even if it can be repetative towards the 2nd half of the book. We are giving this particular title to our friends because we want to give our friends the great idea of antifragility: the ability to gain from and not be disturbed by the shocks and surprises (black swans) life or the world will inevitably keep throwing at us. This is something we are very proud of: as much as possible, we only deal with a small set of clients, but we make sure their doing business with us will mean we will try our best to serve them beyond medical equipment, we are here to help them thrive, solve problems, and even make the world better. What a grand claim: but we can refer to our clients, big and small in their respective industries, to say we live this company philosophy. And our small gift of this book is a tiny example of our vision of ourselves as a corporate citizen.


The Sunshine Act

Below is a short brief description of the so-called Sunshine Act, which we got from a website of a pharmaceutical company. We have had several discussions in our company about this, and the issue of payoffs and gifts in the market place. Being in the Philippines and a Filipino company, we are exempted from the Sunshine Act so far. But yesterday, once again, we reminded our team that we are in a special industry, and as a company, we recognize and are reminded of our responsibilities to the many stakeholders of the medical equipment industry. We gave the Sunshine Act some time in our discussions. Our deep commitment to ethics and professionalism continues, and we commit to build on this as part of who we are.

Beginning August 1, 2013, the Physician Payments Sunshine Act (the “Sunshine Act”), which is part of the Affordable Care Act, requires manufacturers of drugs, medical devices, and biologicals that participate in U.S. federal health care programs to track and then report certain payments and items of value given to U.S. physicians and U.S. teaching hospitals (defined as “Covered Recipients”).
The Sunshine Act requires that manufacturers collect this information on a yearly basis and then report it to Centers for Medicare & Medicaid Services (“CMS”) by the 90th day of each subsequent year. On June 30th of each year, CMS will post the reported payments and other transfers of value on its public website. For the initial year of 2013, the collection time period is August 1, 2013 through December 31, 2013, with a reporting deadline of March 31, 2014 (extended to June 30, 2013). CMS has stated it will post the data reported for 2013 on its public website on September 30, 2014. Best creative/design/book site

For people into issues of design, creativity, books (or even the very issue of the survival of physical books), Designers and Books is the best site to visit, and visit and patronize regularly. We are not much of designers in our company, as we are really a management and trading and medical equipment company; but we are aware of the importance of the concept and execution of design, not just in designing objects, but in designing as an overall concept for management and life. The sheer strength of this site is that it has top people involved in design (fashion, furniture, architecture, interior) listing their favorite books that they generously share for the curious or the fan or the just driven to learn. Okay, those out to change the world will also benefit from a visit to this site.
A small interesting fact is there are hardly any management books in the over one thousand books recommended by these high achievers. Having looked at hundreds of the recommendations, I only can recall Peter Drucker’s Innovation and Entrepreneurship as a classic business book which made the master list (from industrial designer Tim Brown), which tends to affirm the dubious usefulness of business books as being helpful to people out there trying to set up innovative enterprises. Not surprisingly, books about building or designing classics like bicycles and violins have made the reading list of many people. Yet imaginative literature, or fiction, are all over the site and James Joyce’s Ulysses and Italo Calvino’s Invisible Cities being the most cited; and our personal favorites, Herman Melville’s Moby Dick and Nabokov’s hilarious Lolita are there as well (gratifying and flattering those of us in the company who majored in literature, not the more fashionable design or fine arts, in college). This tends to affirm our belief, spoken of as well by Michael Eisner (former CEO of Disney), that literature (novels, short stories, plays) are essential to feeding the human imagination to create, innovate, and interact with and in the world.
Books are in a precarious time these days, if we are to believe many who have declared the death of books as we know it; but for those of us who believe that print is still very much viable, which the recent issue of the Economist (October 11, 2014) shows is making a strong comeback for publishers in terms of income, this site is an incredible resource, a delight to visit, and we can only hope it thrives without having or needing to be acquired by Amazon or some such giant, whose love for books is at best questionable (no matter how innovative they are). We definitely, even if we have never won its regular book lottery (which we admittedly have), love Designers and Books. Visit the site, learn, and be affirmed that intense creativity is happening all around us. We can even contribute to that great human endeavor, and this site encourages that kind of magical thinking. Congratulations to its editor Steven Kroeter and his incredible team.

Filmbox: a bad business model


Filmbox, which you can find in smart TVs like Samsung, will offer you a few days free trial only to reveal later on in your credit card that the few days free is actually an additional free days from what you already bought.There is no free trial. Such marketing strategy to get one’s $5 USD guarantees this company won’t amount to much in customer-service. You inquire about it, and there is no response. This is an important reminder to us that: We in Sunfu Solutions, Inc. commit to NEVER do deceptive advertising.

Interview: Vicente Santos, Jr., MD (Ophthalmologist, Educator, Administrator)


Dr. Vicente Santos, Jr. is an ophthalmologist, president of Fatima Medical Center, educator and board member of Fatima University. No doubt he, together with his family, is a major force in the field of medicine in the Philippines, as a clinician, educator, and businessman.

You wear many hats in your group, which one do you enjoy the most?

First and foremost I am an ophthalmologist, but I enjoy all of them: I like teaching the undergraduates, the medical students. I enjoy doing strategic planning with our management team.

What is exciting you in your field right now?

I just got certified to do a procedure called SMILE, which is an acronym for Small Incision Lenticule Extraction, which is a technology that doesn’t, unlike Lasik, use a blade. Unlike Lasik, this procedure doesn’t need to open the corneal flap. I think there are around six of us certified, five in St. Luke’s Global, their refractive crew, and myself here in Fatima. This has been done 80,000 times already, so it is a pretty stable procedure.

Why should a layman be interested in this procedure?

20 million procedures have been done for Lasik, so it is a work horse in ophthalmology. The risk is minimal, but you also use a blade. A flap or blade complication is possible, even if remote, in Lasik, and this is not there in SMILE. But of course there is no such thing as there is no risk.

How old Fatima?

47 years.

How are you and your siblings different from your parents in managing Fatima?

We are more structured, more objective in our metrics. My parents relied on many things that were more subjective, like relationships, friendships, gut feel. We have professionalized the organization significantly, as a way not only of surviving, but of moving up and improving. We pushed the organization to go through certifications and accreditations. Although of course compared to us, our parents were much more hardworking and driven. Our family lived in the hospital for two or three years, precisely because they were that focused and dedicated, aside from the fact that it was at that time, during the construction phase our house was torn down to build the nursing school, and our ancestral home was being reconstructed.

Nursing as a college major, and the number of unemployed nurses have become problems in our country. You have seen it from both ends as a school that produces nurses, and as a hospital that employs them. What do you think should be done to solve this problem?

I think what the government did is correct: they put a moratorium on new nursing schools. During the peak of the wave of people enrolling in nursing schools, it was almost like people were putting a nursing school in their garage or anywhere they can set up one. That is happily not there anymore. Many have closed down. Enrollment fads come in waves, and there will be a next wave. There was a wave in the 1970s and 2000. There will be another surge because of the population growth, the opening again of opportunities in the First World.

Being a doctor and a hospital administrator: how do you assess Philhealth?

They are very reliable. The various complications in reimbursements are there, but I should say Philhealth is very reliable. We in ophthalmology are paid pretty well, I mean relatively well. For this reason, some have approached their practice by going for volume, while others have wanted to maintain a very high quality, disregarding the volume. But if you are a patient, Philhealth is willing to take care of your needs up to P16,000.00. That is not a small amount, and so hospitals and doctors give it importance.

What would you wish for Philippine health care if you could make a wish?

I would like to see more hospitals built outside Metro Manila. There are still many places that are underserved. Of course I also wish for the same quality that we have here in Manila to be the same all over the country. The WHO recommendation is for 15 beds per 100,000 people, we only have 5 beds for 100,000 people, so even if you double our current number, we are still far from the ideal.

Manuel V. Pangilinan’s group has been buying hospitals and many seem to be ready to put out the welcome mat to sell to them. Are you ready for them? How do you see them?

At the level of competition, of course it keeps everyone on their toes, and that is good. If your question is if we are going to sell out, the answer is no. Maybe for partnerships we are open, but definitely to sell out we are not open as we have worked very hard for years to build Fatima, we won’t just let it go. One can look at them as a threat, and of course that is true; but if we look at the vision, and if the vision of everyone is quality health care, then the threat may be overblown, because as I said, there is a shortage of hospitals and there is actually room for more, but of course we mean there is more room for quality services and quality hospitals, I don’t just mean an increase in number of beds.

Is the quality of human resources a problem? I am interested in knowing your views on this, again because you are in the education of the human resources side of health care, and with the hospital end you are employing these graduates.

Migration is of course a major problem. As soon as a person gets certified, meaning they can already do things at the level above the usual average, they leave or get pirated immediately. Then you start the retraining all over again. We are not just talking about nurses, but the whole spectrum of hospital people, medtechs, laboratory technicians, radtechs, everyone, even doctors. Happily, enrollment for medical doctors is up, there is a surge, and that is good news for medical schools, it is good news for the country, good as well for the global health industry, as it ensures continuity in the entry of doctors in the industry.

Your sub-specialization is retina. How are we in the Philippines compared to other countries?

No doubt we are at par with the best in the world.

What is your vision for Fatima?

We did announce that we hope to build a 150-bed hospital in Antipolo. We are looking for opportunities outside Metro Manila, we want a presence in South Luzon. Maybe even down in the Visayas. We hope for more expansion in the future.

Are the graduates of our high school system improving? You meet the intake of your school on a regular basis.

Yes, I think they are improving and there are a lot of efforts to improve the system. K-12 is a big move, and I think an important move. This is a very concrete move, and quite a sacrifice for colleges and universities, as our population of students would go down by as much as 50 percent for maybe four years. Information is also easily accessible now, and I think it can only help us as a nation to become better, to keep improving.

Who are the biggest influences on you as a doctor?

Dr. Mario Aquino for ophthalmology and Dr. Pearl Tamesis Villalon for retina. These were my mentors in St. Luke’s, and they were really great teachers, not just great doctors. In UERM the list is long, there is Dr. Joven Cuanang, there is Dr. Romeo Divinagracia; the names will be endless if I have to list each of them down.

What will surprise people about running a hospital?

I am not sure if there is anything that will surprise people about running a hospital: there is of course the possibility of making a decent profit, but there is also a large amount of spending to be done on a constant basis. One must be able to balance both in order to do well, and one has to manage the hospital well in order to achieve stability and income. There are a few groups getting money from doctors to put up a hospital, but some have failed to factor in the need for quality equipment, which is also very important.

What do you do outside medicine and management?

I like joining marathons and golf.

Which marathon have you joined that is most challenging?

I have joined the Lu Marathan du Medoc in the Bordeaux region of France, which is quite a challenge. This is a 42 kilometer run, and you have 21 stops where you have to drink wine and water. It was a lot of fun, but it was also very challenging, and actually very difficult.

How about as a golfer: are you good?

I cannot say I am good. But fortunately, in spite of that, I can say I have made a hole-in-one, and according to golf stats, it is quite a rare event, even among the masters. I made that hole-in-one just last March.

Do you have credible witnesses to this event, and did they sign the necessary papers as witnesses?

Yes! (Laughter)

Is this skill or luck?

(Laughter) Well, I am hoping it is partly skill. There are some people who say to increase your chances of doing a hole-in-one, you have to play golf every day for two lifetimes. Of course this doesn’t mean I am more skilled than anyone, because luck definitely had a role in it.

Is there any book you have read that you find very compelling that you would like to share with our readers?

Freakonomics: A Rogue Economist Explores the Hidden Side of Everything by Steven Levitt and Stephen Dubner. It reminds you of many things we tend to either ignore or forget. I also loved the book The Perfection Point: Sports Science Predicts the Fastest Man, the Highest Jump, and the Limits of Athletic Performance by John Breknus. This is a book that tells you what is the optimum performance possible of an athlete in a given event, assuming all conditions are right; it is very data and science driven.

I can see from your two recommended books that you are into facts, hard data, and what they mean in the science of the real world. Maybe that is why you are into marathons, you are into pushing the limits of what is said to be possible and optimum.

Yes, come to think of it, yes.