A trained neurologist with a doctorate from the University of the Philippines College of Medicine, Dr Alfredo ‘Alran’ Bengzon, understands the value of life. “All human life, including adversity, is a gift,” he tells The CEO Magazine. “But learning is one of the greatest gifts.” Alran believes it is learning that makes us truly human.
“When you raise infants and toddlers, you develop them by word and by example, because at that stage they are not in a position to decide one way or the other,” he explains. “As they grow, they retain more information and are able to process it to recognise that they have options; that they can express their preference and do something to get what they want. One of the objectives of developing children is for them to recognise that options are at the core of human existence and human maturity. And options need to be driven by learning through life’s struggles because life is full of dilemmas.”
As President and CEO of The Medical City (TMC), Alran oversees a thriving healthcare network in the Philippines. The business includes a central 18-floor complex in Pasig City, Manila; hospitals in Iloilo, Clarke, Laguna and Pangasinan; and another 40 clinics throughout the country.
It employs more than 1,500 medical staff who cater to around 50,000 inpatients and 500,000 outpatients each year. Although TMC’s governing philosophy is ‘Where patients are partners’, Alran highlights that, internally, those who require medical attention are not referred to as patients.
“We don’t talk about patients because the assumption is the patient is already burdened with disease,” he notes. “We talk about beneficiaries of health, which we believe is the most fundamental human right because it determines the quality of life for individuals and the quality of development of society.”
The Spider-Man rule
Alran explains that the ‘patients as partners’ principle means every individual is co-responsible for their health and the intervention to tackle their disease. “We said to ourselves that if health is a basic human right, then for every right there must be an accompanying responsibility,” he continues.
“This is what I have labelled ‘the Spider-Man rule’: that if you have power, you have responsibilities,” he says, referencing the famous quote from one of the most successful Marvel comic book series.
Alran explains that while there are health professionals available, a lot of diseases and injuries can be prevented by simple techniques taught when people are young. “When we get asked by our patients, ‘How can we be co-responsible for our health?
“We did not go to nursing school. We are not doctors. We are not technicians,’ my answer to them is that many of the things that are conducive to good health you learned from your grandmother or your kindergarten teacher,” he elaborates. “Like washing your hands, covering your mouth when you cough, making sure you drink enough fluids, and getting enough sleep.”
Patients have the power
Alran further provides an example, of type 2 diabetes. “Nobody should be allowed to say, ‘I am powerless over my disease,’ ” he says. “I tell people who are diabetic, ‘Diabetes is a lifestyle disease; it is not handled only by insulin. It’s handled by how you think of fitness, which is the sum total of what you eat and what you burn.’
In England, there was a practice that if a person presented themselves for cardiac bypass surgery and was diabetic or hypertensive, they would get asked, ‘When was the diagnosis made, and what did you do with the advice of doctors with regard to the type of diet you eat, the kind of weight you must maintain, and the kind of fitness activities you must do for exercise?’ If the person said none, or, ‘I did not do anything like that,’ they may be considered ineligible for the surgical intervention because society’s telling them, ‘You cannot demand a right without inputting your accountability.’ ”
After graduating from the University of the Philippines, Alran travelled abroad for additional training. “I went to Germany, Madison in Wisconsin, Montreal and the National Institutes of Health in Bethesda, Maryland, before I came home,” he says. “I thought I was well schooled and well trained enough to begin practising at TMC, which at the time was called the ABM Sison Hospital.”
Despite all of his training, Alran reinforces that learning does not solely come from sitting behind a desk. “I tell people that whatever learnings you have from formal schooling, from elementary even to PhD, as good and as sharp as they might be, they are incomplete until they are complemented by the school of hard knocks,” he asserts. In other words, the school of life.
Whatever learnings you have from formal schooling, from elementary even to PhD, as good and as sharp as they might be, they are incomplete until they are complemented by the school of hard knocks.
For Alran, one of the biggest lessons he learned outside of schooling came after joining ABM. Barely two years after the company started, it began heading towards bankruptcy, and apart from being undercapitalised, Alran learned that a lot of the problems had to do with management.
“Our idea of management was based on the doctors saying they’re experts when it comes to managing hospitals,” he recalls. “When they said that, I thought it was nonsense. Doctors are experts on many things, but management is not part of our curriculum. And yet management is a term used in medicine. Management means you look at the problem, you formulate the cause of the problem, and then you decide how to intervene. When you intervene, you know that you need resources: material resources and human resources."
"That’s the art and science of management. Those general formulations apply to business, where the bottom line is always the bottom line. They also apply to other aspects of the human journey, and yet sadly, in our curriculum in medicine, we do not pay attention to them.”
As ABM’s assistant medical director back then, Alran didn’t feel confident in remaining in the position, but rather than resign, he opted to go to business school, attending the Ateneo Graduate School of Business. “At the time I made the decision, my wife was really unsure, because she said, ‘We worked so hard to help you become a doctor. Now you’re running away from it,’ to which my retort was, ‘I will never abandon the mission of taking care of people who are sick,’” Alran remembers.
I will never abandon the mission of taking care of people who are sick.
“Halfway through the course, I began to suspect that I would be a better physician because I was learning the art and science of management. From that vantage point, I could see things systematically. Now this is standard at TMC. If you are in a certain position – a doctor
or a nurse, et cetera – you need to have credentials in management.”
Striving to know more
Alran has emphasised the importance of learning throughout his professional life. In 1986, he was appointed health secretary of the Philippines Department of Health, where he undertook a restructure within the department, pioneered the National Drug Policy Program and advocated for the generic law, which allowed consumers to select generic brand medicine rather than more expensive brands from overseas. As health secretary, Alran told his team that they didn’t understand how critical their role was in human development and encouraged them to broaden their knowledge.
“I said, ‘You guys do not appreciate how powerful your sector is for good or for evil. In order for you to have the proper budgets and proper organisation, you need to consider labouring not just in your selected field but connecting to other work. You need to understand human beings. You need to understand how people make decisions. You need to understand human suffering. That you will get from other fields and other disciplines.’ ”
Alran recalls a meeting he had with one of the later health secretaries, Dr Paulyn Rosell-Ubial, during an invitation to TMC, where he brought up the idea of change in the healthcare industry. “Paulyn replied, ‘Yes, change is coming,’ and I said, ‘Madam Secretary, with due respect, I want to tell you that change is already here. It’s always been here,’ ” Alran remembers.
“Life is about change. The only place where you cannot find change is in the cemetery, and that’s not where we want to go, not yet anyway. Second, change is needed because people want better lives. They want to be happier and want to move up from where they are. That kind of reality generates expectations, and what binds change and expectations together is management.”
Alran adds that for change and expectations to be managed, three things need to be taken into consideration. “The first is content,” he states. “You need to articulate content and define it for understanding. Then there is context. Many times, things are misunderstood,
and the response and the call for action goes awry because people understand the content but not the context in the desire for change. These could be historical, cultural, sociological contexts, and so on. The last word is ‘constant’.
“All the words I have articulated – change, expectation, content, context – these are all moving parts. In physics, every time you have moving parts, you need a fulcrum. You need an anchor to which the moving parts need to be attached, otherwise there will be disorder and chaos. And in my experience, the constant in the human journey is the human person and their relationship to things, to other people, and to a transcendent being.”
A new way to think about suppliers
Like the concept of a patient, Alran prefers to approach the supplier relationship in a different way. “The word ‘supplier’ can be understood in more than one sense,” he says. “A supplier is often thought about as, on the one hand, somebody selling goods that are designed, manufactured, and then sold. On the other hand, there is the other party that wants these goods being sold, for which there is a financial exchange. It’s a transaction.
“There is a supplier–user relationship there. But there’s another way to think of them. While there are rewards that accrue to either party in the transaction, represented by money, there are also rewards to both parties acting together from a shared vision and an aligned understanding of how to proceed, which will generate something that is far more profound than just monetary terms.”
Alran believes the supplier relationship extends to the individual workers in the healthcare industry. “We can say that health professionals are suppliers in relation to the people who have a need to take care of their health and the challenge of disease,” he says.
“We can even think about the relationship between a patient and a provider as retail. Some medical professionals might argue that we are not a business; we are a service. But the point of that comparison is that there is much that we can understand by studying the dynamics of retail. How did I understand this? From the school of hard knocks. There are certain skills that are necessary for doing retail business, and it is retail business that is the closest to the front line. The front line is where Pope Francis tells his people to go, say, if they are a development worker or a church worker. And that is a retail activity.”
Health as a commodity
Alran continues his analogy by saying the industry’s commodity is health. “It is a very practical way of understanding health, because without it we either can’t live or our existence will be non-functional,” he says.
“A commodity has many dimensions to it. There is a user dimension. There is a supplier dimension. There are dimensions that are dynamic in the relationship between the supply side and the demand side, to the extent that if people understand the common interest and the common need, the relationship will be more productive and more equitable. That should be the standard rule in any business.”
Alran acknowledges that he came to this conclusion after years of learning. “Decades ago, I could not think or talk in these terms, but I am able to do that now because of my learnings and because I recognise that I cannot expand my learning unless I can expand my connections with other sectors.”