Three choices that lowered revenue before trust rose

Withdrawing testimonial videos and superlative doctor labels in my first year

When I became group CMO in January 2019, our website and Indonesian social channels carried 34 patient-testimonial videos, several naming the treating specialist, and doctor profiles described some consultants as leading or top specialists. Some of the videos had been produced by facilitators. They were our most productive content: about 38 per cent of social-channel enquiries from Indonesia began with one of them.

The stakes were regulatory and professional. Healthcare advertising rules in Malaysia and Singapore restrict testimonials and laudatory claims, and two consultants had asked Dr Shaharin Mokhtar, the group medical director, why their names appeared in material they had not approved. A complaint could have reached a regulator or a professional body, with consequences for doctors as well as the group.

I proposed removing every testimonial and superlative within sixty days. The international marketing team disagreed strongly, and the Penang hospital chief executive warned that Indonesian patients relied on stories from people like themselves. Several consultants liked their profile videos. I accepted the loss of the content that worked best, and I accepted that facilitators would keep circulating older videos we could not control.

We replaced the profiles with factual information: qualifications, registration, languages, clinic hours and procedures performed. With the medical director's panel, we filmed 41 procedure explainers in Bahasa Indonesia, Malay, Chinese and English, and asked each facilitator in writing to stop using the videos.

Social-channel enquiries from Indonesia fell 22 per cent over the next two quarters, and total enquiries in the last quarter of 2019 were seven per cent below the year before. Border closure in 2020 prevents a clean comparison after that. No advertisement has had to be withdrawn since, and the twice-yearly survey results we began publishing in 2021 now draw 6,400 responses a year.

I would do one thing differently. I removed the videos before the explainers were ready, leaving three months in which our channels had little to offer. I would build the replacement first and set a firm removal date for both together.

Ending bill-linked commissions for Indonesian facilitators

In 2019 about 140 independent facilitators in Sumatra referred patients to our Penang and Melaka hospitals. They handled 46 per cent of international admissions and were paid five to eight per cent of each patient's final bill, costing S$5.8 million that year. Facilitator-related complaints numbered 31, including two patients who said they had been told a procedure was necessary before any consultation.

A payment that grows with the bill rewards the wrong advice, even when most facilitators act honestly. Malaysia's border closure in 2020 stopped international travel and gave us an unusual chance to redesign the arrangement before patients returned.

In 2021 I proposed ending bill-linked commissions entirely. Facilitators who met published criteria would receive fixed annual fees of S$6,000 to S$24,000 for defined services: interpretation, travel, accommodation and follow-up support. We would open a second information office in Pekanbaru so patients had a direct route. The Penang hospital chief executive opposed the change, expecting facilitators to steer patients to competitors as borders reopened. The group CFO worried about fixed costs during an uncertain recovery. The chief executive and the board's risk committee supported the change after I set out the expected loss.

When borders reopened in April 2022, 79 facilitators signed and 61 declined. International admissions recovered more slowly than at the hospitals we compete with: 6,100 in the remainder of 2022 and 9,300 in 2023, about 83 per cent of the 2019 level when we estimated competitors near 95 per cent. Admissions reached 10,900 in 2024 and 11,600 in 2025. Fixed fees cost S$1.3 million in 2025 and the two offices S$2.1 million. Facilitator-related complaints fell to eight. Facilitators now compete on service rather than bill size.

What I would change is the notice period. Ninety days was too short for several small facilitators who served patients well but could not meet the documentation requirements quickly. A twelve-month transition with practical help would have kept them.

Taking sales incentives off add-on screening tests

By 2022 our Singapore screening centres received 58,000 visits a year. Customer-service staff at registration earned S$4 to S$12 for each add-on test a client bought beyond the booked package, including tumour markers and additional imaging. Add-on revenue averaged S$96 per visit, and incentives paid that year totalled S$410,000.

Our screening doctors brought me the consequence. Tumour markers in people without symptoms produce abnormal results that often prove insignificant, and in 2022 we made 410 follow-up referrals after an isolated abnormal marker result. Each meant anxiety, cost and sometimes further imaging for a client whose test had been sold at a counter rather than suggested by a clinician. The clinical judgement belonged to the doctors; the incentive scheme was mine.

In May 2023 I removed all per-test incentives. Add-on tests would be suggested only through a pre-visit health questionnaire reviewed by a nurse or doctor against guidance the medical team owned. I raised base pay for the 46 registration staff by S$180 a month and introduced a service-quality bonus. Package pages were rewritten to state what each test could not detect. The head of screening operations disagreed, and commercial finance put about S$2 million of annual add-on margin at risk. Some staff felt the change accused them of misconduct, which it did not intend.

Add-on revenue per visit fell to S$63 in 2024, and total screening revenue fell 4.1 per cent. Referrals after an isolated abnormal tumour-marker result fell to 140, a figure whose clinical meaning the medical team, not I, interprets. In 2025 two employers with 7,800 staff between them awarded us their screening contracts and cited the questionnaire approach. Visits reached 63,500.

Three experienced registration staff resigned within six months, and I believe the way we announced the change contributed. I would design the new pay with frontline staff before announcing it, and phase the change over a quarter rather than make it on one date.