Friday 28 June 2013

The skilful surgeon does not operate a patient for the second time

The skillful soldier does not raise a second levy, neither are his supply-wagons loaded more than twice. Bring war material with you from home, but forage on the enemy. Thus the army will have food enough for its needs. Poverty of the State exchequer causes an army to be maintained by contributions from a distance. Contributing to maintain an army at a distance causes the people to be impoverished.

Translated from the Chinese By Lionel Giles, M.A. (1910)

Discussion:

The concept of "foraging on the enemy" requires careful consideration in translation. As the philosophy of Sun Tzu was acquiring the whole capacity of the enemy to enlarge your own advantage rather than destroying it, "foraging on the enemy" would never mean an outright plunder which would eventually cause rebels against invaders and make the control over the territory difficult. The main point is that the shift of resources from being used up by the enemy to supporting the friendly army. Thus it can be translated to shifting the resource from used up by inefficient management of care to supporting innovations of healthcare delivery.

Translation:

The skilful surgeon does not operate a patient for the second time, neither are his supply-wagons for an operation loaded more than twice. Fund operational expenses from capitation, but fund extras on innovations in efficiency and effectiveness. Thus the hospital will have capacity enough for increasing health needs. Poverty of the State exchequer causes a hospital to be maintained by contributions from the general public not directly benefiting from healthcare. Contributing to maintain an hospital not servicing them directly causes the people to be impoverished.

Ray Murakami

Wednesday 26 June 2013

Effectiveness has never been seen associated with long admissions

Thus, though we have heard of stupid haste in war, cleverness has never been seen associated with long delays. There is no instance of a country having benefited from prolonged warfare. It is only one who is thoroughly acquainted with the evils of war that can thoroughly understand the profitable way of carrying it on.

Translated from the Chinese By Lionel Giles, M.A. (1910)

Discussion:

Administrative targets such as "Shorter stays in the emergency department" are often criticised that they does not necessarily reflect the true efficiency of healthcare provided there and sometimes encourage superficial achievement by sacrificing quality, safety or satisfaction of patients. However, it is so true that there is no instance of a country having benefited from prolonged warfare even against diseases.

Translation:

Thus, though we have heard of initiatives for shortened stays in hospitals, effectiveness has never been seen associated with long admissions. There is no instance of a health system having benefited from prolonged hospital stays. It is only one who is thoroughly acquainted with the adverse effects of hospitalisation that can thoroughly understand the profitable way of carrying it on.

Ray Murakami

Tuesday 25 June 2013

In actual treatment, if discharge is long in coming

When you engage in actual fighting, if victory is long in coming, then men's weapons will grow dull and their ardor will be damped. If you lay siege to a town, you will exhaust your strength. Again, if the campaign is protracted, the resources of the State will not be equal to the strain. Now, when your weapons are dulled, your ardor damped, your strength exhausted and your treasure spent, other chieftains will spring up to take advantage of your extremity. Then no man, however wise, will be able to avert the consequences that must ensue.

Translated from the Chinese By Lionel Giles, M.A. (1910)

Discussion:

There is no need to discuss much about the implications of prolonged hospital stays as well as protracted military campaigns.

Translation:

When you engage in actual treatment, if discharge is long in coming, then staff's focuses will grow dull and their ardour will be damped. If you run over capacity of a hospital, you will exhaust your strength. Again, if the admission is protracted, the resources of the teams will not be equal to the strain. Now, when your focuses are dulled, your ardour damped, your strength exhausted and your expenditure spent, adverse events and complications will spring up to take advantage of your extremity. Then no practitioners, however wise, will be able to avert the consequences that must ensue.

Ray Murakami


Monday 24 June 2013

The cost of providing healthcare services for 100,000 people

Sun Tzu said: In the operations of war, where there are in the field a thousand swift chariots, as many heavy chariots, and a hundred thousand mail-clad soldiers, with provisions enough to carry them a thousand li, the expenditure at home and at the front, including entertainment of guests, small items such as glue and paint, and sums spent on chariots and armor, will reach the total of a thousand ounces of silver per day. Such is the cost of raising an army of 100,000 men.

Translated from the Chinese By Lionel Giles, M.A. (1910)

Discussion:

I referred to the statistics of the healthcare expenditures par capita of the OECD countries to have realistic order of the magnitude for expenditure per day for the healthcare of 100,000 population. I was amazed by how easily the description for the army of 100,000 men can be translated into the one for healthcare for 100,000 population.

Translation:

From the statistics: In the operation of healthcare, where there are in the hospital a thousand outpatient visits, as many acute inpatient beds, and a hundred thousand catchment population, with provision enough to provide full 24 hours a day, 7 days a week and 365 days a year services, the expenditure at back offices and at the front, including hospitality for the guests, small items such as pens and paper, and sum spent on scrubs and linens, will reach the total of hundreds of thousands dollars per day. Such is the cost of providing healthcare services for 100,000 people.

Ray Murakami