It is a medical axiom not to advance treatment uphill for the patient

It is a military axiom not to advance uphill against the enemy, nor to oppose him when he comes downhill.

Do not pursue an enemy who simulates flight; do not attack soldiers whose temper is keen.

Do not swallow bait offered by the enemy. Do not interfere with an army that is returning home.

When you surround an army, leave an outlet free. Do not press a desperate foe too hard.

Such is the art of warfare.

From "Sun Tzu on the Art of War - The Oldest Military Treatise in the World"

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

Discussion:

Again creativity was required in translating the word "enemy" in this part. With agreements of wordings in mind, utilised various contexts where clinicians are required comparable manoeuvres.

Translation:

It is a medical axiom not to advance treatment uphill for the patient, nor to operate him when the patient's complications are downhill.

Do not prescribe for a patient who hoards medications; do not administer drugs whose adverse reaction is keen.

Do not swallow bribe offered by the patient. Do not interfere with a patient that is returning home.

When you summon a patient, leave an outlet free. Do not press a desperate family too hard.

Such is the art of healthcare.

Ray Murakami

Spoken word does not carry far enough: hence the institution of prompts and checklists

The Book of Army Management says: On the field of battle, the spoken word does not carry far enough: hence the institution of gongs and drums. Nor can ordinary objects be seen clearly enough: hence the institution of banners and flags.

Gongs and drums, banners and flags, are means whereby the ears and eyes of the host may be focused on one particular point.

The host thus forming a single united body, is it impossible either for the brave to advance alone, or for the cowardly to retreat alone. This is the art of handling large masses of men.

In night-fighting, then, make much use of signal-fires and drums, and in fighting by day, of flags and banners, as a means of influencing the ears and eyes of your army.

A whole army may be robbed of its spirit; a commander-in-chief may be robbed of his presence of mind.

Now a soldier's spirit is keenest in the morning; by noonday it has begun to flag; and in the evening, his mind is bent only on returning to camp.

A clever general, therefore, avoids an army when its spirit is keen, but attacks it when it is sluggish and inclined to return. This is the art of studying moods.

Disciplined and calm, to await the appearance of disorder and hubbub amongst the enemy:--this is the art of retaining self-possession.

To be near the goal while the enemy is still far from it, to wait at ease while the enemy is toiling and struggling, to be well-fed while the enemy is famished:--this is the art of husbanding one's strength.

To refrain from intercepting an enemy whose banners are in perfect order, to refrain from attacking an army drawn up in calm and confident array:--this is the art of studying circumstances.

From "Sun Tzu on the Art of War - The Oldest Military Treatise in the World"

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

Discussion:

This part was translated referring Improving patient safety in the operating theatre – teamwork and communication from The Health Quality & Safety Commission New Zealand and WHO surgical safety checklist and implementation manual. Creativity was required in translating the word "enemy" as in operation theatre there are no apparent enemies.

Translation:

The Book of Health Management says: On the theatre of operation, the spoken word does not carry far enough: hence the institution of prompts and checklists. Nor can ordinary objects be seen clearly enough: hence the institution of visual aids and markers.

Prompts and checklists, visual aids and markers, are means whereby the ears and eyes of the team may be focused on one particular point at a time.

The team thus forming a single united body, is it impossible either for the brave to advance alone, or for the cowardly to retreat alone. This is the art of handling a multi-professional team.

Before the induction of anaesthesia, make use of “sign in” checklist, before the incision of the skin, of “time out” checklist and before the patient leaves the operating room, of “sign out” checklist as a means of confirming completion of tasks by the ears and eyes of your surgery team.

A whole team may be affected in its spirit; a chief surgeon may be affected in his presence of mind.

Now a team's spirit is keenest in "sign in"; by "time out" it has begun to flag; and in "sign out", its mind is bent only on returning to station.

A clever surgeon, therefore, avoids a team's too eagerness when its spirit is keen, but cautions it when it is sluggish and inclined to return. This is the art of studying moods.

Disciplined and calm, to await the appearance of disorder and focus amongst the site:--this is the art of retaining self-possession.

To be near the area while the operating time is still far from the limit, to wait at ease while the aid is toiling and struggling, to be well-oxygenated while the bleeding is controlled:--this is the art of husbanding one's strength.

To refrain from intercepting a team member whose points are in perfect order, to refrain from attacking an objection drawn up in calm and confident way:--this is the art of studying circumstances.

Ray Murakami

In incision and surgical removal be like fire, in watchful waiting like a mountain

In war, practice dissimulation, and you will succeed.

Whether to concentrate or to divide your troops, must be decided by circumstances.

Let your rapidity be that of the wind, your compactness that of the forest.

In raiding and plundering be like fire, in immovability like a mountain.

Let your plans be dark and impenetrable as night, and when you move, fall like a thunderbolt.

When you plunder a countryside, let the spoil be divided amongst your men; when you capture new territory, cut it up into allotments for the benefit of the soldiery.

Ponder and deliberate before you make a move.

He will conquer who has learnt the artifice of deviation. Such is the art of maneuvering.

From "Sun Tzu on the Art of War - The Oldest Military Treatise in the World"

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

Discussion:

In pathway management, there is no plundering countryside or capturing new territory. So they are translated into achieving a positive outcome and receiving new resources respectively.

Translation:

In healthcare, practice personalisation, and you will succeed.

Whether to concentrate or to divide your regimens, must be decided by circumstances.

Let your swiftness be that of the wind, your calmness that of the forest.

In incision and surgical removal be like fire, in watchful waiting like a mountain.

Let your plans be deep and encompassing as darkness, and when you move, proceed like a lightning bolt.

When you achieve a positive outcome, let the praise be distributed amongst your team; when you receive new resources, cut it up into allotments for the benefit of the soldiery.

Ponder and deliberate before you make a move.

He will conquer who has learnt the articulation of variances. Such is the art of pathways.

Ray Murakami

Cannot enter into alliances until acquainted with neighbour facilities

We cannot enter into alliances until we are acquainted with the designs of our neighbors.

We are not fit to lead an army on the march unless we are familiar with the face of the country--its mountains and forests, its pitfalls and precipices, its marshes and swamps.

We shall be unable to turn natural advantage to account unless we make use of local guides.

From "Sun Tzu on the Art of War - The Oldest Military Treatise in the World"

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

Discussion:

In the shared care contexts, administrating care plans and pathways requires not only internal knowledge and understanding of resources and issues within the hospital, but also external alliances and liaison with neighbouring facilities and local practitioners.

Translation:

We cannot enter into alliances until we are acquainted with the designs of our neighbour facilities.

We are not fit to lead an army of orders unless we are familiar with the faces of the hospital--its departments and wards, its problems and issues, its risks and hazards.

We shall be unable to turn community advantage to account unless we make use of local general practitioners.

Ray Murakami

Managing a clinical pathway with an undisciplined multitude is most dangerous

Maneuvering with an army is advantageous; with an undisciplined multitude, most dangerous.

If you set a fully equipped army in march in order to snatch an advantage, the chances are that you will be too late. On the other hand, to detach a flying column for the purpose involves the sacrifice of its baggage and stores.

Thus, if you order your men to roll up their buff-coats, and make forced marches without halting day or night, covering double the usual distance at a stretch, doing a hundred LI in order to wrest an advantage, the leaders of all your three divisions will fall into the hands of the enemy.

The stronger men will be in front, the jaded ones will fall behind, and on this plan only one-tenth of your army will reach its destination.

If you march fifty LI in order to outmaneuver the enemy, you will lose the leader of your first division, and only half your force will reach the goal.

If you march thirty LI with the same object, two-thirds of your army will arrive.

We may take it then that an army without its baggage-train is lost; without provisions it is lost; without bases of supply it is lost.

From "Sun Tzu on the Art of War - The Oldest Military Treatise in the World"

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

Discussion:

A physician does not have full authority to hospital staff but has it for the orders made by the physician. So the army of soldiers are translated into the army of orders.

Translation:

Managing a clinical pathway with an army of observations and interventions is advantageous; with an undisciplined multitude, most dangerous.

If you set a fully specified army of orders in every detail in order to snatch an advantage, the chances are that you will be too late. On the other hand, to detach an ongoing column of an active pathway for the purpose involves the sacrifice of its already dispensed solution bags and supplies.

Thus, if you order your observations and interventions to roll over their cutoffs, and make forced STATs without halting day or night, covering double the usual stint at a stretch, doing a hundred rounds in order to wrest an advantage, the leaders of all your three divisions will fall into the hands of the illness.

The stronger staffs will be in front, the jaded ones will fall behind, and on this care plan only one-tenth of your army of orders will reach their outcomes.

If you march fifty rounds in order to outperform the clinical indicators, you will lose the leader of your first division, and only half your staff will reach the goal.

If you march thirty rounds with the same object, two-thirds of your army of orders will be achieved.

We may take it then that an army of orders without sufficient nursing carts is lost; without provisions it is lost; without bases of supply it is lost.

Ray Murakami