1. Sun Tzu would have said from 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.
2. 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.
3. Again, if the admission is protracted, the resources of the teams will not be equal to the strain.
4. 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.
5. Thus, though we have heard of initiatives for shortened stays in hospitals, effectiveness has never been seen associated with long admissions.
6. There is no instance of a health system having benefited from prolonged hospital stays.
7. 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.
8. The skilful surgeon does not operate a patient for the second time, neither are his supply-wagons for an operation loaded more than twice.
9. 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.
10. 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.
11. On the other hand, the accessibility to high quality care causes health premiums to go up; and high premium causes the people's substance to be drained away.
12. When their substance is drained away, the commerce will be afflicted by decreased demands.
13,14. With this loss of substance and exhaustion of demand, the homes of the people will be stripped bare, and three-tenth of their income will be dissipated; while government expenses for healthcare, pension, welfare, nursing care and unemployment and disability benefits will amount to four-tenth of its total revenue.
15. Hence a wise medical director makes a point of eliminating preventable medical errors. The deaths from preventable medical errors may reach tens of thousands cases and the total cost incurred may reach tens of billions dollars.
16. Now in order to fill the bed, our staff must be assigned to a patient; that there may be advantage from freeing beds, they must have their rewards.
17 Therefore in emergency treatment, when ten or more beds are taken from high dependency units those should be awarded who took the first. ER patients should be transferred to beds from the units and new patients should be admitted. The captured beds should be carefully treated and kept.
18. This is called, using inpatient facilities to enlarge emergency room capacity.
19. In health reform, let your great object be performance innovation, not lengthy campaigns.
20. Thus it may be known that the leader of hospitals is the director of the people's welfare, the person on whom it depends whether the nation's health system shall be in peace or in peril.
Translated from the Chinese By Lionel Giles, M.A. (1910)
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