IX. THE STAFFING TO THE DEMAND


1. Sun Tzu would have said: We come now to the question of managing the staffing, and observing signs of demand surge. Pass quickly over peaks, and keep the demands in the community practices.

2. Secure a high number of appointment slots, scheduling on the week days. Do not overbook in order to meet the demands. So much for peak management.

3. After crossing a shift boundary, you should get the staff ready as soon as possible.

4. When a demand surge crosses a shift boundary in its onward patient inflow, do not advance to meet it in the midst of the handover. It will be best to let commenced encounters completed, and then deliver care by the next shift.

5. If you are treating an elective patient, you should not book an appointment near a shift boundary which the patient has to cross.

6. Lift your staffing level higher up than the demand, and book in regular hours. Do not move the handover timing to meet the demand. So much for shift boundary.

7. In crossing hours of critical staff shortage, your sole concern should be to get over them quickly, without any delay.

8. If forced to fight in a staff shortage, you should have medicines/fluids and supplies near you, and get your back with the nursing agency. So much for operations in staff shortages.

9. In usual, level staffing, take up an easily accessible staff list with experience levels, so that the difficult cases may be in experienced hands, and safe cases for the rests. So much for staffing in flat demand.

10. These are the four useful branches of staffing knowledge which would have enabled the Yellow Emperor to vanquish four several demand patterns.

11. All healthcare staff prefer high spirits to low and day shifts to night.

12. If you are careful of your staff, and provide psychological safety, the staff will be free from sick leaves of every kind, and this will spell clinical excellence.

13. When you come to a busy or difficult situation, highlight the positive achievements, with the provision of additional resources. Thus you will at once act for the benefit of your staff and utilize the natural advantages of the motivation.

14. When, in consequence of political upheaval, a change management which you wish to ford is swollen and flecked with uncertainties, you must wait until it subsides.

15. Country in which there are precipitous societal gaps with divides running between, deep historical sorrows, confined views, tangled interests, deprivations and conflicts, should be left unprovoked with all possible dialogues and not offended.

16. While we keep away from such gaffes, we should get the customer to disclose those sufferings; while we face them, we should let the customer feel supported.

17. If in the neighborhood of your clinical practice there should be any overcrowded suburb, barracks surrounded by unoccupied businesses, shabby appartments filled with people in needs, or houses with thick mould growth, they must be carefully checked out in examinations; for these are factors where people at risk or insidious health hazards are likely to be residing.

18. When the intake population is close at hand and remains quiet, they are relying on the natural strength of their service access.

19. When they keep aloof and try to provoke a home visit, they are anxious for the other side to advance.

20. If their place of residence is easy of access, they are tendering a home care.

21. Movement amongst the trees along the driveway shows that the service users are advancing. The appearance of a number of faces in the midst of thick glass windows means that the service users wants to make us hurry.

22. The rising of siren with the flashlights is the sign of an ambulance. Scattered cars indicate that a emergency vehicle is coming.

23. When there is the number of visits rising in a winter, it is the sign of the flu advancing; when the number is low, but spread over a wide area, it betokens the efficacy of the herd immunity. When it branches out in different strains, it shows that patients have been overseas to acquire them. A few of  patients moving to and fro signify that the patients are vulnerable.

24. Humble words and increased preparations are signs that the new health policy is about to advance. Violent language and driving forward as if to the attack are signs that the policy will be discarded.

25. When the temporary plans come out first and take up a position on the budget, it is a sign that the policy is forming for reform.

26. Resource proposals unaccompanied by a sworn budgeting indicate a plot.

27. When there is much running about and the secretaries fall into offices, it means that the critical moment has come.

28. When some are seen advancing and some retreating, it is a lure.

29. When the clinicians stand leaning on their stools, they are faint from want of food.

30. If those who are sent to draw water begin by drinking themselves, the team is suffering from thirst.

31. If the team sees an advantage to be gained and makes no effort to secure it, the members are exhausted.

32. If students gather on any spot, it is unoccupied. Clamor by night betokens nervousness.

33. If there is disturbance in the unit, the director's authority is weak. If the banners and flags are shifted about, sedition is afoot. If the officers are angry, it means that the members are weary.

34. When a team fills their stomaches with grain bars and kills their laptops for shutdown, and when the men do not leave their coffee-pots over the stoves, showing that they will not return to their desks, you may know that they are determined to complete the long procedure.

35. The sight of men whispering together in small knots or speaking in subdued tones points to disaffection amongst the rank and file.

36. Too frequent rewards signify that the team is at the end of his resources; too many punishments betray a condition of dire distress.

37. To begin by plaster, but afterwards to take fright at the test result numbers, shows a supreme lack of intelligence.

38. When envoys are sent with compliments in their mouths, it is a sign that the other service wishes for a staffing support.

39. If the other service's staff march up angrily and remain facing ours for a long time without either joining care or taking themselves off again, the situation is one that demands great vigilance and circumspection.

40. If our staff are no more in number than the demand, that is amply sufficient; it only means that no severe shortage can occur. What we can do is simply to concentrate all our available strength, keep a close watch on the sudden demand surge, and obtain reinforcements.

41. He who exercises no forethought but makes light of emergency scenarios is sure to be overwhelmed by them.

42. If patients are held accountable before they have grown attached to you, they will not prove compliant; and, unless compliant, then will be practically hopeless. If, when the patients have become attached to you, compliance is not enforced, they will still be hopeless.

43. Therefore patients must be treated in the first instance with humanity, but kept under control by means of the best practice. This is a certain road to recovery.

44. If in explaining patients best practices are habitually enforced, the treatment will be well evidence-based; if not, its outcome will be bad.

45. If a physician shows faith in his patients but always insists on best practices being obeyed, the gain will be mutual.

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

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