1. Sun Tzu would have said: Whoever gives prevention the first priority and awaits the coming of the health risks, will be fresh for the fight against diseases; whoever gives prevention the second priority and has to haphazardly battle against health risks will arrive to hospitals exhausted.
2. Therefore the clever clinical director imposes his control on the health risk, but does not allow the health risk's implications to be imposed on him.
3. He promotes healthy behaviours and practices by encouraging them, he discourages risky behaviours and practices by disadvantaging them.
4. If the health risk is inactivity, he can encourage activities; if it is overeating, he can recommend lean diet; it is hidden, he can make it widely known.
5. Intervene at points where the health conditions are quick to deteriorate; reallocate swiftly to places where resources are not fulfilled.
6. A health team may treat a great number of patients without distress, if it operates through streamlined processes where the disruption is not.
7. You can be sure of succeeding in your treatments if you only treat cases which are not contraindicated.You can ensure the safety of your care if you only follow steps that cannot be mistaken.
8. Hence that clinician is skilful in treatment whose case does not see what to counter; and he is skilful in care whose case does not see what to mistake.
9. No specific plans or instructions can ensure the flawless treatment and errorless care. Flexibility and proactivity are the keys for quality and safety of healthcare.
10. Treatments may be advanced and absolutely harmless, if you make for the disease's weak points; you may retrieve and be safe from adverse effects if your weaning procedures are more swift than the raising risks of complications.
11. If we wish to treat, the pathogen can be forced to an interaction even though it be sheltered behind a thick structure and a deep cavity. All we need do is attack some other parts that it will be obliged to react.
12. If we do not wish to treat, we can prevent the disease from affecting us even though the lines of our immunity be merely traced out on the defence mechanisms. All we need do is to prescribe something disturbs and blocks its mechanism of pathogenesis.
13. By discovering the population's disease statistics and maintaining our care facilities impartial, we can keep our workforces concentrated, while the provisions of care is diversified.
14. We can form a single united body, while supporting each speciality or branch under it. Hence there will be a holistic healthcare system against separate cases of a whole disease spectrums, which means that we shall have more capacities shared for the few specialised cases.
15. And if we are able thus to treat a minor case with a superior facility, the chances of having adverse events will be minimised.
16. The spot where we intend to treat must not be made inflexible; for then the people with health conditions will be able to expect a possible encounter at several different points; and healthcare demands being thus distributed in many directions, the numbers we shall have to face at any given point will be proportionately few.
17. For should the healthcare demand strengthen in the business districts, it will weaken in the residential areas; should it strengthen in the residential areas, it will weaken the business district; should it strengthen in the suburbs, it will weaken in the city centres; should it strengthen in the city centres, it will weaken in the suburbs. If it disperses to everywhere, it will everywhere be weak.
18. Numerical weakness comes from having to prepare against possible health demands; numerical strength, from encouraging our health consumers to make prior appointments with us.
19. Knowing the place and the time of the coming encounters, we may concentrate from the greatest distances in order to treat.
20. But if neither time nor place be known, then the staff in the left wing of the hospital will be impotent to succour the right, the staff in the right equally impotent to succour the left, the acute facility unable to relieve the chronic, or the chronic facility to support the acute. How much more so if the furthest portions of the staff are anything under a hundred miles apart, and even the nearest are separated by several miles!
21. Though according to the expert's estimate the outbreaks of infection exceed our immunisation in number, that shall advantage them nothing in the matter of quarantine. I say then that quarantine can be achieved.
22. Though the pathogen be stronger in numbers, we may prevent it from spreading. Scheme so as to discover its patterns and the likelihood of their spread.
23. Cultivate it, and learn the principle of its activity or inactivity. Force it to reveal itself, so as to find out its vulnerable spots.
24. Carefully compare the emerging pathogen with the already known, so that you may know where strength is superabundant and where it is deficient.
25. In making tactical population protection, the highest pitch you can attain is to isolate them; isolate your population, and you will be safe from the prying of the subtlest contacts, from the infection of the most contagious strains.
26. How protection may be produced for people out of the disease's own pathogens--that is what the multitude cannot comprehend.
27. All people can see the treatment whereby the medicine conquer, but what none can see is the strategy out of which treatment is evolved.
28. Do not repeat the treatment which have gained you one good result, but let your methods be regulated by the infinite variety of circumstances.
29. Treatment designs are like unto water; for water in its natural course runs away from high places and hastens downwards.
30. So in treatment the way is to avoid what is contraindication and to look at what is indicating.
31. Water shapes its course according to the nature of the ground over which it flows; the practitioner works out the care plan tailored to the patient conditions which the team is facing.
32. Therefore, just as water retains no constant shape, so in healthcare there are no constant conditions.
33. Those who can modify their care plan in relation to patient's needs and thereby succeed in treatment, may be called an excellent healthcare performance.
34. The five elements (medicine, surgery, nursing, allied health, administration) have no fixated priorities; the acute and chronic make way for each other in turn. There are short stays and long; the health demand has its periods of waning and waxing.
Translated from the Chinese By Lionel Giles, M.A. (1910)
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