In treatment, the physician receives his authority from the patient

Sun Tzu said: In war, the general receives his commands from the sovereign.

Having collected an army and concentrated his forces, he must blend and harmonize the different elements thereof before pitching his camp.

After that, comes tactical maneuvering, than which there is nothing more difficult. The difficulty of tactical maneuvering consists in turning the devious into the direct, and misfortune into gain.

Thus, to take a long and circuitous route, after enticing the enemy out of the way, and though starting after him, to contrive to reach the goal before him, shows knowledge of the artifice of DEVIATION.

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:

After some considerations this chapter's title manoeuvre was translated into (clinical) pathway.

Translation:

In treatment, the physician receives his authority from the patient.

Having collected staff and examined shifts, he must blend and harmonise the different elements thereof before pitching his team.

After that, comes clinical pathway, than which there is nothing more difficult. The difficulty of clinical pathway consists in turning the devious into the direct, and outlier into gain.

Thus, to take a long and circuitous route, after enticing the infection out of the way, and though starting after predisposed conditions, to contrive to reach the goal before onset of those conditions, shows knowledge of the artifice of VARIANCE ANALYSIS.

Ray Murakami

Just as water retains no constant shape, so in healthcare, no constant conditions

Military tactics are like unto water; for water in its natural course runs away from high places and hastens downwards.

So in war, the way is to avoid what is strong and to strike at what is weak.

Water shapes its course according to the nature of the ground over which it flows; the soldier works out his victory in relation to the foe whom he is facing.

Therefore, just as water retains no constant shape, so in warfare there are no constant conditions.

He who can modify his tactics in relation to his opponent and thereby succeed in winning, may be called a heaven-born captain.

The five elements (water, fire, wood, metal, earth) are not always equally predominant; the four seasons make way for each other in turn. There are short days and long; the moon has its periods of waning and waxing.

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 is rather straight forward translation. However, the last paragraph may well stay as it is but a trial was made to put it into the context of the whole system approach in the healthcare.

Translation:

Treatment designs are like unto water; for water in its natural course runs away from high places and hastens downwards.

So in treatment the way is to avoid what is contraindication and to look at what is indicating.

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.

Therefore, just as water retains no constant shape, so in healthcare there are no constant conditions.

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.

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.

Ray Murakami

Do not repeat the treatment which have gained you one good result

Though according to my estimate the soldiers of Yueh exceed our own in number, that shall advantage them nothing in the matter of victory. I say then that victory can be achieved.

Though the enemy be stronger in numbers, we may prevent him from fighting. Scheme so as to discover his plans and the likelihood of their success.

Rouse him, and learn the principle of his activity or inactivity. Force him to reveal himself, so as to find out his vulnerable spots.

Carefully compare the opposing army with your own, so that you may know where strength is superabundant and where it is deficient.

In making tactical dispositions, the highest pitch you can attain is to conceal them; conceal your dispositions, and you will be safe from the prying of the subtlest spies, from the machinations of the wisest brains.

How victory may be produced for them out of the enemy's own tactics--that is what the multitude cannot comprehend.

All men can see the tactics whereby I conquer, but what none can see is the strategy out of which victory is evolved.

Do not repeat the tactics which have gained you one victory, but let your methods be regulated by the infinite variety of 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:

The protection of population against epidemics is often misunderstood by the general public. Each time an epidemic of an exotic and deadly disease in foreign country floods news media, people often are panicked as though the disease mentioned is just outside of their doorsteps. However, such a news  scrum rarely encourages people to immunise against known but potentially deadly diseases. Sun Tzu's tricks on how to deceive enemies, which interestingly correspond to tactics to battle against contagious pathogens, also remind us on difficulties of publicising population health policies including epidemic prevention.

Translation:

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.

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.

Cultivate it, and learn the principle of its activity or inactivity. Force it to reveal itself, so as to find out its vulnerable spots.

Carefully compare the emerging pathogen with the already known, so that you may know where strength is superabundant and where it is deficient.

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.

How protection may be produced for people out of the disease's own pathogens--that is what the multitude cannot comprehend.

All people can see the treatment whereby the medicine conquer, but what none can see is the strategy out of which treatment is evolved.

Do not repeat the treatment which have gained you one good result, but let your methods be regulated by the infinite variety of circumstances.

Ray Murakami

We can form a single united body, while supporting each speciality or branch under it

By discovering the enemy's dispositions and remaining invisible ourselves, we can keep our forces concentrated, while the enemy's must be divided.

We can form a single united body, while the enemy must split up into fractions. Hence there will be a whole pitted against separate parts of a whole, which means that we shall be many to the enemy's few.

And if we are able thus to attack an inferior force with a superior one, our opponents will be in dire straits.

The spot where we intend to fight must not be made known; for then the enemy will have to prepare against a possible attack at several different points; and his forces being thus distributed in many directions, the numbers we shall have to face at any given point will be proportionately few.

For should the enemy strengthen his van, he will weaken his rear; should he strengthen his rear, he will weaken his van; should he strengthen his left, he will weaken his right; should he strengthen his right, he will weaken his left. If he sends reinforcements everywhere, he will everywhere be weak.

Numerical weakness comes from having to prepare against possible attacks; numerical strength, from compelling our adversary to make these preparations against us.

Knowing the place and the time of the coming battle, we may concentrate from the greatest distances in order to fight.

But if neither time nor place be known, then the left wing will be impotent to succor the right, the right equally impotent to succor the left, the van unable to relieve the rear, or the rear to support the van. How much more so if the furthest portions of the army are anything under a hundred LI apart, and even the nearest are separated by several LI!

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:

Now Sun Tzu's principle can be applied to the resource management in healthcare and importance of the clinic appointment management.

Translation:

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.

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.

And if we are able thus to treat a minor case with a superior facility, the chances of having adverse events will be minimised.

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.

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.

Numerical weakness comes from having to prepare against possible health demands; numerical strength, from encouraging our health consumers to make prior appointments with us.

Knowing the place and the time of the coming encounters, we may concentrate from the greatest distances in order to treat.

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!

Ray Murakami

You may retrieve and be safe from adverse effects if your weaning procedures are more swift

You may advance and be absolutely irresistible, if you make for the enemy's weak points; you may retire and be safe from pursuit if your movements are more rapid than those of the enemy.

If we wish to fight, the enemy can be forced to an engagement even though he be sheltered behind a high rampart and a deep ditch. All we need do is attack some other place that he will be obliged to relieve.

If we do not wish to fight, we can prevent the enemy from engaging us even though the lines of our encampment be merely traced out on the ground. All we need do is to throw something odd and unaccountable in his way.

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, Sun Tzu's principle is shown to be in line with low-invasive treatments and preventive healthcare.

Translation:

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.

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.

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.

Ray Murakami

No specific plans or instructions can ensure the flawless treatment and errorless care

Appear at points which the enemy must hasten to defend; march swiftly to places where you are not expected.

An army may march great distances without distress, if it marches through country where the enemy is not.

You can be sure of succeeding in your attacks if you only attack places which are undefended.You can ensure the safety of your defense if you only hold positions that cannot be attacked.

Hence that general is skillful in attack whose opponent does not know what to defend; and he is skillful in defense whose opponent does not know what to attack.

O divine art of subtlety and secrecy! Through you we learn to be invisible, through you inaudible; and hence we can hold the enemy's fate in our hands.

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 this section, attack and defence are translated into treatment and care, respectively. The enemy is translated to the obstacles in treatment and care. The sentences require creativity in translation and the last paragraph is the pinnacle of them. I read carefully the original contents in the Chinese text and decided to rewrite that part completely regardless of the English translation. I think this is much inline with the original text even outside of the healthcare context.

Translation:

Intervene at points where the health conditions are quick to deteriorate; reallocate swiftly to places where resources are not fulfilled.

A health team may treat a great number of patients without distress, if it operates through streamlined processes where the disruption is not.

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.

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.

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.

Ray Murakami

The clever clinical director imposes his control on the health risk

Sun Tzu said: Whoever is first in the field and awaits the coming of the enemy, will be fresh for the fight; whoever is second in the field and has to hasten to battle will arrive exhausted.
 

Therefore the clever combatant imposes his will on the enemy, but does not allow the enemy's will to be imposed on him.
 

By holding out advantages to him, he can cause the enemy to approach of his own accord; or, by inflicting damage, he can make it impossible for the enemy to draw near.
 

If the enemy is taking his ease, he can harass him; if well supplied with food, he can starve him out; if quietly encamped, he can force him to move.

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:

Sun Tzu always put emphasis on preventive and proactive measures over responsive and reactive ones. This chapter is about understanding the situation and take precautionary actions against them. Especially analysis of "Weak Points and Strong" is crucial in risk assessment. This section saw quite a lot of rewriting to convey the original meaning after considering the original Chinese text.

Translation:

It could be 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.

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.

He promotes healthy behaviours and practices by encouraging them, he discourages risky behaviours and practices by disadvantaging them.

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.

Ray Murakami