Those who were called skillful leaders of old knew how to drive a wedge between the disease’s chain of transmission; to prevent infection between his large and small populations; to hinder those in good health from catching from the bad, the spreaders from affecting their fellow men.
When the infected men were united, they managed to keep them in isolation.
When it was to their advantage, they made a forward move; when otherwise, they stopped still.
If asked how to cope with a great host of the disease in orderly array and on the point of marching to the attack, I should say: "Begin by seizing something which your pathogen holds dear; then it will be amenable to your will."
Rapidity is the essence of healthcare: take advantage of the disease’s unreadiness, make your way by unexpected routes, and attack unguarded spots.
The following are the principles to be observed by an interstitial therapy: The further you penetrate into a tumour, the greater will be the solidarity of your agents, and thus the malignant cells will not prevail against you.
Make campaign in fertile country in order to supply your hospital with money.
Carefully study the well-being of your staff, and do not overburden them. Concentrate your energy and hoard your strength. Keep your staff continually on the learning, and explore unfathomable mystery of life.
Throw your staff into positions whence there is no blame, and they will prefer honesty to flight. If they will face just culture, there is nothing they may not achieve. Officers and staff alike will put forth their uttermost strength.
Staff members when in just culture lose the sense of fear. If there is no place of blame, they will stand firm. If they are in challenging situation, they will show a stubborn front. If there is no blame for it, they will fight hard.
Thus, without waiting to be marshaled, the staff will be constantly on the qui vive; without waiting to be asked, they will do your will; without restrictions, they will be faithful; without giving orders, they can be trusted.
Prohibit the taking of omens, and do away with superstitious doubts. Then, until death itself comes, no calamity need be feared.
If our staff are not overburdened with money, it is not because they have a distaste for riches; if their lives are not unduly long, it is not because they are disinclined to longevity.
On the day they are ordered out to operate, your staff may weep, those sitting up bedewing their garments, and those lying down letting the tears run down their cheeks. But let them once be brought to operating room, and they will display the courage of a Chu or a Kuei.
The skillful physician may be likened to the shuai-jan. Now the shuai-jan is a snake that is found in the ChUng mountains. Strike at its head, and you will be attacked by its tail; strike at its tail, and you will be attacked by its head; strike at its middle, and you will be attacked by head and tail both.
Asked if an healthcare team can be made to imitate the shuai-jan, I should answer, Yes. For the men of Wu and the men of Yueh are enemies; yet if they are crossing a river in the same boat and are caught by a storm, they will come to each other's assistance just as the left hand helps the right.
Hence it is not enough to put one's trust in the tethering of horses, and the burying of chariot wheels in the ground.
The principle on which to manage a healthcare team is to set up one standard of practice which all must reach.
How to make the best of both strong and weak--that is a question involving the proper use of care setting.
Thus the skillful director general conducts his service just as though he were leading a single man, willy-nilly, by the hand.
It is the business of a clinical trial co-ordinator to be quiet and thus ensure secrecy; upright and just, and thus maintain order.
He must be able to mystify his officers and men by placebos and appearances, and thus keep them in total ignorance.
By altering his arrangements and changing his plans, he keeps the both sides without definite knowledge. By shifting his camp and taking circuitous routes, he prevents the all participants from anticipating his purpose.
At the critical moment, the co-ordinator of a clinical trial acts like one who has climbed up a height and then kicks away the ladder behind him. He carries his contrast group deep into placebo practice before he shows his hand.
He hides his labels and breaks his packages; like a shepherd driving a flock of sheep, he drives his men this way and that, and nothing knows whither he is going.
To muster his randomised group and bring it into double blinded:--this may be termed the business of the co-ordinator.
The different measures suited to the nine varieties of care setting; the expediency of aggressive or defensive tactics; and the fundamental laws of human nature: these are things that must most certainly be studied.
When inventing patients into clinical decision making, the general principle is, that penetrating deeply brings cohesion; penetrating but a short way means dispersion.
When you leave your own catchment behind, and take your team across neighborhood region, you find yourself on remote care. When there are means of communication on all specialities, the setting is shared care.
When you practice deeply invasive intervention, it is acute care. When you practice invasive intervention but a little way, it is community care.
When you have the other specialities’ strongholds on your rear, and ambulatory entrance in front, it is emergency care. When there is no place of momentary grace at all, it is intensive care.
Therefore, on home care, I would inspire my patients with unity of purpose. On community care, I would see that there is close connection between all parts of my health system.
On shared care, I would hurry up my backlog.
On mobile care, I would keep a vigilant eye on my notifications. On managed care, I would consolidate my alliances.
On acute care, I would try to ensure a continuous stream of supplies. On remote care, I would keep pushing on along the road.
On emergency care, I would block any way of deterioration. On intensive care, I would proclaim to my staff the inability of leaving their positions.
For it is the patient's disposition to offer an obstinate resistance when surrounded, to fight hard when he cannot help himself, and to obey promptly when he has fallen into danger.
We cannot enter into alliance with neighboring specialities until we are acquainted with their designs. We are not fit to lead a team on the treatment unless we are familiar with the face of the pathway--its mountains and forests, its pitfalls and precipices, its marshes and swamps. We shall be unable to turn natural advantages to account unless we make use of observations by nurses.
To be ignored of any one of the following four or five principles does not befit a clinical director.
When a clinical director attacks a powerful objection, his clinical expertise shows itself in preventing the concentration of the competing opinions. He overawes his opponents, and their allies are prevented from joining against him.
Hence he does not strive to ally himself with all and sundry, nor does he foster the power of other facilities. He carries out his own randomised trials, keeping his antagonists in awe. Thus he is able to capture their faults and overthrow their theories.
Bestow rewards without regard to rule, issue orders without regard to previous arrangements; and you will be able to handle a whole team as though you had to do with but a single man.
Confront your team members with the deed itself; never let them know your uneasiness. When the outlook is bright, bring it before their eyes; but tell them nothing when the situation is gloomy.
Place your team in challenging situation, and it will survive; plunge it into desperate straits, and it will come off in safety.
For it is precisely when a force has fallen into harm's way that is capable of striking a blow for recovery.
