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

The clever consultant looks to the effect of a multidisciplinary team

Thus one who is skillful at keeping the enemy on the move maintains deceitful appearances, according to which the enemy will act. He sacrifices something, that the enemy may snatch at it.

By holding out baits, he keeps him on the march; then with a body of picked men he lies in wait for him.

The clever combatant looks to the effect of combined energy, and does not require too much from individuals. Hence his ability to pick out the right men and utilize combined energy.

When he utilizes combined energy, his fighting men become as it were like unto rolling logs or stones. For it is the nature of a log or stone to remain motionless on level ground, and to move when on a slope; if four-cornered, to come to a standstill, but if round-shaped, to go rolling down.

Thus the energy developed by good fighting men is as the momentum of a round stone rolled down a mountain thousands of feet in height. So much on the subject of energy.

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 is the summary section of this chapter about engagement. The first part is about the engagement between the clinician and the patient and put in the mobile care context. The second and the last part is about engagement within clinical team and put in the context of the multidisciplinary team.

Translation:

Thus one who is skilful at keeping the patient on the move maintains the online presence, according to which the patient will access. He provides some information, that the patient may snatch at it.

By holding out portals, he keeps the patient informed; then with a clinic of picked staff he calls in the patient for an appointment.

The clever consultant looks to the effect of a multidisciplinary team, and does not require too much from individuals. Hence his ability to pick out the right people and utilise a multidisciplinary team.

When he utilises a multidisciplinary team, his staff become as it were like unto rolling logs or stones. For it is the nature of a log or stone to remain motionless on level ground, and to move when on a slope; if four-cornered, to come to a standstill, but if round-shaped, to go rolling down.

Thus the engagement developed by good clinical team is as the momentum of a round stone rolled down a mountain thousands of feet in height. So much on the subject of engagement.

Ray Murakami

The good medical officer will be comprehensive in his onset, and prompt in his decision

The onset of troops is like the rush of a torrent which will even roll stones along in its course.

The quality of decision is like the well-timed swoop of a falcon which enables it to strike and destroy its victim.

Therefore the good fighter will be terrible in his onset, and prompt in his decision.

Energy may be likened to the bending of a crossbow; decision, to the releasing of a trigger.

Amid the turmoil and tumult of battle, there may be seeming disorder and yet no real disorder at all; amid confusion and chaos, your array may be without head or tail, yet it will be proof against defeat.

Simulated disorder postulates perfect discipline, simulated fear postulates courage; simulated weakness postulates strength.

Hiding order beneath the cloak of disorder is simply a question of subdivision; concealing courage under a show of timidity presupposes a fund of latent energy; masking strength with weakness is to be effected by tactical dispositions.

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:

For the second time, I changed the English translation of the title of this chapter to fit it into healthcare context. Now it is Engagement. The original translation was "energy" and I thought it means what moves a lot of people in a coordinated way after considering this section. In healthcare, what brought people on the same page is engagement. There are many other expressions required creative translations. Those were about the "deceptive" nature of the war which makes enemy believe what is actually not. I have chosen anaesthesia, sedation and relaxant as such elements in healthcare.

Translation:

The onset of a treatment is like the rush of a torrent which will even roll stones along in its course.

The quality of decision is like the well-timed swoop of a falcon which enables it to strike and destroy its victim.

Therefore the good medical officer will be comprehensive in his onset, and prompt in his decision.

Engagement may be likened to the bending of a crossbow; decision, to the releasing of a trigger.

Amid the turmoil and tumult of treatment, there may be seeming disturbance and yet no real disturbance at all; amid confusion and chaos, your array may be without head or tail, yet it will be proof against defeat.

Induced unconsciousness postulates perfect consciousness, induced calmness postulates vitality; induced weakness postulates strength.

Hiding consciousness beneath the cloak of coma is simply a question of anaesthetics; concealing vitality under a show of timidity presupposes a fund of latent energy by sedation; masking strength with weakness is to be effected by relaxant.

Ray Murakami

Remote deliveries, efficiently applied, are ubiquitous as Heaven and Earth

In all fighting, the direct method may be used for joining battle, but indirect methods will be needed in order to secure victory.

Indirect tactics, efficiently applied, are inexhaustible as Heaven and Earth, unending as the flow of rivers and streams; like the sun and moon, they end but to begin anew; like the four seasons, they pass away to return once more.

There are not more than five musical notes, yet the combinations of these five give rise to more melodies than can ever be heard.

There are not more than five primary colors (blue, yellow, red, white, and black), yet in combination they produce more hues than can ever been seen.

There are not more than five cardinal tastes (sour, acrid, salt, sweet, bitter), yet combinations of them yield more flavors than can ever be tasted.

In battle, there are not more than two methods of attack--the direct and the indirect; yet these two in combination give rise to an endless series of maneuvers.

The direct and the indirect lead on to each other in turn. It is like moving in a circle--you never come to an end. Who can exhaust the possibilities of their combination?

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 hint for this translation came from a conversation with a Zen monk, Venerable Yushi Shimada who is a Facebook/Twitter friend of mine. I thought these passages illustrated that the limitation of options did not necessarily limit what we could do about with them. It seemed to me that the notion was relevant to modern healthcare, too. But I thought I would need better examples for today's audience than Sun Tzu used to describe it.

Then Yushi mentioned about our previous discussion about the movie "Matrix" on indistinctness between physical reality and virtual reality. Then I found that I could translate those passages within the context of remote healthcare delivery. I really appreciate Yushi for that.

Translation:

In all healthcare deliveries, the direct method may be used for the first encounter, but remote methods will be needed in order to maintain access.

Remote deliveries, efficiently applied, are ubiquitous as Heaven and Earth, continuous as the flow of rivers and streams; like the sun and moon, they are timely and repeatable; like the four seasons, they accommodate any stages of life.

There are not more than sixteen bits, yet the combinations of these can record more melodies than can ever be heard.

There are not more than eight bits each for three primary colours, yet in combination they can record video streams with more hues than can ever been seen.

There are not more than blood-oxygen level test, yet pulse oximetry yield more favours than other methods ever be tested.

In healthcare, there are not more than two methods of delivery--the direct and the remote yet these two in combination give rise to an endless series of manoeuvres.

The direct and the remote lead on to each other in turn. It is like moving in a circle--you never come to an end. Who can exhaust the possibilities of their combination?

Ray Murakami