Sun Tzu said, "The art of war recognizes nine varieties of ground: (1) Dispersive ground; (2) facile ground; (3) contentious ground; (4) open ground; (5) ground of intersecting highways; (6) serious ground; (7) difficult ground; (8) hemmed-in ground; (9) desperate ground."
Interestingly, they can be well interpreted within the healthcare context. I will explain each variety of ground in each of following articles, but I would like to do a quick walk-though of "The Nine Situations" interpreted as nine clinical settings.
(1) Dispersive ground: Primary Care
Sun Tzu said, "When a chieftain is fighting in his own territory, it is dispersive ground." In a primary care setting, a general practitioner or a primary care nurse plays its role in its own territory and a patient is taken care in its own community.
(2) Facile ground: Day Surgery/Short Stay
Sun Tzu said, "When he has penetrated into hostile territory, but to no great distance, it is facile ground." In a day surgery/short stay setting, practitioners only perform non to minimally invasive care and a patient is admitted to the facility in a short period of time.
(3) Contentious ground: Open Clinics
Sun Tzu said, "Ground the possession of which imports great advantage to either side, is contentious ground." In an open clinic setting, the practitioners within a contract can utilise advanced equipment in the same open clinics and a patient can consult a number of services in the same location.
(4) Open Ground: Mobile Care
Sun Tzu said, "Ground on which each side has liberty of movement is open ground." In a mobile care setting, practitioners are equipped with an outfit which enables to provide health services anywhere practical and a patient have a choice where to receive services or sometimes portable devices do the job anywhere the patient carries them around.
(5) Ground of intersecting highways: Multidisciplinary Care
Sun Tzu said, "Ground which forms the key to three contiguous states, so that he who occupies it first has most of the Empire at his command, is a ground of intersecting highways." In a multidisciplinary care setting, the service includes multiple specialities and significant health outcomes can be achieved if an integrated management established there.
(6) Serious ground: Secondary Care
Sun Tzu said, "When an army has penetrated into the heart of a hostile country, leaving a number of fortified cities in its rear, it is serious ground." In a secondary care settings, practitioners perform invasive procedures which requires hospitalisation and a patient need to be admitted in a hospital with advanced facilities for both treatment and daily life. A large hospital is often described as a little city.
(7) Difficult ground: Tertiary Care
Sun Tzu said, "Mountain forests, rugged steeps, marshes and fens--all country that is hard to traverse: this is difficult ground." In a tertiary care setting, specialist cancer care, brain surgery and burns care - difficult cases which require personnel and facilities for special investigation and treatment are treated.
(8) Hemmed-in ground: Intensive Care
Sun Tzu said, "Ground which is reached through narrow gorges, and from which we can only retire by tortuous paths, so that a small number of the enemy would suffice to crush a large body of our men: this is hemmed in ground." In an intensive care setting, a patient can only be revived by tortuous paths, so that a small change of conditions would suffice to damage the whole body systems.
(9) Desperate ground: Emergency Medicine
Sun Tzu said, "Ground on which we can only be saved from destruction by fighting without delay, is desperate ground." In an emergency medicine setting, we can only be saved from treatments performed without delay.
How do you think of them? As Sun Tzu's categorisation is based on literally "invasiveness", "intensity" or "going how far" to fight the battle, it would be natural to be able to find equivalents in the healthcare context. You would see more of interesting correspondences as we study closer each variety of the battle grounds.
The English texts of Sun Tzu's 'The Art of War' are from The Project Gutenberg eBook, The Art of War, by Sun Zu
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