THIS BLOG HAS MOVED

This blog has moved to a Tiapana ICT's company blog, "Health IT Kawaraban."
http://healthitkawaraban.blogspot.co.nz/

Do Not Challenge the Right to Command of the Physician

Sun Tzu said, "If the opponent is occupying the strategic point (contentious ground) whose possession decides the dominant side in the battle, do not attack it."

This is especially true for a health IT project where a physician in a senior position is taking leadership role.

Of course, we should challenge any notions technically make no sense, but all of the stakeholders would be better off by simply letting the physician take the lead.

The physician is trained to be a leader in healthcare, so naturally feels most comfortable in a leading position.

Challenging the position would cause serious consequences as the physician fights for dear life to defend it. That would certainly be a losing battle for you except you are yourself a physician. What on earth is worth for it in health IT project management?

Let's concentrate on more productive things.

Ray Murakami

Do not halt at the fringe of healthcare world

After departing from the comfort of the technical territory, the next challenge for an IT technician new to health IT would be testing the water of the field of medicine.

For anyone who are not from healthcare background, the hospital is a place you won't visit unless you are, or someone close to you is, in a deteriorated health condition, in other words, ill. Sometimes this makes interesting effect. Even if you are totally healthy you may feel ill just because you are in a hospital!

My advice is follow the maxim of Sun Tzu, "If you have entered enemy territory but not proceeded deep into it, that's facile ground. Do not halt there."

In fact, just visiting a hospital would not increase your knowledge about healthcare considerably. You need to more proactive to start learning something about medicine. Escorting your nanny to regular check-ups would not make you any closer to put "health" before your IT specialist title.

Ray Murakami

First, leave the comfort of the techy home territory

As a health IT analyst having informatics as the primary expertise, there is one thing I have kept in my mind: never assume myself to be a technical expert, but commit to be a professional in healthcare.

Thus I have followed the maxim by Sun Tzu, "Never fight in your home territory. It's the dispersive ground where you can't keep the formation and morale."

If I resort to the position of a technical expert in general informatics, I would risk my focus to miss the ultimate costumer, the patient, by talking about the aspects only inside of computers and networks.

I have seen lots of health IT technicians who concentrate only on IT issues and are hesitant to leave their home territory. They made me feel left alone while we are talking with clinicians on technical issues. That's really the dispersive ground.

My tactics is refraining to use technical jargons as far as possible and introducing clinical examples as much as possible. That would move the battle ground a bit away from the technical ground and closer to the healthcare side where the clinicians and patients reside.

My personal observation is that most of the failed health IT projects have been fought on such dispersive grounds, intensively technical territories.

Ray Murakami

Revisiting Sun Tzu's Nine Grounds - This time Informatics meets Medicine.

Sun Tzu said, "The history has seen clumsy victories by hurried hands, but never a perfect win by wary hands."

I am afraid that my blog is becoming another proof of his claim. So I will change my strategy to seek speed rather than perfection.

Since the last update, I have been studying at a postgraduate programme of health informatics and learned a lot. I would like to put them into the context of The Art of War by Sun Tzu.

To begin with, I am going to revisit the "Nine Grounds". This time from the proximity to informatics to the very heart of medicine.

This is also a challenge one of my lecturers put on me by pointing out that I am still playing safe in the realm of health informatics.

OK, let's start diving into the hostile territory :)

Ray Murakami

Interpreting Sun Tzu's "The Nine Situations" (1) Dispersive ground: Primary Care

To illustrate the relevant strategies according to the occasions, Sun Tzu categorised the battle fields into nine categories. He dedicated a whole chapter to describe them, the eleventh chapter titled "The Nine Situations" in his "The Art of War".

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. In this issue, the first situation "Dispersive ground" is interpreted as Primary Care.

Firstly, look at the definition.

Sun Tzu said, "When a chieftain is fighting in his own territory, it is dispersive ground."

The chieftain who fights battle can be assimilated to a healthcare professional and a patient as they fight against diseases. In a primary care setting, a healthcare professional is a general practitioner or a primary care nurse who plays its role in its own territory. The patient is provided healthcare service in the proximity of its own community.

So far so good. Then secondly, what about strategy there?

Sun Tzu said, "On dispersive ground, therefore, fight not."

Because of proximity of the battlefield to home, soldiers rather run away than taking risk of fight. In healthcare context, a patient would not tolerate heavy stressful treatment or intervention. So in the primary care setting it would be wise to concentrate on prevention and health promotion rather than intensive battle against diseases.

The final words for this situation.

Sun Tzu said, "On dispersive ground, I would inspire my men with unity of purpose. "

In Primary Care setting, definitely this is very important point. The general practitioner and the primary care nurse should be informed of latest best practices and the awareness and participation of patient should be encouraged and supported by adequate information in the same purpose of lifting health.

So what should be dispersed here are the proper information and knowledge, not the people, or even worse, diseases.

The English texts of Sun Tzu's 'The Art of War' are from The Project Gutenberg eBook, The Art of War, by Sun Zu

Interpreting Sun Tzu's "The Nine Situations" within the healthcare context

To illustrate the relevant strategies according to the occasions, Sun Tzu categorised the battle fields into nine categories. He dedicated a whole chapter to describe them, the eleventh chapter titled "The Nine Situations" in his "The Art of War".

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