1. Five Laws of Life, Medicine and Patient Flow
Erica Reid,
NHS Borders,
June 2011

2. Five Laws of Life, Medicine and Patient Flow What are they?
Occam’s Razor
Sutton’s Law
Hickam’s Dictum
Murphy’s Law
Zanuck’s Corollary

3. 14th Century Philosopher
Occam’s Razor
William Occam
14th Century Philosopher
‘Razor’- shave any unnecessary assumptions from a theory

4. Effective Patient Flow Occam’s Razors?
Identify potential bottlenecks
EDs/Assessment Units – are processes unnecessarily complicated?
Simple Discharge Processes
What time of day are you discharging the majority of patients?
Is it matching the demand for admission?

5. ‘Because that’s where the money is’
Willie Sutton
Never carried a loaded gun ‘someone might get hurt’
Stole from the rich and kept it.
Never robbed banks if women screamed or babies cried.
Why did he rob banks?
‘Because that’s where the money is’
Robbed about 100 banks from the late 1920s to his final arrest in 1952
Throughout his professional criminal career he never killed anyone.

6. Sutton’s Law
When investigating a patient look in the place most likely to give the diagnosis

7. Effective Patient Flow Sutton’s Law?
Have you acknowledged active management of length of stay is a key priority?
Are all wards proactively managing patient flow?
EDDs, Daily Board Rounds, etc

8. ‘Patients can have as many diseases as they damn well please’
Hickam’s Dictum
‘Patients can have as many diseases as they damn well please’

9. Effective Patient Flow Hickam’s Dictum?
Patients can have many diseases at the same time, but may also have many and complex social care needs
How can you work more effectively with social work colleagues to reduce delays?

10. "Anything that can go wrong, will go wrong"
Murphy’s Law
"Anything that can go wrong, will go wrong"

11. Origin of Murphy’s law Dr. John Stapp, USAF Col. & Flt Surgeon
1946-7, High altitude experiments
Human tolerance of G-forces in rapid decelerations using test sleds

12. "Anything that can go wrong, will go wrong"
Murphy’s Law
Stapp’s rocket sled team’s good safety record, explained it was due to awareness of Murphy’s Law and the need to circumvent it.
Term was picked up by the aerospace industry.
"Anything that can go wrong, will go wrong"

13. Effective Patient Flow Murphy’s Law?
Mondays and Tuesdays?
To board or not to board?
Moving patients to the ‘wrong’ bed to avoid breaches

14. Zanuck’s Corollary
If two men on the same job agree all the time, one of them is useless. If they disagree all the time, both are useless
Darryl Zanuck quoted Oct 1949
Movie Producer & owner of Fox Studios
Movies inc. 42nd Street, How Green was my Valley, The Grapes of Wrath, Longest Day

15. Effective Patient Flow Zanuck’s Corollary?
Some measure of disagreement and debate essential
Management of process and clinical need
Strict protocol versus case-by-case tailoring

16. Kenney’s Law Just because you don’t agree with me,
doesn’t mean I’m wrong!
With thanks to Dr Ian Kenney,
Consultant Paediatric Radiologist, Brighton.