Healthcare Improvement and Bruce Lee

In April I attended the BMJ/IHI Forum on Quality and Safety in Healthcare in London. Maureen Bisognano, President and CEO of the IHI was one of the main speakers.

Maureen discussed an area of healthcare we haven’t been fantastic at improving in recent years; funnily enough, she didn’t talk about innovation, but exinnovation – this term referring to what we can reduce, minimize, throw-away and do without to make healthcare run more smoothly, economically and effectively.

So much of modern healthcare involves doing more – starting from a stance of scarcity; more equipment, more time, more money, more tests, medicines, etc – part of this stems from the human necessity to do more, explore and expand – this is the basis of evolution, learning and improvement.

Yet, sometimes we don’t realize what we already have. We forget that not only are we surrounded by plenty, oftentimes we are surrounded by too much – too much information, too much clutter, to many investigations and procedures.

And this is where Bruce Lee comes-in. In 2015 Maureen Bisognano was discussing something that Bruce Lee, the legendary martial artist discussed in the 1960’s – One of his famous mantras was ‘It is not daily increase, but daily decrease – hack away the unessentials’ Lee was talking about the superfluous, often over-indulgent and at times flouncy movements of some martial arts – Lee was interested in effectiveness, not wasting time and effort perfecting moves that he didn’t feel added to the outcomes.

In how many areas of modern healthcare do we do too much? Unnecessary procedures, reports and documents – how many times is a patient asked about their history, their symptoms, how many superfluous investigations are performed, bed, ward and hospital moves? How much less could we do to become more effective?

The shortest distance between two points is a straight line – sometimes we need to wander, we need to take the scenic route to arrive at our destination; how often could we achieve for our patients equivalent and even better outcomes by exinnovating, stripping away that which is not essential?IMG_3508


  1. I loved this blog, Rod. Stripping away the inessentials was indeed what Bruce Lee was about. He’d have loved this article! Can you please give some practical examples?


    • Hi Nig,

      I can’t tell you how many times over the years I have repeated this phrase to myself – ever since 1986 when I first read the Tao of Jeet Kune Do, this has been part of my life philosophy – long before it was anything to do with healthcare.

      When I became a doctor in the late 1990’s, doing more with less was not part of the language – it was a time of expansion, optimism and growth. The world has changed, the recession, although bringing with it innumerable woes to scores of people, has changed the focus of society and with it the way we approach healthcare.

      Hacking away the unessentials is doing more with less, it is offering better care with less, it means fewer unnecessary investigations and treatments to arrive at the same result, less waste; If I can treat my patient in one day when previously it would have taken five, that is a win for the patient and the system as a whole – in particular, by reducing my patient’s exposure to the potential harm of hospitalisation, everyone wins.

      When an older person is sick and takes to their bed with say, pneumonia, every day that passes, despite whatever treatment is offered, weakens that individual, reduces the likelihood they will ever walk or become independent again – that is why, on my ward, patients are encouraged to be dressed and out of bed as soon as possible – we hack away at the concept of disease or illness; the less time the patient, their relatives and the system see that older person (or anyone, for that matter) as being a patient (from the Latin, suffering), the quicker they can recover.

      This philosophy is also congruent with me being a specialist in older people – often here, less is more, reducing the strength of the antihypertensive can prevent my patient from falling, or the pain killer, from them becoming confused, by using direct non-jargonized language I can better convey what is happening.


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