Process improvement: the sorcerer and the sorcerer's apprentice.

In this essay, I focus on how we should think about emerging "guidelines" that standardize care for hospitalized patients who require cardiac operations.

I propose that when we standardize care based on the results of randomized controlled trials (RCTs), we act in concert with the greatest of sorcerers, the producer of the most extraordinary and surprising outcomes, that is, science.

On the other hand, when we regiment care based on guidelines that are the best guesses of experts without the benefit of well tested hypotheses, we act like the sorcerer's apprentice, that is, we impede ourselves and the care of those we serve.