--- title: "Process improvement: sorcerer and the sorcerer's apprentice. | Sutter Health" description: "In this essay, I focus on how we should think about emerging \"guidelines\" that standardize care for hospitalized patients who require cardiac operations." url: "https://www.sutterhealth.org/research/publications/process-improvement-inpt-cardiac-operations-1055312402" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Process improvement: sorcerer and the sorcerer's apprentice. # Process improvement: the sorcerer and the sorcerer's apprentice. Gaudiani VA. _Rev Bras Cir Cardiovasc. 2009 Jan-Mar;24(1):1-3._ 2009-01-01 ## Abstract 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. [PubMed abstract](http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76382009000100002&lng=en&nrm=iso&tlng=e) ## Research topics - [Cardiovascular Diseases](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Cardiovascular+Diseases%5C%22%22) - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Development of a patient decision aid for syncope in the emergency department: the SynDA tool.](https://www.sutterhealth.org/research/publications/pt-decision-aid-for-syncope-in-er-1055312333) Probst MA, Hess EP, Breslin M, Frosch DL, Sun BC, Langan MN, Richardson LD. Acad Emerg Med. doi: 10.1111/acem.13373. \[Epub ahead of print\] 2017 Dec 30 - Publication ### [Predictors of statin compliance after switching from branded to generic agents among managed-care beneficiaries.](https://www.sutterhealth.org/research/publications/statin-compliance-predictors-branded-to-generic-1055312734) Romanelli RJ, Segal JB. J Gen Intern Med. \[Epub ahead of print\] 2014 Jun 24 - Publication ### [Compliance after switching from branded to generic statins.](https://www.sutterhealth.org/research/publications/compliance-switch-from-branded-to-generic-statins-1055312703) Romanelli RJ, Jukes T, Segal JB. Pharmacoepidemiol Drug Saf. doi: 10.1002/pds.3630. 2014 May 09 - Publication ### [Moderating effects of patient characteristics on the impact of financial incentives.](https://www.sutterhealth.org/research/publications/effects-of-pt-characteristics-on-financial-incentives-1055312755) Rosenthal MB, Troxel AB, Volpp KG, Stewart WF, Sequist TD, Jones JB, Hirsch AG, Hoffer K, Zhu J, Wang W, Hodlofski A, Finnerty D, Huang JJ, Asch DA. Med Care Res Rev. 76(1):56-72. doi: 10.1177/1077558717707313. Epub 2017 May 8. 2019 Feb 01 - Publication ### [Financial incentives and cholesterol levels.](https://www.sutterhealth.org/research/publications/financial-incentives-and-cholesterol-levels-1055312411) Lesser LI, McCormack JP. JAMA. 315(15):1657-8. doi: 10.1001/jama.2016.0309. 2016 Apr 19 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/process-improvement-inpt-cardiac-operations-1055312402#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Process improvement: sorcerer and the sorcerer's apprentice."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/process-improvement-inpt-cardiac-operations-1055312402#medicalscholarlyarticle","name":"Process improvement: the sorcerer and the sorcerer's apprentice.","headline":"Process improvement: sorcerer and the sorcerer's apprentice.","abstract":"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.","description":"In this essay, I focus on how we should think about emerging \"guidelines\" that standardize care for hospitalized patients who require cardiac operations.","keywords":["Cardiovascular Diseases","Health Services"],"datePublished":"2009-01-01","url":"https://www.sutterhealth.org/research/publications/process-improvement-inpt-cardiac-operations-1055312402","inLanguage":"en-US","isPartOf":{"@type":"Periodical","name":"Rev Bras Cir Cardiovasc"},"author":[{"@type":"Person","name":"Gaudiani VA"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Cardiovascular Diseases","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Cardiovascular+Diseases%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Health Services","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Health+Services%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/process-improvement-inpt-cardiac-operations-1055312402","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/process-improvement-inpt-cardiac-operations-1055312402#breadcrumblist"}}} ```