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Language Matters

Posted By Wendy Leebov, Monday, August 25, 2014
Updated: Thursday, August 21, 2014

I’m struck daily by the fact that the words we use strongly influence our goals, strategies and outcomes. In my view, those of us determined to achieve breakthroughs in the patient, family and employee experience need to become more self-conscious about the words we choose, so that these words advance our cause, inspire people and accelerate improvement and transformation.

In the last few years, we’ve made very positive and far-reaching language shifts. Patient experience has replaced patient satisfaction. And employee engagement has replaced employee satisfaction. These language changes reflect and also drive progress.

Still, we are on automatic pilot with words. They pop out of our mouths, pens and keystrokes without much deliberation, and, when that happens, our words reflect our habitual thinking. This is a problem because our habitual thinking often limits our imagination, aspirations, goals and, therefore, our results.

Words That Reinforce Hierarchies and Pecking Orders

Some of our words reinforce the destructive pecking order and hierarchy that have discouraged the teamwork, partnership, collaboration and mutual respect we desperately need throughout healthcare.

  • Compliance vs Adherence: The term patient compliance implies that the doctor knows best, issues orders to the patient and expects the patient to obediently follow their direction. Adherence works so much better because we need to engage and partner with patients, co-develop a plan and, then, we certainly do want to help them adhere to it. We need to develop care plans with patients and families, not for them. Down with compliance! This word disempowers patients. We need engagement and partnership.
  • Super-User: Sure, it’s powerful to identify staff members who excel at certain skills and engage them in helping their colleagues strengthen these same skills. But must we call them "Super-Users”, which, in my view, implies a superiority? Why not "coach?” This is so much more descriptive of how we want to recognize and engage people in helping their peers sharpen their skills.

And how about health partner, care partner and care team instead of caregivers and caretakers?

Words That Narrow Our Scope

Then come the words that reflect a healthcare system of the past, not the present and future. Our language and our strategies have been hospital-focused, not person-focused, and illness-centered, not health-centered. Hospital-centricity encourages relative inattention to homes care, ambulatory care, wellness care, longterm care, health coaching, health education and much more.

How about transition plan, get-well action plan or recovery plan instead of discharge plan? Discharge plan is about what we are doing, not about what the patient is doing.

And the word patient itself is suspect. Is a newborn child a patient? Are her parents attending parenting classes at an outpatient center patients? Does my 96-year-old mother living at home see herself as a patient? When healthcare professionals teach a factory work team to lift in an ergonomic way, are these workers patients? No, and, in fact, they’re trying to avoid BECOMING patients. The term patient works in a healthcare system focused on making sick people well, but it does not work well to describe people who are well and who seek to maintain optimal health and prevent illness. Increasingly, I hope, people will rely on the healthcare system to help them achieve the best possible health, wellness and state of being possible for them throughout their lifetime. We need to focus on person experience, not just the patient experience.

Do we want people to view experiences like these as something a part from the healthcare system? People ARE having a healthcare experience; they are relying on us as members of their healthcare team. I think it’s time we help people see health, wellness and prevention in whatever setting as part and parcel of the healthcare system. Wellness care is what we need. Disease management is what we have. Disease management is for patients. Wellness care is for people.

And while patient and family-centered care is better than patient-centered care, person-centered care is even better.

Words That Impact Behavior in the Moment

Language even affects our behavior and empathy. I no longer talk about "difficult people.” I now think and say difficult-for-me-people or distressed people so I can approach people with loving-kindness, patience and compassion.

Language matters. That’s why my colleagues and I just renamed our company Language of Caring, LLC. We are fanatically committed to helping everyone in healthcare speak the language of caring so patients, coworkers, persons, or whatever you want to call people, feel our caring in every conversation and every interaction 24/7.

Wendy Leebov is a lifelong activist for creating healing experiences for patients, families and the entire healthcare team. She is internationally respected as a thought leader, healthcare executive, culture change strategist, coach and author who has helped hospitals, health systems and medical practices to achieve breakthroughs in the patient and family experience. Wendy is Managing Partner, Language of Caring, LLC.

Tags:  caring  engagement  healthcare  language  patient 

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Comments on this post...

Mary Clough says...
Posted Tuesday, August 26, 2014
Wendy, as always I think your words are quite on point and impactful. In particular I would like to partner with you on working to get compliance out of our vocabulary--for all the reasons you note. When I was doing bedside care I was always troubled when a nurse would note that the patient was non-compliant with a medication because they did not take it at the time that the computer told the nurse to offer it. But they would take it an hour or two later when the patient (oops....person) normally took this when at home.
The only part of your post I am not so sure about is the term person instead of patient. While I agree with all your reasons not to use patient, I have some thoughts about why not to use person. Everyone is a person. Every staff person, MD, visitor, etc. If we go to person centered care do we not risk everyone then feeling it's about them? While I understand we need a different word, I do believe we need a word or term for the person receiving care or care planning.
I am in total agreement however that language matters and we need to pay more attention to what we say and what we write. Thanks.
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Catherine W. Smith says...
Posted Tuesday, August 26, 2014
I also deeply value the impact of our word choices. I appreciate Mary's comment about "person" instead of "patient" and the potential confusion that might arise. I'm not sure it's the ideal word, but we have more and more been using "consumer" rather than "patient" as an inclusive term that might cover family members and potential patients as well. Thoughts?
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Wendy Leebov says...
Posted Tuesday, August 26, 2014
Mary and Catherine, I absolutely see your points about the word "person." It's not clear enough for our purpose, but I am having a very hard time figuring out a solution. The other words I can think of have their own inherent limits or off-target connotations. Personally, I don't care for the words "consumer" or "user." Perhaps we're trying to find one word that embodies too many possibilities (inpatient, outpatient, sick person, well person, etc.) Still, it would be great to solve this... So keep the ideas coming!
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