The use of language in healthcare can significantly influence patient safety in several ways.
We identify communication as a contributing factor to investigation recommendations but I would like to explore if the words by which we describe our world, reveals the culture in which we work.
Robust Standards of Documentation
We are fully aware of the need for accurate and comprehensive documentation in compliance with our professional bodies standards, however reducing complexity to black and white statements of fact leads to the loss of context.
Clear and accurate communication between professionals and our patients is crucial in safety. Misinterpretation or misunderstanding can lead to errors in medication, treatment plans, and other aspects of care but within the words we use, we create labels and our sense making often reveals categorisation which creates those who belong and those who are ‘other’.
Patients need to fully understand their health conditions and the treatment options available to them in order to make informed decisions. However, health is a complex bio-psycho-social interaction which requires time and positive communication strategies to create a personalised plan.
Examples of Language in Safety and Quality
An example, is a lady who complained to a nurse, that she wanted to see a doctor after having surgery earlier in the week and fearing complications.
This led to conflict as the system utilised nurses and no doctor was available.
The clinical team united and labelled the person as ‘trouble’ rather than seeing her as a scared post-operative patient and no-one recognised that there was reasonableness in the request.
No-one identified that the system was flawed and did not meet the needs of the patient rather they preferred to label our patient as a ‘problem’.
A second example is from Sussex Prisoners Families which is part of a shared narrative in relation to a child who witnessed their mother being arrested.
My name is ……………..
This is my story about when the police came to our house and took my mum away (when I was five years old). I don’t remember much. We were all in the living room when there was a big bang on the door. I could hear a lot of people talking. The next thing I remember is my mum being on the floor. I was very scared and was crying a lot. My mum was asking them not to hurt her arm and didn’t want me or my baby brother Bobby to see. I was yelling for my mum and crying more. I remember screaming for my mum as they were fighting with my mum. My mum told me it was okay, and it is a game the police was playing, looking all around the house and pulling things out and making a mess everywhere. I was so scared because I didn’t know what was going on. They took my mum out the house and I didn’t know what was going on. They took my mum out the house and I didn’t know if I was going to see her again.
We rarely have our patients histories shared in a narrative which reveals their true thoughts and feelings, which prevents us from being able to truly understand.
Professional Language
Interprofessional communication is an interesting area as we have generated a business biased language where resources, assets, efficiency and effectiveness all blossom, but paying attention, having compassion, being open and creative is absent.
Cultural differences can be seen in our language. Culturally insensitive language can lead to miscommunication, misunderstanding, and harm but to be able to constantly place ourselves in others shoes, creates a cognitive load that is under appreciated. Once again, those who are different appear outsiders in our systems.
The language we use can have a significant impact on psychological well-being. Through the creation of trauma informed environments, in which we actively listen and try to generate psychologically safe environments is important so that we understand the experiences and reactions of those for whom we care.
If we reviewed our patient safety transcripts, what we would find is business and expert language being promoted and the narrative being lost.
The 20th century, and particularly from the 1940s onward, saw a significant shift in many professional fields towards a more business-oriented and technically precise language. This shift was driven by numerous factors, including the rise of large corporate structures, increased global trade, and the rapid advance of technology.
In healthcare, this shift was reflected in a growing emphasis on medical research and evidence-based practice, which necessitated a more precise, technical language which lacks constructs surrounding connection, imagination, creativity and belonging.
Introduction of Philosophy
In recent years, there’s been a growing recognition of the importance of communication in healthcare, and efforts are being made to strike a better balance between the technical/business language and the language of empathy and understanding.
Toxic language, such as harsh criticism, insults, dismissive language, and frequent negative feedback can foster a toxic culture. It can lead to low morale, decreased motivation, high stress, and we feel undervalued and disrespected. Strength based approaches which build on relationships of trust are being cited as critical.
Adopting respectful, inclusive, clear, and positive language is crucial in building a healthy work culture. The language used in philosophy can provide inspiration for change.
Philosophical language often deals with abstract concepts and principles, such as truth, justice, morality, existence, consciousness, and the nature of reality. The goal of philosophical language is to clarify concepts, question assumptions, explore possibilities, and stimulate thought and discussion. This language is often subjective and open-ended, allowing for a wide range of interpretation.
On the other hand, business and scientific language aims to be more objective, precise, and efficient. The goal is to convey specific information clearly and concisely, make decisions, solve problems, and accomplish tasks.
These two forms of language reflect different ways of understanding and interacting with the world. Philosophical language encourages reflection, questioning, and exploration of ideas, while business/scientific language focuses on accuracy, clarity, and efficiency in accomplishing specific goals. Of course, both forms of language have their value and are necessary in different contexts.
Lets study language as a theme within patient safety
I propose we should analyse our conversations and that a well-rounded approach should incorporate elements of both philosophical language which can ensure that we take into account the full range of human experiences and values, alongside business and scientific language which allows for precise communication and efficient operation within the healthcare system. Combining these approaches can contribute to more effective, compassionate, and patient-centered care and I propose that we measure how language can underpin our safety cultures.
