Insights (Essays) February 2015

The Paradox of Patient-Centred Care & Use of Language

Marg McAlister, Sue VanderBent and Hugh MacLeod

Sue VanderBent and Marg McAlister join me on the “balcony of personal reflection.” Humans use language as the primary means for sharing thoughts, ideas, needs and wants. Language may be spoken, signed or written. It is estimated that there are between 6,000 and 7,000 languages in the world (“Language”, 2014). The English language consists of 1,025,109 words ("No. of Words", 2014) as of January 2014 and is constantly changing. History demonstrates that word use evolves as humans attempt to communicate thoughts in new ways or reflect specialized subjects, such as healthcare. This essay considers the “new and emerging” language of today’s healthcare leaders – one that appears to be creating new complex applications of existing words.

The evolution of language used in healthcare will be useful if it improves clarity of message, as the aim of good communicators is to ensure the comprehension of the listener or reader. And, more importantly, new language can create new conversations with new people. However, there is a risk of creating and communicating confusing messages. Effective communicators are known for the clarity, simplicity and sensitivity of their language.

The Ghost of Healthcare Hope appears…

“Today, your challenge is to strike the right balance of complexity and simplicity, brevity and the need to remain sensitive to the perceptions of others. While it is generally acceptable to target communications to the “audience,” it is increasingly apparent that the language of healthcare leaders is rife with the sanitized and truncated syntax of business and the creative application of various common words to describe issues that require attention. The question is – are you really trying to communicate more clearly? Trying to be trendy? Or are you attempting to moderate the message?” 

Most would agree that the ability to communicate clearly and be understood is essential in healthcare, from the bedside to the most senior planning tables. The importance of health to our aging population and economy is so critical that every Canadian is impacted. However, listening to a meeting of healthcare leaders today, even those within the profession can become lost in the maze of acronyms, techno-speak, and creative application of common words. We speak broadly of “grabbing low-hanging fruit,” “optimizing efficiencies,” “leveraging best practices” and “achieving outcome-based care.”

“Best practice” is a term that appears to create considerable angst and word competition. Healthcare leaders will also describe a successful model of care as a “leading practice”, or a “promising practice”, not to be outdone by an “evidence-based practice” or “evidence-informed practice”. Even the odd term “good-enough-for-now practice” is beginning to resonate in healthcare boardrooms. (Although arguably an accurate depiction given the evolution of practice, this term hardly inspires confidence!) In our eagerness to coin new phrases that we hope will accurately communicate the message, do we run the risk of becoming lost in a linguistic morass when plain language reflecting our desire to excel in the delivery of healthcare would be more readily understood?

When people lose sight of the intent of the message they can disassociate from the process. A “quick-win” might be to ‘bust this ghost’ and insist on speaking like a real human being – using clear messages devoid of jargon and acronyms!

Instead, increasingly in healthcare we “dialogue”; develop “comm” strategies; “execute” plans; “socialize” reports; and deal with emotional “touchpoints” which obviously include “pain points” and “pinch points.” Why do we speak this way? Is it to be exclusionary? Is it a rite of passage? Are we too rushed to express concepts fully? Does this use of language heighten our importance or credibility? Does it distance us from the consequences? Are the results better – for us or for the system that we are trying to create for the patients in our care?

Consider this statement chock full of acronyms for which the average person requires a thesaurus: “In Ontario the OHCA, OCSA, OACCAC, APACTS, and CHCPN are engaged in a shared enterprise to implement QVHC as a result of the MOHLTC ECFAA.” Plain language translation: “A number of Ontario associations are partnering to implement the ‘Quality and Value in Home Care’ initiative as a result of the Ministry of Health and Long-Term Care Excellent Care for All Act.”

Imagine the impact if we said “excellent care for all” each and every time we refer to this important piece of legislation. In doing so, would we remind ourselves of the need to stay on a critical path to quality care through excellence in everything we do? Would it inspire us and help us to stay focused and committed? Would it generate greater clarity, perhaps reminding us of the importance of healthcare, the reason for choosing to work in healthcare and the goals that we are working to achieve?

What if we insisted on eliminating the use of acronyms? What if we simply become the ones who ask, “What does that mean?”

With the shifting focus of the healthcare system to managing the chronic diseases typical in an older population, a host of new communication dilemmas arise. Should our “vintage” citizens (translation: seniors) be referred to as “patients,” “consumers” or “clients”? If those in our care follow through with their plan, are they “compliant,” “adherent” or “concordant”? In the continuing effort to be politically correct are we obscuring the meaning, the intent, the compassion and the usefulness of the interaction? To what end? Tolerating ambiguous, exclusionary and confusing language can detract us from our purpose as healthcare leaders. The very brevity and precision that we seek can ultimately put our quest for quality interactions at risk.

Bottom line: language matters. Our basic humanity is voiced through clear language, and effective engagement requires simple, direct methods of communication at all times and at all levels of the system. It is time to end confusing messages and adopt an approach to communication that is simple, humanizing and inclusive.

The Ghost of Healthcare Hope returns…

“Think about the message you send to citizens and families when we use terms like “bed blockers” and “ALC patients”… The message is… you are creating a problem by using hospital beds.

Health literacy, language, changing demographics and an explosion of new technology make new conversations necessary. My hope is integration of literacy, culture and language will improve healthcare quality for diverse populations.”


ASK questions to challenge the assumptions we hold about the effectiveness of our labels, words and communication actions.

LISTEN to ourselves and the language we use.

TALK in plain language to be understood.

My guest next week is Don Ford in a conversation about choice.

See essays in this series.

See essays from series 2

See essays from series 1

About the Author

Sue VanderBent, CEO, Home Care Ontario

Marg McAlister, Director of Policy, Home Care Ontario

Hugh MacLeod, engaged and concerned citizen


Language. (2014). Retrieved from           
No. of Words. (2014). Retrieved from  



kathy Kastner wrote:

Posted 2015/02/18 at 09:40 AM EST

As a non healthcare professional whose business has been making comprehensible the oft confounding language of health, I found this quote ironic.
"the language of healthcare leaders is ->>rife with the sanitized and truncated syntax of business and the creative application of various common words to describe issues that require attention"
While I have utmost respect for the authors, I suggest expanding sensitivity to seemingly simple single one and syllable words that – our of context - confuse to the point of medical error: dressing, gait, coated, wound care, treat and one of my favorite confounders: stool


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