It’s a well-worn quotation from George Bernard Shaw that Britain and America are countries divided by a common language. But is it also true that the language of health and of social care betrays a chasm of understanding and intention between leaders and practitioners in the respective systems? Can a linguistic divide also be a barrier to our efforts to bring together health and social care for the benefit of patients and users?
Recently I have been involved in supporting some of the local developments to bring together social care and CCGs around the shadow Health and Well-being boards based within local authorities. In this context it might be anticipated that professional and organisational language might be a barrier to partnership, but confusion isn’t confined to the technical or specialised lexicons in play. Its ordinary words that also get in the way.
Listening to the discussions between the representatives of clinicians, local authority managers, elected members and representatives of users and patients it is striking how people use common terms very differently. It reveals a wide range of understanding and intention that could hamper the development of positive Health and Wellbeing integration.
The use of one simple word – quality – struck me as a particularly revealing illustration of the differences in conception and meaning that can abound between key actors in a system.
To many clinical leaders quality means the deployment of best treatments and procedures in an appropriate and effective way. Described by NICE and developed by trials and expert networks, researched and evidenced at a high level, quality in these terms means the best possible outcomes for a given input. In this case quality is more concerned with production – with the quality measures familiar to manufacturing and physical industries. In business terms this may lean towards EFQM, Six Sigma and the rest. It is absolute, definite and time-bounded.
In contrast local authority and social care leaders might have a more process orientated understanding of what quality means. Quality in their terms might cover the process and experience of service delivery and might be much more about the level of overall engagement and satisfaction as well as sustained relationships and co-production. In Business speak this may lean more towards the notions of loyalty and relationship management found in service industries. For these participants quality is more conditional, emergent and ephemeral.
Just as the English language stands between Britain and the US, so too does the common language of health, social care and local government. It’s a bit like the Rosetta Stone in reverse – instead of finding a tool that can make two separate languages transparent these common words can actually obscure the meanings that players assume and understand.
The answer to unravelling this linguistic muddle aren’t easily prescribed. More time together is undoubtedly part of the answer, as is finding ways to do more things together – to merging the routine processes of health, social care and local governance so that a material reality begins to provide an underpinning to shared understanding. But time is the one resource that is in shortest supply and when people are busy finding the space for developing understanding generally gets little priority.
Stopping to ask the awkward question, maintaining a drive for understanding and adopting behaviour of active listening are ways that we can make the most of the time available to us.
And therein lays hope – for asking questions, challenging assumptions and being persistently curious are things that exceptional leaders display across the divide.
Brian Cox 