Hospitals and health systems throughout the country face many of the same challenges. One of the most dangerous — and almost always overlooked (if an organization is even aware of it) — is the persistent use of inconsistent terminology.
When there are a lack of rules guiding definitions, spelling and acronyms or initialisms of words used in an organization, the result is an inconsistent lexicon that can negatively affect planning, operations, communication and credibility.
At the low end of concern is when inconsistencies make a project more challenging or frustrate new staff trying to learn their jobs. Of much more concern is when inconsistencies and varying vocabularies change the meaning of policy, cause erroneous calculations in financial projections or cause patient information to become lost or confused.
Trustees may even find themselves victims of an inconsistent lexicon, particularly if they lack a health care background. It can be a challenge to learn basic health care vocabulary and acronyms; that challenge is magnified significantly if trustees are presented with information that is described differently from one meeting or conversation to the next. This can lead to confusion and frustration and inhibit a trustee's ability to serve the organization effectively.
Fortunately, trustees are in a position to bring the issue of their organization's inconsistent lexicon to the attention of the C-suite. An organization's failure to take these problems seriously and work to address them immediately will cause issues to compound over time and make efforts at correction much more difficult.
5 Examples of Misused Terms
There are numerous ways language is used inconsistently — and often incorrectly — in hospitals and health systems. Here are a few examples heard and seen in today's organizations:
1. Cases and procedures: A common example surrounding outpatient surgery is when an organization uses "case" (an individual treatment or patient) and "procedure" (a unique surgical event) synonymously. One case may include multiple procedures. Depending on which is counted, an organization runs the risk of dramatically over- or under-calculating projected revenues.
2. Integrated and integrative care: Another common miscommunication occurs over confusion of similar words with different meanings. There is currently a move toward hospitals offering "integrated" and "integrative" care. Integrated care is a systematic coordination of primary care with specialty care, often colocated and with a team approach. Integrative care combines evidence-based traditional clinical medicine with alternative modalities (e.g., yoga, meditation, acupuncture). Mixing up these two words when developing or marketing a program could lead to confusion with providers and patients.
3. Quality improvement, quality assurance and performance improvement: All organizations have a quality committee. How it's identified — as a quality improvement committee, quality assurance committee, performance improvement committee or something else — can vary. When agendas and minutes do not use a consistent committee name, information retrieval can be difficult, especially if all names used are not known. This can lead to omission of critical quality information in documentation, which may result in a survey citation, not to mention staff frustration.
4. Cost and price: It wasn't long ago when nearly all organizations had staff and leadership using cost and price synonymously. While it now happens less frequently, these terms are still used interchangeably when they should not. In short, "price" is the actual amount of money required to acquire a certain product or service (i.e., charges). "Cost" is the amount paid to produce a product or service before it is sold. While both terms involve money, the context is not the same.
5. 3M: Not every inconsistency involves confusion with another word; some are the result of misspellings. As an example, most organizations use 3M products. Some organizations may have hundreds of the company's goods in inventory. In the push toward value-based pricing, organizations must calculate the actual cost of supplies used in each care episode. But what happens if someone tasked with entering a shipment of 3M merchandise into a system labels it as "3-M" or "MMM" (or one of the many other ways to possibly spell 3M)? A search for "3M" may not include the products ordered. This lack of consistency and the resulting ignorance of what is on hand can lead to increased spending and inflate inventories, and it makes calculating accurate costs more difficult.
Clearing up the confusion
These examples only begin to show the potential harm caused by an inconsistent lexicon. Unfortunately, the issue is often initially dismissed as trivial. An organization's leaders may not believe it is a problem or at least not significant. But not dealing with inconsistent language is careless. And there is no room for that in health care organizations, which are judged on precision and an eye for detail.
What can organizations do to address the problem? The first step is to become aware of it. That's where trustees come in. They can express concerns about an inconsistent lexicon to the CEO. Once the CEO understands the problem and acknowledges that it exists (or at least may exist), trustees can offer recommendations on how to tackle it and then support leadership as efforts get underway to address word use.
It may be worthwhile to assemble a "lexicon task force" (choose the name carefully) to examine the issue and assess how the problem is affecting the organization. This group can brainstorm confusing words, names and phrases it knows are used in the organization and try to untangle them. Then it becomes a matter of developing a process to codify each set term and enforce its consistent and correct use in written and oral communication.
A helpful step may be to develop style guides for various committees and departments. Organizations may want to have discussions with their electronic system vendors about solutions available to help prevent mistakes; fixes could involve search engines that detect misspellings and software that eliminates the ability of staff to manually enter the names of vendors and products.
Another step — and a critical one — is to build a safe environment where anyone can ask questions when confused by terms used (or misused). Staff need to feel empowered to essentially serve as "word police." Make it acceptable for anyone to ask anyone to explain what is meant by a word or name.
Every organization will face different language challenges corresponding to its services, treatment types and other variables. Turning a blind eye to the issue of an inconsistent lexicon is a recipe for disaster. If organizations pride themselves on delivering high-quality care and outcomes, improving communication and clarity must be a priority.
Joan Dentler (firstname.lastname@example.org) is the president and CEO of Avanza Healthcare Strategies in Austin, Texas.