Friday, 28 February 2014

Week 4: Opening Up For NHS Change Day & the UpGoer5


NHS Change Day
Last year a single tweet (not by me I hasten to add!) sparked an idea that led to 189,000 people making personal pledges to change something in to improve the NHS for patients.  This was the first NHS Change Day.  March 3rd 2014 is the second NHS Change Day where the aim is for over half a million pledges. Before it's official launch on March 3rd we are already over half way to this target.

Being Open With Patients
This year, as well as supporting pledges made by others, mypersonal pledge is about improving the openness and transparency of the NHS.  The NHS has a chequered track record on being open.  The National Patient Safety Agency originally published guidance in 2005 on communicating effectively with patients when things go wrong, under a headline of Being Open.  Since 2009 it has been it has been a key requirement of the NHS Litigation Authority, who provide insurance cover for all NHS Trusts, that they have well designed policies to help ensure they are open with patients and families when things go wrong (requirement 2.10 of the NHSLARisk Management Standards).

In April 2013 it became a contractual requirement for providers of NHS services to be open with patients and their families when they suffer serious harm through a contractual duty of candour (section SC35 in the StandardNHS Contract).  It was a recommendation of Sir Robert Francis’s report on the public inquiry into failings at Mid Staffordshire NHS Foundation Trust that there should be a statutory duty of candour.  The government, in theirresponse, said they will pass laws to introduce this.

NHS Board Transparency
The Professional StandardsAuthority Standards for members of NHS boards and Clinical Commissioning Group governingbodies in England require that board members, and therefore boards, are open.  It states:

“I will be open about the reasoning, reasons and processes underpinning my actions, transactions, communications, behaviours and decision-making and about any conflicts of interest”

In spite of all these guidance, requirements, contractual duties, standards and impending legislation, some parts of the NHS on some occasions are still not as open and transparent as we should be.  I deliberately say ‘we’ because I take personal responsibility for the actions or inactions within my power to change where we are not open in the best interest of patients and public.

This is why my NHS Change Day pledge is to challenge any lack of, or perceived lack of, transparency or openness that I come across.

Using Open Language
Another significant way in which the NHS can be less than transparent to patients and the public is in the language that we use.  During last night’s WeNursesTwitter Chat about ‘standardised languages’ part of the conversation turned to the jargon, abbreviations and acronyms that health professionals use on an all too frequent basis.

As a key part of my pledge, I aim to challenge others and reduce my own use of unexplained jargon, abbreviations and acronyms.  One conclusion from last night’s chat was that the use of jargon can alienate people, engaging with people in a language they understand is essential to build rapport and ensure they are not disempowered.  Nelson Mandela once said:

"If you talk to a man in a language he understands, that goes to his head. If you talk to him in his language, that goes to his heart."

Sometimes not using complicated language can be difficult.  If you want to see in practice how hard this can be; try using the Up Goer 5 tool to explain any every day concept, object or idea.  It will only let you use the most often used ten hundred words.  This idea came from a challenge to explain the Saturn V rocket in simple terms.  An explanation of the story is here.


  1. That amount of jargon is pretty amazing - it got me thinking, and... well... you know me, I tend to think in spreadsheet format. So. In the true spirit of the open, public, crowd-sourced world of the web I'll share my thinking, so to speak!

    I've saved a table made up from your jargon dictionary here

    After a bit of tinkering - whiling away a minute or two over lunch, in between BBC news articles - I wondered just how confusing this 'jargon' language is compared to the English we learn at school. If we can for now set aside the fact that very few people speak Jargon (Jargonish?), how confusing is it really?

    The very first page of jargon had a few definitions for the very same letters, so I looked at how many bits of jargon have more than one definition. Seems simple enough?

    There are a whopping 1,374 bits of jargon on your list alone that have two definitions for the same bunch of letters. Nearly one in ten bits of jargon can mean two things - that's a lot? Isn't it? Surely that alone shows it's too complicated to be usable in the workplace?!

    Digging deeper...

    Homonyms and homographs are fairly common, I thought to myself - not my everyday kind of thought I must say. Thinking about it here in my seat, I reckon 1 in 10 words in English have two meanings. I know, oddly, that in the Chinese languages more than 1 in 10 words are homonyms.

    Jargonish, give or take, based on my armchair reckonings, has the same amount of confusing homonyms as some of the most common languages on Earth. Almost as though the construction of language has some common way of evolving, huh? (...cue X-Files theme music...)

    Nothing suspicious so far... My mind is put at ease.
    This fails the Daily Mail test - headlines of "Confusing Language Blights NHS" are flashing before my eyes. In reality, though, Jargonish doesn't yet seem any more complicated than English - setting aside, the fact you don't learn it at school, and only a small number of people speak it fluently, and there is no dictionary that people agree on - all barriers that any evolving language or Welsh would need to overcome.

    At the other end of the spectrum two abbreviations in your list are tied at pole position with FIFTEEN different definitions each for the same few letters.

    'ARC' and 'CA' both have 15 possible definitions - the word in Jargonish is spelled the same for each of the 15 definitions so it's a true homograph. Now, I know homographs are common.... but... 15 definitions?

    I'm trying to think of a work with as many meanings but can't get above 7 with 'bow'.

    Maybe, just maybe, Jargonish does get a little complicated as a language after all.

    Anyhow, that's pretty much my lunch hour used up!


    1. Wow Kirk, I'm honoured that you've given up your lunch hour for this amazing anlysis of the list. (anyone who doesn't know Kirk should know he's an Excel Guru!).

      I'm not surprised, but intrigued to read that you've found two acronyms with 15 definitions!!!

      What I didn't share from my list, as it didn't work too well in pdf form, is the third column of info. This contains a definition of the definition! On many occasions in the early days of producing the list I found that in spelling out what an acronym stood for I was left none the wiser as to what it actually meant, so I sought further definitions. In particular this was helpful for historic acronyms, for example, if you want to know what CCG stands for it may also be helpful to know that they have replaced PCTs, that PCTs evolved from PCGs, which in turn were developed from HAs, which were previously FHSAs (enough I hear you cry!).

      Thanks again for your comments Kirk, much appreciated and if you want me to mail you the full Excel version of my list, let me know and I'll send it on to you.

  2. Incredible list of abbreviations!!

    As a wonderful addition, Fellows of the United Kingdom Clinical Pharmacy Association are able to use the post-nominals FUKCPA... I imagine that only the disgruntled and disenchanted do, though!