Watch your language! (and you might just find out what you are thinking…)

A little while back, I was looking at the regular e mail update from the Institute for Healthcare Improvement in Boston. Among their various initiatives of the week was an announcement about a training and learning programme on how to improve care for “frail elders”. Not “elderly”. Elders.

How much meaning can hinge on one word! When I think of frail elderly, whether I like it or not, what comes to mind is debility, disability, the loss of faculties and of independence. “Frail elderly” evokes a sense of burden, of problem, of impending crisis; linked to depersonalising discussions about “DTOCs” or the capacity in Emergency Departments, it makes me think about how “we” can “cope” with the numbers and the need. At best, I associate “elderly” with quiet old folk sat contentedly in armchairs, being looked after, and maybe even sung to by well-intentioned volunteers.

But when I think of frail elders, a very different set of associations click on in my brain. This time, they are about respect; wisdom; even vigour (making the development of frailty a sadness that should evoke compassion and action).  An elder is a person of status, with much to offer if we choose to access it; a person of power. An elder might still be out on the bus, playing bowls in the park, involved in politics, working in my hospital’s League of Friends, keeping society moving and alive and vibrant. Jenny Joseph’s old woman in “Warning” (“When I am an old woman I shall wear purple…”, reference 1) is definitely an elder! An elder might well be loved and revered; is Nelson Mandela one of the “frail elderly”, or a frail elder?

The trouble is that so much of what emanates from our speech centres is at once a result of our conscious thought and, given how fast it sometimes has to come out, probably also the product of less conscious parts of brain processing.  We speak off the cuff; we reply instinctively; we fall into habits of speech, enjoying our favoured turns of phrase and “bons mots” of the moment, only to abandon them some days or weeks later, when we have tired of them or they have ceased to work for us or (worse) have popped out in the wrong context or once too often in the same company.  Some we keep for life, and don’t even notice when they jar on other people.

Only today I was quite reasonably taken to task for using the expression “at scale and pace” about a possible “leadership intervention”. My critic helpfully pointed out that this was a popular phrase of the moment that sometimes disguised poorly thought out and uncompassionate approaches to making change with indecent haste.

I had to admit he might be right. I had been infected by the term some months earlier on reading a job description calling for the delivery of medical engagement “at scale and pace” in a multi-site merged megatrust with over a thousand doctors, and the term itself had moved at scale and pace to take up residence in some neural net in my cortex, with close connections to emotional pathways important in drive and achievement; resonant with pacesetting, power, delivery, and ambition. Maybe no harm in that….but as my corrector might have commented, scale and pace describes a landslide, an avalanche, the demolition of a block of flats, or a river bursting its banks. It would be wonderful if it also described a social movement approach to compassionate leadership, but we might not get the actual outcome we want without a more measured approach. Literally, of course, it could also describe climbing a cliff (scale) and taking a step at the top (pace)… so there is a meaning that is not so fast after all!

So paying attention to what words mean, what they evoke beyond their specific meanings, and why we choose them, is important, and often fun. Small children know this instinctively; try saying “I am going to get to the bottom of this” to a group of five year olds. Older and more educated and sophisticated teenagers would pick you up on “Freudian slips”, and pantomime innuendo of course depends for success on our willingness to notice additional meaning; but overall, as we get older, we often seem to lose the habit of noticing what the unintended meanings of our words might be, unless we are lawyers, diplomats, or politicians.

This is even the case when we deliberately choose words with additional meaning – metaphors and similes – as part of our leadership stories or images. If I tell colleagues we are turning around a supertanker heading for the rocks, and that to do so successfully we will need not just a tugboat with a hugely powerful engine (and a clear sense of direction) but also the maintenance of constant connection to the supertanker with a very strong hawser or chain, I may think I am talking about engagement being crucially different to direction and power. I may think others will understand graphically my belief in the importance of maintaining engagement even when it’s painful.

But others might understand it differently…for what else does the metaphor evoke? Passivity, enormity, a cargo of noxious sticky and polluting material that has no involvement in its own direction or destiny, merely a lumpen momentum; that has to be carried around from one location to another to generate value, and is guaranteed to cause a disaster if upset and spilled on the way? Not a great thing to be if you are one of the led, however attractive I might find the notion of being the successful tugboat captain who saved the big ship.

We don’t have to limit our attention to the meanings of the words; we can also wonder why we chose them in the first place. Why the attraction of a nautical organisational metaphor and not building a cathedral, or a jetliner? No idea…perhaps the deep meaning is about the vast unfathomableness of sea that ship metaphors float on, whether its “ship at sea in stormy weather”, “into calmer waters”, or “tsunami approaching!” There is no answer…but it’s at least as interesting to try to notice why I come up with the specific metaphor (because it tells me about me and my relationship to the organisation) as it is to use it to try to mobilise others.

My favourite organisational metaphor right now is about the NHS as a large and complex garden full of blooms of all kinds, weeds, foodplants, poisonous ones, teeming with life…something like a tropical rain forest. I think this may have come from John Ballatt and Penny Campling (2). The job of leadership is to tend the garden, and to create enough order for it to be flourishing and productive with a minimum of dangerous weeds. But how do we view this unruly, overgrown garden? Beautiful and full of potential, or dangerous and full of threat?  How do we view the task ahead? Needing some serious hacking back and weeding with a machete, a flamethrower, or Agent Orange; or careful tending, watering, planting, pruning, weeding?  

Thinking of our NHS garden, how much disorder can we agree is safe and tolerable (or even innovatively desirable) in order not to kill off the essence of the garden while hunting out the very last pest? Are we able to tolerate the kind of messy sustainable benign diversity and productivity I recall seeing when I visited the Centre for Alternative Technology at Machynlleth years ago? Perhaps the NHS garden is mostly scary only when you don’t understand it?  Maybe…but then we confront Mid Staffs, the Keogh Review, Winterbourne View…some serious trouble in the undergrowth there for sure.

So…pay attention to what you say. Not just in case you upset others who don’t get your intended meaning (and spotted another or brought their own), but because you may find out levels of meaning and association that tell you something about yourself or your organisation’s silent attitudes, spoken only through the medium of your highjacked cerebral cortex as it chooses the words it thinks you want to say in the context of all the other data its processing that you are not being mindful of.

Of course in so doing, it might be doing us a favour. If we do pay attention and we do learn more about the unconscious attitudes of the organisation we are immersed in, we may be much more effective as leaders. Perhaps we need to take the advice in Peter Hawkins’ lovely little book “The Wise Fool’s Guide to Leadership” (3):

“Don’t just DO something! Sit there and listen!”

References.

(1)    Warning; Jenny Joseph http://en.wikipedia.org/wiki/Jenny_Joseph accessed 24/07/13

(2)    Ballatt, J and Campling, P (2011) “Intelligent Kindness”, RCPsych press

(3)    Hawkins, P (2006) The Wise Fools Guide to Leadership, O books