Quality Improvement Through Obfuscation?
The dictionary definition of “obfuscation“:
“verb (used with object), obfuscated, obfuscating.
1. to confuse, bewilder, or stupefy.
2. to make obscure or unclear:
to obfuscate a problem with extraneous information”
Wikipedia says that “obfuscation” means:
It can be intentional or unintentional, as wikipedia says.
Healthcare is full of terms that obfuscate things. Ironically, use of the word “obfuscate” can be an example of obfuscation.
Instead of saying, “Healthcare leaders often obfuscate a situation,” we can say, “The language used in healthcare often makes things sound better or more complicated than they really are.”
People often complain about the overabundance of Japanese words in the Lean literature (or in pravrice). I agree that saying things like:
- “kamishibai board” instead of “process observation board”
- “muda” instead of “waste”
- “hoshin kanri” instead of “strategy deployment”
- “kaizen” instead of “continuous improvement”
- “yokoten” instead of “spread”
can confuse or bewilder people. I'm guilty of it myself sometimes, although I do try to minimize my use of Japanese words and confusing jargon. But, what's understandable to one person might be jargon to others. So, we have to think about the audience when we're communicating.
As I revise early drafts of Measures of Success, I'm trying to be very mindful of not confusingnor bewildering the reader.
Healthcare often obfuscates things through the use of Latin. One example is saying “nosocomial infection” instead of “hospital-acquired infection.” Using the word “nosocomial” sounds really fancy and almost makes it sound like something that naturally occurs, instead of framing it as a “preventable error” or a so-called “never event.”
Even the term “never event ” obfuscates reality by making it sound like wrong-site surgeries NEVER happen. The truth is that “never events” happen far too often. They're called “never events” because they SHOULD never happen, or they wouldn't happen if we have solid processes and if we have a culture that encourages and supports quality and safety improvement (i.e., not having a culture of fear).
I saw some first-class obfuscation in the recent issue of the magazine Health Leaders, as I shared on LinkedIn:
The text reads:
“In a healthcare environment, falls can be devasting,” she says. “They can lead to a negative perspective for patient morbidity if they're injured during the fall, and have a negative impact to the organization on a cost-of-care perspective.”
My reaction to that:
OK, sorry, I don't mean to be having fun with such a serious topic.
Is that nurse leader creating clarity around the problem? Do words like that help inspire staff? Does that explanation provide better understanding to the community?
“In a healthcare environment, falls can be devasting,” she says.
Yes, hospital falls can be devastating. They can cause harm or death. The nurse leader isn't being very clear about this. Read more here, including some data and the “never event” description.
“They can lead to a negative perspective for patient morbidity if they're injured during the fall…”
What is “a negative perspective for patient morbidity?” Even “patient morbidity” alone is an obfuscation for death. Would it be more clear to say “Falls can directly lead to or contribute to a patient's death” or how would you say it? “Falls can hurt or kill patients” is a blunt alternative.
“Hey team, let's reduce the negative perspective for patient morbidity!” isn't much of a rallying cry.
“and have a negative impact to the organization on a cost-of-care perspective.”
Does mean “increases costs” since the care required after injuries caused by never event falls doesn't get reimbursed? Wait, that's obfuscation. It's more clear to say, “Payers won't pay us for the care that's required after a patient fall.”
A friend on Facebook asked me, “If the patient dies, wouldn't that reduce cost?” The answer to that seems complicated. Would there be a lawsuit? Does the hospital get paid less if the patient doesn't live as long? Does the hospital get paid less over time if the patient dies instead of needing recurring care (appropriate and necessarily care, as opposed to the hated “readmission”)?
I'm curious to hear your thoughts on this. What examples of obfuscating language can you think of? A few healthcare examples off the top of my head:
- “Locums” or “locum tenens” instead of “temporary staff”
- “STAT” instead of “right away”
- “NPO” instead of “nothing by mouth”
What can we do to provide better clarity around healthcare language? Is that a good first step toward improvement?