The Language of Leadership: small words that make a difference

Introduction Text:
When it comes to leadership, can a few small words make a difference?

Jules Acton National VoicesI’d argue yes, they can help shape our thinking and keep our minds focused on the main goal of high quality, people-centred care. Below are some examples that have come up in discussions about the design of the new professional development programmes run by the NHS Leadership Academy.

For, with, to

Patients, carers, families and other people who use services are fed up with paternalism.

The thing about being paternalistic is that we don’t necessarily realise we are doing it, not least because very often this comes from a genuinely caring nature – however even very small things can help to start break this down. The differences in the following sentences may help to demonstrate this:

  • We are working with staff to improve care for patients
  • We are working with patients and staff to improve care

Social care and health

To make real progress on coordinating care we need to open people’s minds up way beyond the NHS. In terms of the language we use I’d suggest a soft rule that whenever we are about use the words ‘NHS’ or  ‘healthcare’ we should consider whether the simpler but broader term ‘care’ would be more appropriate. Or indeed, should we be writing ‘health and social care’ instead?

Improving care versus improving services

National Voices’ policy advisor, Laura Robinson, recently told me to stop and think whenever I use the term ‘service’:  the ultimate aim – improving care – often requires stepping out beyond one particular service. Improving the service is, to some extent, secondary. I think Laura is right: while we probably don’t need a hard rule to avoid the word ‘service’ completely, we should be aware of it and decide in each case whether it is the best word to use.

Hard to reach

Should people be defined as hard to reach? The very term can put up barriers. ‘Less heard’ can be a more helpful way of saying things.

Coordinated care versus integrated care

Coordinated care means more to patients than ‘integrated care’, and it can be helpful to qualify it as ‘person-centred coordinated care’. ‘Integration’ or ‘integrated care’ are jargon and also tend to steer our thoughts towards systems rather than the real goal of improving care.

Care quality

This is a vital concept but needs defining. The new leadership programmes will offer a number of different definitions of quality for participants to consider, however for impact and memorability I don’t think you can beat the quality trio below, based on Lord Darzi’s definition, which is also enshrined in the 2012 Health & Social Care Act. Quality is about:

  • Safety
  • Clinical effectiveness (outcomes)
  • Patient experience

Change versus improvement

We’ve all seen changes that don’t necessarily make things better. Let’s remember that change should always be about improvement.

Innovation versus replication

Innovation is sexy and we all like a gadget, however these are simply tools and approaches that may or may not help us improve care quality. Meanwhile, spreading good practice in care is a serious challenge so we need to find ways of getting people excited about replication; let’s reward people for copying stuff.

Minefield words

The word ‘patient’: it’s a bit of a minefield, linguistically speaking.

Some people who use health, and especially care services, don’t consider themselves ‘patients’ – those who are pregnant or use mental health services often feel strongly about this. In any case, we should also plan health and care around people who aren’t currently patients – there are groups of people who don’t use services now but will do in the future. There are also people who should be patients but don’t find it easy to access health and social care (eg travellers, prisoners, vulnerable older people, asylum seekers, sex workers). And carers should have a strong say. So is there a better word? Well it’s debatable, let’s try the following:

  • Service users: it’s a bit clunky and impersonal as a term (how many people really call themselves a ‘service user’).
  • People who use services: much better, if a bit of a mouthful
  • Clients: urgh – very transactional
  • Customer: not much better than the above.

The truth is we don’t have a perfect word to fit all occasions. At National Voices, the way we tend to handle this is to preface documents and presentations with the long list: ‘Patients, carers, families and people who use services’, then use short hand further down eg ‘patients and carers’. Even better, we build the sentence around the word ‘people’ where possible.  This is far from perfect as a system and, if you know a better way of doing it, I would love to hear it.

In fact, none of the above examples should be taken as rules. Language is changeable, and no one person has all the answers. This is why it would be fantastically helpful to have further comments, improvements or suggestions on the way leaders can use language to the best effect. What do you think? Do let us know.

9 replies on “The Language of Leadership: small words that make a difference”

  • I read the above with interest. I think we should all be mindfull when speaking to people and take time to consider how it would feel to be on the receiving end of what you are saying.
    I do believe that generally people would not be too insulted or upset by how you address them as long as they can genuinely feel you are caring being helfull and considerate and appear to have their best interests at heart. It’s also amazing how body language and tone of voice can influence what you are saying.

    Caroline Carew
    • I agree language and style so important, certainly should enhance any treatment or care not diminish it. Having used services as well as working within the NHS, I was surprised how objectified I felt as I became a “patient”. In response I proposed a “CHARM offensive” to recognise good communication style, which Roy Lilley kindly published on nhs managers guest publication:-

      NHS CHARM Offensive (Care, Help And Remember Manners)
      In the wake of all the criticisms about the NHS, the loss of bedside manner and the alleged impersonality of some of the services, I would like to launch a CHARM offensive for the product CHARM!
      Everyone knows what “charm” is, it is positive, feels nice – even a snake will rise out of a basket if it is charmed! Thus, I think it is time we made a conscious effort to launch the product CHARM. We are all well aware of the NHS resource shortages, but the good thing about the product CHARM is it is absolutely free – costs nothing, no installation, no invoices, no improvement grant requests, just the mere matter of people wanting to use it – like a really nice perfume or after shave!
      All we have to do is find it in ourselves and show it to those we work for – the public. We all have it, but if recent reports are to be believed, some of us hide or even bury it when we do our jobs. This is unacceptable, unfair to our public, and detracts from the value of other skills and talents we use in carrying out our work. So to use CHARM enables win-win, beneficial to both the giver of CHARM and the receiver. Why can’t we all deploy the most natural communication style of treating someone else as you would want to be treated? For anyone unclear about what it is, below is my definition of the product CHARM:-
      Care – Demonstrate you are bothered – it is not enough just to serve and treat mechanically or indifferently, we are here to care it’s the business we are in
      Help – Share the issue, do what you can to assist, and show you want to help
      And Remember Manners- Be polite, speak to everyone as equals, nicely and as if you are glad they are there
      For managers, whether on hospital wards, in out-patient or GP practice environments, we should strive to launch a CHARMing environment by:
      • Finding ways to measure your organisation’s levels of CHARM – walk the floor, talk to the people, acknowledge it when you see it in use and lead by example
      • Staff appraisals – make the first question: “Are you CHARMing?” If not, why not, tackle head-on those who deliberately act “unCHARMingly” – we probably all know some of this sort but we should never ignore it
      • Surveys and suggestion boxes could campaign the question: “Did you find our service CHARMing?”
      • Finding a way of rewarding CHARM, identify role models for deploying CHARM, and pledges to our populations to be CHARMing”
      • And on no account ever confuse it with SMARM (Stand-offish, Moody, Artificial, Reluctant and Miserable – which no-one likes)
      It makes sense, let’s do it


      Anne Marie
  • I read this with interest – I am neither an NHS ‘professional’ nor a patient – or am I? I have had hospital treatment in the past, see my GP from time to time and my dentist twice a year. When I read of some panel to include patients, I wonder who they are. In a school it’s obvious – pupils or parents are easily identified – but patients …?

    No don’t call us ‘customers’ that is far too commercial. Clients – maybe. Service users – very impersonal!

    As to ‘Care’ – not specific enough – also includes Care Homes and home carers. Nor do I want the doctors, nurses, therapists and the rest to be lumped together as ‘carers’ – I want to know who they are and what their role is.

    Co-ordinated care (treatment?) OK as long as it is – the pricipal failing in NHS and other ‘services’ is lack of co-ordiation and communication, as I have seen over many years not least with elderly relatives (of whom I suppose I am now one!).

    So, I hope these ramblings from one who has family members who have worked in and who still work in the NHS, but who is now an octogenarian, may be of interest, if not of help!

    Good luck.

    David Roberts
  • Language is so powerful – delighted to read this blog. How do we get action

    Susan McLean
  • Good piece. You’re right about hard to reach being a poor phrase. The tobacco companies don’t seem to find many people hard to reach. They understand and listen better.
    Good point about the words service > care. I wonder if we should not go further. Even the word care has a paternalistic tone in many contexts. It tends to be from one person or group TO another. I am not sure of the exact words, but it may enablement always, support often and direct care when needed. My first dimension of quality is compassion, caring, consideration…. Like the phrase. Was taught at med school. Comfort always, relieve often, cure sometimes.

    David Pencheon
  • Great to know there will finally be leadership training.
    One major concern is the Wheelchair Services are neither Hospital nor Community Services. Out on a limb. Government thrust is eternally hospital focused and directives couched in hospital terminology, therefore our management ignores it as irrelevant.
    So service still in 1970’s.
    Teach leaders to look at how information is disseminated so all departments get relevant or associated information and question how it may have missed services like Wheelchair Services and feed it back to the top.

    Richard Wallace
  • This conversation has reminded me of another I regularly follow. I’m an NHS Manager, keen road cyclist and cycling blogger in my spare time. I often ride to work. So, because of my profile as a blogger people want me to define myself as a cyclist or a cycle-commuter or a “roadie” (to make sure I’m not a mountain biker) or any one of a number of other terms.

    But the truth is, I also drive a car, I sometimes go to work by bus and I do quite like mountain bikes. I don’t like arguments that pit cyclists against motorists.

    So in the end, I define myself as “a person who rides a bike”. When I access the health service I want to be considered a person accessing treatment, or a person accessing a service. After all, at different points in the same day I can be a person running a service (in the hospital I work in) and a person accessing a service (at my GP) and a person working with another person (former patient) to design a new service.

    Person or people. Wherever possible.

    Stephen Lock
  • […] about how they describe what their organisations offer and the people this is for. In her blog The language of leadership: Small words that make a difference, Jules Acton, director of engagement and membership at National Voices, gives an insight into […]

  • Great article but was resonates most of all to me is replication, if it works well copy copy and copy again. I find too often we wrap ourselves up in our own situation and are not open to just plain copying other people’s ideas. I’m not particularly bright but am happy to steal anyone’s good idea and replicate it. I will be stealing he ideas from this and looking at the language used in my various patient / service user / client / care partner environments. Thanks for a thought provoking article.

    Jeff walker

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