Monday, 29 July 2013

What's in a word?

The words we use allow us to think and talk about concrete things (such as cars) and abstract concepts (such as love). Although it depends on the definition of the word "word", today there are either 600,000 or over 1 million words in the English language, with the number of words increasing at the rate of 8500 per year. Depending upon education and literacy, a person will know between 35,000 to 75,000 words.

Language shapes our world

The language we use helps us to communicate with one another. Even more than that, the language we use both affects and reflects how we see the world. This is called "linguistic relativity". To show how language affects how we see the world we need only think about terms such as "global warming" and "credit crunch". These concepts express previously unknown dangers which affect how secure we feel about our own and our children's futures.

"Piegnartoq”: the snow [that is] good for driving sled
Language also reflects the importance we attach to certain ideas or things. For example, the Inuits have more than 50 distinct words for snow, reflecting the importance of this substance in their culture. (Although there is controversy regarding the exact number of words.)

The exclusion of particular words in a language system also implies a framework of values to the language users. When a behavioural marking system such as Anaesthesia Non-Technical Skills (ANTS) lists the behaviours expected of a good anaesthetist, these are endowed with added importance and those behaviours not listed may be considered to be less important. The idea that our language limits and determines our ability to think is called "linguistic determinism".

As an example of how language may affect thinking, let us imagine two new words: 
  • Sladen
  • Quaden
Sladen means the leadership required by a person in charge of strategy and long-term effects. Quaden is the leadership required when decisions are needed immediately with little or no information. One could use these terms to discuss a given individual's strengths and weaknesses, or to compare the characteristics of those who have one or the other type of leadership. The use of these new words would affect how we think about leadership. The words would also reflect our thinking, in the sense that we are interested enough in leadership for us to want to discern different types. (I'm using Sladen and Quaden as fictitious examples and am aware that terms such as "strategic leadership" already exist.)

The language of human factors

The language of human factors allows us to be more precise about what went well and what we found to be a challenge. If you have a teaching role then the human factors vocabulary will allow you to move from: "Well, that was terrible, wasn't it?" to "Your main problem was that you lost situational awareness when you volunteered to take over chest compressions." Learning the human factors vocabulary and concepts will also allow you to reflect both more effectively  and more efficiently on your own performance. For example, in the language of human factors, errors may be divided  into slips/trips, lapses, mistakes and violations. These types of errors have different causes and therefore different remedies. But without the vocabulary, a mistake is a mistake is a mistake; your ability to  improve yourself and others will be compromised.

Spreading the word(s)

Many religions have missionaries who "spread the Word". Although I don't equate patient safety or human factors with a religion, I would suggest that one of the activities that those of us involved in these fields should be doing is "spreading the word(s)". J├╝rgen Habermas reasoned that all speech acts have a goal, ie. by talking we are trying to have an effect on the world around us. The goal for us in the patient safety arena should be a wider understanding of the words and concepts which define human factors. With this vocabulary, the rest of the healthcare community and the people we care for will be better able to reflect, understand and discuss our failings and successes. Without this vocabulary we will be less able to improve the care we provide. Let us help transform the healthcare system so that when we talk about "hindsight bias", "power gradient" and "task fixation" every HCA, every nurse, every chief executive knows what we mean.

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