My husband and I have just returned to New Zealand after 4.5 years in Oxford, UK. The re-entry process has reminded us – by virtue of repeat experience – how readily misunderstandings and different interpretations can ensue, particularly when one is placed in a new environment. For example, when eating out shortly after we first arrived in Oxford, my husband ordered the ‘flapjacks’ and was puzzled when he was presented with a dense, sweet muesli bar rather than the expected stack of fluffy pancakes. More embarrassingly, we learnt the hard way – and on more than one occasion – that the words ‘pants’ and ‘trousers’ are not used synonymously in the UK. Of course, the stories go both ways. Back in Auckland, I recently had what felt like a rather unusual conversation with a friend. Well, it felt unusual up until the time that I recognised my failure to translate what I was hearing (“use”, “disk” and “hips”) to what had actually been said (“yous”, “desk” and “heaps”).
Of course, hindsight and a basic recognition of the inevitability of human error dictate that misunderstandings are to be expected. Nevertheless, in the moment one can’t help but find such situations surprising – particularly given that both New Zealand and the UK share our most widely spoken language. However, whether due to differences in accents, phraseology, cultural norms, definitions, a combination of these, or something else entirely, it seems that a shared language can in fact become the seed from which misunderstandings grow.
Over the last week, I have been reflecting on how this same issue applies in healthcare.
In my first week at Ko Awatea, I was struck by the use of common language. I heard familiar terms being used in diverse conversations – terms such as value, innovation, transformation, systems-level thinking, and integration. Furthermore, these terms were often being used to help communicate a clear aim to deliver improved, indeed world-leading, healthcare services. Overall, it appears we are finding common ground in our language and intent. What is critical is that we also achieve the next step: a consistent understanding of this language.
Naturally, a common language or shared set of terminology is rather important for communication. It is a great starting point because it allows us to read from the same book, so to speak. However, whilst necessary, this is not sufficient. We also need to be on the same page of that book. We all know this, yet we witness and experience misunderstandings that occur because of the simple, subtle assumption that using the same words means that we are saying the same things.
So, how do we move beyond purely sharing a common language to the point where we share a common understanding of that language? Funnily enough, we must communicate to communicate. Specifically, we must ask the question, “What do you mean by that?” Also, we must be so bold as to routinely provide a definition of the terminology we use – especially when terms are first used in a different project or context, or with different people. For certain terms or in certain settings, it can be useful to outline what lies outside the scope of a given term.
This is not a redundant process: clarifying our starting position is a powerful way to move us forward. Also, we may just find an unexpected gap in our understanding and, with this, an opportunity to grow and learn. Finally, it will come as no surprise that this approach tends to prove more efficient in the long run.
However, we need to get the balance right. In particular, we must ensure that our quest for aligned understanding does not come at the expense of creative thinking. On this note, one can argue that the former actually enables the latter through the freedom that boundaries (somewhat paradoxically) afford.
No matter our role, location or language, let us replace assumption with awareness. For the principal danger is not that misunderstandings might occur, but that they pass unrecognised.