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Essay Review

Essay reviewM. Loughlin

E S S AY R E V I E W

Tackling NHS Jargon – Getting the Message Across

(Sarah Carr, Radcliffe Medical Press, Oxford, £19.95, ISBN 1-85775-428-X)

Michael Loughlin PhD

Senior Lecturer in Health Philosophy, Manchester Metropolitan University, Stoke-on-Trent, UK

This is a guide book for National Health Service(NHS) managers who want to learn how to speakand write in English. That such a book should beneeded is surely remarkable. That an entire profes-sion or ‘professional culture’ should have acquiredwhat the opening lines of the Preface describe as ‘aspeech problem’, a natural disposition to ‘talk non-sense’, is a fact crying out for an explanation. But thebook’s author, Sarah Carr, is less concerned withexplaining this phenomenon than with providingpractical guidelines to address the problems itcreates.

The title, and the example of managerial gibberishin the opening lines of the Preface, might generatehopes of an entertaining polemic – a confrontationbetween common sense and the pretentious, pseudo-intellectual nonsense that is contemporary NHSmanagement speak. The dull, utilitarian, very NHSsubheading and the rest of the Preface sound a morecautionary note. Carr commends her book to thereader as an effort to promote ‘evidence-based com-munication’ in the health service – a service, sheclaims, that is ‘increasingly interested in evidence-based management’ (p. v). Although she offers noevidence in support of this claim, on the assumptionthat it is true, Carr supplies her intended audience ofmanagers with the evidence they will undoubtedlyrequire to explain why they should make the effort totalk less nonsense.

The book is divided into four sections. The first dis-tinguishes three categories of jargon: technical jar-gon, gobbledegook and buzzwords. Technical jargonis not always a bad thing. All academic disciplinesand professional groups have their technical terms,which usually function as short-hand for complex

ideas. What matters when using such jargon is (ratherobviously, I would have thought) whether or not thetarget audience understands it. If they are unlikely tounderstand a term, then, the author points out, itneeds to be adequately explained.

Gobbledegook is language that uses unnecessarilylong words and is badly put together. By implication,it is never a good thing. Similarly buzzwords are met-aphors and euphemisms that serve no purpose otherthan to exclude listeners who are not ‘in the know’ –and, presumably, to signal to those who are ‘in theknow’ how trendy the speaker is.

Having explained what jargon is in section 1 of thebook, the author uses section 2 to supply evidence ofthe usefulness of plain English, as opposed to jargon,in communication. The most obvious reason (thatstaff and patients might actually understand you) ispresented, along with considerations about the finan-cial costs of poor communication and a brief refer-ence to the (well-documented) links between clarityof expression and clarity of thought. This section alsodiscusses how to introduce plain language into NHSorganizations and to encourage its widespread use.

The third section offers practical guidelines onhow to produce plain English documents, and how totest and revise them – going sometimes into labori-ous detail and supplying mathematical formulae tocalculate optimal paragraph and sentence lengths.(The preceding sentence would almost certainly betoo long and this one probably shouldn’t be in brack-ets. Brackets distract the typical English reader whoapparently has a reading age of no more than15 years.) The fourth section contains lists of NHSjargon with plain English translations. My favouritesare ‘to parachute in’, ‘to helicopter up’ and ‘to pick

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the low-hanging fruit’, because of the amusing waysthey can be combined. I am sure there are funnierexamples omitted from the list, but the list is notmeant to be exhaustive and in any case its goal, asCarr makes clear in the Preface, is not to amuse.

When absurdity is only natural

It is not the book’s refusal to take advantage of themany opportunities for humour presented by thesubject matter that represents its most striking omis-sion. As noted, Carr is concerned less with explainingthe problem than with addressing it. Yet it is not clearthat one can adequately address a problem withoutan adequate account of its nature and causes. WhileCarr’s book may well improve some NHS docu-ments, it seems to me unlikely that it will have aswidespread an effect as one might hope, because anadequate account of the causes of jargon would haveto consider factors that Carr seems unprepared totake seriously.

For much of the time Carr writes as though jargonwere the native language of ‘NHS communicators’.She suggests that, when first attempting to write inplain English, her readers (the NHS communicatorswhose practice she hopes to improve) may need to‘produce a jargon-ridden draft’ which they can then‘translate’ (p. 75) using the guidelines she provides.(In rather the same way that, when learning French,a native English speaker might first think of what hewants to say in English and then work out the trans-lation, perhaps with the help of a dictionary.) Thoughthis ‘translating stage’ will be time consuming, withpractice they should soon be so fluent in the ‘new’language they are ‘learning’ that writing it will be justas natural as writing jargon and thus will take nolonger – though it will ‘require more thought andskill’ (p. 19). Carr notes that to some NHS managers:

It might seem easier just to pay a consultant, ortrain a small number of NHS communicators, towrite important communications in (or editthem into) plain English. (p. 17)

Such appearances aside, Carr argues that it isworth investing a good deal of effort and significantsums of money in training the entire organization to‘develop’ the requisite ‘skills’ of communicating inEnglish. Even so, she concedes, it might be a goodidea to employ ‘external experts’ to write the really

important documents, and ‘you may choose to trainsome staff to a higher level than others’ (p. 17).

To someone lacking Carr’s experience of workingin public sector management, some of this may sounda little strange. Were she considering moving an orga-nization staffed by British workers to Spain, debatesabout the levels of linguistic retraining required fordifferent sorts of staff might make perfect sense. ButNHS managers are not economic migrants from acountry whose native tongue is ‘nonsense’, findingthemselves suddenly forced to adapt to a newenvironment where the locals can only understand‘sense’. These are, predominantly, people whosenative language is English and who are almostcertainly beneficiaries of a liberal education in theEnglish language. Carr notes (p. 17) that it will benecessary to affect significant changes ‘in terms oforganisational culture and people’s attitudes’ if ‘last-ing change’ in favour of plain speaking is to be pos-sible. Why? Why should mystifying rhetoric comemore naturally to some than making sense? What is itabout the ‘organizational culture’ of the NHS thatmitigates against talking sense and how, in theabsence of a serious and detailed answer to this ques-tion, can we hope to affect the requisite changes tothat culture? Carr’s book is a response to an absur-dity. There is something surreal about so stridentlycommonsensical a book treating such a bizarre phe-nomenon as though it were as natural as the tides.

Questionable explanations

Insofar as she considers any explanations for thisphenomenon, Carr seems happier to blame groupslike English teachers in schools (p. 32) than to findfault with the managers she hopes will buy her bookin large numbers. At the risk of using terminology theaverage 15-year-old wouldn’t recognize, I come overwith an unexpected flush of existentialism when con-fronted with such arguments. If any group is to beheld responsible for the proliferation of manage-ment-speak, it must surely be the managers whoactually speak it. School teachers don’t make youorganize workshops to undertake mind-mappingexercises to share current realities. They don’t ‘para-chute in’ (at least mine never did) and if they evertold you to ‘pick the low-hanging fruit’ you wereprobably on a school trip to the local fruit farm.

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School teachers don’t teach you to write sentenceslike: ‘The client has an overly high expectation,market penetration-wise’ and ‘when you’re in aconsumer-focussed situation, you need more productawareness than their sort of low-profile image isgoing to generate.’ You learn that sort of thing in a

management

school.In a subsection entitled ‘The Importance of Involv-

ing Everyone’ (p. 47), Carr states that managers‘must include themselves in any assessment of lan-guage use and training needs’. This is because ‘theyare no more likely than any other NHS employee tobe able to communicate in plain language’. No morelikely? They are, of course, far

less

likely than anyother group on the pay-role to be able to do this. Farfrom adopting an ‘evidence-based’ approach, in por-traying management as the group best fitted to res-cue ‘NHS culture’ from the grip of inane jargon, Carris flying in the face of all the evidence about thecauses of the problem.

As a plain language expert, Carr should agree thatthere is a clue to the origins of management-speak inthe term ‘management-speak’. Far from being a nat-ural fact of organizational life, the prevalence of jar-gon in the NHS is a relatively recent development,and its historical origins are well known. The rise ofmanagerial power in organizations is precisely corre-lated to the spread of management-speak, in muchthe same way that the spread of American English iscorrelated to American economic and military dom-inance of the globe.

There is an extensive literature offering explana-tions for the rise of managerialism and documentingthe uses of managerial language in the control ofworking populations and public perceptions. [See, forinstance, Power (1999), several chapters in Miles

et al

. (2000, 2001), especially those by BruceCharlton, Neville Goodman and Michael Power,Darbyshire (1993), Willmot (1993) and my own con-tributions to the debate (Loughlin 2002a,b). Thereare many, many other examples.] Carr refers to noneof these works, though she alludes to this generaltype of account in a brief reference to the claim thatmanagerial writing is ‘political’ in nature (p. 32). Carrpromptly dismisses this claim as the view of ‘cynics’.Offering neither analysis nor argument nor any evi-dence whatsoever, she asserts that such ‘dishonour-able’ uses of jargon represent ‘a minority’ of NHS

communications. As far as Carr is concerned, the vastmajority of NHS communication can be analysedwith reference to the ‘values’ of ‘communicating hon-estly with the public’ and ‘the government’s commit-ment to increased public and patient participation’.Similarly, despite extensive research (much of it donein business and management schools) on the manyuses of business language to persuade and manipu-late (‘opinion management’, ‘culture management’,‘perception management’, ‘agenda setting’, etc.),Carr asserts as if it were just plain obvious that busi-ness language is ‘just about getting a factual messageacross’ (p. 33). In short, it would appear that thereare no ideological dimensions to the use of manage-ment-speak worth worrying about. Managers andpolicy makers who employ such jargon almost alwayshave something clear and important to say; they just(for some reason) tend to say it very badly – probablybecause they were failed by their English teachers inschool. Once all ‘political’ uses of jargon have beendismissed in this manner, it becomes easy for Carr tothink she can begin to eliminate jargon from thehealth service by pointing out that it in fact has nouse, and that the purposes of honest communicationare better served by ‘plain speaking’. Because thosewho think that language serves other purposes thanhonest communication have been dismissed as ‘cyn-ics’ (a textbook case of the use of persuasive lan-guage as a substitute for argument!), there is no needto address such issues as the power structure in thehealth service, the commercialization of the serviceor any other ‘political’ factor in a book about how toget rid of management jargon.

Would that life was really that straightforward.Even some of Carr’s ‘plain language’ translations oftechnical jargon (the sort of jargon that can be legit-imate if ‘properly explained’) are propagandist innature. For instance, ‘clinical governance’ is ‘a systemfor making sure clinical services are up to scratch’.Obviously this doesn’t just tell us the ‘straight facts’.It doesn’t say what clinical governance is or why weshould believe that it will improve anything. It justassures us that, whatever clinical governance is, it will(by definition) improve the health service – leavingsenior management free to define its real meaning inwhatever operational terms they choose. So the‘plain speaking’ definition serves the same politicalpurposes as earlier, more verbose definitions (cf.

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Halligan & Donaldson 2001, discussed in Loughlin2002b). In this respect Carr’s work is entirely inkeeping with the tradition of managerial writing,which frequently has very little to do with honestcommunication.

Whether or not you should read this book

Despite the foregoing, for the most part this is one ofthose books that does just what it says on the packet.It doesn’t surprise or enlighten or delight, but thenthe author never claimed to be doing any of thosethings. If you really can’t help talking nonsense, butwant to write documents that make some sense, youwould probably do well to read it. Personally, I don’tsee how calculating average sentence lengths andcounting the numbers of three-syllable words withina 100-word sample from a text is going to help peoplewrite well, and I feel fortunate that my Englishteachers didn’t adopt a quite so scientific and evi-dence-based an approach when I was learning how towrite. Even so, if people find that this sort of thinghelps them to write clearly, then fine.

However, if you already feel that you express your-self quite well, you would perhaps be wise to avoidthis book and the approaches it advocates. Readingwork like this does have a strange, and I suspectdebilitating, effect. Carr stresses that there are no‘hard and fast rules’, only ‘guidelines’, but still thereis something insidious about the positivistic, mecha-nistic approach of the ‘plain speaking’ mentality.

While writing a number of the sentences in thisreview (the preceding one included), I found myselfimagining Carr cutting them up into more user-friendly pieces. This no more helped me to improvemy writing style than my years of reading the gibber-ish produced by those Carr hopes to educate.

References

Darbyshire P. (1993) Guest editorial: ‘preserving nursingcare in a destitute time’.

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Halligan A. & Donaldson L. (2001) Implementing clinicalgovernance: turning vision into reality.

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Ethics, Management and Mythology

.Radcliffe Medical Press, Oxon.

Loughlin M. (2002b) On the buzzword approach to policyformation.

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Miles A., Hampton J.R. & Hurwitz B. (eds) (2000)

NICE,CHI and the NHS Reforms

. Aesculapius Medical Press,London.

Miles A., Hill P. & Hurwitz B. (eds) (2001)

Clinical Gov-ernance and the NHS Reforms

. Aesculapius MedicalPress, London.

Power M. (1999)

The Audit Society: Rituals of Verification

.Oxford University Press, Oxford.

Willmot H. (1993) Strength is ignorance; slavery is free-dom: managing culture in modern organisations.

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