Language is a crucial marker of tribal identity. Both ethnic and professional tribes use language to recognise members of their own tribe and to exclude members of other tribes. Two ethnically related tribes may be distinguished by their use of different languages, but in other cases the linguistic differences may be subtle.
Small but significant linguistic markers of identity are known as shibboleths, after the Old Testament story in which the pronunciation of this word was used to identify members of an 'out-group.'
Where two tribes share a genuinely common language, tribal politics may encourage the creation of artificial shibboleths. Serbs and Croatians share what used to be a common language, but Serbs chose to write it using the Cyrillic (Russian) alphabet while Croatians adopted the Latin script. Over time, small differences in usage have evolved.
When two tribes live together harmoniously over a long period, a new ethnic and cultural identity often emerges, accompanied by a new language, formed from elements of the original language of both tribes. This kind of language is called a creole.
The tendency to create shibboleths and the so-called 'creolisation' process are both products of two cultures living and working alongside each other. Where community relations are good, creolisation is the stronger process. Where they are bad, shibboleths form and are used to mark the boundaries between the tribes.
"Hospice culture has evolved, like a creole culture, by taking elements from each profession, fusing the nursing, psychosocial, medical and pastoral models."
In my previous blogs in this series, I have been seeking to show the correlation between the maturity of a collaboration and the maturity of the common language used by its members to do their work. In this final blog, I want to describe how collaborations can intentionally create a creole which is both a marker of shared identity for the partnership, and an externally useful product of its collaboration.
Long-term collaborations will automatically create the conditions both for creolisation and for the formation of shibboleths. Creolisation is a helpful process for collaboration, providing a new language in which a partnership can further its goals using concepts and vocabulary in which all partners have an equal stake. Shibboleths, on the other hand, reinforce unhelpful barriers and slow the realisation of collaborative benefits by reducing trust and mutual comprehension.
A well-known example of such a creole term is the PEPSICOLA model of holistic assessment used in the gold standards framework for end of life care.
Palliative care has a distinct professional culture that reflects its roots in the hospice movement. Hospices are voluntary sector organisations staffed by lay volunteers, nurses, complementary therapists, counsellors, GPs, clergy and specialist doctors. Their culture has evolved, like a creole culture, by taking elements from each of these professions, fusing the nursing, psychosocial, medical and pastoral models. Since, in the face of approaching death, none of these models can have the final say, there is a remarkable equality of discourse; the implicit hierarchy, familiar in other healthcare contexts, in which the medical model trumps the others, is notably absent.
The PEPSICOLA tool is a striking example of this productive creole culture. Each element of the assessment aligns closely to one or other of the professional disciplines involved in end of life care, but the tool itself can be used by any professional with the support of colleagues. The tool empowers its users both with the knowledge they inherit from their own profession and with the frames of reference used by other professional 'tribes.'
The development of a shared problem-solving tool should be an early project for any collaboration that intends to survive in the long term.
Contributing to, using and refining the tool, whether it is for assessment, for performance evaluation, or for modelling, is itself a powerful context for accelerating benign creolisation. Further, the tool itself can become a visible statement of intent for the partnership, enshrining its creole values and blended capabilities in something that can be evaluated, shared and celebrated even as it contributes to the outcomes the collaboration has been designed to achieve.
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