"We need to find a common language." This is often said when two or more organisations or disciplines are working together. At first sight it appears everyone is working to a common goal: improving outcomes, reduced costs, better experience. Not much to argue with there.
Then the misunderstandings and tensions begin to build up. To try to resolve them, you go back to first principles: "It’s all about the patient!"
But by this stage, even the most basic assumptions about the partnership start to seem questionable. What, exactly, is all about the patient? What about the patient is it all about? What is a patient anyway?
These are not stupid questions. Different professional cultures will answer them in different, and deeply rooted, ways. Within those cultures, different individuals will answer them differently too. Is a patient a person with a body that needs fixing, a condition that needs managing, a set of health risks that needs mitigation, a set of expectations that needs meeting, a set of needs that must be assessed, a set of rights that must be honoured, an economic value that must be maximised, or a soul that must be accompanied on its journey?
Every comma in that list is a chasm of potential misunderstanding. The wise tread carefully, the unwary fall. A common language is a bridge over the chasm.
But common languages, like bridges, are slow and expensive to build. In a system that wants change, and collaboration, 'at pace and scale', it’s easy to understand why people think it might be better to close your eyes, hope for the best, and jump.
The results can be very messy. But it’s also true that, all over the health and social care system, different professionals from different organisations are routinely and safely collaborating for the good of their neighbours – without any explicit attention to their common language. Why does this work sometimes? And why doesn’t it work all the time? The answer lies in understanding that there is more than one type of 'common language'.
"Common languages, like bridges, are slow and expensive to build."
Linguists have identified several ways in which people who speak different languages learn to communicate. Each of these language types have an analogy in the cultural 'common languages' developed by successful collaborations of various kinds.
A lingua franca is a second language used as a common means of communication by an elite – such as Global English in our time or Latin in the Western Middle Ages. The cultural equivalent is the 'policy speak' that is the common language of system leaders: cerebral, precise, abstract, it can seem very far removed from the daily experience of patients and frontline staff.
Gesture or 'sign language' is the lowest common denominator of common languages. It enables simple exchanges of information but is easy to misunderstand and is incapable of conveying complex ideas. The cultural equivalent is the often largely wordless 'transfers of care' that are still quite common: "I am referring this patient to you for treatment."
A pidgin is a trading language formed of key terminology from two or more natural languages. It contains words for all the most common kinds of transaction and so is far more precise than gesture. But it is not a full language and struggles to convey emotion and abstract ideas. Most collaboration in health and social care uses the cultural equivalent of a pidgin. Transfers of care, contracts, memoranda of understanding: these use precise terminology to describe exactly what is being exchanged in the collaboration, but fail to describe the states of mind, values and behaviours that accompany these transactions.
A creole is a new language, formed when two cultures begin to merge into a new one. Unlike a pidgin, a creole is a proper language, capable of expressing any idea needed by its speakers. Enduring, productive collaborations develop their own creoles as a shared asset of all the partners, adding to the richness of the partnership.
At Kaleidoscope, we are fascinated by the many creative ways in which people across health and social care collaborate. We love to celebrate, share, and promote the best approaches, such as our Kaleidoscope network approach, which is based on successful US experience. And we are constantly innovating new perspectives and approaches ourselves.
In my next three blogs, I will explain how choosing the right kind of common language can help collaborations develop more quickly without over-investing in their cultural development: we call this the creole approach.
Since you’re here… ...we’ll let you in on a secret about Kaleidoscope’s funding. Spoiler alert: it’s not a secret. We’re a business. We design and support collaborations, run events, and help to develop strategy and policy. Our work is shaped by our clients’ challenges. We’d love to hear about yours: find out more.