The Power of the Unspoken Word

I want to revisit a point I made a few weeks ago: Business school can be harmful. Actually, I wasn’t careful with my language there. That sloppiness is probably ironic given that linguistic precision is the theme of today’s article. 

A few weeks ago, I wrote about how business school phrasing can make it hard to defend a kickback case. Today I have a similar, but slightly more general, message. The vocabulary that they teach people in business school is almost never helpful in the healthcare context.  

On some level there’s no disputing that healthcare is a business. The number of hospital closures occurring right now alone is compelling proof that it is impractical to separate healthcare from economics.  

But people overwhelmingly would prefer to pretend that money doesn’t influence healthcare decision-making. While I think the idea that money is not relevant to healthcare is so naïve as to border on silly. However, if your goal is to lower your organization’s compliance risks, it’s imperative to recognize the reality that people often embrace “silly,” and are deeply troubled when they believe healthcare decisions have been influenced by the bottom line.  

I want healthcare organizations to survive, so I am not in any shape, way or form suggesting one should disregard profit, or in the world of nonprofits, margin. I am suggesting that all discussions about healthcare-related topics try to avoid certain words that inspire vitriolic reactions. Discussion about profit, return on investment, margin, and other similar terms will immediately alienate regulators and juries.

If you’re contemplating a program that will compensate physicians for lowering the cost of care in a hospital, labeling the program as co-management will sound infinitely better than characterizing it as gainsharing. Instead of referring to a program as” hurting the bottom line” or “lowering the organization’s margin,” state that it will necessitate cuts in other programs that might benefit more people.

Instead of a cold business-like term like “the market area,” or “demographics” refer to “neighborhoods” or “patients.”

My thesis is that if there is a term that would appear in a business school curriculum, I would try to banish it from any discussion in your healthcare organization. And if you run across a board member who thinks that this focus on wording means you’re being too soft or touchy-feely, explain that the reality is you’re being strategic.  

Because saying that you want to protect the ability of the organization to provide patient care for years to come can deliver exactly the same message as a desire to protect the organization’s operating margin, but it does it in a way that won’t annoy regulators, politicians and the public. 

The current political climate often has people thrilled when they can “own” the other side. But a wise litigator or negotiator knows that the easiest way to win a fight is to let the other side think they have won.

If they get to choose the words that are used, but you get what you want? Well, that is a win. A cunning win, for that matter. 

Sometimes the best words are the ones you leave unsaid.