The greatest challenge we face in human interactions is understanding. Toward that end, I'd like to promote some new words and phrases and ask your help in stopping the use of others.
Finding 'systemness' and other useful words
I've always loved ideas surrounding morphology, the study and description of word formation. My awareness of language started when I was a kid. My father had a fascination with language, which I must have inherited. My children heightened my awareness. When they were young, they used the term "flutterby" to reference those beautiful winged creatures we call butterflies. Flutterby seems so much more descriptive. When my daughter was just 5 years old, I heard her tell my mother-in-law that the cat who owned us (yes, she was the mistress of the house) that had just returned from being spayed (or "fixed," when she had perfectly good working parts) had her "neuterus" removed.
My children, then, were my muses who inspired me to create my own words. One that I coined recently, for the "new busy," is "hecticity," a measure that doesn't need explanation but should be monitored constantly. From almost every article written about healthcare IT, it is clear to me that, like Newton's entropy, the hecticity of the universe is increasing.
So let's get to the most misused word today—"cloud." When the Internet was first invented, it was difficult for people to describe it, although the word itself does have its own intrinsic meaning. To help others understand the concept, the metaphor of a spider web was used; even search engines were referred to as "crawlers." Some early adopters even coined the verb "spidering" to describe the search process.
But a Web was too difficult to draw and somewhat disconcerting for arachnophobes, so an innocent cloud metaphor was adopted. In the College of Healthcare Information Management Executives' boot camp, we even taught (with tongue firmly embedded in cheek) current and future chief information officers that every good diagram that accompanied a capital request should have a least one cloud and two lightning bolts. I've dropped the bolts, but the cloud is still a great metaphor for the Internet.
What concerns me now is the sometimes implied and often direct message that putting something in the cloud is preferable. If you work in healthcare information technology, it's just the opposite. I do fully support the concepts and terms SaaS, DaaS, and IaaS frequently associated with cloud computing, but not the term cloud. I want my data, which is often critical for patient care and delivery system operations, kept in a vault, not a cloud. Even the security companies are marketing their services with cloud terminology. Surely we'd all feel safer with data in a vault.
At our enterprise, we've been involved for a while with clinical transformation—a frequently misunderstood term. For years, I've been trying to find a succinct phrase to describe clinical transformation, but without success. Regardless of the clarity with which I thought the phrase was written, it was often misunderstood by the recipient or it required further explanation. One of our technology-friendly board members who chaired our Clinical Transformation Advisory Board as a subcommittee of the board coined the perfect phrase; it's "Hardwiring STEEEP," where STEEEP is an acronym created by rearranging the first letters of the six aims suggested by the Institute of Medicine in its 1991 publication, Crossing the Quality Chasm: A New Health System for the 21st Century. So simple, yet so easy to understand. STEEEP was a phrase familiar to the board and staff at Baylor Health Care System in Dallas. The "Aha" moment was exciting.
One of the most useful words I know doesn't appear on either Merriam-Webster.com or Dictionary.com: "systemness." When you’re trying to achieve high quality, it's critical—a basic tenet—that you look for and eliminate unnecessary variation. Normally you do that by standardization. In this case, standardization is considered a desirable state, but it does have limitations. It doesn't recognize (and here’s the phrase I learned long ago) "legitimate uniqueness."
In one of our smaller facilities, a pharmacist is not available in the evenings. Trying to standardize processes there and in a facility where a pharmacist is available in the evening is not optimal for either facility. We use the concept of systemness, the process of getting input from all participants, using standardization where it makes sense, but allowing legitimate uniqueness to create necessary variation. Systemness is a desirable state of interaction. I hope you will be able to achieve it.
Finally, I'd like to address a pet peeve: the synonymous use of the terms abbreviation and acronym. They are not the same. An abbreviation as defined by Dictionary.com is "a shortened or contracted form of a word or phrase, used to represent the whole, as ‘Dr.’ for ‘doctor,’ ‘U.S.’ for ‘United States,’ ‘lb. for pound.’ ” An acronym is an abbreviation which is pronounceable; for example, laser is an acronym created from "light amplification by stimulated emission of radiation.” Acronyms, then, are fun abbreviations.
Being from East Texas does give one license to use abbreviations in a creative way. In my hometown, the word 'Why" was actually an abbreviation. When we saw or thought "Why?" we substituted the whole phrase, "How come do you do that?" I do hope these thoughts will prove useful and help us all reduce the amount of "hecticity" in our lives. That's how come I did this.
David MuntzSenior vice president and chief information officerBaylor Health Care SystemDallas
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