- Email: [email protected]
‘Managing the curve downwards’: A cross-sectional study of the use of management speak in public health
Public Health (2008) 122, 1443e1446
www.elsevierhealth.com/journals/pubh
Short Communication
‘Managing the curve downwards’: A cross-sectional study of the use of management speak in public health A. Ali, J. Sheringham*, K. Sheringham Department of Epidemiology and Public Health, University College London, 1e19 Torrington Place, London WC1E 6BT, UK Received 19 March 2008; accepted 9 May 2008 Available online 29 July 2008
Since the early 1990s, it has been recognized that ‘management speak’ is becoming endemic in the workplace.1 Health services have long ignored this problem, perhaps assuming that their natural behaviours such as avoidance and quarantining of National Health Service (NHS) managers2,3 somehow conferred passive immunity. However, there are indications that health is, indeed, vulnerable; individual trusts are now producing their own ‘jargon busters’,4,5 and books6 are now available on the subject. This short report will, for the first time, directly quantify the true extent of this phenomenon by examining one susceptible subgroup e public health. The Faculty of Public Health’s annual scientific conference in Eastbourne in June 2007 provided an opportunity to monitor large numbers of the workforce in a unique environment. Here, free from the scrutiny of strategic health authorities and with no need to be on speaking terms with their directors of commissioning, the authors sought to determine a representative use of management speak
* Corresponding author. Tel.: þ44 79 19 444064. E-mail address: [email protected] (J. Sheringham).
without the day-to-day pressures that might increase its application. An English recreational pastime popular in Eastbourne was adapted to quantify the usage of selected management-speak terms. The British Indicator of Nonsense or Grammatically Odd Constructions and Rubbish Dialect (BINGO card, Appendix A) was populated with phrases or words using the following inclusion criteria: words or phrases that made absolutely no sense whatsoever; classic management speak (e.g. ‘thinking outside the box’); terms suffering from overuse (defined as the authors being sick of reading them); or obfuscatory language (the authors did not know what it meant but were too embarrassed to ask). An expert panel (of those visiting the authors’ office) were consulted on an initial version of the card, which was amended in light of their responses. The representativeness of the terms for the final version of the card were also checked against a random sample of documents on the Faculty of Public Health’s website.7
0033-3506/$ - see front matter ª 2008 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2008.05.012
1444
A. Ali et al.
Data gatherers were recruited at the Trainee Bingo Night or on a tea break at the conference. All data gatherers met the minimum selection criteria of having normal hearing levels and a sense of humour, although these were not tested formally. Each data gatherer recorded every occurrence of the words on the card and had the opportunity to note additional ‘bonus words’ that fulfilled the inclusion criteria (or that they found particularly annoying and/or ludicrous). The data gatherers completed cards in both plenary and learning sessions throughout the conference. A £10 voucher was offered as an incentive in a prize draw for every completed card. This prize was sponsored by the authors and will not contribute to the NHS deficit. Completed cards were analysed quantitatively to examine the scale of the problem and qualitatively to identify themes. Fig. 1 illustrates the recorded use of selected management-speak terms over 2 days of the 3-day conference. Overall, there was an overwhelming desire to ‘engage’ (27 occurrences), followed by sessions most at risk of being ‘at risk’ with 26 occurrences. The frequency of ‘working in partnership’ was ranked third, with 15 occurrences. However, the ‘bonus word’ list suggests that the public health community may be developing resistance to some strains of classic management speak, and are mutating their language to develop a breed of new variants such as ‘being effective in the people business’, ‘the personalization agenda’ and a ‘network of networks’. Traditional modes of communication are also being modified as we are encouraged to both ‘intertalk’ and ‘cross talk’. However, both of these variants may have evolved as a direct response to discussing cost-cutting initiatives and budget deficits with a chief executive. The ‘bonus word’ element of the cards also yielded further examples of classic management speak. It was possible, for the first time, to quantify
just how endemic ‘mainstreaming’ (six occurrences) and ‘incentivizing’ (two occurrences) are in public health. These figures are likely to be significant underestimates due to limited coverage of sessions. The other bonus terms fell into three key themes: manifestations of physical activity; financial expressions and duplication.
Manifestations of physical activity As the living embodiment of the spirit of public health, the speakers displayed a strong commitment to movement and physical activity through their language. ‘Ring-fencing’ and ‘championing’ in some form appear to be almost routine in public health departments. One speaker actually admitted to performing ‘a drill down’. There also appears to be some focus on one particular direction of travel. Backwards or sideways movement have disappeared from the lexicon, as all presenters wanted to be ‘moving forwards’ or suggested ways of ‘taking it forward’. Commonplace activities such as ‘sharing’ information have been invigorated as we must now ‘actively share’. There also appears to be unprecedented movement taking place in primary care trusts up and down the land as patients and practitioners embark on an epic and apparently never-ending ‘journey’. Sports and exercise were also clearly high in the consciousness of one delegate who warned us, ‘If we take our eye off the ball, we lose sight of the patients’.
Financial expressions There is potent evidence from the widespread use of ‘business’, ‘finance’ and all their associated terminology that management is even embraced
Frequency of use
30 25 20 15 10 5 Fit for purpose
Re-inventing the wheel
Criteria
Rocket science
Transparent
incentivise
Feedback
Toolkit
Robust
Supportive environment
Advocacy
mainstream/ed(vb)
Evidence base
Joined-up
issue
Long term
Joint strategic needs
Network
Choice
Sustainable
Capacity
At risk
Working in partnership
Engage
0
Bingo term
Figure 1
Recorded use of selected terms at the Faculty of Public Health conference sessions, 27e28 June 2007.
Management speak in public health in public health. For the first, and hopefully last, time, the role of public health was even described as ‘front-end business’. Despite the ‘hole in the NHS budget’, there was a single mention of ‘investment’, with its benefits described as ‘adding value’. Tangentially, the data gatherers also picked up a rash of ‘intelligent commissioning’ (three occurrences), although this remained localized to a few sessions (which is where it should stay until someone explains what it actually means).
Duplication In early sessions, repetition was limited to subtle tautologies as the audience were encouraged to ‘lead from the front’, introduced to ‘key fundamental’ ideas, discovered systems to ‘help support improvements’ and urged to ‘effectively improve’ their organization. However, this repetition evolved to something far more overt as the conference progressed. Later sessions heard of a ‘standardized approach to standards’ and ‘progressive developments in developing practitioners’.
Conclusion This short report demonstrates that the epidemic of management speak is rife within the public health community, even when it is removed from putative sources of infection. While some traditional examples of management speak remain prevalent, a new crop of words and phrases is appearing. Tracking and managing these will prove to be a significant challenge. Some control over management speak may be established by investigating the causal factors of the outbreak. Some mutations may simply reflect the natural evolutionary processes of language. Others may be created consciously in an attempt to make an impact, ensure that nobody understands the core message (thereby maintaining demand for the speaker as an ‘expert’) or in a desperate bid to keep up with the Department of Health. The use of physical imagery by some public health personnel may reflect a genuinely held belief that the use of these words in some way contributes to their 10,000 recommended daily steps. The imagery of the journey may also provide a sense of purpose and outcome to the user, although with no map available and only one direction of travel, these aspirations may prove groundless.
1445 However, the novel and innovative use of management speak may be encouraging in one respect. It indicates that the public health workforce is resourceful and enthusiastic. The employment of repetition and redundancy, unconventional techniques to engage audiences, were widespread. The authors hypothesized that this was not poor preparation on the part of the presenters, but instead, an ingenious strategy to compensate for lapses in their audience’s concentration. The main reasons for these were: (a) physiological (sleeping); (b) technological (Blackberry usage); and (c) graphological (doodling). However, the authors feel strongly that the resourcefulness of public health practitioners can be manifested in positive ways that are not reliant on the use of management speak. Given the increasing exposure of public health professionals to turnaround teams, financial balance and public service agreements, the risks to this population are tangible and increasing. Management speak is a highly infectious and dangerous condition, and increased mixing within and between organizations will only increase its rate of spread. As this report illustrates, the danger of many of these phrases lies in their capacity, once registered, to infiltrate communication so imperceptibly that otherwise clearly written papers and presentations start to display spots of obfuscation and redundancy. In order to address the problem of management speak, or, as one speaker urged us, to ‘manage the curve downwards’, a thorough and integrated response is undoubtedly required. On no account, however, must a task force be set up. These groups are literally the breeding ground of this pathogen. Local practitioners can make their own quarantine arrangements such as shutting management consultants in cupboards or wearing surgical masks and respirators during meetings. The resilience, and legality, of these arrangements will only be tested once they are rolled out. * Practitioners should also have a high threshold of suspicion for contaminated materials distributed by post, in meetings or by e-mail. Further research is urgently required in order to build a comprehensive evidence base that can be constantly reviewed and updated to inform future planning. Similar quantification exercises must be undertaken in other settings to map the extent of this problem. To facilitate this process, the BINGO * The editors wish to apologise unreservedly for this particular use of management speak by the authors. It was not recognised as a potential error until the proof stage of this work. We have left it in place to highlight the pervasive nature of this problem.
1446
A. Ali et al.
card is supplied in Appendix A to assist fellow practitioners with their own surveys. These findings should form the basis of a comprehensive campaign to counteract this pandemic, and place the UK at the vanguard of management-speak control.
Acknowledgements
B Use the bonus word box to customize the card for your session (i.e. add a word you hear many times that you think qualifies as public health jargon) B No matter how many or how few words you have ticked, hand in the card to Ayesha/ Jessica
The authors would like to thank the following for comments on the BINGO card and completing cards at the conference: Dr Agnes Marossy, Dr Geraint Lewis, Chris Lovitt, Dr Araceli Busby, Dr Marilena Korkodilos, Susan Hird, Dr Kathrin Thomas, JoAnne Alner, Dr Dulcie McBride and Isobel Duckworth. The authors would also like to acknowledge Dr Penny Toff for successfully using the term ‘rocket science’ in her presentation, and Dr Jennifer Mindell for her comments on the final draft.
Ethical approval
Thank you for taking part in this groundbreaking piece of research!
None sought.
Funding
References
None declared.
Competing interests JS and AA are both members of the Faculty of Public Health and hope that publishing this paper will not invoke a lifetime ban. After all, at base level, this whole paper just comes down to homogenized management paradigm shifts.8
Appendix. A Faculty of Public Health conference BINGO card NAME OF SESSION ATTENDED: B Tick the relevant box each time the word is mentioned
1. Plain English Campaign. Available from, http://www. plainenglish.co.uk/[accessed 15.11.07]. 2. Edwards N, Marshall M, McLellan A, Abbasi K. Doctors and managers: a problem without a solution. BMJ 2003;326: 609e10. 3. Motley R. Doctors and managers: NHS needs political administration, not ‘‘management’’. BMJ 2003;326:1213. 4. NHS Improvement Network East Midlands. Your guide to understanding terms used in the NHS. c. Available from, http:// www.tin.nhs.uk/a-z-jargon-buster; 2002 [accessed 7.12.07]. 5. Heart of England NHS Foundation Trust. Jargon dictionary. Available from, http://www.goodhope.org.uk/jargon_ dictionary.asp [accessed 7.12.07]. 6. Carr S. Tackling NHS jargon. Oxford: Radcliffe Medical Press; 2002. 7. Faculty of Public Health. c. Available from, http:// www.fphm.org.uk/[accessed 7.12.07]; 2007. 8. Mike Wills Learning Services. Business jargon generator. c. Available from, http://www.mwls.co.uk/jargon.htm; 2007 [accessed 22.08.07].
Available online at www.sciencedirect.com
www.elsevierhealth.com/journals/pubh
Short Communication
‘Managing the curve downwards’: A cross-sectional study of the use of management speak in public health A. Ali, J. Sheringham*, K. Sheringham Department of Epidemiology and Public Health, University College London, 1e19 Torrington Place, London WC1E 6BT, UK Received 19 March 2008; accepted 9 May 2008 Available online 29 July 2008
Since the early 1990s, it has been recognized that ‘management speak’ is becoming endemic in the workplace.1 Health services have long ignored this problem, perhaps assuming that their natural behaviours such as avoidance and quarantining of National Health Service (NHS) managers2,3 somehow conferred passive immunity. However, there are indications that health is, indeed, vulnerable; individual trusts are now producing their own ‘jargon busters’,4,5 and books6 are now available on the subject. This short report will, for the first time, directly quantify the true extent of this phenomenon by examining one susceptible subgroup e public health. The Faculty of Public Health’s annual scientific conference in Eastbourne in June 2007 provided an opportunity to monitor large numbers of the workforce in a unique environment. Here, free from the scrutiny of strategic health authorities and with no need to be on speaking terms with their directors of commissioning, the authors sought to determine a representative use of management speak
* Corresponding author. Tel.: þ44 79 19 444064. E-mail address: [email protected] (J. Sheringham).
without the day-to-day pressures that might increase its application. An English recreational pastime popular in Eastbourne was adapted to quantify the usage of selected management-speak terms. The British Indicator of Nonsense or Grammatically Odd Constructions and Rubbish Dialect (BINGO card, Appendix A) was populated with phrases or words using the following inclusion criteria: words or phrases that made absolutely no sense whatsoever; classic management speak (e.g. ‘thinking outside the box’); terms suffering from overuse (defined as the authors being sick of reading them); or obfuscatory language (the authors did not know what it meant but were too embarrassed to ask). An expert panel (of those visiting the authors’ office) were consulted on an initial version of the card, which was amended in light of their responses. The representativeness of the terms for the final version of the card were also checked against a random sample of documents on the Faculty of Public Health’s website.7
0033-3506/$ - see front matter ª 2008 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2008.05.012
1444
A. Ali et al.
Data gatherers were recruited at the Trainee Bingo Night or on a tea break at the conference. All data gatherers met the minimum selection criteria of having normal hearing levels and a sense of humour, although these were not tested formally. Each data gatherer recorded every occurrence of the words on the card and had the opportunity to note additional ‘bonus words’ that fulfilled the inclusion criteria (or that they found particularly annoying and/or ludicrous). The data gatherers completed cards in both plenary and learning sessions throughout the conference. A £10 voucher was offered as an incentive in a prize draw for every completed card. This prize was sponsored by the authors and will not contribute to the NHS deficit. Completed cards were analysed quantitatively to examine the scale of the problem and qualitatively to identify themes. Fig. 1 illustrates the recorded use of selected management-speak terms over 2 days of the 3-day conference. Overall, there was an overwhelming desire to ‘engage’ (27 occurrences), followed by sessions most at risk of being ‘at risk’ with 26 occurrences. The frequency of ‘working in partnership’ was ranked third, with 15 occurrences. However, the ‘bonus word’ list suggests that the public health community may be developing resistance to some strains of classic management speak, and are mutating their language to develop a breed of new variants such as ‘being effective in the people business’, ‘the personalization agenda’ and a ‘network of networks’. Traditional modes of communication are also being modified as we are encouraged to both ‘intertalk’ and ‘cross talk’. However, both of these variants may have evolved as a direct response to discussing cost-cutting initiatives and budget deficits with a chief executive. The ‘bonus word’ element of the cards also yielded further examples of classic management speak. It was possible, for the first time, to quantify
just how endemic ‘mainstreaming’ (six occurrences) and ‘incentivizing’ (two occurrences) are in public health. These figures are likely to be significant underestimates due to limited coverage of sessions. The other bonus terms fell into three key themes: manifestations of physical activity; financial expressions and duplication.
Manifestations of physical activity As the living embodiment of the spirit of public health, the speakers displayed a strong commitment to movement and physical activity through their language. ‘Ring-fencing’ and ‘championing’ in some form appear to be almost routine in public health departments. One speaker actually admitted to performing ‘a drill down’. There also appears to be some focus on one particular direction of travel. Backwards or sideways movement have disappeared from the lexicon, as all presenters wanted to be ‘moving forwards’ or suggested ways of ‘taking it forward’. Commonplace activities such as ‘sharing’ information have been invigorated as we must now ‘actively share’. There also appears to be unprecedented movement taking place in primary care trusts up and down the land as patients and practitioners embark on an epic and apparently never-ending ‘journey’. Sports and exercise were also clearly high in the consciousness of one delegate who warned us, ‘If we take our eye off the ball, we lose sight of the patients’.
Financial expressions There is potent evidence from the widespread use of ‘business’, ‘finance’ and all their associated terminology that management is even embraced
Frequency of use
30 25 20 15 10 5 Fit for purpose
Re-inventing the wheel
Criteria
Rocket science
Transparent
incentivise
Feedback
Toolkit
Robust
Supportive environment
Advocacy
mainstream/ed(vb)
Evidence base
Joined-up
issue
Long term
Joint strategic needs
Network
Choice
Sustainable
Capacity
At risk
Working in partnership
Engage
0
Bingo term
Figure 1
Recorded use of selected terms at the Faculty of Public Health conference sessions, 27e28 June 2007.
Management speak in public health in public health. For the first, and hopefully last, time, the role of public health was even described as ‘front-end business’. Despite the ‘hole in the NHS budget’, there was a single mention of ‘investment’, with its benefits described as ‘adding value’. Tangentially, the data gatherers also picked up a rash of ‘intelligent commissioning’ (three occurrences), although this remained localized to a few sessions (which is where it should stay until someone explains what it actually means).
Duplication In early sessions, repetition was limited to subtle tautologies as the audience were encouraged to ‘lead from the front’, introduced to ‘key fundamental’ ideas, discovered systems to ‘help support improvements’ and urged to ‘effectively improve’ their organization. However, this repetition evolved to something far more overt as the conference progressed. Later sessions heard of a ‘standardized approach to standards’ and ‘progressive developments in developing practitioners’.
Conclusion This short report demonstrates that the epidemic of management speak is rife within the public health community, even when it is removed from putative sources of infection. While some traditional examples of management speak remain prevalent, a new crop of words and phrases is appearing. Tracking and managing these will prove to be a significant challenge. Some control over management speak may be established by investigating the causal factors of the outbreak. Some mutations may simply reflect the natural evolutionary processes of language. Others may be created consciously in an attempt to make an impact, ensure that nobody understands the core message (thereby maintaining demand for the speaker as an ‘expert’) or in a desperate bid to keep up with the Department of Health. The use of physical imagery by some public health personnel may reflect a genuinely held belief that the use of these words in some way contributes to their 10,000 recommended daily steps. The imagery of the journey may also provide a sense of purpose and outcome to the user, although with no map available and only one direction of travel, these aspirations may prove groundless.
1445 However, the novel and innovative use of management speak may be encouraging in one respect. It indicates that the public health workforce is resourceful and enthusiastic. The employment of repetition and redundancy, unconventional techniques to engage audiences, were widespread. The authors hypothesized that this was not poor preparation on the part of the presenters, but instead, an ingenious strategy to compensate for lapses in their audience’s concentration. The main reasons for these were: (a) physiological (sleeping); (b) technological (Blackberry usage); and (c) graphological (doodling). However, the authors feel strongly that the resourcefulness of public health practitioners can be manifested in positive ways that are not reliant on the use of management speak. Given the increasing exposure of public health professionals to turnaround teams, financial balance and public service agreements, the risks to this population are tangible and increasing. Management speak is a highly infectious and dangerous condition, and increased mixing within and between organizations will only increase its rate of spread. As this report illustrates, the danger of many of these phrases lies in their capacity, once registered, to infiltrate communication so imperceptibly that otherwise clearly written papers and presentations start to display spots of obfuscation and redundancy. In order to address the problem of management speak, or, as one speaker urged us, to ‘manage the curve downwards’, a thorough and integrated response is undoubtedly required. On no account, however, must a task force be set up. These groups are literally the breeding ground of this pathogen. Local practitioners can make their own quarantine arrangements such as shutting management consultants in cupboards or wearing surgical masks and respirators during meetings. The resilience, and legality, of these arrangements will only be tested once they are rolled out. * Practitioners should also have a high threshold of suspicion for contaminated materials distributed by post, in meetings or by e-mail. Further research is urgently required in order to build a comprehensive evidence base that can be constantly reviewed and updated to inform future planning. Similar quantification exercises must be undertaken in other settings to map the extent of this problem. To facilitate this process, the BINGO * The editors wish to apologise unreservedly for this particular use of management speak by the authors. It was not recognised as a potential error until the proof stage of this work. We have left it in place to highlight the pervasive nature of this problem.
1446
A. Ali et al.
card is supplied in Appendix A to assist fellow practitioners with their own surveys. These findings should form the basis of a comprehensive campaign to counteract this pandemic, and place the UK at the vanguard of management-speak control.
Acknowledgements
B Use the bonus word box to customize the card for your session (i.e. add a word you hear many times that you think qualifies as public health jargon) B No matter how many or how few words you have ticked, hand in the card to Ayesha/ Jessica
The authors would like to thank the following for comments on the BINGO card and completing cards at the conference: Dr Agnes Marossy, Dr Geraint Lewis, Chris Lovitt, Dr Araceli Busby, Dr Marilena Korkodilos, Susan Hird, Dr Kathrin Thomas, JoAnne Alner, Dr Dulcie McBride and Isobel Duckworth. The authors would also like to acknowledge Dr Penny Toff for successfully using the term ‘rocket science’ in her presentation, and Dr Jennifer Mindell for her comments on the final draft.
Ethical approval
Thank you for taking part in this groundbreaking piece of research!
None sought.
Funding
References
None declared.
Competing interests JS and AA are both members of the Faculty of Public Health and hope that publishing this paper will not invoke a lifetime ban. After all, at base level, this whole paper just comes down to homogenized management paradigm shifts.8
Appendix. A Faculty of Public Health conference BINGO card NAME OF SESSION ATTENDED: B Tick the relevant box each time the word is mentioned
1. Plain English Campaign. Available from, http://www. plainenglish.co.uk/[accessed 15.11.07]. 2. Edwards N, Marshall M, McLellan A, Abbasi K. Doctors and managers: a problem without a solution. BMJ 2003;326: 609e10. 3. Motley R. Doctors and managers: NHS needs political administration, not ‘‘management’’. BMJ 2003;326:1213. 4. NHS Improvement Network East Midlands. Your guide to understanding terms used in the NHS. c. Available from, http:// www.tin.nhs.uk/a-z-jargon-buster; 2002 [accessed 7.12.07]. 5. Heart of England NHS Foundation Trust. Jargon dictionary. Available from, http://www.goodhope.org.uk/jargon_ dictionary.asp [accessed 7.12.07]. 6. Carr S. Tackling NHS jargon. Oxford: Radcliffe Medical Press; 2002. 7. Faculty of Public Health. c. Available from, http:// www.fphm.org.uk/[accessed 7.12.07]; 2007. 8. Mike Wills Learning Services. Business jargon generator. c. Available from, http://www.mwls.co.uk/jargon.htm; 2007 [accessed 22.08.07].
Available online at www.sciencedirect.com