World-class, state-of-the-art, best-practice bullshit

If Professor Michael O’Keeffe, Consultant Ophthalmic Surgeon in Temple Street Children’s Hospital, Dublin, is as good a doctor as he is a man, then he’s one of the best.

On 9 July, he was interviewed by Pat Kenny on RTE Radio 1 (‘Today with Pat Kenny’).

What provoked the interview was the cancellation of operations at Temple Street on children with cataracts, glaucoma, etc. Mr O’Keeffe pointed out that such children risk going blind if the operation is not carried out in good time.

One of the children was, in fact, a six-week-old baby with cataracts – and a baby of six weeks, he said, is at a “critical period in visual development”.

Mr O’Keeffe went on to contrast the PR spin – “the statistics” and “the lies” – of those who manage the Irish health system with the “reality on the ground”, which is “a disaster”. The “system is breaking down”, he said: inefficiencies, cutbacks, phones not answered, lists cancelled, outpatients not starting on time or cancelled.

“I think patients have become a nuisance in hospitals,” he said sardonically. “We could run them so well without them.”

Meaningless jargon

He added: “We talk about grandiose schemes … a ‘world-class health system’ and all this sort of thing, this jargon, which is meaningless, because none of the basics are happening.

“I recently got an email from one of the hospitals saying they now wanted to discuss biological management of patient care. Now you tell me what that means, it’s meaningless stuff, this is the sort of garbage we’re into …”

Looking after patients was “really quite simple, but we’re into management speak”, complicating things, and “we’re forgetting the basics”.

Pointing out the current jargon for closing down – reconfiguration – Mr O’Keeffe said: “World-class means nothing down at my level.”

He spoke passionately and with a savage indignation that it’s not possible to convey in print.

‘Transformation and reconfiguration’

After listening to the interview, I went to the Health Service Executive website and had a look at its 2009 annual report: “implementing our transformation and [here we are!] reconfiguration agenda”, “have achieved 70% of our 2011 targets in 23 of the 35 representative areas … we maximised every possible measure to protect frontline services”, and so on.

Then I googled world class state of the art best practice and got three million results. One of the sites listed was a “world-class data center” which uses various “mission-critical systems”, including a “state-of-the-art fire suppression system”.

Another of the sites was that of a “leading” American health-care provider, which asserted: “Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management.”

This health-care provider may actually be quite good but, if you’re fussy about hyphens (or the lack of them), you’ll notice that the phrase “chronic disease management”, strictly speaking, means “chronic management of disease”.

Indeed. After all, what Mr O’Keeffe was surgically cutting into was all the grandiose, high-flying management speak that masks chronic management and “disaster” at the ground level.

A new rule

With the shakespearean perception “Methinks she doth protest too much” in mind, I now suggest a new rule:

The quantity and grandiosity of management speak is in inverse proportion to the quality of the service provided.

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