Published: 11/4/2002, Volume II2, No. 5800 Page 33
Like any other large collection of humanity, the NHS contains all that is good and bad about human behaviour. Devotion to duty, care for others and innovation on the one hand, indifference, selfishness and refusal to change on the other.
The NHS lives on words.What we say, how we say it, who we say it to, when we say it, and why we say it, all combine to keep the big wheels turning. Or conspires to grind them to a halt.
Been to any leaving parties lately? Was it a positive, enjoyable experience for everyone present? Or was it a 'political' party? Have you ever been to a leaving party where you have sensed or heard the truth everybody knows but nobody speaks, potentially disruptive, irredeemable true statements or the use of metaphors for disguise?
The Kiriwina tribespeople of the Trobriand Islands of New Guinea have had nouns for these human interactions for thousands of years.
1The English language has no exact equivalents. But the behaviour they describe is something of an art form within the NHS. The effect this has on those of us working in it contributes in no small way to the difficulty in changing behaviour for the better.
Mokita is the noun used by the Kiriwina for those unspoken truths that we are all aware of but cannot bring ourselves to talk about openly.We are all aware of the mokita in our own workplace. The incompetent manager; the dinosaur consultant; the member of staff in any profession and at any level who really should have gone on to pastures new a long time ago.
We may kid ourselves that we use mokita as an act of kindness, but really the biggest fear about speaking about it is that once said, there is an obligation to do something about it.
The opposite of mokita is biga peula; a one-way ticket to conflict for which there is no redemption, or apology good enough. An accusation that a colleague is a liar, or that the boss is brain dead, are statements from which there is no way back.
I remember an exit interview with a director of nursing some years ago. Shortly after qualifying as a nurse, I was asked into his office to talk about why I wasn't intending to work in the hospital where I had trained.
Without knowing about biga peula at the time, I told him his entire management team was rotten to the core, spent more time in the social club than at work, and ignored the abuse and neglect that went on in many of the wards. I was still smarting from the unpleasant personal consequences of reporting three staff for abusing patients soon after I started training.
I had already organised a post at another hospital, but it still struck me as I left his office that I was unlikely to be coming back - at least while he was in post.
Compare this with biqa viseki - those veiled references conveying various levels of meaning to different people in the same audience so that friends or others 'in on it'will pick up the hidden allusions, while the remainder of the audience simply provide the means by which the target of the references is prevented from publicly picking them up and responding directly to them.Worse still are the biqa veseki expressed with the target being unaware of what is going on. This is like the schoolboy prank of putting a notice saying 'kick me' on the back of some hapless junior.
When these are played out at an individual's departure from an organisation, you end up with one of those cringingly embarrassing leaving parties, like one I went to recently.
It was one of those parties where the majority of people are aware they are witnessing it, but not quite sure where the side swipes, digs, carefully chosen words being played out at the front are coming from (or indeed, what they all mean).
The person leaving ends up with the opportunity to vent their spleen, in an extremely targeted and personal manner, with as much meaning in what is unsaid as in what is actually expressed.
Most of the audience is left with the impression that the major players had major differences, but could never find the right words when they worked together to sort them out.
The most damaging part is that those remaining in the organisation have to choose whether to endorse - publicly or privately - whatever criticism was levelled, and whether to treat their former colleague like a revered deity, or the disgraced uncle who doesn't get talked about in polite circles.
A leaving party should be the opportunity for a personal acknowledgement of an individual's time with an organisation, where the positive aspects are highlighted and where healthy links between everyone can be maintained. If this is not possible then perhaps they are best avoided.
If a veiled reference is intended to humiliate, punish or otherwise harm its recipient, using the assembled gathering for this end is perhaps not the most honourable motive for a leaving party.Maybe there is a case for simply 'leaving'.
Or sticking to biga peula in private.
REFERENCE 1Rheingold R. They Have a Word for It. Louisville, Kentucky: Sarabande Books.2000.
Richard Knowles is operational manager, acute medicine, Isle of Wight Healthcare trust.