UnfortunatelyLit By Robert Fromberg
For Lynn Kahn
As I look back on my multi-decade crawl through something I once heard called the “business of healthcare,” I reflect on the usual mix of modest successes, glorious failures, and scenes straight out of a bad comic opera. But what I hold most precious, what will give me comfort as I approach the idyll that is life without PowerPoint presentations, is a secret history that only now can I safely share.
As far as I can determine, the American College of Healthcare Executives was formed in 1933 (likely as the American College of Hospital Executives or Hospital Administrators—the history here is oddly difficult to uncover). An aggressively formal name to be sure, one that I infer to be a sign of the eagerness of these hospital administrators to be seen in a serious, studious, scholarly, rarified light. My theory is that they wanted to be seen in the same such light as the physicians—cf, the American College of Medicine and the American College of Surgeons—who constantly vex administrators with the trump-card ability to walk into an administrator’s office wearing bloody scrubs and rant:
“Patients will die unless you—”
As windily named organizations attempted to stand shoulder to shoulder with more modern creations in our increasingly snappy world, I witnessed the proliferation of initialisms and acronyms, and the American College of Healthcare Executives began referring to itself as ACHE. As an initialism, ACHE was a bit of an awkward move for the tongue, although otherwise harmless. But as an acronym, ACHE was a groaner for a group of executives that, by virtue of their administrative prowess, sought to relieve each patient of his or her ache. The professional credential, FACHE, which I fear was often pronounced “fake,” was equally problematic. Ouch.
However, this situation was just the kind of challenge marketing agencies are made to overcome. I was not myself at an executive level then, but so often have I imagined the scene that it is as real to me now as my first wedding in a police station conference room with all the staff watching through a window.
Members of such an agency, sitting around a polished-to-perfection oak conference table with logo-bearing pens and composition-style notepads at the ready, took a collective deep breath and observed something along these lines:
“The need for stature and respect for history and the overriding importance of brand recognition dictate that the organizational name must remain. Modernity dictates that we must keep the initialism. But the desire to avoid snorts and chuckles and the attendant organizational embarrassment dictates that people must not be easily enabled to think or say ‘ache.'”
One agency member sitting stage left to the agency’s chief executive arched his eyebrows in anticipation. Then—or so I imagine—he raised a hand, not asking permission to speak, but rather notifying his colleagues that he would do so. As he began, the others, sensing the import of his words, sat up straighter in their chairs.
“The solution,” he said (a word that has continued to romp through company taglines and mission statements (“a shaving solution,” “a personal lubrication solution”) to the point that just last week a young man with a long beard in a digital marketing firm told me, “My role is solutioning”) “is simple. Stack the letters!”
Stack the letters? A moment of perfect silence grasped the room. Yes! Stack the letters!
Thus, the new logo was a capital A and a capital C resting atop a capital H and a capital E. ACHE, but not, most definitely not, ACHE.
This logo held its own until, a decade later, a new marketing executive at ACHE looked at the logo and, legend has it, said, “What the fuck is that?” She started to suggest changing the bloated name of the organization entirely, but that idea was shot down before its first sentence emerged from her lips.
And so she oversaw another marketing firm in the development of a new logo that spelled out the full name of the association (in tiny, so tiny letters) and added the tagline for leaders who care®, which is damned clever. The maxim accomplished the dual goals of linking these executives more closely with the actual touching of patients and also disabusing those in the field of the pervasive (although unjustified) notion that administrators are bean-counting enemies of patient wellbeing.
Accompanying the new logo, the word came down to all staff: “Always use the full name when referring to the American College of Healthcare Executives. Never use ‘ACHE.'”
I was, as we team players said, “on board.” (A born follower, I love style rules. A born watcher, I made a note in the diary I kept by my bed.)
This logo, and its complicated battle with surrounding forces, has survived for several decades, that lengthy duration itself suggesting an unspoken organizational affirmation of the stodginess of the original name.
Note that this is but one tale of the singular strife that is the relationship between a company name and its acronym. I have witnessed many other instances from my position of embedded observer in the guise of fresh-scrubbed participant. A few others of note:
I took up arms in the battle of the Joint Commission on Accreditation of Healthcare Organizations against JCAHO, so joyfully transformed by accreditor-hounded wags into “jackoff.”
I also hoisted a few wobbly attempts to help the Healthcare Information and Management Systems Society slough off all those words and emerge a sleek HIMSS. (These days, the acronym is likely mistaken in many a Google search for “hims,” the lowercase acronym for a company specializing in solutions for erectile dysfunction, a topic close to my heart as I enter my golden years.)
But even I, my very self, wasn’t immune to the pitfalls of acronymity. In an early attempt to be not a cog but a design engineer, I oversaw the naming and promotion of what I now think of as “the event with the self-immolating acronym”: Strategies for Healthcare Information Technology. Fortunately, the CEO’s assistant noticed the indelicacy before I had gotten any further than printing a save-the-date postcard, which I hastily reprinted with a new conference name, Healthcare Information Technology Solutions, with the lively acronym HITS.
In my many years of toiling in this field, I have been proud to witness one small part of an era in which unwieldy words have been replaced by sweet clusters of letters that we aim to make mean anything we want them to mean. I have been proud to witness the growing pains of this important movement, as we sought to select, shape, and control these letters, all in, so we assured ourselves, service of the sacred mission of healthcare. And truly, I have been proud and gratified to see that, despite our application of wit, energy, and the brute force of the conference table, these letters have shown a remarkable ability to continue to shape themselves into meanings we never intended.
Robert Fromberg is the author of How to Walk with Steve, a new memoir about autism, art, death, and embarrassment from Peoria to CBGB (Latah Books). His other prose has appeared in the Los Angeles Review of Books, Hobart, San Antonio Review, and many other journals. For more information, visit http://robertfrombergwriter.com/ or find him on Twitter @RobFromberg.
Why we chose this piece: The editors are all former bureaucrats deeply entrenched in the world of acronyms, so this essay is kind of perfect for us. In a piece about acronyms and trying to control meaning, we loved that Rob played so much with long sentences and parentheticals while wielding a deadpan tone. We think this essay is a hilarious and thoughtful reflection on the office grind and human error.
