In 2006, I went to work for Harvard Business School Professor Michael Porter . I started as his student and later became a staff researcher, and research fellow.

Porter was a giant intellect and known for his precision with language. His collaborators both feared and revered the red felt-tipped pen he used to mark up our work. Words mattered. Definitions mattered. If you used a term loosely, you could expect to see that red pen.

Porter and his longtime collaborator Elizabeth Teisberg popularized the term “value-based care” in the American healthcare vernacular, though one could argue that the underlying idea had been around for much longer.

They wrote a substantial book, Redefining Health Care , and spent more than 300 pages describing the idea in remarkable detail. It became an award-winner and a bestseller (at least by healthcare standards).

They described organizing care around the needs of patients rather than the traditional structures of medicine. They identified example after example and articulated the concept of integrated practice units: focused organizational units designed around patients with particular medical conditions. And they offered a deceptively simple equation to anchor the whole idea:

Twenty years later, the term they helped define is nearly everywhere.

And yet it carries remarkably little of the texture and gravity it once did.

Recently, I spoke on a conference panel about “value-based care” and found myself wondering: How do terms gradually lose their meaning in healthcare?

There was a time when we got excited about words like “innovation” and “transformation.”

Today, they often elicit little more than an eye roll and a cynical comment.

“Patient-centered” has been applied to virtually everything in healthcare, including plenty of things patients themselves would struggle to recognize as centered on them.

“Disruption” once implied fundamentally changing an industry. Now it can describe a new scheduling app.

“Artificial intelligence” is rapidly traveling down the same road.

I think there are three stages through which useful language gradually becomes meaningless.

We begin by applying a term to things that loosely resemble the concept it was originally meant to describe.

Something isn’t quite value-based care, but it involves a quality measure and some financial risk, so we call it value-based care. Something isn’t really transformational, but it changes a workflow, so we call it transformation. Something isn’t particularly innovative, but it’s new to our organization, so we call it innovation.

There is usually no bad actor involved. There is no language police. Each individual expansion seems harmless.

But the slight corruption of language accumulates.

Linguists have a memorable term related to this phenomenon: semantic bleachin g. A word gets used so frequently and broadly that some of its original force is weakened.

The edges of the concept blur.

Once a term develops positive associations, people want those associations attached to what they are doing.

The word becomes a brand.

Nobody wants to say, “We’re making an incremental operational improvement.” We’re transforming.

Nobody wants to say, “We’re entering another risk contract.” We’re accelerating value-based care.

Nobody wants to say, “We bought some new software.” We’re innovating.

The rhetorical value of the term begins to exceed its descriptive value.

This is where the corruption becomes more consequential. We are no longer using language principally to describe what we are doing. We are using language to confer status upon it. And once a word confers status, saying it can begin to feel like doing it.

Because everyone (except patients) benefits from the inflation, almost nobody has an incentive to object.

Consultants use the terminology. Conferences organize around it. Companies build strategies around it. Investors reward it. Executives repeat it. Eventually an entire ecosystem develops around a word whose definition nobody particularly wants to police.

The word remains everywhere.

The underlying idea becomes harder and harder to find.

Eventually we have used the word to describe so many things that it ceases to distinguish among them.

And a word that cannot distinguish eventually cannot communicate.

The term becomes ubiquitous at precisely the moment it becomes meaningless.

Everything is innovative, so nothing is particularly innovative.

Everything is transformational, so transformation tells us almost nothing.

Everyone is patient-centered, including organizations whose patients spend hours on hold.

And virtually everyone in healthcare now claims to participate in value-based care, even though the organizational redesign Porter and Teisberg originally described remains comparatively rare.

I know what that redesign looks like because I spent time studying it. With Michael, I wrote case studies on ThedaCare in Wisconsin and MD Anderson Cancer Center in Houston . At ThedaCare, leaders rebuilt how care was delivered from the ground up and measured whether it made patients better off. At MD Anderson, care was organized around specific cancers, with multidisciplinary teams built around the patient’s condition rather than around medical specialties. Neither organization described what it was doing with slogans. They described it with outcomes, costs, and org charts. That was value-based care.

At the exhaustion stage, cynicism sets in.

People hear the word and roll their eyes. Often this isn’t because the original idea was wrong. It’s because they have heard the language used so many times without experiencing the thing it was supposed to describe.

That distinction matters.

We sometimes respond to exhausted language by inventing new language. The old term has become stale, so we find another one. The new phrase enjoys a few years of conceptual clarity before the same cycle begins again.

But perhaps what we need isn’t another vocabulary.

Perhaps we need greater discipline about the vocabulary we already have.

George Orwell understood the stakes. His famous essay “Politics and the English Language” was ostensibly about writing, but its deeper subject was thinking. Imprecise language makes imprecise thinking easier. And abstractions can create distance between the words we use and the realities those words are supposed to describe.

Healthcare is particularly vulnerable because we are an industry overflowing with aspirational language: mission, quality, equity, innovation, transformation, accountability, patient-centeredness, value.

These are not meaningless ideas. Quite the opposite. They are important enough that we should resist making them meaningless.

And there is an even greater danger.

Sometimes saying the right word becomes a substitute for doing the difficult thing the word describes.

An organization talks constantly about accountability and convinces itself that it has become accountable.

A company declares itself patient-centered and stops asking whether patients actually experience it that way.

A health system announces its transformation and mistakes the announcement for evidence that transformation has occurred.

Language doesn’t merely describe reality in these situations. It can insulate us from it (This is a phenomenon I discuss at length in my forthcoming book, The Moral Alibi ). That is why definitions matter.

I sometimes wonder what Michael would make of what happened to a term he and Elizabeth Teisberg took such pains to define and popularize.

I suspect he would ask a characteristically Porterian question:

What, precisely, do you mean by value-based care?

And then he would listen intently to the answer.

Twenty years later, healthcare might benefit from taking out the red pen again.