Reality is created by the language we use. Language creates reality rather than describing it; that is the consistent message from Ludwig Wittgenstein, Benjamin Lee Whorf, and John R Searle. If we want to change reality one way is to change the language used, and for this reason we ban, or try to ban, the use of the terms primary, secondary, acute, and community in the workshops we run, like the workshop with great participants from West Berkshire that was held on the 2 February.

What emerged at that workshop was the need to change the mindset about A&E and the new term that emerged was SFS—the system failure service. The term “accident” implies chance, fate, or luck. The word “emergency” implies an unplanned uncontrollable event, but the workshop decided to consider them system failures and to assume that good systems should make A&E “redundant.” Obviously they won’t, but the shift in mindset would be of great importance in identifying system failures and reducing A’s and E’s.

The iconic Taiichi Ohno introduced the practice of the “five whys” to Toyota; ask why five times when any problem occurs. Try it when a frail elderly person has been brought in from a nursing home in a blue light ambulance, or when a young person has been rushed in with stab wounds. What systems have failed?

I asked it myself when I had my STEMI and got as far as the answer that I had given up taking the polypill because of the nuisance of cutting two of the constituent pills in half. Would it have prevented my trip to, and excellent care in, A&E? Who knows but a system failure had been identified and in my next life I will stick with the regime!

So, goodbye A&E, hello SFS, to pick up a theme from a previous blog.

Muir Gray is visiting professor of knowledge management, Nuffield Department of Surgery, University of Oxford.