Public health leadership: creating the culture for the twenty-first century.

Ludwig Wittgenstein said that almost all arguments were due to a failure to agree on the meanings of the terms being used. This certainly applies in the health service where discussions roam aimlessly over topics such as efficiency or equity or quality when it is quite obvious that all those involved are using a term with a different meaning. Where a term has a relatively sharply defined, technical, meaning, such as meta-analysis, its management is relatively straightforward, but as a term becomes more widely used, it acquires more meanings and reaches a point where it may cause more confusion than clarity; the term ‘systematic review’, for example, is now no longer as clear as it once was. There is no term in modern management with as many meanings as ‘leadership’, and some examples of the definitions collected in the Knowledge Into Action Glossary are shown below.