54 terms on how institutions are seen, and how their people grow. Defined plainly, with their sources.
An institution’s image is built from inside, by its people, every day. A team that shares its words sees the same problems and fixes them together. Here are the terms we use, from patient experience to decision logs, so a nurse, a teller and a director mean the same thing.
How people outside see you, and how you can measure it.
The picture people hold of an institution: what they expect from it and how far they trust it. It is shaped less by what the institution says than by what people live with its staff, visit after visit. That is why it is built from inside, every day.
Brand Promise vs Patient Experience: How to Audit the GapRoadyom MirrorBrand promise
What an institution tells the public to expect from it, in its advertising, signs, website and words at the desk. A promise people can test, such as “results within 24 hours”, is one they will also judge you on.
Brand Promise vs Patient Experience: How to Audit the GapRoadyom MirrorService quality gap model
Everything patients and their families live through in their contact with a health service, from booking to billing. It covers how they were spoken to, informed, kept waiting and cared for, not only the clinical result. Surveys such as HCAHPS measure part of it.
Source: Centers for Medicare & Medicaid Services, 2026
Hospital Online Reviews: What They Can and Cannot Tell YouRoadyom MirrorHCAHPS
The sum of a customer’s contacts with an organisation and how they felt about them. In a bank, a school or a municipality, it is made at the counter, on the phone and in the queue. It is the same idea as patient experience, outside health.
Roadyom MirrorNet Promoter Score (NPS)Statistics: Experience and online reviews
The experience of residents, students, families or citizens with a public institution. It includes people who never chose the service and cannot easily go elsewhere, which raises the stakes of every contact.
Roadyom MirrorInstitutional imageStatistics: Service waiting
A model by Parasuraman, Zeithaml and Berry (1985) that explains poor service as a series of gaps between what customers expect and what they receive. Each gap points to a different place to fix: listening, standards, delivery or communication.
Source: Journal of Marketing, 1985
Brand Promise vs Patient Experience: How to Audit the GapRoadyom MirrorCommunication gap (Gap 4)
The fourth gap in the service quality model: the distance between what an institution promises in public and what it actually delivers. Overpromising raises expectations, and the same service then feels worse.
Source: Journal of Marketing, 1985
Brand Promise vs Patient Experience: How to Audit the GapRoadyom MirrorBrand promise
A survey scale built from the gap model that compares what customers expected with what they perceived. It has been adapted to hospitals, banks and schools, and its dimensions remain debated.
Source: Health Services Research, 1992
Service quality gap modelBrand Promise vs Patient Experience: How to Audit the Gap
Hospital Consumer Assessment of Healthcare Providers and Systems: the first national, standardised, publicly reported survey of patients’ views of hospital care in the United States. Results have been public since March 2008.
Source: Centers for Medicare & Medicaid Services, 2026
Hospital Online Reviews: What They Can and Cannot Tell YouStatistics: Experience and online reviewsOnline reviews
Ratings and comments people post in public about a service, unprompted. They are not a representative sample, yet studies find they track formal patient surveys and raise topics surveys never ask about.
Source: BMJ Quality & Safety, 2012
Hospital Online Reviews: What They Can and Cannot Tell YouRoadyom MirrorStatistics: Experience and online reviews
A 2024 US Federal Trade Commission rule that bans fake reviews, buying reviews of a set sentiment, undisclosed insider reviews and review suppression. Answering reviews well is allowed; manufacturing them is not.
Source: Morgan Lewis, 2024
Hospital Online Reviews: What They Can and Cannot Tell YouOnline reviews
A loyalty measure introduced by Fred Reichheld in 2003, based on one question: how likely are you to recommend us, from 0 to 10. The share of detractors (0–6) is subtracted from the share of promoters (9–10). It is simple to track, and says little about why.
Source: Harvard Business Review, 2003
Customer experience (CX)Statistics: Experience and online reviews
How long a wait feels to the person waiting, as opposed to the minutes on the clock. In emergency departments, perceived waits, information and courtesy predicted satisfaction better than actual waits did.
Where the image is made: on the floor, in the shift, in the conversation.
The people who meet the public directly: nurses, receptionists, teachers, tellers, clerks and drivers. For most visitors, they are the institution. Their daily practice builds or wears down its image.
Roadyom ReflectionFrom Field Notes to Staff Development, Without SurveillanceInstitutional image
Regular visits by leaders to where the work happens, to ask staff what is getting in their way and to act on it. Rounds help only when people hear back about what changed; otherwise they can make things worse.
Source: Institute for Healthcare Improvement, 2023
Leadership Rounding: How to Run Rounds That Change PracticeRoadyom ReflectionPatient Safety Leadership WalkRounds
A structured form of leadership rounding developed in US hospitals in the early 2000s and promoted by the Institute for Healthcare Improvement. Senior leaders ask frontline staff about safety concerns, record them and report back on actions.
Source: Institute for Healthcare Improvement, 2023
Leadership Rounding: How to Run Rounds That Change PracticeStatistics: Coaching and feedbackSafety culture
From lean management: “gemba” is Japanese for the real place where work is done. A gemba walk is a practice for grasping the current situation through direct observation and inquiry before taking action.
Source: Lean Enterprise Institute, 2020
Leadership Rounding: How to Run Rounds That Change PracticeLeadership rounding
A management style in which managers leave their offices to talk with staff where they work. A randomised hospital study found it can lower staff ratings of performance when problems raised are not solved.
Source: FierceHealthcare, 2015
Leadership Rounding: How to Run Rounds That Change PracticeStatistics: Coaching and feedback
The shared attitudes, beliefs and practices that shape how safely a team works, including whether people feel able to speak up. It is usually measured by staff surveys of safety climate.
Source: BMJ Quality & Safety, 2018
Leadership Rounding: How to Run Rounds That Change PracticeStatistics: Coaching and feedbackPatient Safety Leadership WalkRounds
Individual, regular and sustained support in which an experienced colleague observes practice and helps a person improve one concrete thing at a time. In teaching, causal studies show it changes classroom practice.
Source: Review of Educational Research, 2018
From Field Notes to Staff Development, Without SurveillanceRoadyom ReflectionStatistics: Coaching and feedback
Any action that gives people information about their performance on a task. A major meta-analysis found that more than a third of such interventions lowered performance, especially when feedback pointed at the person rather than the task.
Source: Psychological Bulletin, 1996
From Field Notes to Staff Development, Without SurveillanceStatistics: Coaching and feedbackCoaching
Practice designed to improve a specific part of performance, with clear goals, feedback and repetition, as described by Ericsson and colleagues in 1993. Later replications found it matters, though less than first reported.
Source: Psychological Review, 1993
From Field Notes to Staff Development, Without SurveillanceStatistics: Coaching and feedbackRoadyom Reflection
A short, factual record of what someone did in a real situation at work, written soon after it happened. Tied to a named situation, field notes become material for coaching rather than surveillance.
From Field Notes to Staff Development, Without SurveillanceRoadyom ReflectionCoaching
The use of technology to observe, record or analyse what employees do at work, such as keystrokes, screens, calls or location. A meta-analysis of 94 samples found no evidence it improves performance and found it linked to higher stress.
Source: Personnel Psychology, 2023
Bringing people in well, and knowing they are qualified for the work.
The process of helping new colleagues adjust to the social and performance sides of a new job, quickly and smoothly. It runs well beyond the first day, and for new clinicians often beyond the first months.
Source: SHRM Foundation, 2010
New Staff Onboarding: A 90-Day Checklist That WorksRoadyom RefractionFour Cs of onboarding
Compliance, Clarification, Culture and Connection: the four building blocks in Talya Bauer’s onboarding guide. Most organisations cover compliance; about one in five formally addresses all four.
Source: SHRM Foundation, 2010
New Staff Onboarding: A 90-Day Checklist That WorksStatistics: Turnover and onboardingOnboarding
How newcomers learn the knowledge, behaviour and attitudes they need to take part as members of an organisation. Research links role clarity, self-confidence and social acceptance to newcomers staying and performing.
Source: Journal of Applied Psychology, 2007
New Staff Onboarding: A 90-Day Checklist That WorksOnboarding
A structured programme that supports newly qualified clinicians through their first year of work. The better programmes are formal, backed by senior leaders, run 9 to 12 months and include an educated preceptor.
Source: National Council of State Boards of Nursing, 2026
New Staff Onboarding: A 90-Day Checklist That WorksStatistics: Turnover and onboardingPreceptor
An experienced practitioner who works alongside a new colleague, teaching, observing and signing off competence. Preparing preceptors for the role is one of the features of programmes that keep new staff.
Source: National Council of State Boards of Nursing, 2026
New Staff Onboarding: A 90-Day Checklist That WorksTransition to practiceRoadyom Reflection
A documented check that a person can do the specific tasks of their role safely. Accreditation bodies distinguish it from orientation: telling someone how things work is not proof they can do them.
Source: The Joint Commission, 2026
New Staff Onboarding: A 90-Day Checklist That WorksRoadyom RefractionOnboarding
The share of staff who leave in a period, usually a year. It is often split into voluntary (resignations) and involuntary (dismissal, illness or injury). In small teams, report the number of people as well as the percentage.
Source: Policy, Politics, & Nursing Practice, 2014
New Staff Onboarding: A 90-Day Checklist That WorksStatistics: Turnover and onboardingRoadyom Refraction
The formal process of checking a professional’s qualifications, experience, registration and standing before they are allowed to practise in an organisation. In health care it is repeated at set intervals and when concerns arise.
Source: Australian Commission on Safety and Quality in Health Care, 2026
Hospital Staff Credentialing and Licence Expiry TrackingRoadyom RefractionPrimary-source verification
The decision, after credentialing, about which procedures and services a clinician may perform in a particular hospital. In the US, the medical staff reviews candidates and recommends privileges to the governing body.
Source: Legal Information Institute, Cornell Law School, 2026
Hospital Staff Credentialing and Licence Expiry TrackingScope of clinical practiceCredentialing
The extent of a clinician’s practice within a particular organisation, based on their credentials, competence and performance, and on what the organisation can support. It is the Australian counterpart of privileging.
Source: Australian Commission on Safety and Quality in Health Care, 2026
Hospital Staff Credentialing and Licence Expiry TrackingPrivileging (clinical privileges)
Verifying a practitioner’s reported qualifications with the original source, or an approved agent of that source, such as the university or licensing board. A photocopy of a certificate is not verification.
Source: The Joint Commission, 2026
Hospital Staff Credentialing and Licence Expiry TrackingRoadyom RefractionCredentialing
Repeating the credentialing review at set intervals, which Australian guidance puts at 3 to 5 years, and sooner when concerns arise or registration changes. Licences and certificates that expire in between need their own tracking.
Source: Australian Commission on Safety and Quality in Health Care, 2026
Hospital Staff Credentialing and Licence Expiry TrackingCredentialing
A WHO method that sets staffing needs from the actual workload of a health facility, using time standards for each activity. It compares the staff a facility needs with the staff it has, and shows where the pressure is.
Source: World Health Organization, 2023
What a team knows, and why it decided what it decided.
Deliberate steps to keep critical know-how in the organisation when people leave, retire or change roles. It works best when it starts years before a departure, not in the last week.
Source: APQC, 2025
Knowledge Loss: What Leaves When Experienced Staff LeaveRoadyom PrismStatistics: Knowledge loss and lessons learned
The loss of know-how, relationships and context when experienced people leave. David DeLong framed it in 2004 as a threat from an ageing workforce; it hits hardest when the knowledge was never written down.
Source: Oxford University Press, 2004
Knowledge Loss: What Leaves When Experienced Staff LeaveRoadyom PrismStatistics: Knowledge loss and lessons learned
Knowledge people use without being able to fully put it into words, such as recognising a deteriorating patient or a difficult customer. Michael Polanyi summed it up: “we can know more than we can tell.” It passes mostly through shared work and conversation.
Source: University of Chicago Press, 2009
Knowledge Loss: What Leaves When Experienced Staff LeaveRoadyom PrismExplicit knowledge
Knowledge that can be written, stored and shared as text, numbers or procedures. It is easy to move, but it rarely carries the judgement that tells you when a rule does not apply.
Source: Organization Science, 1994
Knowledge Loss: What Leaves When Experienced Staff LeaveTacit knowledgeSECI model
Ikujiro Nonaka’s model of how organisations create knowledge through four conversions between tacit and explicit: Socialisation, Externalisation, Combination and Internalisation. Knowledge grows through a continuous dialogue between the two.
Source: Organization Science, 1994
Knowledge Loss: What Leaves When Experienced Staff LeaveTacit knowledgeRoadyom Prism
What an institution knows about its own past: decisions and their reasons, what was tried, what worked and who knows what. When it lives only in people’s heads, it leaves with them.
Roadyom PrismDecision Log: How to Record Decisions So the Reasons SurviveDecision log
The policies, processes and roles an organisation uses to create, share and apply knowledge. ISO 30401:2018 sets requirements for establishing, maintaining, reviewing and improving such a system.
Source: International Organization for Standardization, 2018
Why Lessons Learned Rarely Change the Next ProjectRoadyom PrismKnowledge retention
A running record of significant decisions: what was decided, when, by whom, and why, including the options rejected. It lets a team revisit a decision with the reasons that existed at the time, not with hindsight.
Source: Microsoft, 2024
Decision Log: How to Record Decisions So the Reasons SurviveRoadyom PrismArchitecture decision record (ADR)
A short, numbered document for one significant decision, with its context, the decision and its consequences, proposed by Michael Nygard in 2011 for software projects. The format works for any team that wants decisions to survive staff changes.
Source: Cognitect, 2011
Decision Log: How to Record Decisions So the Reasons SurviveDecision logRoadyom Prism
The tendency, once an outcome is known, to judge it as more predictable than it was. Baruch Fischhoff showed it in 1975. It makes past decisions look careless or obvious unless their original reasons were recorded.
Source: Journal of Experimental Psychology, 1975
Decision Log: How to Record Decisions So the Reasons SurviveDecision log
Turning what happened into what happens next.
Knowledge gained from experience that should change how future work is done. A lesson is only learned when practice changes; a list of observations in a report is not enough.
Source: International Journal of Project Management, 2015
Why Lessons Learned Rarely Change the Next ProjectRoadyom PrismStatistics: Knowledge loss and lessons learned
NASA’s database of lessons from its programmes and projects. Reviews in 2001 and 2012 found that many managers did not use it, and that most centres did not fully follow the agency’s own process.
Source: NASA Office of Inspector General, 2012
Why Lessons Learned Rarely Change the Next ProjectStatistics: Knowledge loss and lessons learnedLessons learned
A structured conversation after an event, developed by the US Army, that asks what was supposed to happen, what actually happened, why, and what to do differently. It focuses on the work, not on blame.
Source: U.S. Army Research Institute for the Behavioral and Social Sciences, 2007
Why Lessons Learned Rarely Change the Next ProjectPause and Learn (PaL)Roadyom Prism
NASA Goddard’s adaptation of the after-action review for projects. A facilitated session brings 10 to 20 members of one team together for about 90 minutes at key milestones, while memories are fresh.
Source: NASA Technical Reports Server, 2016
Why Lessons Learned Rarely Change the Next ProjectAfter-action review (AAR)Roadyom Prism
A guided interview with an experienced person, recorded so others can learn how they think and decide. NASA used oral histories in 2008 to capture tacit knowledge from the Space Shuttle programme before it ended.
Source: NASA History Office, 2008
Knowledge Loss: What Leaves When Experienced Staff LeaveTacit knowledgeRoadyom Prism
A US framework for assessing organisational performance across leadership, strategy, customers, measurement, workforce, operations and results. Its knowledge management item asks how you build organisational knowledge and embed learning in daily work.
Source: NIST Baldrige Performance Excellence Program, 2021
Why Lessons Learned Rarely Change the Next ProjectKnowledge management system (ISO 30401)
Telling the people who raised a concern or a lesson what was done about it. In WalkRounds research, staff who heard back reported a much stronger safety culture than those who did not.
Source: BMJ Quality & Safety, 2018
Leadership Rounding: How to Run Rounds That Change PracticeWhy Lessons Learned Rarely Change the Next ProjectLeadership rounding
Each Roadyom product holds one part of this vocabulary in practice.