communication problems are abundant, such as using pictures but not words to clearly communicate instructions for operating construction tools and airplane exit doors. Drawing from Wolf’s and Pignone’s discussions (see Chapters 3 and 4), innovative methods for communication have been developed by others and should be creatively used in health care.

Education is an important field for collaboration, Lurie said. The bridge connecting health literacy and basic education needs more attention, as increased graduation and GED rates are fundamental for health and health literacy. Leaders in both communities must engage in cross-cutting conversations. Those in the health field must pay attention to how general education, performance measures, and accountability influence patients’ health care. Bridges must be built with other fields that have components that overlap with health. Learnings from these bridges should be leveraged and shared, Isham said.


Communication is at the heart of quality care and needs to be improved, Boat said. A growing body of literature describes effective ways to communicate. For example, motivational interviewing, which uses open-ended questions and reflective interchanges of words, is being adopted in various health care settings. Physicians lack knowledge about how to communicate effectively, including how to listen to patients and provide them with opportunities to share information necessary for developing the best possible action plan, Boat said. Changes in health professions training are needed to improve clinician communication.


As discussed throughout the workshop, data are necessary but not sufficient to drive action, requiring the development of new methods and incentives, Lurie said. While the moral imperative is enough for some providers, others require financial incentives, resulting in the development of pay-for-performance programs. Such programs must be implemented carefully, however, as they may disadvantage some populations. Other types of individual incentives, such as cash transfers, should also be explored, Lurie said. Such programs are being tested in Mexico and New York City to get people into care. Institutional incentives should also be put

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