Eugene Washington, M.D., M.Sc. UCLA Health Sciences and David Geffen School of Medicine at UCLA
Washington addressed four questions pertaining to health literacy in his presentation: Why is health literacy important? Who must understand its importance? How can its importance best be conveyed? What is the role of the academic community in addressing the needs of health literacy? Washington pointed out that the focus of the workshop is state-based approaches to health literacy, but he emphasized the global nature of the problem of low health literacy. He suggested that what is learned from local and statewide efforts could be translated to affect care around the world.
The transitive property states that, “If a = b and b = c, then a = c.” This formula is used in philosophy, especially in the understanding of logic. Using the transitive property in the context of health literacy and quality health care means that if the quality of health care (a) depends on effective patient provider communication (b) and effective provider communication depends on understanding the health literacy level of the patient (c), then the quality of care depends on understanding the patient’s health literacy level. In short, the quality of care depends on both the patient’s level of literacy and the effectiveness of provider communication. This transitive property can also be applied in the context of population health. The ability to improve the overall health status of a population or a community depends on the effectiveness of communication with the entire community. And that, in turn, depends on understanding the health literacy level of the population.
The IOM report, Crossing the Quality Chasm, stated that health care should be safe, effective, patient centered, timely, efficient, and equitable (IOM, 2001). If care is patient centered, individuals leave their clinical encounter with the understanding that their specific needs have been met. Timely care means that necessary interventions are available and the processes of care are efficient. Washington observed that poor communication is often what leads to medication errors. A clinician may choose the wrong therapy for a patient because he or she did not understand what the patient was saying. Alternatively, a patient may not take medications appropriately because the clinician did not give specific instructions.
In early research that examined the elements of patient-provider communication and shared decision making, episodes of care were videotaped with the provider knowing that the encounter was being recorded. Patients and providers rated the encounters in terms of whether “part-