How Can Health Care Organizations Become More Health Literate? Workshop Summary (2012) / Chapter Skim
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Appendix A: The Other Side of the Coin: Attributes of a Health Literate Health Care Organization
Appendix A: The Other Side of the Coin: Attributes of a Health Literate Health Care Organization
Pages 69-96
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From page 69... ...
Nearly 90 million adults in the United States have limited health literacy. While limited health literacy affects individuals across the entire spectrum of socio-demographic characteristics, it disproportionally affects more vul nerable populations, including the elderly, disabled individuals, people with lower socioeconomic status, ethnic minorities, those with limited English proficiency, and people with limited education (National Center for Education Statistics, 2006)
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From page 70... ...
. Compared to patients with adequate health lit eracy, patients with limited health literacy exhibit patterns of utilization of care reflecting a greater degree of unmet needs, such as excess emergency room visits and hospitalizations, even when comorbid conditions and health insurance status are held constant (Hardie et al., 2011)
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, the Agency for Healthcare Research and Quality, and the National Institutes of Health. There is perhaps no more critical time than now to shift focus from the health literacy skills of patients to the health literacy–promoting attributes of health care organizations.
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Health literate health care organizations, however, also pay particular attention to ensuring that patient skill-building efforts reach the populations most in need by making special investments, and they recognize that special system redesign efforts may be needed to further reduce health literacy demands in order to better match the health lit eracy demands of the health care system with the skills of subpopulations so as to mitigate the untoward effect of individuals' limited health literacy skills on their health. A health literate health care organization that openly acknowledges the centrality of clear and interactive communication and invests in optimizing communication for more vulnerable populations can realize benefits for patient access, satisfaction, quality, and safety; can reduce unnecessary patient suffering and costs; can enhance health care provider well-being; and can improve its risk management profile.
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From page 73... ...
However, a majority are also relevant to the broader range of organizations and institutions that comprise the modern health care system, such as health insurers and health plans, pharmacies, pharmacy benefits managers, disease management companies, and vendors of health IT and patient education products. We see this paper less as a definitive response to the challenge of defining a "health literate health care organization" and more as an attempt to advance a vision of how organizations should evolve to be more responsive to the needs of populations with limited health literacy in tangible ways, thereby improving care for all.
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From page 74... ...
Leadership should raise organization-wide awareness about the importance of health literacy and clear communications across all facets of the health care system and should participate in local, state, and national efforts to improve organizational responses to limited health literacy. Organizational leaders should make clear statements about the responsibility of all sectors of their health care system to advance patients' and families' capacities to learn about their illness, carry out self-care, effectively communicate, and make informed decisions.
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Rather than waiting for others to identify solutions, health literate health care organizations develop
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3. Measure and Assess the Health Literacy Environment and Communication Climate A health literate health care organization establishes ongoing mechanisms and metrics to measure the success of its system in achieving the health literacy attributes described above, to evaluate special health literacy programs, and to identify areas for further improvement.
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Health literate health care organizations recognize that promoting patient comprehension and building patient skills requires high-quality human, technical, and pedagogi cal resources that are easily accessible across the organization. As such,
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Health literate health care organizations can also establish a formal process of involving the members of the low-literacy community via a health literacy advisory board in planning, developing, and testing written health information to ensure appropriateness. Multiple tools are available to assist health educators and administrators tasked with developing health-related written materials (NCI, 1994)
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AHRQ is currently supporting an effort to develop a set of standards to determine the attributes of elec tronic health communication resources that make them appropriate for populations with limited health literacy. As described above, health literate health care organizations not only show a willingness to employ such
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Health literate health care organizations implement educational initiatives so that end users can be oriented, assisted, trained, and motivated in pEHR use to the greatest extent possible. Finally, because the diffusion of digital innovations will be slower among populations with limited health literacy, health literate health care organizations do not sup
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Priority should be placed on hiring and integrating health educators, health coaches, social workers, patient navigators, nurses, medical assistants, and even peers into health management and health education roles. Health literate health care organizations should also ensure that members of the health care team reflect the socio-demographic profiles of the patient popula tions served as another means to improve trust and communication.
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From page 82... ...
As such, health literate health care organizations reallocate existing resources or allocate additional resources to underperforming regions or sites so that underperformance attributable to a disproportion ate concentration of patients with limited health literacy can be improved upon. This approach to the allocation of resources extends to educational and communication initiatives.
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10. Employ a Higher Standard to Ensure Understanding of High-Risk Decisions and High-Risk Transitions While promoting patient understanding through well-written health information, understandable verbal communication, and visual aids is a core value of health literate health care organizations, there are highrisk decisions in health care and important transitions that demand a heightened level of assurance that patients (or their surrogates, if the patient is not competent)
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From page 84... ...
into medication counseling and labeling can reduce medication-taking errors (Machtinger et al., 2007) , health literate health care organizations employ such visual aids to enhance safety.
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Health literate health care organizations, including insurance plans, insurance exchanges, and pharmacy benefits management compa nies, provide information about benefits packages that is readily available to patients and their families, ensure that this information is understand able, and establish straightforward methods for patients and families to access in-person support for additional assistance. Recently proposed regulations regarding the Health Insurance Exchange will assist patients in deciding between health insurance plans.
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Health literate health care organizations work at establishing a shame-free environment so that patients and their families will be comfortable asking for help when needed. Employing clear signage and designing patient-friendly office procedures, including establishing a welcoming environment; offering assistance with all literacy-related tasks, such as reading and completing forms; and assisting patients with scheduling and finding referral and diagnostic test locations can help overcome these challenges.
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There are some examples of efforts by health care organizations to partner with community resources. The Health Leads program (Health Leads, 2011; Robert Wood Johnson Foundation, 2011)
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Health literate health care organizations encourage and expect patients to be asking questions of their health care teams. The National Safety Foundation's Ask Me 3 campaign attempts to facilitate communication between patients and providers by encouraging patients to ask the following questions: 1.
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17. Continually Assess and Track Patient Comprehension, Skills, and Ability to Problem-Solve Around Health Conditions While health literate health care organizations create "shame-free" environments where the asking of questions by patients is encouraged and expected, these organizations also build in procedures and systems to periodically assess and document patient comprehension and basic problem-solving skills across a range of common conditions that rely on self-management.
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. A health literate health care organi zation prioritizes providing culturally and linguistically competent care and seeks to implement guidelines and recommendations for culturally and linguistically appropriate services (HHS, 2001)
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We see this paper less as the definitive response to the challenge of defining a "health literate health care organization" and more as an attempt to advance an optimistic vision of how organizations should evolve to be more responsive to the needs of populations with limited health literacy in tangible ways, thereby improving care for all. REFERENCES AHRQ (Agency for Healthcare Research)
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2010. The development of a health literacy assessment tool for health plans.
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2005. Improving Patient Safety Through Informed Consent for Patients with Limited Health Literacy.
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2010b. Hypo glycemia is more common among type 2 diabetes patients with limited health literacy: The Diabetes Study of Northern California (DISTANCE)
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2011. Interventions for individuals with low health literacy: A systematic review.
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2010. Validation of an organizational communication climate assessment toolkit.
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