Becoming a Becoming a Health Literate OrganizationHealth Literate Organization

Cindy BrachCindy Brach

Center for Delivery, Center for Delivery, Organization, and MarketsOrganization, and Markets

OverviewOverview

DefinitionDefinition Implementing what you’ve learnedImplementing what you’ve learned System changeSystem change Being a health literate organizationBeing a health literate organization

Health Literate OrganizationsHealth Literate Organizations

A health literate organization A health literate organization makes it easy for people to makes it easy for people to navigate, understand, and navigate, understand, and use information and services use information and services to take care of their health.to take care of their health.

Brach et al. 2012Brach et al. 2012

Health Literacy EquationHealth Literacy Equation

Skills/Abilities x Skills/Abilities x Difficulty/Complexity Difficulty/Complexity = Health Literacy = Health Literacy

XX ==

Implementing what Implementing what you’ve learnedyou’ve learned

Communicate ClearlyCommunicate Clearly

Warm GreetingWarm Greeting Eye Contact Eye Contact ListenListen Use Plain, Non-medical Use Plain, Non-medical

LanguageLanguage Slow Down Slow Down Limit Content Limit Content

Show How It’s Done Show How It’s Done Use Teach-BackUse Teach-Back Repeat Key Points Repeat Key Points Use GraphicsUse Graphics Invite Patient Invite Patient

Participation Participation Encourage QuestionsEncourage Questions

Source: AHRQ Health Literacy Universal Precautions Toolkit, Tool 4Source: AHRQ Health Literacy Universal Precautions Toolkit, Tool 4

Implementing Clear Implementing Clear CommunicationCommunication

Online training, e.g., http://www.teachbacktraining.org/http://www.teachbacktraining.org/

Practice, e.g., role play Assessments

– Communication Self-Assessment– Communication Observation Form– Patient Feedback Form

Reminders: team huddles, posterSource: AHRQ Health Literacy Universal Precautions Toolkit, Tool 4 and Source: AHRQ Health Literacy Universal Precautions Toolkit, Tool 4 and Implementing the AHRQ Health Literacy Universal Precautions Toolkit: Implementing the AHRQ Health Literacy Universal Precautions Toolkit: Practical Ideas for Primary Care PracticesPractical Ideas for Primary Care Practices

Make Action PlansMake Action Plans

Ask permissionAsk permission Determine motivationDetermine motivation Patients chooses goalsPatients chooses goals Manageable stepsManageable steps Assess confidenceAssess confidence Identify barriersIdentify barriers Follow upFollow up

Source: AHRQ Health Literacy Universal Source: AHRQ Health Literacy Universal Precautions Toolkit, Tool 15Precautions Toolkit, Tool 15

Implementing Action PlanningImplementing Action Planning

Watch ACP video and discussWatch ACP video and discuss Practice, e.g., role playPractice, e.g., role play Address team roles and workflowAddress team roles and workflow

– Who places copies of Action Plan forms in Who places copies of Action Plan forms in the chart?the chart?

– Who helps patients choose goalsWho helps patients choose goals– How can EHR support and track Action How can EHR support and track Action

Planning?Planning?– Who follows up with patient?Who follows up with patient?

Improving Written Improving Written MaterialsMaterials

Clear purposeClear purpose Everyday languageEveryday language No jargonNo jargon Active voiceActive voice Visuals reinforce Visuals reinforce

messagesmessages

White spaceWhite space Short linesShort lines Short sectionShort section Informative Informative

headingsheadings Logical flowLogical flow

Implementing Improvements Implementing Improvements in Written Materialsin Written Materials

Establish processEstablish process Assess materialsAssess materials

– Formal assessments, e.g., PEMAT, CCIFormal assessments, e.g., PEMAT, CCI– Review by consumers/patientsReview by consumers/patients

Replace poor materialsReplace poor materials– Find better onesFind better ones– Create better ones, use guides e.g., Toolkit Create better ones, use guides e.g., Toolkit

for Making Written Material Clear & Effectivefor Making Written Material Clear & Effective

Consider alternatives to printConsider alternatives to print

Improving Informed ConsentImproving Informed Consent

Informed consent informed choiceInformed consent informed choice

Clear, unbiased information about all Clear, unbiased information about all optionsoptionsHelp aligning options with patient’s goals Help aligning options with patient’s goals & values& values

Implementing Informed Implementing Informed Consent ImprovementsConsent Improvements

PolicyPolicy– Why, who, what, when, howWhy, who, what, when, how– DisseminationDissemination– Enforcement Enforcement

Building systems to improve IC processBuilding systems to improve IC process– Library of forms Library of forms – Library of decision aidsLibrary of decision aids– Remove communication barriersRemove communication barriers– Establish efficient workflowsEstablish efficient workflows

SystemsSystems

ChangeChange

Koh et al. 2012

Health Literacy Health Literacy Universal PrecautionsUniversal Precautions

Structuring the delivery of care as if Structuring the delivery of care as if everyone may have limited health everyone may have limited health literacy literacy – You can’t tell by lookingYou can’t tell by looking– Higher literacy skills Higher literacy skills ≠≠ understanding understanding – Health literacy is dynamicHealth literacy is dynamic– Everyone benefits from clear Everyone benefits from clear

communicationcommunication

Re-Engineered Re-Engineered Discharge Program (RED)Discharge Program (RED)

Evaluated their current Evaluated their current discharge process and discharge process and re-engineered using re-engineered using health literacy principleshealth literacy principles

RCT: 30% reduction in RCT: 30% reduction in rehospitalizationsrehospitalizations

New RED Toolkit for New RED Toolkit for serving diverse serving diverse populationspopulations

1.1. Obtain language assistance for patients/families Obtain language assistance for patients/families

2.2. Make appointments for follow-up medical appointments and post Make appointments for follow-up medical appointments and post discharge tests/labs. discharge tests/labs.

3.3. Plan for the follow-up of results from lab tests or studies that are Plan for the follow-up of results from lab tests or studies that are pending at discharge. pending at discharge.

4.4. Organize post-discharge outpatient services and medical equipment. Organize post-discharge outpatient services and medical equipment.

5.5. Identify the correct medicines and a plan for the patient to obtain and Identify the correct medicines and a plan for the patient to obtain and take them. take them.

6.6. Reconcile discharge plan with national guidelines.Reconcile discharge plan with national guidelines.

7.7. Teach a written Discharge Plan the patient can understand. Teach a written Discharge Plan the patient can understand.

8.8. Educate the patient about his/her diagnosis. Educate the patient about his/her diagnosis.

9.9. Assess the degree of the patient’s understanding of this plan. Assess the degree of the patient’s understanding of this plan.

10.10. Review with the patient what to do if a problem arises.Review with the patient what to do if a problem arises.

11.11. Expedite transmission of the discharge summary to clinicians Expedite transmission of the discharge summary to clinicians accepting care of the patient.accepting care of the patient.

12.12. Provide telephone reinforcement of the Discharge Plan. Provide telephone reinforcement of the Discharge Plan.

RED ComponentsRED Components

RED ImpactRED Impact

Reduction in readmissions (heart failure, Reduction in readmissions (heart failure, COPD and facility-wide)COPD and facility-wide)

Increased HCAHPS Care Transition Increased HCAHPS Care Transition scoresscores

Increase in patients reporting teach-Increase in patients reporting teach-backback

More time spent with patients and More time spent with patients and families around transitions families around transitions

Changed organizational cultureChanged organizational culture

Being a Being a health literate health literate health care health care organizationorganization

Attribute 1Attribute 1A Health Literate OrganizationA Health Literate Organization

Leadership: Leadership: Makes health literacy integral to its mission, Makes health literacy integral to its mission, structure, & operations structure, & operations Makes clear & effective communication a Makes clear & effective communication a priority priority Assigns responsibility for health literacy Assigns responsibility for health literacy oversight oversight Sets goals for health literacy improvementSets goals for health literacy improvementAllocates fiscal and human resources Allocates fiscal and human resources

Attribute 2Attribute 2 A Health Literate Organization A Health Literate Organization

Integrates health literacy into planning, Integrates health literacy into planning, evaluation measures, patient safety, and evaluation measures, patient safety, and quality improvement.quality improvement.

– Incorporates health literacy into all Incorporates health literacy into all planning activitiesplanning activities

– Conducts ongoing organizational Conducts ongoing organizational assessments assessments

– Measures success & identifies areas for Measures success & identifies areas for quality improvementquality improvement

Attribute 3Attribute 3 A Health Literate Organization A Health Literate Organization

Prepares the workforce to be health Prepares the workforce to be health literate and monitors progressliterate and monitors progress– Hires diverse staff with HL expertise Hires diverse staff with HL expertise – Sets and meets goals for training all staff and Sets and meets goals for training all staff and

members of governing bodiesmembers of governing bodies– Provides HL training and incorporates HL Provides HL training and incorporates HL

into orientations and other trainingsinto orientations and other trainings– Arranges for staff to take advantage of on-Arranges for staff to take advantage of on-

line HL training resources line HL training resources

Attribute 4Attribute 4 A Health Literate Organization A Health Literate Organization

Includes populations served in the Includes populations served in the design, implementation, and evaluation design, implementation, and evaluation of health information and servicesof health information and services– Includes members of the population on Includes members of the population on

governing bodiesgoverning bodies– Establish advisory groups that involve Establish advisory groups that involve

individuals with limited health literacy, adult individuals with limited health literacy, adult educators, and experts in health literacyeducators, and experts in health literacy

– Collaborate with community members in Collaborate with community members in design and implementation of interventions design and implementation of interventions and development and testing of materials. and development and testing of materials.

Get Patient FeedbackGet Patient Feedback

Include patients on HL TeamInclude patients on HL Team Shadow patients Shadow patients Conduct a walk through Conduct a walk through Observe patients using your patient Observe patients using your patient

portalportal Ask patients for feedback on forms or Ask patients for feedback on forms or

other materials other materials Have a suggestion box Have a suggestion box Survey your patients Survey your patients

Source: AHRQ Health Source: AHRQ Health Literacy Universal Literacy Universal Precautions Toolkit, Tool 17Precautions Toolkit, Tool 17

Attribute 5Attribute 5 A Health Literate Organization A Health Literate Organization

Meets needs of populations with a range Meets needs of populations with a range of health literacy skills while avoiding of health literacy skills while avoiding stigmatizationstigmatization– Adopts health literacy universal Adopts health literacy universal

precautions, such as offering everyone precautions, such as offering everyone help with literacy tasks help with literacy tasks

– Allocates resources proportionate to the Allocates resources proportionate to the concentration of individuals with limited concentration of individuals with limited health literacy health literacy

AHRQ Health Literacy AHRQ Health Literacy Universal Precautions ToolkitUniversal Precautions Toolkit

22ndnd edition with 21 tools: edition with 21 tools:

– Make Referrals EasyMake Referrals Easy

– Follow up with PatientsFollow up with Patients

– Encourage QuestionsEncourage Questions

– Link Patients to Non-Link Patients to Non-Medical SupportMedical Support

New companion guide for New companion guide for practice facilitatorspractice facilitators

http://ahrq.gov/qual/literacy

Vision of a Health Vision of a Health Literate SocietyLiterate Society

Provides everyone access to Provides everyone access to accurate, actionable health accurate, actionable health informationinformation

Delivers person-centered health Delivers person-centered health information and servicesinformation and services

Supports life-long learning and skills Supports life-long learning and skills to promote good healthto promote good health

The vision informing the National The vision informing the National Action Plan is of a society that:Action Plan is of a society that:

AHRQ Health AHRQ Health Literacy InformationLiteracy Information

AHRQ Health Literacy Topic PageAHRQ Health Literacy Topic Page

HHS ResourcesHHS Resources

30,000+ subscribers to AHRQ Email 30,000+ subscribers to AHRQ Email UpdatesUpdates

What Questions Do You Have?

www.ahrq.govwww.ahrq.gov