Organizational Change to Improve Health Literacy Workshop Summary (2013) / Chapter Skim
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3 Panel 2: Implementing Attributes of a Health Literate Organization
3 Panel 2: Implementing Attributes of a Health Literate Organization
Pages 33-62
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From page 33... ...
It is not a transcript. Novant Health is actively pursuing implementation of the 10 attributes of a health literate organization.
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From page 34... ...
The fifth attribute of a health literate organization is that it meets the needs of populations with a range of health literacy skills while avoiding stigmatization. To do this, Novant Health applies the universal precautions methodology2 to address health literacy issues.
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Novant Health created patient education materials called focus sheets, which are one-page documents that answer the three questions of Ask Me 3 for the condition being presented: What is my main problem? What do I need to do?
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This theme includes health literacy, patient empowerment, and patient activation. Novant Health hired coaches for each one of the four themes, including Bauer as the coach for voice and choice.
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At Novant Health, there is a program called the Senior Leadership Academy. In response to the results of the research, that academy began work on health literacy, which helped garner support for the effort as a whole.
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Health literacy is a part of the patient-centered medical home, and the patient education process is contained within those systems. Bauer concluded his presentation by saying that the organization's next steps are implementing the AHRQ Health Literacy Universal Precautions Toolkit and assessing and determining what tools are necessary for the practices.
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From page 39... ...
Although a patient education team had been in place for many years, the team needed to be trained on health literacy principles. The health literacy team leadership was able to attend the American Medical Association's Train the Trainer Program and returned to the hospital to spread lessons learned to other members of the team.
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One of the first objectives was to assess current patient education materials. A random sampling of patient education materials used at the hospital showed that the average reading level was about twelfth grade.
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There is a health literacy institute that sets V its own team goals and has its own budget. Health literacy measures have been incorporated into hospital policies, including the use of plain language, universal precautions, and a teach-back technique.
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From page 42... ...
In 2012, they hosted a conference series and four different short workshops on writing for easier reading. This effort culminated in the October Health Literacy Month Inaugural Ohio Health Literacy Conference, which had about 200 attendees, including physicians, nurses, and others from a wide array of disciplines.
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Dowling also receives monthly updates on office activities, initiatives, and plans. The health system has a patient education policy and procedure process, a systemwide patient education committee, and a systemwide anguage and communication access committee.
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Individual learning needs are assessed, and staff members use plain language and incorporate teach-back methods into communication. The organization also uses the AHRQ Health Literacy Universal Precautions Toolkit and will soon launch a health literacy competency program for nursing staff.
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Senior leadership learned that health literacy strongly correlates with patient safety and patient outcomes. The leadership believes that improving health literacy is an integral part of providing high-quality care, Parnell said.
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Yin discussed a project aimed at reducing medication errors through the implementation of a health literacy intervention called HELPix. Her presentation focused on local champions engaged in implementing HELPix and the following 8 of 10 attributes of a health literate organization:
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As a first step, medication instruction sheets were developed. These sheets are patient-specific, are available in English and Spanish, and use plain language.
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48 ORGANIZATIONAL CHANGE TO IMPROVE HEALTH LITERACY and frequency of administration, storage, how long to take the medication, and who to call when there are questions (see Figure 3-3)
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Yin explained that the complete HELPix intervention does not involve the instruction sheets alone. HELPix is a five-step intervention.
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In terms of dosing accuracy for as-needed medicines, trial results showed that about 40 percent of caregivers who received standard medication counseling made dosing errors compared to about 16 percent of caregivers exposed to the HELPix intervention. For every four families who received the intervention, one family was prevented from making a dosing error.
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. Using the Web application, a provider can generate instruction sheets for more than 50 liquid and pill-form medications, with more than 300 variations, for as-needed and daily dose medicines.
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Hospital system support was obtainable because health literacy was recognized to be a patient safety issue that is especially important in the population the system serves, which is composed largely of immigrant families with low socioeconomic status. Evaluation of HELPix was considered to be a key part of moving the HELPix project forward, because showing the impact of HELPix on dosing errors and adherence was important to getting support for the project from hospital leadership as well as providers.
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The HELP project began in 2001. The idea for the HELPix instruction sheets was conceived in 2002, and the development of the Web application began in 2007.
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It is a great way to "hardwire" health literacy into an organization so that providers can easily access health literate instruction sheets for a range of disease processes and issues. One of the difficulties is working within the silo of an organization's EMR.
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Whether the heightened awareness is due to accountable care organizations, value-based purchasing, or worry about readmissions and patient outcomes, the organizational culture is changing. Health literacy is thought of at the beginning of projects rather than at the end.
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she asked. Parnell said a rationale to present to executive leadership is that health literacy is foundational for patient safety, improved patient outcomes, and patient satisfaction, all of which ultimately tie into reimbursement.
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The deafaccess coordinator is an active member of the health literacy team, and she conducts health literacy training with the American Sign Language interpreters. Yin said that when they are training providers about the instruction sheets, they tell them to use the interpreter line for communicating with patients who do not speak English.
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When they reach out to other hospital committees, such as the patient safety committee, that is where health literacy becomes integrated and institutionalized. And members of the health literacy team sit on virtually every hospital committee, whether it is patient safety or infection control.
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Patrick McGarry, roundtable member, said that he finds it disconcerting that physicians are perceived to be barriers to implementing health iteracy. Would health literacy efforts be more palatable if they were l couched in terms of patient self-management?
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Bauer said that they saw a large decrease in readmissions for congestive heart failure after health literacy efforts were implemented. But, he added, it is very difficult to show that health literacy was the driving factor, given the many variables involved.
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From page 61... ...
2013. Powerpoint presentation, Institute of Medicine Workshop on Organizational Change to Improve Health Literacy, Washington, DC, April 11.
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