Organizational Change to Improve Health Literacy Workshop Summary (2013) / Chapter Skim
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2 Panel 1: Implementing Attributes of a Health Literate Organization
2 Panel 1: Implementing Attributes of a Health Literate Organization
Pages 5-32
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From page 5... ...
Effective communication is an issue for patients at the Shared Care Free Clinic, especially because complicated ideas about conditions and treatments are being conveyed to people who often have low health literacy. Health literacy, for those working at the clinic, is defined as "understandable and two-way communication about wellness and illness for you and those you care about," which helps ensure that the two-way 5
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From page 6... ...
A clinic team composed of the director of the clinic's medication program, the front office clinic coordinator, and McCandless worked on simplifying complex regimens and developing treatment plans to help patients adhere to intensive lifestyle interventions and increase their abilities to engage with health care providers. The team also included four patients who acted as advisers.
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From page 7... ...
McCandless said that preparation for the visit was a concern, because often patients had not given any thought to what they needed from their time with the physician. In response to this concern, the clinic staff developed some tools to help patients be better prepared.
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From page 8... ...
As a result, almost all patient education material at the clinic has been shortened to one page. In addition, providers are using the teach-back1 method, so that now, following a discussion, the patient explains to the provider in his or her own words the treatment plan and how to accomplish it, and agrees to the plan.
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From page 9... ...
Some examples of questions and statements are as follows: "Are you having a hard time taking your medication? " "What is it that you need in patient education?
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From page 10... ...
The reminder lists the health literacy efforts the clinic expects them to make while there and asks for feedback. So far, this method has worked well.
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From page 11... ...
The team has focused on general awareness, environment navigation, and patient education and has developed a literacy volunteer program, implemented teach-back education, and instituted plain-language document preparation. Rogers said that her organization exhibits most of the attributes of a health literate organization.
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From page 12... ...
Health Literacy Universal Precautions Toolkit.2 The hospital is focusing on overall patient safety, safety with medication, and its core measures.3 Rogers noted that another accomplishment is a patient education policy, which is revised every 3 years and is based on what the hospital has learned from prior years' experience. The hospital has a very large volunteer population.
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From page 13... ...
As part of a patient education campaign, the team created a libraryon-wheels program to provide needed information resources. Eight portable carts with computers are now available for use.
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From page 14... ...
The hospital set a goal to decrease emergency department admissions for mental health patients by getting them help earlier, Rogers said, and the health literacy team is working in this area. Figure 2-1 shows the material the hospital is using to prompt people to seek help at the first sign of trouble.
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From page 15... ...
Franklin Memorial is also collaborating with the Geriatric Education Center at the University of New England and with four other teams in the state to share ideas and combine initiatives. One barrier the health literacy efforts have confronted is an entrenched way of thinking or acting.
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From page 16... ...
Some financial support for patient education materials has been received from the local Oddfellows group, which donated money specifically for patient education. Health literacy efforts at Franklin Memorial have been under way for 6 years, and there has been a shift in culture.
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From page 17... ...
It began as a single community hospital that was also an academic hospital with community-based residency programs and a strong educational component. Now it has developed into a fully integrated health care delivery network, working to deliver value in three important ways -- through patient experience, through high-quality outcomes and delivery processes, and through cost savings and efficiency.
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From page 18... ...
patient experience, which included more than just patient satisfaction. The task force was involved in testing the AHRQ Health Literacy Universal Precautions Toolkit in one of the system's clinic settings.
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From page 19... ...
Noonan said that the task force believed that one of the most critical factors in improving patient outcomes was to help patients understand and be involved. For this reason, teach-back and Ask Me 3 were confirmed as top priorities for the next phase of spread.
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From page 20... ...
In response, they tried a new approach that incorporated design strategy, Established Evidence-Based Best Practices ASK ME 3TM TEACH BACK An educational program to help patients Asking patients to explain or demonstrate and their families be better informed about understanding of information after it is explained their medical care. to them.
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From page 21... ...
Nevertheless, one of the challenges Noonan noted is that although the system has spent a lot of time and money on training, more is now being invested in accountability. Employees must see health literate practices as "the way we do business." These practices must be recognized as a requirement, not a choice.
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From page 22... ...
Another facilitating factor was the use of improvement science methodology and the use of data to drive change, along with shared learning. Finally, the success of the project also rested on the fact that staff did not have to create a change package on their own.
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From page 23... ...
The system has identified a chief patient experience officer; it has a chief diversity officer and a patient experience team or health literacy team at the highest levels of the organization. The patient experience and quality and safety leadership teams are now well aligned and working together in this area.
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From page 24... ...
The hospital is supporting health literacy and patient education efforts because the staff realize those efforts can affect the bottom line. McCandless said that it is easy for a provider to check a box, and, using that method, 90 percent of providers in her organization document using teach-back.
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From page 25... ...
The community hospital is very pleased. It is important to note that this reduction is not due simply to implementing health literacy efforts; it is something the clinic has worked on for a very long time.
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From page 26... ...
Noonan said a significant challenge is finding and hiring health literacy experts who know how to create health literate materials. The question then becomes whether and to what extent to outsource development of materials.
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From page 27... ...
Patients receiving mental health care have built-in patient advocates who can be provided by state caseworkers. Wilma Alvarado-Little, roundtable member, asked how the needs of those with limited English proficiency, the deaf, and the hard-of-hearing community are addressed.
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From page 28... ...
Everyone had an example of how health literacy could have improved things. R ogers said they related health literacy to the monetary bottom line.
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From page 29... ...
The AHRQ Health Literacy Universal Precautions Toolkit is extremely helpful, Noonan said. The toolkit action plan is simple and straight forward, and although it is designed for primary care, the Carolinas HealthCare System has tested it and found it useful in the pediatric intensive care unit, the inpatient unit, and specialty centers.
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From page 30... ...
McCandless agreed that it was a good guide that allowed her clinic staff to see how they were doing in their efforts to become a health literate organization. Patrick Wayte, roundtable member, asked how the presenters were balancing what the providers thought were the most important things to address versus what patients were most willing to change.
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From page 31... ...
PowerPoint presentation, Institute of Medicine Workshop on Organizational Change to Improve Health Literacy, Washington, DC, April 11.
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