Safety News: Boosting health literacy is a team effort

Use the phrase “health literacy,” and heads will nod in recognition. But what’s likely to follow is a flurry of questions similar to this one: 'How can something so ambitious and aspirational be translated into real life activities that impact quality and safety?’

For starters, researchers have found, boosting the effectiveness of providers’ communication with patients is best approached as a systems-focused, rather than individual-focused, effort.

“Health literacy practices really need to be built into the system,” said Cindy Brach, MPP, a senior health care researcher at the federal Agency for Healthcare Research and Quality (AHRQ) who recently studied  many different health care organizations’ approaches to translating health literacy theory into action. “It’s a team effort, from leadership at the top to champions at every level” of the practice or hospital, she noted.

Jennifer Pearce, whose advocacy stems from her own experiences navigating the health care system since she was diagnosed with lupus in her 20s, agreed. “We need to shift the burden of communication off the patient and onto the health care system.”

Shifting payment models favor health literacy work

Pearce and Brach were among dozens of contributors to a roundtable discussion, organized by the National Academies of Sciences Engineering and Medicine in Washington, D.C. last week, to describe the current state of health literacy in the U.S. and discuss ways to make the health care system more responsive to patients’ needs for information about their medical care.

Brach Headshot Med
Cindy Brach

As payment models shift from fee-for-service to value-based payments that reward positive health outcomes, Brach underscored that there is more interest now in addressing the gap between patients’ health literacy skills and the difficulty of health information and the complexity of the tasks clinicians set. “If your patients don’t understand what you are saying and what to do when they leave your office, your metrics won’t be very good,” she said.

“It’s not that these organizations didn’t always want to do their best to serve their patient population,” Brach added. “They used to think they couldn’t afford to spend time and money on work like this. Now, they’re starting to realize they can’t afford not to.”

AHRQ offers several toolkits, articles and other material for organizations to start or enhance efforts to close the health literacy gap.

What is health literacy?

The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Health literacy occurs when system demands and complexities are aligned with individual skills and abilities.

Brach’s research, captured in a  chapter of a recently published book entitled, "New Directions in Health Literacy Research Theory and Practice," highlighted strategies used by three organizations — Carolinas HealthCare System, Intermountain Healthcare, and Northwell Health — to become health literate organizations.

Three health systems offer different models

Carolinas, for example, developed a hefty 30-item “change package” of interventions to improve health literacy with mandatory monthly reporting on nine different measures. When adoption of the improvements stalled, a new chief nurse executive worked with the organization’s health literacy collaborative to narrow the focus to two interventions with their frontline care providers across 900 care locations that include hospitals, physician practices, home health agencies, rehabilitation facilities and more, headquartered in Charlotte, N.C.

At Intermountain, a Utah-based organization with 22 hospitals, 185 clinics, a health plan division, and a medical group with 1,400 employed physicians, leadership committed to the development of a strategic plan to become a health literate organization but also to score some “quick wins” with immediate  efforts to bring greater awareness of the topic to frontline practitioners and to revise patient education material so that it was consistent across the organization and more understandable to patients.

Northwell Health, headquartered in Long Island, N.Y., with more than 20 hospitals, rehabilitation centers, skilled nursing facilities, outpatient care, and other services, undertook a health literacy gap analysis as a basis for its multi-year strategic plan. There, health literacy efforts are intertwined with diversity and inclusion work in recognition between the strong link between a person’s culture and the way he or she perceives and understands health problems and outcomes.

At the roundtable, a team of researchers released a new report “Improving Health and the Bottom Line: The Case for Health Literacy,” that describes health literacy work underway across the country by organizations large and small. They concluded that there is both a business and ethical case to be made for closing the health literacy gap.

While research to better understand the longer term efficacy of these efforts is needed, there is enough material available to help health care facility and organization leaders get started. “Solutions don’t have to be expensive,” said Stan Hudson, MA, lead author of the study. And, he added, with shifts in funding and payment models, “Now we can get paid for health literacy projects.”  


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