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Becoming aBecoming a
Health Literate OrganizationHealth Literate Organization
Cindy BrachCindy Brach
Center for Delivery,C...
OverviewOverview
 DefinitionDefinition
 Implementing what you’ve learnedImplementing what you’ve learned
 System change...
Health Literate OrganizationsHealth Literate Organizations
A health literate organizationA health literate organization
ma...
Health Literacy EquationHealth Literacy Equation
Skills/Abilities xSkills/Abilities x Difficulty/ComplexityDifficulty/Comp...
Implementing whatImplementing what
you’ve learnedyou’ve learned
Communicate ClearlyCommunicate Clearly
 Warm GreetingWarm Greeting
 Eye ContactEye Contact
 ListenListen
 Use Plain, N...
Implementing ClearImplementing Clear
CommunicationCommunication
 Online training, e.g.,
http://www.teachbacktraining.org/...
Make Action PlansMake Action Plans
 Ask permissionAsk permission
 Determine motivationDetermine motivation
 Patients ch...
Implementing Action PlanningImplementing Action Planning
 Watch ACP video and discussWatch ACP video and discuss
 Practi...
Improving WrittenImproving Written
MaterialsMaterials
 Clear purposeClear purpose
 Everyday languageEveryday language
 ...
Implementing ImprovementsImplementing Improvements
in Written Materialsin Written Materials
 Establish processEstablish p...
Improving Informed ConsentImproving Informed Consent
Informed consent informed choiceInformed consent informed choice
Cle...
Implementing InformedImplementing Informed
Consent ImprovementsConsent Improvements
 PolicyPolicy
– Why, who, what, when,...
SystemsSystems
ChangeChange
Koh et al. 2012
Health LiteracyHealth Literacy
Universal PrecautionsUniversal Precautions
Structuring the delivery of care as ifStructurin...
Re-EngineeredRe-Engineered
Discharge Program (RED)Discharge Program (RED)
 Evaluated their currentEvaluated their current...
1.1. Obtain language assistance for patients/familiesObtain language assistance for patients/families
2.2. Make appointmen...
RED ImpactRED Impact
 Reduction in readmissions (heart failure,Reduction in readmissions (heart failure,
COPD and facilit...
Being aBeing a
health literatehealth literate
health carehealth care
organizationorganization
Attribute 1Attribute 1
A Health Literate OrganizationA Health Literate Organization
Leadership:Leadership:
Makes health l...
Attribute 2Attribute 2
A Health Literate OrganizationA Health Literate Organization
Integrates health literacy into planni...
Attribute 3Attribute 3
A Health Literate OrganizationA Health Literate Organization
 Prepares the workforce to be healthP...
Attribute 4Attribute 4
A Health Literate OrganizationA Health Literate Organization
 Includes populations served in theIn...
Get Patient FeedbackGet Patient Feedback
 Include patients on HL TeamInclude patients on HL Team
 Shadow patientsShadow ...
Attribute 5Attribute 5
A Health Literate OrganizationA Health Literate Organization
 Meets needs of populations with a ra...
AHRQ Health LiteracyAHRQ Health Literacy
Universal Precautions ToolkitUniversal Precautions Toolkit
 22ndnd
edition with ...
Vision of a HealthVision of a Health
Literate SocietyLiterate Society
 Provides everyone access toProvides everyone acces...
AHRQ HealthAHRQ Health
Literacy InformationLiteracy Information
 AHRQ Health Literacy Topic PageAHRQ Health Literacy Topi...
What Questions Do You Have?
www.ahrq.govwww.ahrq.gov
Cindy Brach - Becoming a Health Literate Organization
Cindy Brach - Becoming a Health Literate Organization
Cindy Brach - Becoming a Health Literate Organization
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Cindy Brach - Becoming a Health Literate Organization

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Presented by Cindy Brach, MPP, on March 13, 2015 at the fifth Center for Health Literacy Conference: Plain Talk in Complex Times.

Published in: Health & Medicine
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Cindy Brach - Becoming a Health Literate Organization

  1. 1. Becoming aBecoming a Health Literate OrganizationHealth Literate Organization Cindy BrachCindy Brach Center for Delivery,Center for Delivery, Organization, and MarketsOrganization, and Markets
  2. 2. OverviewOverview  DefinitionDefinition  Implementing what you’ve learnedImplementing what you’ve learned  System changeSystem change  Being a health literate organizationBeing a health literate organization
  3. 3. Health Literate OrganizationsHealth Literate Organizations A health literate organizationA health literate organization makes it easy for people tomakes it easy for people to navigate, understand, andnavigate, understand, and use information and servicesuse information and services to take care of their health.to take care of their health. Brach et al. 2012Brach et al. 2012
  4. 4. Health Literacy EquationHealth Literacy Equation Skills/Abilities xSkills/Abilities x Difficulty/ComplexityDifficulty/Complexity = Health Literacy= Health Literacy XX ==
  5. 5. Implementing whatImplementing what you’ve learnedyou’ve learned
  6. 6. Communicate ClearlyCommunicate Clearly  Warm GreetingWarm Greeting  Eye ContactEye Contact  ListenListen  Use Plain, Non-medicalUse Plain, Non-medical LanguageLanguage  Slow DownSlow Down  Limit ContentLimit Content  Show How It’s DoneShow How It’s Done  Use Teach-BackUse Teach-Back  Repeat Key PointsRepeat Key Points  Use GraphicsUse Graphics  Invite PatientInvite Patient ParticipationParticipation  Encourage QuestionsEncourage Questions Source: AHRQ Health Literacy Universal Precautions Toolkit, Tool 4Source: AHRQ Health Literacy Universal Precautions Toolkit, Tool 4
  7. 7. Implementing ClearImplementing 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, poster Source: AHRQ Health Literacy Universal Precautions Toolkit, Tool 4 andSource: 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
  8. 8. 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 UniversalSource: AHRQ Health Literacy Universal Precautions Toolkit, Tool 15Precautions Toolkit, Tool 15
  9. 9. 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 inWho 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 ActionHow can EHR support and track Action Planning?Planning? – Who follows up with patient?Who follows up with patient?
  10. 10. Improving WrittenImproving Written MaterialsMaterials  Clear purposeClear purpose  Everyday languageEveryday language  No jargonNo jargon  Active voiceActive voice  Visuals reinforceVisuals reinforce messagesmessages  White spaceWhite space  Short linesShort lines  Short sectionShort section  InformativeInformative headingsheadings  Logical flowLogical flow
  11. 11. Implementing ImprovementsImplementing 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., ToolkitCreate 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
  12. 12. Improving Informed ConsentImproving Informed Consent Informed consent informed choiceInformed consent informed choice Clear, unbiased information about allClear, unbiased information about all optionsoptions Help aligning options with patient’s goalsHelp aligning options with patient’s goals & values& values
  13. 13. Implementing InformedImplementing Informed Consent ImprovementsConsent Improvements  PolicyPolicy – Why, who, what, when, howWhy, who, what, when, how – DisseminationDissemination – EnforcementEnforcement  Building systems to improve IC processBuilding systems to improve IC process – Library of formsLibrary of forms – Library of decision aidsLibrary of decision aids – Remove communication barriersRemove communication barriers – Establish efficient workflowsEstablish efficient workflows
  14. 14. SystemsSystems ChangeChange
  15. 15. Koh et al. 2012
  16. 16. Health LiteracyHealth Literacy Universal PrecautionsUniversal Precautions Structuring the delivery of care as ifStructuring the delivery of care as if everyone may have limited healtheveryone may have limited health literacyliteracy – You can’t tell by lookingYou can’t tell by looking – Higher literacy skillsHigher literacy skills ≠≠ understandingunderstanding – Health literacy is dynamicHealth literacy is dynamic – Everyone benefits from clearEveryone benefits from clear communicationcommunication
  17. 17. Re-EngineeredRe-Engineered Discharge Program (RED)Discharge Program (RED)  Evaluated their currentEvaluated their current discharge process anddischarge process and re-engineered usingre-engineered using health literacy principleshealth literacy principles  RCT: 30% reduction inRCT: 30% reduction in rehospitalizationsrehospitalizations  New RED Toolkit forNew RED Toolkit for serving diverseserving diverse populationspopulations
  18. 18. 1.1. Obtain language assistance for patients/familiesObtain language assistance for patients/families 2.2. Make appointments for follow-up medical appointments and postMake 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 arePlan 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 andIdentify 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 cliniciansExpedite 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
  19. 19. RED ImpactRED Impact  Reduction in readmissions (heart failure,Reduction in readmissions (heart failure, COPD and facility-wide)COPD and facility-wide)  Increased HCAHPS Care TransitionIncreased HCAHPS Care Transition scoresscores  Increase in patients reporting teach-Increase in patients reporting teach- backback  More time spent with patients andMore time spent with patients and families around transitionsfamilies around transitions  Changed organizational cultureChanged organizational culture
  20. 20. Being aBeing a health literatehealth literate health carehealth care organizationorganization
  21. 21. Attribute 1Attribute 1 A Health Literate OrganizationA Health Literate Organization Leadership:Leadership: Makes health literacy integral to its mission,Makes health literacy integral to its mission, structure, & operationsstructure, & operations Makes clear & effective communication aMakes clear & effective communication a prioritypriority Assigns responsibility for health literacyAssigns responsibility for health literacy oversightoversight Sets goals for health literacy improvementSets goals for health literacy improvement Allocates fiscal and human resourcesAllocates fiscal and human resources
  22. 22. Attribute 2Attribute 2 A Health Literate OrganizationA Health Literate Organization Integrates health literacy into planning,Integrates health literacy into planning, evaluation measures, patient safety, andevaluation measures, patient safety, and quality improvement.quality improvement. – Incorporates health literacy into allIncorporates health literacy into all planning activitiesplanning activities – Conducts ongoing organizationalConducts ongoing organizational assessmentsassessments – Measures success & identifies areas forMeasures success & identifies areas for quality improvementquality improvement
  23. 23. Attribute 3Attribute 3 A Health Literate OrganizationA Health Literate Organization  Prepares the workforce to be healthPrepares the workforce to be health literate and monitors progressliterate and monitors progress – Hires diverse staff with HL expertiseHires diverse staff with HL expertise – Sets and meets goals for training all staff andSets and meets goals for training all staff and members of governing bodiesmembers of governing bodies – Provides HL training and incorporates HLProvides 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 resourcesline HL training resources
  24. 24. Attribute 4Attribute 4 A Health Literate OrganizationA Health Literate Organization  Includes populations served in theIncludes populations served in the design, implementation, and evaluationdesign, implementation, and evaluation of health information and servicesof health information and services – Includes members of the population onIncludes members of the population on governing bodiesgoverning bodies – Establish advisory groups that involveEstablish advisory groups that involve individuals with limited health literacy, adultindividuals with limited health literacy, adult educators, and experts in health literacyeducators, and experts in health literacy – Collaborate with community members inCollaborate with community members in design and implementation of interventionsdesign and implementation of interventions and development and testing of materials.and development and testing of materials.
  25. 25. Get Patient FeedbackGet Patient Feedback  Include patients on HL TeamInclude patients on HL Team  Shadow patientsShadow patients  Conduct a walk throughConduct a walk through  Observe patients using your patientObserve patients using your patient portalportal  Ask patients for feedback on forms orAsk patients for feedback on forms or other materialsother materials  Have a suggestion boxHave a suggestion box  Survey your patientsSurvey your patients Source: AHRQ HealthSource: AHRQ Health Literacy UniversalLiteracy Universal Precautions Toolkit, Tool 17Precautions Toolkit, Tool 17
  26. 26. Attribute 5Attribute 5 A Health Literate OrganizationA Health Literate Organization  Meets needs of populations with a rangeMeets needs of populations with a range of health literacy skills while avoidingof health literacy skills while avoiding stigmatizationstigmatization – Adopts health literacy universalAdopts health literacy universal precautions, such as offering everyoneprecautions, such as offering everyone help with literacy taskshelp with literacy tasks – Allocates resources proportionate to theAllocates resources proportionate to the concentration of individuals with limitedconcentration of individuals with limited health literacyhealth literacy
  27. 27. AHRQ Health LiteracyAHRQ 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 forNew companion guide for practice facilitatorspractice facilitators http://ahrq.gov/qual/literacy
  28. 28. Vision of a HealthVision of a Health Literate SocietyLiterate Society  Provides everyone access toProvides everyone access to accurate, actionable healthaccurate, actionable health informationinformation  Delivers person-centered healthDelivers person-centered health information and servicesinformation and services  Supports life-long learning and skillsSupports life-long learning and skills to promote good healthto promote good health The vision informing the NationalThe vision informing the National Action Plan is of a society that:Action Plan is of a society that:
  29. 29. AHRQ HealthAHRQ Health Literacy InformationLiteracy Information  AHRQ Health Literacy Topic PageAHRQ Health Literacy Topic Page  HHS ResourcesHHS Resources  30,000+ subscribers to AHRQ Email30,000+ subscribers to AHRQ Email UpdatesUpdates
  30. 30. What Questions Do You Have? www.ahrq.govwww.ahrq.gov

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