Introduce myself. Photo- bridge under construction…bridging the communication gap
Resource: Last Trip to That Store
LAST TRIP TO THAT STORE! When I was ready to check out and pay for my groceries, the cashier said, "Strip down, facing me." Making a mental note so I could complain to our congressman about this Homeland Security running amok crap, I did just as the clerk had instructed. After the shrieking and hysterical remarks finally subsided, I found out that he was referring to how I should position my credit card. None the less, I've been asked to shop elsewhere in the future. They really need to make their instructions a little clearer for seniors.....
So who needs Teach-Back? Raise your hand if you have direct contact with patients… students? An employee? Colleagues? A boss? A partner (either at work or domestic)? A spouse? A child? A friend? As you can see, this can really affect anyone who talks to anyone. Most of the examples in this program are in the healthcare field, but it’s applicable to any relationship.
A few of the important resources that I used to make this presentation are…
What is Health Literacy? This video was taken from the AMA CME; these are real patients and real providers, and they will give us a clearer idea of the importance of health literacy in health care today.
Resource: AHRQ Toolkit
Were you surprised that some of the people in the video had a health literacy issue, or could you tell just by looking at them? Can’t really tell.
Resource: Heart Failure booklet I adapted for PHSW
Is anyone worried about offending your patients by ‘dumbing things down’? If you know your patient well, and they are asking high level questions, go ahead and use more clinical words. Otherwise, it’s best to start low and go up if needed. In the research, no one has ever complained about their providers being too clear. Everybody wants clear communication. My parents as an example with the HF booklet- not offended by low literacy HF booklet.
What is Teach-Back? Closed loop communication.
Resource: Two research articles on Teach-Back and time factor
Institute for Healthcare Improvement (IHI)
How many of you do a needs assessment before giving your spiel to a patient, staff member, or student? What does that do? Identifies knowledge base, barriers to understanding, misunderstandings, and shows adult learners respect- they want to know that you know that they know stuff. Also can save time if they already know it all.
Do demo with volunteer
Resource: Teachback cheat cards and cheat sheet
With a partner, teach your key learner how to use the call bell, and ask them to teach it back to you in their own words to determine your patient’s/key learner’s understanding. 5 min max
Resource: Dr House Asthma video. Start out and tell them that the patient has just said “It’s my asthma. The doctors said they’d fix it but it hasn’t made any difference at all”…
Kelly Pick - Teach Back: Make Sure They Understand
Teach-Back: Make Sure they Understand
Kelly Pick MSN RN-BC NPD
Patient and Community Education
PeaceHealth Southwest Medical Center
Who needs Teach-Back?
AMA Health Literacy and Patient Safety: Help Patients
Understand. Manual for Clinicians, Weiss et al. (2007)
AHRQ Universal Precautions Toolkit, DeWalt, et al. (2010)
Always Use Teach-back! Training Toolkit, AMA, Picker Institute,
UnityPoint Health, Des Moines University, et al. (2014)
How does Teach-Back help?
• Patient safety
• Patient engagement and
–unnecessary clinic visits
–emergency room visits
• Provides clarity
• Improves customer/constituent
Family and Friends
• Better relationships
All: Quick and easy way to assess understanding
“I don’t have time”
Studies and Pilot Projects
• One patient encounter per day (last visit)
• Work up to more as you get more
• Practice at home
Identify and involve as much as possible
Need-to-know versus Nice-to-know
A Physician’s Experience
Knowledge: Can you tell me how much insulin
you should give yourself every day?
Attitude: Do you know why it’s important for
you to take your Lasix every day?
Behavior: How do you plan to remember to
take all your medicines correctly
Three Types of Questions:
Avoid yes/no questions
• Do you understand?
• Does that make sense?
• Is that clear?
Check for Understanding
I want to make sure you understand…
Whose fault is it?
I want to be sure I’ve been clear...
Avoid the Parrot
Teach back in your own words
What questions do you have?
You don’t have any questions, do you?
Teach-Back Reminder Card
Keep card with you to refer to for Teach-Back
Demo and Practice
• Teach your partner how to use the call light
(less than a minute)
• Use Teach-Back card to remind you of the steps:
1. Teach concept
2. Take responsibility
3. Ask for Teach-Back in own words
4. Ask for questions
• Switch roles
When Teach-Back isn’t used…
From House, M.D., Episode #511, Joy to the World, Fox Network 22
What questions do you have?
Kelly Pick MSN, RN-BC NPD
Patient and Community Health Education
PeaceHealth Southwest Medical Center
References and Further Reading
5 Million Lives Campaign. (2008). Getting started kit: Improved care for patients with congestive heart failure
how-to guide. Cambridge, MA: Institute for Healthcare Improvement. (Available at www.ihi.org)
The Advisory Board Company. (2011). Innovating on 'teach-back' to prevent avoidable readmissions. Retrieved
from The Advisory Board Company.
Brach C., Dreyer, B., Schyve, P., Hernandez L.M., Baur, C., Lemerise, A. J., Parker, R. (2012). Ten attributes of health
literate health care organizations. Institute of Medicine Roundtable on Health Literacy. Retrieved from: http://
Centers for Disease Control and Prevention (2009). Simply put: A guide for creating easy-to-understand
materials. Third Edition. Atlanta, GA. Retrieved from http://stacks.cdc.gov/view/cdc/11938/
DeWalt D. A., Callahan, L.F., Hawk, V. H., Broucksou, K. A., Hink, A., Rudd, R., & Brach, C. (April 2010). Health
Literacy Universal Precautions Toolkit. Rockville, MD: Agency for Healthcare Research and Quality. AHRQ
Publication No. 10-0046-EF. Retrieved from http://www.ahrq.gov/qual/literacy/index.html
Fidyk, L., Ventura, K. & Green, K. (2014). Teaching nurses how to teach: Strategies to enhance the quality of patient
education. Journal for Nurses in Professional Development, 30(5): 248-253.
Healthcare Benchmarks and Quality Improvement. (December, 2010). Readmission rates for HF reduced by 30%.
Volume 17(12), p.137-138. Retrieved from http://www.henryfordconnect.com/documents/Sladen
In Focus: Topics in Health Care Ethics (April, 2006). Teach back: A tool for improving provider patient
communication. National Center for Ethics in Health Care.
Institute for Healthcare Improvement (2008). Good heart failure care follows patients home. Cambridge, MA:
Institute for Healthcare Improvement (Available at www.ihi.org).
Institute of Medicine (2004). Health literacy: A prescription to end confusion. Washington DC: The National
Kripalani, S., Bengtzen, R., Henderson, L.E., & Jacobson, T. A. (2008). Clinical research in low-literacy populations:
Using Teach-Back to assess comprehension of informed consent and privacy information. IRB: Ethics and
Human Research. March-April, pp.13-19.
Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The Health Literacy of America’s Adults: Results From
the 2003 National Assessment of Adult Literacy. U.S. Department of Education. Washington, DC: National
Center for Education Statistics. (NCES 2006–483)
London, F. (2009) No time to teach: The essence of patient and family education for health care providers. Atlanta,
GA: Pritchett & Hull.
National Quality Forum (2010). Safe Practices for Better Healthcare – 2010 Update. Retrieved from
Osborne H. (2011). In other words...Confirming understanding with the Teach-Back Technique. Health Literacy
Consulting. Retrieved from http://www.healthliteracy.com/article.asp?PageID=6714
Press, V., Arora, V., Shah, L., Lewis, S., Charbeneau, J., Naureckas, E., & Krishnan, J. (2012). Teaching the use of
respiratory inhalers to hospitalized patients with asthma or COPD: A randomized trial. Journal of
General Internal Medicine, 27(10), 1317-1325.
Sandberg, E., Sharma, R., & Sandberg, W. (2012). Deficits in retention for verbally presented medical
information. Anesthesiology, 117(4), 772-779.
Schillinger, D., Piette, J., Grumbach, K., Wang, F., Wilson, C., Daher, C., … Bindman, A. B. (2003). Closing the
loop: Physician communications with diabetic patients who have low health literacy. Archives of Internal
US Department of Health and Human Services. (2010). Health literacy. Retrieved from
Weiss, B.D. (2007). Health literacy and patient safety: Help patients understand, manual for clinicians, Second
edition, A Continuing Medical Education opportunity. Date of most recent activity review April 2009.
Chicago, IL: American Medical Association Foundation and American Medical Association.