The health literacy environment of a hospital describes how well the facility and its staff provide health information and services to their users. Some of these are in the form of the physical aspects of the hospital, such as signs and postings to help users to find their way; print materials such as medical history forms, information booklets, and consent forms; and the ability of the staff to talk to patients in plain language. Forward-looking hospitals that put patients first will ensure that promoting health literacy is one of their priorities; and will use technology to do so effectively.
The major problem with hospitals today is that they are designed for doctors and the medical staff – not for patients. While these 5-star hospital buildings can inspire awe and confidence, they can also make patients feel insignificant and terrified. Health literate hospitals understand that poor communication harms patients. The health care system can be complex, and even people with high literacy skills have trouble navigating it. The complexities are not limited to conversations between doctor and patient, and they include every step of the process – right from the receptionist asking for a form to be filled out, to making sense of the hospital bills at discharge.
A picture is worth a thousand words. A simple way to help people with limited language and literacy skills is to provide signage and symbols that assist patients in finding what they need. Multilingual signs are best if you only have a few languages in your practice, but if you encounter people from many different cultures, symbols may be a better way to communicate universally with more people.
HablamosJuntos (“We Speak Together”) is a project from the Robert Wood Johnson Foundation that has developed 28 easy-to-understand health care symbols for use in healthcare settings. For example:
Please visit their website @ http://www.hablamosjuntos.org/to download a complete set of symbols at no cost, and for ideas on how to use them in your practice.
Brach et al (2011) developed a series of 10 Attributes of Health Literate Health Care Organisations to help guide the development of policies and plans that support organisational health literacy. While these are primarily designed for large hospitals, they can be applied to clinics as well.
1. Make health literacy a priority; it should be an integral part of your mission.
2. Include health literacy in all planning and evaluation activities.
Conduct regular evaluations of your organisation’s physical environment and internal support systems for health literacy. Ask your illiterate patients for help assessing the impact of your programs and policies.
3. Train staff members in health literacy.
Make best practices such as teach-back and plain language known to all staff members and develop a standard training program for current staff at all levels.
4. Include your illiterate patients in the planning, implementation, and evaluation of health services.
Respect them - they are the ones who are likely to provide the most ingenious solutions, because they have to live with these problems daily.
5. Implement universal precautions as a method for reaching people with a range of literacy skills and avoiding stigmatisation.
6. Implement specific health literacy strategies to ensure understanding before, during, and after interpersonal communication.
Foster a culture of clear communication in which questions are welcome and comprehension is regularly verified. When possible, provide interpreters for patients whose native language is not English. Limit instructions and messages to two or three main ideas at a time.
7. Provide assistance with navigating the organisation, internally and externally.
Provide universal visual signage for facilitating movement. While your staff may know your building like the back of their hand, it’s very easy for visitors to go around in circles– especially when they are sick. When possible, group related services and clinics in similar locations so patients don’t get lost. Provide patient navigators to personally guide people through your building(s).
8. Provide multiple types of health information including print, audio, video, online and interactive materials that are easy to access and comprehend.
Involve your patients and their caregivers in the development of easy-to-understand materials in multiple media formats, such as audio-visual kiosks for patient education. Test your materials for readability and cultural suitability. Do not worry about making your materials “too simple”, because research has shown that even those with no literacy problems prefer clear, simple materials. Make sure your hospital website becomes a trusted source of Information Therapy for your patients and caregivers.
9. Highlight high-risk situations in which health literacy interventions may be critical to patient outcomes.
It is important to identify those situations that carry a high risk of miscommunication and poor outcomes. Examples include: providing informed consent prior to surgery, end-of-life decisions, and discharge from hospital. Provide extra help such as interpreters, peer support, and video or audio materials to ensure these high-risk times are dealt with appropriately and sensitively.
10. Provide assistance with understanding health insurance plans, bills and out-of-pocket expenses.
As health insurance plans become more and more complex, they need to become a focus of health literacy interventions. An effective health literate organisation will provide people with personalised assistance in understanding what their insurance covers, and what it does not.
This may seem to be a lot of work, but any hospital that does not respect its patients is going to find it increasingly hard to fill its beds.
Good hospital CEOs take pride in the fact that their hospital provides quality medical services to their patients. They understand the importance of having a good reputation in the community, so that patients will be happy to refer other satisfied patients to them, when they are pleased with the outcome of their clinical care. Smart hospital CEOs understand that it’s no longer enough just to provide a pleasant ambience; or the latest medical technology. How patients perceive the quality of care they receive depends to a very large extent on the bedside manner of their doctor; and patients will judge the doctor by how caring and compassionate he is.
Every hospital CEO knows how difficult it can be to manage medical professionals - especially doctors. This is especially true of the “star” doctors, who have such a great reputation that they attract patients simply based on their personal “brand”. These are often doctors who will make patients wait for hours on end, simply because they're so busy - and they often take perverse pride in the fact that patients have to wait for hours in order to see them. These are also often doctors whose bedside manners are not very polished, and who sometimes can be astoundingly rude or uncaring, simply because they're so rushed and busy – and because they know that they can get away with this kind of cavalier behaviour. These doctors are often surgeons, who would rather be spending time in the operating theatre, instead of talking to patients. Because these star doctors are great for attracting patients and making sure that the beds in the hospital are filled, hospital CEOs treat these doctors with great respect. They are handled very gingerly, and most of these doctors behave like prima donnas, simply because they know that they no one is going to pull them up, no matter how atrocious their behaviour.
These are exactly the kind of doctors who give hospital CEOs a nightmare, because they are not very compassionate and can be quite rude and rough when dealing with patients. The CEO’s fear is that in case there is a complication with one of the patients, the patient will want to sue because he is angry at the way the star doctor treated him.
Simply because the doctor is so busy and sees such a large number of patients, it's pretty much inevitable that there will eventually be a complication. If this unhappy patient is not handled properly, he will end up suing both the doctor and the hospital. This can cause enormous damage to the hospital’s hard-earned reputation, which may have taken years to build. Any hospital CEO will vouch for the fact that this happens with surprising frequency – and they have to work hard to hush matters up.
One way of mitigating this problem is by making sure that all patients are provided with information therapy. This way, patient’s expectations are much more realistic because they have been provided with objective high-quality information from the hospital’s website – they no longer need to depend on information the doctor may or may not provide the patient.
Hospitals often have very poor mechanisms for ensuring informed consent; and many “big-shot” doctors may not even bother to take informed consent personally from the patient. If informed consent is not provided properly, this is potentially a medico-legal malpractice suit waiting to be slapped on the hospital, if and when something goes wrong. As a basic rule of risk management, it's far better to prevent problems, and expecting doctors to improve their behaviour is unrealistic. Rather than indulge in wishful thinking, hospitals can use their website to ensure that patients are armed with the right information. The beauty is that because this information is being provided on the website, the doctor does not need to provide this information himself, so it doesn't end up eating into the doctor’s precious time. In fact, online Information Therapy actually improves the doctor’s efficiency, because he is reassured that his patient is well-informed; and can move on to providing the actual medical care, rather than spend time educating the patient face to face.