Are You a Health Literate Organization?

By Jennifer Larson, contributor

July 13, 2012 - The Institute of Medicine has published a new discussion paper intended to help leaders of health care organizations improve their health literacy efforts, which experts say is a key component in becoming more patient-centered.

Entitled “Ten Attributes of Health Literate Health Care Organizations,” the paper includes a list of 10 top attributes that a health care organization can aspire to embrace, along with detailed explanations of each attribute and references to original research.

The paper's authors noted that health literacy doesn't just depend on the individual. “Health literacy is the product of individuals' capacities and the health literacy-related demands and complexities of the health care system,” the authors wrote.

How significant a problem is the lack of health literacy in the United States? Consider these points:

  • The National Assessment of Adult Literacy estimates that approximately 12 percent of adults have proficient health literacy. That means that only about 1 out of 10 adults have the knowledge and skills they need to manage their health and prevent disease.
  • The Center for Health Care Strategies reports that minorities and immigrants tend to be disproportionately affected, as are older adults and people with lower incomes.
  • Research has shown that people with limited health literacy are less likely to seek out preventive care and more likely to have trouble effectively managing chronic health conditions.

Since the entire health care system plays a role in the health literacy issue, health care organizations must be willing to step up and address their ability to effect change.

And it needs to start at the top, said Benard P. Dreyer, M.D., professor of pediatrics at the New York University School of Medicine at NYU Langone Medical Center and a participant in the IOM's Roundtable on Health Literacy. That's why the first attribute on the list emphasizes that leadership must make health literacy integral to a facility's mission, structure and operations.

“To me, that's the beginning of any change,” Dreyer said, adding that, without leadership on board, it will be hard to achieve any of the other items on the list.

He added, “The leadership has to say that this is important, these are our standards….and we will allocate at least some fiscal and human resources to help.”

The rest of the list includes characteristics such as preparing your workforce to be health literate and monitoring progress; including your patient population in the design, implementation and evaluation of the services and care you provide; meeting your various patient populations' needs without stigmatization; and addressing health literacy in high-risk situations.

Is it possible to achieve all 10 characteristics on the list? The list is indeed ambitious, said co-author  Ruth Parker, M.D., who also participates in the Roundtable on Health Literacy.

“We know that no one does all of those things,” she said.

But it is reasonable to ask organizations to work toward these goals, Dreyer said.  He suggested that leadership teams start with No. 1 and then select a couple of others from the list to begin addressing.

“Our goal is that they would do even one or two things, and they would be instantly ahead of where they are,” he said.

Parker pointed out the final item on the list is particularly noteworthy, namely “Communicates clearly what health plans cover and what individuals will have to pay for services.”

Many people grasp the concept of putting health information for patients into plain language, but it would also be very helpful to provide clear and specific information upfront about health insurance coverage for specific procedures and treatments. That way, patients would know exactly what their insurance covered--or didn't cover--and what they would have to pay out of pocket for various types of treatments, instead of getting an unexpected bill in the mail.

“Receiving large bills in hard economic times doesn't make anybody feel better,” she said. “It makes you worry, it makes you anxious…We have an enormous opportunity, as we move forward, to say, ‘What are we doing and how are we going to make sure everybody understands what this means?'”

Parker said she hopes that healthcare organizations will carefully consider the list. “It is well accepted that being patient-centered is essential for quality, and there is nothing more patient-centered than what people can understand and act on,” she said. “I think health literacy starts and ends with patients. You really cannot ignore it and be patient-centered.”

But it may take more formalized monitoring to truly bring health literacy to the top of everyone's priority list. If hospitals and organizations were graded or rated for health literacy measures the same way that they are held accountable for patient safety and patient satisfaction measures, that could make a difference, Dreyer said. But it probably would take involvement from regulatory organizations, such as The Joint Commission, to achieve that.

“It hasn't quite gelled yet,” Dreyer said.

For information about how to bring a greater degree of health literacy to your organization, read the IOM paper.


A Health Literate Health Care Organization:
1. Has leadership that makes health literacy integral to its mission, structure, and operations.
2. Integrates health literacy into planning, evaluation measures, patient safety, and quality improvement.
3. Prepares the workforce to be health literate and monitors progress.
4. Includes populations served in the design, implementation, and evaluation of health information and services.
5. Meets the needs of populations with a range of health literacy skills while avoiding stigmatization.
6. Uses health literacy strategies in interpersonal communications and confirms understanding at all points of contact.
7. Provides easy access to health information and services and navigation assistance.
8. Designs and distributes print, audiovisual, and social media content that is easy to understand and act on.
9. Addresses health literacy in high-risk situations, including care transitions and communications about medicines.
10. Communicates clearly what health plans cover and what individuals will have to pay for services.

Source: “Ten Attributes of Health Literate Health Care Organizations,” a discussion paper from the Institute of Medicine (IOM).