Improving the Health Literacy Environment of Wisconsin Hospitals – A Collaborative Model

Sue Gaard, RN, MSWisconsin Primary Care Research & Quality Improvement Forum

November 7, 2008

When do I take my orange pill?

Can I park here?

Topics today

• Why health literacy?

• Results from local focus groups

• A collaborative model to improve health literacy

• Lessons learned

• Next steps

• Questions and discussion

Health literacy defined:

“The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”

Institute of Medicine

A failing grade…

36% of U.S. adults have Basic or Below Basic health literacy skillswho cannot:

• recognize a medical appointment on a hospital form

• understand a clearly written pamphlet about a medical test

U.S. Department of Education National Assessment of Adult Literacy, 2003

A local perspective on health literacy

Local literacy council recruitment

• English speaking adults

• English language learners

• 2 groups in Oshkosh, Racine, Madison

• 61 participants

Smith, Paul. What are important health issues for low literate adults? A focus group evaluation of health literacy issues, March 2008

Health literacy barriers – five themes

Health information

Medications

Access to health care

Forms and consent

Anxiety and shame

Smith, Paul. What are important health issues for low literate adults? A focus group evaluation of health literacy issues, March 2008

Improving the health literacy environment of Wisconsin hospitals – a collaborative model

Project sponsors and supporters

American Academy of Family Physicians

St. Mary’s Hospital

MetaStar

Wisconsin Hospital Association

Project goals

• Test a collaborative model

• Identify health literacy barriers

• Propose effective solutions

• Recommend processes for future collaboration

Can a collaborative model work?

Literacy students are the eyes of the community

Health care systems can improve health literacy through service, product, and environmental design

Both adult educators and health care providers benefit when literacy students enhance their reading and health care skills

Target population

Project focus: St. Mary’s Hospital Patient’s with low literacy or limited English skills

Project reach: 122 Wisconsin hospitals and the patients they serve58 Wisconsin Literacy member programs

Methods

Identify common area of study (e.g. navigation, consent forms)

Form internal and external evaluation teams• St. Mary’s evaluation team• Omega School evaluation team

Train 6-8 adult literacy students as evaluators

Develop assessment tool for students and hospital staff (modified from National Center for the Study of Adult Learning and Literacy guide, The Health Literacy Environment of Hospitals and Health Centers – Partners for Action: Making Your

Healthcare Facility Literacy-Friendly)

Methods

Conduct internal and external reviews, report findings

Roundtable dialogue for staff and students to share findings, prioritize barriers and identify potential solutions

Program evaluation focus groups for student and staff teams

Identify best practices and areas for improvement

Develop guidebooks/toolkits for health care systems and literacy programs

External evaluation of process

Keys to successful partnerships

• Create a shared base on knowledge

• Identify shared goals and problems

• Address needs of both entities

• Secure executive support

• Collect evidence to measure progress

• Use existing relationships

Keys to successful partnerships

• Create a sense of trust

• Prepare partners for a lot of work

• Launch the project with an event

• Seize the opportunity to focus on systemic issues

• Engage in joint planning and goal setting

New York Literacy Assistance Center, Healthy Relationships: A Guide to Forming Partnerships between Health Care Providers and Adult Education Programs.

Lessons learned

• Joint partnership is key

• Students need support, community and trust

• Executive sponsorship within the hospital is necessary yet not sufficient

• Achieving an authentic experience for students is challenging

• Don’t promise what you can’t deliver

• “When you think simple, think complex.”

Next steps

Student review and evaluation of “Conditions of Admission Agreement”

Student reception at St. Mary’s (project “launch”)

Refinement of plan for navigation evaluation

Continued student training

Development of staff and student evaluations

Questions?

Contact:

Sue Gaard, RN, MS

Confident Conversations, LLC

Sue@confidentconversations.com

608-230-6392