Health literacy and patient safety: assuring quality communication

July 2017 – Vol. 36, No. 6

Phyllis B. Bouvier, MD, Vice Chair, BOG Governance & Society Engagement Committee

Me: “Honey, what did the oral surgeon say about swimming now?”

Husband: “I don’t know; maybe you could come next time?”

Phyllis B. Bouvier, MD, Vice Chair, BOG Governance & Society Engagement Committee

My husband is the smartest person I know, able to develop complex medical programs from mere ones and zeros. What, then, is the issue?

Ensuring clear, effective communication in the clinician-patient encounter is pivotal to quality of care, patient satisfaction, and patient safety.

Health literacy is an individual’s ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions and to accurately follow treatment recommendations. When health literacy is limited, studies show there are more medication errors, inpatient admissions, emergency room visits, and higher medical costs. Preventive services are less likely to be accessed and negative outcomes are higher.

As the complexity of the information supplied increases, health literacy may become more limited such that the plan of care would be less likely to be acted upon correctly or completely. It is even more challenging in times of stress or in critical situations. Fluency in the dominant language is also a key factor in the ability to navigate the healthcare organizational structure. Those who are linguistically isolated, such as some of our hard-of-hearing patients, face even more challenges in obtaining quality healthcare. English language materials contain jargon that cannot be translated into American Sign Language (ASL), and words may have a different meaning.

Although limited health literacy may be seen at a higher rate in some racial/ethnic groups or in older populations, it is seen in all socioeconomic groups. It is difficult to recognize when someone has limited health literacy based on appearance or level of education. Therefore, providers should assume all patients and/or caregivers will have difficulty understanding information given during the exam and should communicate in terms anyone can understand. Medical educational materials should be created at a sixth-grade reading level. To be effective, the provider or healthcare organization should develop diverse, individualized strategies in the patient’s preferred language, using social media and technology other than written information to help the patient navigate health information and services.

The Joint Commission recommends the use of Health Literacy Universal Precautions developed by the Agency for Healthcare Research and Quality (AHRQ), which involves:

  1. Simplifying written, verbal, and numerical communications for the patient or caregiver in any language.
  2. Verifying comprehension by having a staff member review the after-visit summary as an additional reinforcement for compliance of the care plan.
  3. Creating an office environment that is easier to navigate. A warm hand-off may be necessary when transitioning care to another provider.
  4. Encouraging and supporting the patient’s involvement in his or her own health. This may be the most complicated of the recommendations as it is influenced by numerous factors, such as the physician’s/patient’s/caregiver’s culture, social determinants of health, family dynamics, geography, or physical ability.

Interested in practice-based tips similar to this? Your Board of Governors (BOG) is here for you. Get more involved with the BOG by attending committee meetings held during the AAO-HNSF 2017 Annual Meeting & OTO Experience, beginning on Saturday, September 9, in Chicago, IL.