Culture in the Context of Health Literacy, Essay Example

The Basic Problem: Health Literacy

As the Administrative Manager at Eloise Medical Center, it has recently come to my attention that many of our patients, especially our elderly patients over the age of 65, are illiterate when it comes to their healthcare needs and treatment. What this basically means is that a large number of our patients do not fully understand their medical conditions nor how such conditions are treated by physicians and other healthcare professionals. According to Diana Almader-Douglas of the National Institutes of Health, the foundational problem related to health literacy is that a majority of patients do not possess “the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (2013).

Moreover, patients and their families do not possess the ability to apply skills related to reading, listening, and analyzing, to their immediate health situation. An example is the inability to “understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor’s directions and consent forms” (Almader-Douglas, 2013), all of which are vital when it comes to the healing process while admitted to a hospital, such as our own Eloise Medical Center.

There are several relevant reasons why the problems associated with health literacy need to be resolved at Eloise Medical Center. First of all, when patients are able to more fully understand their conditions and treatment options, the result is that our nurses and physicians will be able to provide better care which in effect will increase the medical center’s reputation as a caring and effective healthcare organization. Secondly, research has demonstrated that low health literacy is clearly “linked to a higher risk of death and more emergency room visits and hospitalizations” (Almader-Douglas, 2013). Therefore, if our patients are more health literate, this would mean a lower mortality rate and  fewer unnecessary visits to the emergency room, thus saving our medical center millions of dollars.

Statistically, it has been determined by the National Assessment of Adult Literacy (NAAL) program in the United States that 36% of patients possess limited health literacy, 22% possess basic health literacy, and 14% possess below average health literacy. This leaves 28% with almost no health literacy. This is a major problem for Eloise Medical Center, due to the fact that most of the individuals in this percentage are immigrants, a group that just happens to make up almost 50% of our patients with a minimal understanding of the English language (Almader-Douglas, 2013). Thus, the main problem here is culturally-related, for as pointed out by former U.S. Surgeon General Dr. Regina Benjamin, “Cultural and linguistic differences among patients directly impact their health literacy levels” (Almader-Douglas, 2013) with the result being substandard care and a lack of clear communication between the patient and his/her caregivers.

The consequences related to our failure to properly address the problems linked to health literacy are dire, especially when it comes to our nation’s economy and the profitability of the Eloise Medical Center. As noted in a 2013 report entitled “Low Health Literacy: Implications for National Health Policy,” it has been estimated that the “financial cost of low health literacy to the U.S. economy exceeds $200 billion on a yearly basis” (Almader-Douglas, 2013).

In perspective, this represents how much it would have cost in 2006 to insure almost 50 million people in the U.S. that did not have healthcare coverage.” Therefore, improving health literacy helps to lower healthcare costs across the board while increasing the quality of care provided by nurses, physicians, and other healthcare professionals (Almader-Douglas, 2013).

Desired Outcomes and Goals

For most of the Management Action Plan that follows from this point on, we are going to consult the National Action Plan to Improve Health Literacy, provided and created by the U.S. Department of Health and Human Services and the Office of Disease Prevention and Health Promotion. As a supportive note, Howard K. Koh of the DHHS relates that the “chasm of knowledge between what professionals know and what. . . patients understand” seems to widen every single year, due mostly to immigration or the movement of a people and their culture into the U.S. without fundamental English language skills like reading and writing. Thus, basic health literacy is “fundamental to the success of each interaction between health care professionals,” such as our outstanding nurses at Eloise Medical Center, and our patients, many of whom desperately need to be health literate (2010, p. iv).

Some of the desired outcomes and goals associated with health literacy and the Eloise Medical Center are quite similar to those found in the National Action Plan. Out of the seven major goals outlined in the National Action Plan, six are relevant for the Eloise Medical Center–1), to develop and disseminate health information to our patients that is accurate and up-to-date; 2), to promote changes in the medical center’s health care paradigm in order to improve health information and the levels of communication between our patients and caregivers; 3), to support and increase community and city efforts to provide healthcare instruction and English language instruction for our immigrant population; 4), to develop and encourage partnerships with local schools and universities related to providing special classes on health topics and issues; and 5), to increase the application of evidence-based health literacy within every unit in our medical center (National Action Plan to Improve Health Literacy, 2010, pp. 16-17).

The overall success of these outcomes and goals is highly dependent on cooperation and collaboration between patients and their healthcare providers/caregivers, especially our nurses that work in the emergency room and the intensive care unit of our hospital. As to measuring and assessing the success of our Management Action Plan, continuous measuring of the plan itself is an essential action in order to evaluate any and all improvements in the health literacy of our patients at Eloise Medical Center. It is also vitally important to monitor the effectiveness of the plan once is it implemented (Tools and Templates for Measuring Success, 2011).

At this time, once our Management Action Plan is implemented, three specific approaches or methodologies will be utilized–1), prior to being admitted or receiving treatment, each patient will be provided with a short form with basic medical questions concerning their condition or illness that can be answered in a few words. When finished filling in the form, the patient’s answers will be graded on a scale from 1 to 5 with 1 being illiterate and 5 being well-informed. Then, the attending nurse or physician will discuss the answers with the patient and relate any corrections or errors in knowledge; 2), patients that are admitted to the Eloise Medical Center for at least three days will be asked if they would volunteer to view some educational programming on the hospital’s cable channel that is related to their condition or illness; and 3), once a patient has been released from the hospital, they will be given the opportunity to attend free classes at the hospital in order to educate them on their condition or illness.

In order to measure and/or assess the success of these three approaches, outside of conducting time-consuming interviews with patients, each patient will be provided with a short survey form after being released from the hospital with questions pertaining to approaches 1 and 2 concerning if their knowledge on their condition or illness was increased. Of course, it is hope that each patient will be sufficiently inspired to tell their family members to educate themselves on healthcare topics and medical terminology.

Also, every nurse and physician at Eloise Medical Center will be given a free copy of Health Care: A Quick Reference Guide (the Joint Commission on Accreditation of Healthcare Organizations, 2002) and advised to read the chapter entitled “Tools for Performance Measurement in Healthcare” which hopefully will result in some relevant suggestions on how to measure the above three approaches more effectively and efficiently.

Possible Actions

In order for any and all actions to be effective, we must first understand the root causes of health illiteracy which will help to devise ways that it can be conquered as an opportunity for improvement in such a vital area of healthcare management. According to the National Action Plan to Improve Health Literacy, the foundation of health illiteracy is a lack of knowledge related to the field of medicine, the human body, and basic scientific facts concerning human health and wellness. In this context, health information is often “unfamiliar, complicated, and technical, even for people with higher levels of education” (2010, p. 40).

Demographically, no one is immune from health illiteracy, for they exist in every age group, culture, and racial group, not just those with limited reading and writing skills, such as immigrants that tend to speak English as a second language (National Action Plan to Improve Health Literacy, 2010, p. 4).

According to the U.S. Department of Education, a mere 12% of American adults that speak English possess proficient health literacy skills, even those who have attained a high level of education. Exactly why this is so is not clear, but it seems to be connected to some type of social stigma related to discussions about the human body and its various functions and dysfunctions. Therefore, in order to health literate, a person must understand a number of topics related to the human body, such as the function of various organs and the overall functioning of the human health system. In some ways, the lack of health literacy is based on simple choice, meaning that most people do not find the subject of human anatomy and bodily functions as an interesting topic for discussion with their friends, families, and associates. Health literacy is also linked to illiteracy itself when it comes to the ability to read and write proper English (Almader-Douglas, 2013).

It has been estimated that about 40% of adult Americans have problems related to reading with about 15% being completely illiterate (Almader-Douglas, 2013). Some may argue that health illiteracy is the fault of nurses, physicians, and other healthcare professionals that work with patients in hospitals and clinics on a daily basis. However, research has shown that this not an accurate position. In fact, nurses and physicians are doing a great deal to help combat health illiteracy by working in a team environment while on the job to educate their patients about their conditions.

Key Priorities and the Management Action Plan

As noted in the section on Desired Outcomes and Goals, the key priority steps required to initiate and implement our Management Action Plan involves five specific key actions–

• Development and dissemination–In order for our patients at Eloise Medical Center to become health literate, we must first develop a way to disseminate the information required concerning a patient’s medical condition, such as diagnosis, prognosis, treatment options, medications, and other medically-related actions. One possible approach would be to create some type of brochure that could be provided to the patient at some point during his/her visit to our hospital.
• Promote changes in our healthcare paradigm–In order to accomplish this rather daunting task, considering that the administration at our hospital is not fully open to changes in the hospital’s way of doing business, we must some together as a team of healthcare professionals and stress to the hospital’s administration leaders the vital importance of health literacy. This could be accomplished by providing some examples, such as acknowledging the success of the health literacy program at Carmel Medical Institute (one of our competitors) and the fact that the U.S. Department of Health and Human Services and the Office of Disease Prevention and Health Promotion consider health literacy as pivotal need for patients which brought about the creation of the National Action Plan to Improve Health Literacy.
• Support and increase community and city efforts–The importance of this action step is based on the suggestion by the major of our city to create a public service program that will be televised on the city’s cable channel. The mayor feels that this type of program on the importance of health literacy will help our citizens to become more knowledgeable on medical issues and will help to prepare them for any possible health-related illnesses and disorders that may arise in the future, considering that a good percentage of our patients that live in the city are over the age of fifty with a growing number over the age of sixty-five. The mayor also suggested that this program should have subtitles (i.e., Spanish and Chinese) in order to reflect the fact that many of the immigrants that live in the city speak English as their second language.
• Develop and encourage partnerships–Much like our efforts at the community and city levels, Eloise Medical Center has joined forces with several prominent leaders in our community to create partnerships with the aim being to support and encourage every effort to educate our patients, both current and future, on the importance of being health literate. The hospital has also been in conference with several local college and university administrators that have agreed to create special classes on health topics free or charge. Some of the instructors associated with these classes are bilingual with several being from cultures outside of the United States.
• Increase the application of evidence-based literacy–According to Berkman, DeWalt, Pignone, Sheridan, et. al of the Agency for Healthcare Research and Quality (AHRQ), due to the fact that health literacy is a “constellation of skills that constitute the ability to perform basic reading and numerical tasks” related to healthcare information, there are several evidence-based instruments or techniques that would help to measure patient literacy–1), the Wide Range Achievement Test which measures reading ability; 2), the Rapid Estimate of Adult Literacy in Medicine test; and 3), the Test of Functional Health Literacy in Adults (2004, p. 1). Thus, by using these tests, we could determine in advance how knowledgeable a patient is when it comes to their specific illness or disorder.

Therefore, the Management Action Plan can only be implemented when administrators at Eloise Medical Center agree to change the hospital’s somewhat narrow business paradigm which at this time does not include any plans for combating the health illiteracy of many of our patients at the hospital. However, if this change is accomplished, there will not be a specific sequence of events and/or actions concerning the Management Action Plan; instead all three of the key priorities–the development and dissemination of health and medical information, an increase in community and city efforts to help lower health illiteracy, and the application of evidence-based health literacy–will occur simultaneously as a sort of “package deal.”

Of course, one of the biggest stumbling blocks is finding a way to finance the Management Action Plan. One of our head nurses at Eloise Medical Center suggested that we create some kind of fund drive with the participation of the local members of our community. Also, the director of the hospital’s Human Resources office suggested that we involve prominent community leaders in our efforts to pay for the Action Plan. These are just a few possibilities that will require some study before an attempt is made to implement them.

Accountability

Overall, creating a strategic implementation plan, such as the one outlined above in the Key Priorities section, helps managers and other key figures to meet objectives, measure the progress of the plan, and hold individuals accountable for attaining goals in assigned positions related to each key priority. In regards to accountability, hospital managers can create accountability by “assigning people to each goal and action plan item” (Rodak, 2013), in this case in roles as promoters.

For example, one of the head nurses at Eloise Medical Center (or perhaps as knowledgeable volunteer) would serve as the main disseminator of medical information; he/she would also be responsible for developing the brochure as mentioned in the Development and Dissemination section. Another nurse or eligible volunteer would be assigned as the promoter of the Management Action Plan at the community and city levels, while another individual with some knowledge on the tests discussed above would be assigned as the promoter of the tests for patients that express an interest in taking them.

One way of keeping track of each promoter’s progress would be to create a simple website on the Internet with email so that each promoter could record his/her progress and report to the hospital manager in a timely manner. As Rodak points out, this simple method would help the manager to “address performance variances before they become a problem” (2013), such as failing to report on one’s progress.

There would of course be plenty of room and opportunities for other interested parties to join in on the Management Action Plan as supporters and volunteers. Hopefully, some of these participants would be lower-level employees of the Eloise Medical Center. Thus, accountability related to the Management Action Plan and its key priorities would serve the hospital well by demonstrating to all employees and the hospital administration the importance of contribution which basically is “essential for employee satisfaction and the hospital’s ability to meet” and hopefully exceed the goal of increasing the health literacy of our patients (Rodak, 2013). Lastly, the completion date for the Management Action Plan would be sometime early next year, provided that all of the participants retain sufficient interest in the plan to bring it to a satisfactory conclusion.

Measurement and Monitoring

At this time, the only approach that will be utilized as a tool to help measure the success of the Management Action Plan will be a randomized trial based on what occurred at the Boston University Medical Center in 2009. This event was designed to “educate patients about their post-hospital care plans” via a new hospital discharge program with the results being a 30% drop in subsequent emergency visits and readmissions (Clancy, 2009). But for our purposes, this trial will test the effectiveness of the brochure mentioned earlier, the information provided on the city’s cable channel, and the various tests that would be administered to patients on a voluntary basis. As to monitoring the success of the Management Action Plan, this would be dependent on the participants and those performing the roles mentioned above. Overall then, measuring and monitoring the success of this project would be based on cooperation, collaboration, and a willingness to see the job through in order for the patients of Eloise Medical Center to better understand their conditions and illnesses and hopefully lead better lives in the future.

References

Almader-Douglas, D. (2013). Culture in the context of health literacy. National Network of Libraries of Medicine. Retrieved from http://nnlm.gov/outreach/consumer/hlthlit.html

Berkman, N.D., DeWalt, D.A., Pignone, M.P., Sheridan, S.L., et. al. (2004). Literacy and health outcomes. RTI International, University of North Carolina Evidence-Based Practice Center. Retrieved from http://www.chpcp.org/servicecoord/chronicdisease/HealthLit/Berkman%20et%20al,%202004.pdf

Clancy, C. (2009). Health literacy measurement: Mapping the terrain. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK45375

National Action Plan to Improve Health Literacy. (2010). U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved from http://www.health.gov/communication/hlactionplan/pdf/Health_Literacy_Action_Plan.pdf

Rodak, S. (2013). Creating accountability in healthcare strategic plan execution. Retrieved from http://www.beckershospitalreview.com/strategic-planning/creating- accountability-in-healthcare-strategic-plan-execution.html

Tools and templates for measuring success. (2011). Retrieved from http://www.washington.edu/research/rapid/tools-and-templates#section4