The coronavirus disease-2019 (COVID-19) pandemic has strained and disrupted health care in the United States and elsewhere,1–3 pushing emergency departments well beyond capacity in some areas,4 while critical health safety net organizations are furloughing workers and are at risk of closure.5 The human connections that are so critical for health and well-being have been diminished, altered, and reinvented through technology in health care delivery even during the most intense moments of life.6–8 Nationally, a massive and innovative move into remote medical care delivery and reimbursement has happened virtually overnight.8–12 Despite considerable stimulus funding for the health care sector, many health systems face significant financial, logistical, and workforce challenges that may last well into the future.13,14
By forcing hospitals and clinics to curtail face-to-face elective services, the COVID-19 pandemic is transforming the health care sector, reshaping health care institutions, priorities, and provider roles. Meanwhile, enormous segments of our populations have lost jobs and health insurance.15,16 Needs for nutrition, housing, health insurance, and other necessities that impact current and future health outcomes and health service use are deep, vast, and likely to grow.17–19 While we have seen temporary moratoriums on actions such as evictions, foreclosures, and stoppage of utilities, these will likely resume well before the economy improves. Chronic conditions that have not been well managed due to logistics, stress, or financial distress in this time of crisis may result in higher rates of health services use, morbidity, and mortality.20–22 Mental health challenges are likely to grow due to the stress of this pandemic, exacerbated by social isolation and stress.23,24 These outcomes are falling hardest on many of our most vulnerable populations, highlighting fault lines of power and privilege in our society.25–28
As health care organizations move from crisis mobilization29,30 to a new paradigm that will include an urgent need to ensure solvency, rebuild a workforce, integrate care with social and behavioral health needs, and respond to these health disparities,31 organizational health literacy offers practical building blocks to provide high-quality, efficient, and meaningful health care even in the face of financial and workforce disruption and social distancing. Even when we are past this pandemic, the effects may be long lasting, or the possibilities of another global pandemic may sustain or warrant organizational health literacy infrastructural changes, such as automatic opt-in mail order pharmacy or telehealth as a first line of treatment.
In particular, organizational health literacy can provide ways to ensure health care is more patient-centered by facilitating personalized, collaborative, and understandable care.32–34 Putting patient preferences, needs, and values at the center of organizational design, workflow, and decision-making has been a goal for many years.35–37 Improving how patients are seen, heard, and cared for via such innovation can improve organizational quality, efficiency, and outcomes as well as attenuate existing, underlying health disparities.35,38,39 The need for patient-centered care has been felt acutely during the time of COVID-19, as providers have struggled to connect, touch, engage, and communicate with their patients from behind their (too often inadequate) personal protective equipment or by remote communication and in a time of information overload and increased responsibility for patients and caregivers.40–43 In this time of extraordinary crisis and health system disruption, there is strong justification and new opportunity to advance patient-centered care using the principles of organizational health literacy.
This article synthesizes insights from organizational health literacy in the context of current major health care challenges and toward the goal of innovation in patient-centered care. It is designed to provide guidance for systems and inform decisions around resource allocation and organizational priorities to best meet the needs of their patient populations in this transformative moment. We first provide a brief overview of the origins and outlines of organizational health literacy research and practice. Second, using an established patient-centered innovation framework,35 we show how the existing work on organizational health literacy can offer a menu of effective, patient-centered innovative options for care delivery systems to improve systems and outcomes. Finally, we consider the high value of management focusing organization health literacy efforts specifically for patients in health care transitions and in the new transformation of care to a distance model. Definitions of key terms used in the article can be found in Table 1.
Table 1. -
Key Definitions Used
||The degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions.44
|Organizational health literacy
||The degree to which an organization implements policies, practices, and systems that make it easier for people to navigate, understand, and use information and services to take care of their health.45
||Patient preferences, needs, and values are central to organizational design, workflow, and patient decision-making.35
|Health care innovation
||The implementation of new or altered products, services, processes, systems, policies, organizational structures, or business models that aim to improve one or more domains of health care quality or reduce health care disparities.46
||When patients move between health care practitioners, settings, and home as their condition and care needs change.47
Organizational health literacy
Organizational health literacy considers “the degree to which an organization implements policies, practices, and systems that make it easier for people to navigate, understand, and use information and services to take care of their health.”48,49(p1) This perspective considers the health care organization responsible for understanding and addressing patient health information needs, rather than putting this responsibility on individual patients and caregivers.49–52 A health literate organization would not just be easy to navigate, but also truly transformative—empowering individuals across cultural, linguistic, economic, and educational backgrounds to meet their health and wellness needs.52 As we create virtual care networks, we must do so with organizational health literacy principles in mind.
While organizational health literacy is a relatively new area of research and practice, it already has strong national and international standards, active momentum in the health care sector, and an innovative and growing evidence base in research and practice.45,48–58 Choosing health literacy as an organizational priority with which to rebuild or reimagine a health system is a management decision with considerable potential, practical guidance, and clear metrics for success.49–52
Brief history of organizational health literacy
Organizational health literacy grew from the field of health literacy, an active research area for the past 30 years. Across varying definitions and conceptualizations of health literacy, it has become clear that only a small minority of Americans have proficiency in the full array of skills and capacities to be “health literate” in our current systems.59,60 Those who are poor, elderly, live in rural areas, have chronic conditions, have poor self-reported health, have limited English proficiency, and are of a minority race/ethnicity are more likely to have low health literacy.59,60 Even those with “adequate” health literacy may struggle to obtain, process, and understand basic health information under the stress of a new diagnosis or when they are not feeling well.61 Low health literacy has been associated with a myriad of poor health outcomes of interest to health care systems including health care quality, equity, and cost.62–64
Health care organizations, and the providers who practice within them, play a major role in building, promoting, and sustaining health literacy for individuals, caregivers, and families.39 Given the ubiquity of health literacy challenges, including the current “infodemic,”65 the strong associations with critical health outcomes, and the disproportionate impact on certain groups,60 addressing health literacy at the organizational level has the potential to achieve the Triple Aim of higher health care quality, reduced costs, and improved population health.51,54,66
Many conceptual models, guidelines, and resources exist for health literacy approaches by health care organizations.45,49,52–55,66 The Institute of Medicine (IOM; now, the Health and Medicine Division of the National Academies) and other key national agencies, accreditation bodies, and international organizations have provided influential guidance on becoming a health literate organization, including toolkits to achieve these goals and measure progress.45,49,52–55,66 Particularly seminal are the Ten Attributes of a Health Literate Organization (“Ten Attributes”) described in 2012 by the IOM.49 These include strong leadership support; health literacy embedded in organizational planning, practice, evaluation, and quality improvement; meeting patient needs without stigmatizing them; and all health information content being easy to access and easy to understand across cultural and linguistic preferences. Critically, these goals align with institutional efforts to reduce health disparities with a recognition that the patient is a partner in their care and that literacy, language, and culture are intertwined.49
Following organizational health literacy principles can reduce inefficiency and duplication while achieving patient-focused goals of engagement, understanding, and support across prevention, decision-making, and self-management.48,49,51 There is hope it can build better patient-provider relationships and deepen trust and communication.32,34 On a deeper level, shifting an organization toward these goals can upend the ways in which health systems and their complexities disempower patients and their families, particularly those who are already vulnerable to health inequities.50,52
Organizational health literacy as a patient-centered innovation
This section identifies synergies between the organizational health literacy perspective and patient-centered quality improvement.67 These are organized according in the Hernandez et al. framework,35 which describes 5 attributes supporting patient-centered innovation: leadership, internal and external motivation, mission and culture, capacity and resources, and feedback loops. Organizational health literacy is considered within and across these domains, especially threading the links between the seminal Ten Attributes of a Health Literate Organization in support of patient-centered care. This is a unique contribution of this article. While these topics are often discussed together, they are not explicitly linked together within existing conceptual models. We also highlight practical guidance throughout this section.
Strong leadership with a clear vision to make health literacy an organizational priority is the first of the Ten Attributes.49 Without meaningful leadership buy-in, specifically a choice by executives to use their resources and power toward ambitious and demanding goals, patient-centered innovation is not possible, practical, or sustainable.35,49 Organizational health literacy has clear priorities, training, and resources toward achieving a health literate organization,45,49,52–55,66 all of which can provide useful guidance and benchmarking for pioneering leadership, especially in a time of stress and uncertainty. Health care leaders have been challenged, exhausted, and frustrated by the uncertainties and demands of COVID-19.68,69 They have critical responsibilities not only for obtaining personal protective equipment, managing risk, and supporting their workforce,29,30 but also for empowering patients to understand social distancing, self-care, and telemedicine.70,71
Empowering patients is a patient-centered, health-literate action that can help flatten the curve for use of health services for COVID-19 and decrease health care utilization for many diseases and health emergencies.71,72 Patients need to understand the balance between social distancing and knowing when to seek care given their preexisting conditions. Patients need to have the skills, knowledge, and confidence to manage their health concerns, including chronic diseases. Providers and public health professionals are concerned that these patients are at even greater risk during this time, due to exposure to COVID-19 and lack of access to care equally.73 Patients now have an even greater responsibility to self-navigate through a health care system that is not as accessible. These are all critical to helping the health system through the crisis. There is hope that on the other side of this pandemic, a more integrative and equitable health care system may be possible.68,69,74
Internal and external motivation to change
Health care organizations are not easy to change. Becoming a patient-centered, health literate organization will necessitate not only major changes in workflow and expectations, but may also add considerable costs.54 Health care organizations have always been complex, extremely busy, and resource constrained. Such a transformative journey must be necessary and worthwhile. Yet, COVID-19 has shown that massive, rapid change can happen. We are making transformative changes now, particularly in telemedicine, that were previously unthinkable.10,11,75 To make this possible, outside forces (eg, economic, cultural, political, technological, and ecological) must support and incentivize this process. Similar forces have been pushing organizations toward models that are both patient-centered and health literate even before COVID-19 and these forces have become even more urgent in this time. This disruption presents incentives toward major change. Table 2 considers this synergy in more detail across these factors generally and in relation to the COVID-19 pandemic.
Table 2. -
Synergistic External Forces Incentivizing Both Patient-Centered Innovation35
and Health Literate Organizations
||Additional Background Forces—Post-COVID-19
||New models of payment are incentivizing teams to address health care needs with patients at the center, including medical homes and accountable care organization. Financial incentive structures prioritize addressing factors as pervasive, as low health literacy not just to improve health outcome and reduction of medical errors, but also patient's experience of being seen, heard, and understood as improved patient quality and experience. These are associated with financial rewards and penalties. Decisions on these topics may impact position in market competition and organizational survival.
||Systems are under strain and need to innovate. Telehealth and related products are now reimbursable, providing new opportunities. The system is in flux as much care, including elective surgical procedures, has been halted to respond to this crisis and other funds are needed to sustain health care. Funding will come to health care from stimulus packages.
||Recent health reform legislation has influenced the prioritization of both health literacy and patient-centered care. The Affordable Care Act (ACA) made plain language critical to health insurance information. This is related to one of the goals of becoming a health literature organization in the Ten Attributes—being clear about what is covered and what is not.
||Health care is an extremely visible economic sector and critical community asset in this pandemic. This brings considerable political attention and tremendous public support. Still, patients may be fearful to engage with the health care system due to concerns about contracting COVID-19. Patient-centered, health literate care can build trust, understanding, and empowerment.
||Community initiatives to improve public health are growing. Initiatives to address health literacy fit into the larger efforts (also driven by economic and policies forces) to address social factors in health care more generally even from acute care facilities, health insurers, and others who have not typically engaged with population health and social factors. These include efforts to understand and measure patient's social vulnerabilities but then address them, necessitating changed workflows and new electronic medical record systems.76,77
||Health disparities are deeply visible. The need for social factors to integrate into health care to achieve both individual and population-level health will be vast and continue well into the foreseeable future. The need for materials translated in other languages and understandable to all around health care empowerment and access to resources to meet social and behavioral health needs are a matter of clear personal and community health. Patient-centered, health literate care can provide this information.
||Advancements in technology, including in electronic medical records, can incentivize organizational efforts to address health literacy, including making community-clinical linkages more plausible. Ensuring health literacy is not simply the demands of health but may include the ability to access needed services to ensure health such as legal, social, and other services. In the health literate care model, community-clinical linkages are critical to help patients manage their vulnerabilities.52
||Communications on telehealth, mail order pharmacy, and use of online patient portals to communicate with their providers are central and will certainly grow at this time, but are not necessarily patient-centric. Automatic opt-in mail order pharmacy or telehealth may become the first line of treatment. These innovations will have new opportunities, as many patients across all demographics become more familiar with remote options and these options adjust to the particular needs of health care privacy, functionality, and connectivity. A health literate health care system will ensure that all patients can engage with these technologies and feel seen and known.
||The shift toward patient-centered care, team-based models of care, population health, and reducing health disparities in the health care system have all been incentivized by factors such as new funding models and ACA rules, fundamentally changing the perspective and leadership directions needed for many high-level health care managers. This is a dramatic cultural norm shift. Addressing low health literacy as an organization can help not only to achieve these goals, but support this cultural norm change in practice.78
||There is hope and possibility for true transformation of the health care system in this moment. By paying attention to the patient's pathways and informational needs at this time, management can see where the gaps lie and where patient-centered needs exist in their organization now and in the future.
Organizational mission and culture
Organizational health literate communication and practices should be vertically integrated into health care systems. With COVID-19, organizations have struggled to protect the workforce especially in the context of personal protective equipment shortages not only for doctors and nurses but for everyone in the health system (eg, food service personnel, maintenance workers, therapists, chaplains, and pharmacists).79,80 And it takes more than the immediate safety of the workforce to fulfill the mission.81 A mission and culture of organizational health literacy helps remind people to keep patient and family empowerment in decision-making at all levels.
For some health care organizations, making patient needs and preferences a central principle of their missions demands a massive shift from traditional models of health care systems, which typically prioritize provider and organizational needs, effectively changing the power dynamic.78 Changing this may take major investment and thoughtful, practically minded insights into how systems are disempowering to patients. The Ten Attributes49 offer a number of concrete strategies to revitalize an organizational mission and culture to be more patient-centered. This includes a key directive: “Being a health literate organization is more than initiating a few projects that address health literacy; it means that health literacy is an organizational value. Health literacy strategies are infused throughout the organization and embraced as part of the organization's core business.”49(p4)
Patient-centered innovation thrives in organizations that create a culture in which learning and experimentation occur at all levels.35,78 Other activities can promote a cultural shift toward health literacy. Patient- and family-centered councils are becoming a popular strategy across health systems as part of institutional efforts to ensure partnerships with patients to improve communications and align care with patients and supportive family needs and preferences.82,83 As health care organizations begin to envision their future directions and continue to develop remote health care options and tools, patients and families should be part of health system transformation and redesign. In this case, councils will need to continue in a remote fashion. Some health systems have continued to support these councils to meet virtually,82 a critical step to keep these voices in decision-making in this dynamic time. These councils can potentially support and target organizational health literacy efforts to meet the needs of individual patients, their families, and community needs. However, they need autonomy, investment, and independent leadership to allow truly visionary goals and to ensure they do not just rubber-stamp the status quo. While organizational health literacy centers on strong communication, communicating remotely has many challenges. Still, the disruption of COVID-19 may open space for truly transformative action and innovation, as we identify the critical portions of our health care relationships that are missing and those pieces that were not necessary.10,11,75 During this time, the need for organizational health literate communication that is also patient-centered has often been hard to address; however, this will be critical in the long run for patients, especially those with chronic disease.12 Telehealth appointments are great, but these must have human connectivity in the virtual space to be meaningful. Strong collaborations with community organizations toward connectivity, resources, and cultural relevance are critical; patients and their own voices should be at the table as well in these redesigns toward organizational health literacy.
Capacity and resources
An organization's ability to become a health literate organization will be constrained by its capacity and resources, including variation in staff, size, location, design, and technology. In times of financial strain, it will be important to leverage resources that organizations already have in place or can create. Innovation in the face of need has become very visible in the COVID-19 response (eg, ventilators with multiple patients and impromptu personal protective equipment).84,85 A focus on patient-centered care is critical to resource allocation, as it can guide treatment decisions and inform resource prioritization as health systems will need to continue to innovate going forward, in what will hopefully be somewhat less dire circumstances.
Supporting the health literacy of the workforce itself is one of the Ten Attributes.49 Provider training on low health literacy and strategies to address this relevant to patient populations are useful.39,48,50 Simplifying health care facilities and systems navigation is also crucial. The system should build in points of communication and engagement with patients and their “support teams” to ensure they understand the patient's condition and how to manage it.86 These encounters with patients and families should include teach-back and mutual respect. Investing in community health workers and patient navigators, especially with cultural relevance, can better link patients to resources and lead to improved health.87–90 Diversifying the health care workforce to resemble the demographic and cultural mix of the patient population can ultimately support broad organizational health literacy and patient-centered goals.
For innovation to be both sustained and effective, continuous feedback loops are needed to realign strategies and ensure they are meeting patients' health needs, preferences, and values. This is an ongoing process; there is no full attainment and systems are always learning.49,52 A recent literature review and expert panel found 22 measures that organizations can use to monitor their health literacy quality improvement efforts (eg, number of staff trained in the teach-back method) that were useful, meaningful, feasible, and had face validity computed from clinical, administrative, quality improvement, or staff-reported data.48 These could complement data collected by patients around their health literacy-related experiences or collected in tools such as the Consumer Assessment of Healthcare Providers and Systems.91,92 Feedback loops can be difficult, taxing, and even politically inconvenient, revealing findings that are hard to address. Also, while a variety of measures exist, best practices on measuring organizational health literacy and marking improvements are still emerging.48,53–55,66 Thus, the comprehensive impacts of large-scale initiatives are often loosely assessed or missing altogether from operational workflows. However, these are critical to understand and to see progress relative to benchmarks. Internal and external recognition programs tied to these can also be a motivator for organizational innovation.49,93
The 5 domains described previously work together. For instance, leadership strives to improve capacity in response to internal and external pressures. From a management perspective, there are many important, sometimes competing agendas and initiatives. Addressing these separately divides resources and attention. A focus on organizational health literacy as a patient-centered innovation presents an opportunity to align not only strategic goals and efforts, but also the quality improvement metrics to measure meaningful progress. Integrating measures for key metrics such as health literacy, language access, and cultural competence could prevent duplication and confusion and could allow leadership to expend efforts and capital synergistically.94
Health care transitions for patients with complex health needs
Care transitions for complex, high-needs patients may be an area for a practical first step toward implementing health literacy into the care systems and can test system readiness for this form of patient-centered innovation. These issues have been deeply considered over time in light of health literacy and patient-centered care. We provide a brief, practical synthesis of this literature here and links to additional useful literature.
Patients in care transitions are among the high-need, high-cost patients who comprise only 5% of the US population, but account for 50% of the US annual health care spending.95 In care transitions, patients and their families are faced with more opportunities for confusion, miscommunication, and significant adverse outcomes in health, cost, and quality.45,60,96–101 Patients in these care transitions are perhaps the most susceptible to adverse outcomes resulting from a systems failure to account for health literacy.102–104 And ignoring health literacy in care transitions initiatives may exacerbate inequalities.96–101 Thus, a considerable amount of useful research exists at the nexus of health literacy, care transitions, and patient-centered care toward understanding and addressing care transitions generally and reducing readmissions specifically.96–101,105–111
Project RED is one seminal project designed to reduce readmission and improve health care quality, built with health literacy principles in mind, and supported by a strong evidence base.108,111,112 Practical toolkits from this project and others with similar goals are available for health system use.108–110,113 These include efforts in medication reconciliation, improved patient education, and ensuring that patients leave the hospital with an appointment with their primary care provider within a week of discharge. These are often now part of typical practice, helping to promote health literacy and providing links with a supportive health care system to answer questions and reduce complexity. Table 3 considers health literacy concerns in care transitions and evidence-based, patient-centered resources for organizational health literacy efforts to address them, providing practical guidance.
Table 3. -
Justification of Health Literacy Efforts in Care Transitions and Examples of Evidence-Based Interventions
|Care Transition Needs
||Health Literacy Challenges
||Options for Evidence-Based Patient-Centered Innovation to Address Health Literacy Challenges
||Patients with low health literacy are more likely to lack understanding of key elements of transitional care, including diagnosis and medications97
||Universal precautions and plain language, which can benefit all patients61
Project RED provides comprehensive, mutually reinforcing strategies to promote patient safety and reduce rehospitalization rates108,111,112
||BOOST Risk Assessment Tool identifying 8 modifiable risk factors that guide discharge planning114
||Using the teach-back method to review this information with the patient115
||Educate patients on red flags signaling complications116
||Include strong interdisciplinary patient engagement and rapid primary care follow-up117
||Protected time for discharge teaching with patients and families to review the information and allow them to ask questions
||Streamline the discharge paperwork making it complete concise and easy to read
||Use visuals, checklists, and itineraries when appropriate in printed materials
||Additional resources (care coordinators, clinical cardiologist, care management, insuring follow-up appointments) if patients at risk99
||Poor ability to take medications appropriately118,119
||Personal health record to document medication issues120
Medication reconciliation worksheet121
|Patient and family communication
||People with low health literacy often draw upon the health literacy skills of others to seek, understand, and use health information122,123
||Family Caregiver Activation in Transitions (FCAT) Tool124
Sending reminders on medication refills, appointments, and important time-sensitive tasks
||DECAF Family Caregiver Tool: D = Direct Care Provision, E = Emotional Support, C = Care Coordination, A = Advocacy, and F = Financial125
||Stop and watch early warning sign tool126
|Primary care provider communication
||People with low health literacy have difficulty navigating the health care system127
||Personal health record to create list of questions for provider128
||Providers may not be aware of the challenge patients face in health literacy and health communication129
How to Talk to Your Doctor HANDbook130
||There may be inequity in health communication by race/ethnicity, income, gender, and other factors associated with health literacy, which may exacerbate health disparities131
||Patient-centered care and shared decision-making132
||Patients with low health literacy may be less satisfied with their care132
Health care transitions for remote care
Remote care, telehealth, telemedicine, and mobile care are also areas where attention to health literacy from an organizational perspective is critical to ensuring that care remains patient-centered, especially for those who are not familiar with such technology or do not own these tools.133–138 Remote management of many chronic diseases can be improved by adding tools such as scales, blood pressure monitoring, pulse oximetry, glucose monitoring, heart rate monitor apps, video, thermometers, and digital electrocardiograph systems.139,140 Responsive health systems may be able to pivot to provide these, but getting the devices to the patients is only part of the puzzle. An organizational health literate system must empower patients to utilize the devices, understand the information,137 and use the information in calls with providers and for self-care. Patients will develop their own skills in self-monitoring and learn to recognize for risk factors such as leg swelling, shortness of breath, wheezing, and fever that would indicate health system contact would be needed. To empower patients in these ways has become newly urgent in the time of COVID-19.
Other than materials translated in other languages, patient-centric interventions include infographics provided by the Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, and other public health agencies.141–144 Communications on the use of telehealth, mail order pharmacy, and online patient portals are central but not necessarily patient-centric. Patients in systems that followed organizational health literacy principles may have transitioned better than those systems that have not subscribed to these principles. Home blood pressure readings and mailed colorectal cancer screening kits already exist, but we expect to see an influx of initiation and sustained use in the wake of COVID. Patients must understand why they are using them, and how to do so, for best results.
Investment in information technology (IT) has the potential to improve health care and access, including transitions for patients with complex conditions. At the same time, greater use of even the most innovative IT (eg, smartphone-based applications to improve care coordination, interactive patient-centered discharge toolkits to promote self-management, and access to personal health records) can present patients with new complex information with fewer personal touchstones, potentially exacerbating digital divides, health literacy challenges, and health disparities.35,145–147 Communication in the digital realm must follow patient-centered and organizational health literacy principles.86
Focusing on organizational health literacy is a useful, transformative patient-centered innovation that can provide meaningful goals, activities, and metrics in this time of disruption and strain. The article contributes to the literature on this topic by weaving together existing lines of research and practice around organizational health literacy and patient-centered innovation in a practical document designed to be informative and useful to practice generally and also specifically relevant to concerns in the COVID-19 pandemic around care transitions and the rapid transformation to remote care.
Toolkits, momentum, and measurement tools for organizational health literacy exist as described in detail previously. The research on the need for organizational health literacy, especially in priority groups and populations, is clearly articulated. Efforts to improve organizational health literacy should improve patient safety and quality of care, which yields both financial and nonfinancial benefits.49 Other benefits include lower emergency department visits, fewer preventable admissions, fewer medical errors, reduced disparities, and higher patient satisfaction. Newer payment models have incentivized these efforts. The need for health care systems to innovate and change from the status quo is even more urgent and visible in this crisis. The system is in flux, presenting an opportunity for change. As we have created a shift from in-person and emergency department care to the same care over telephone or video calls, we may need to build innovative structures between hospitals and health care systems and home and community to keep patients known, engaged, and healthy in this time of physical distancing.
Pioneering efforts can move a health system to be more patient-centered, using strong existing guideposts to set the conversation and agenda. Changing organizational culture is not simple, no matter how strong the need or logic for improvement. Barriers to wholesale change to improve organizational health literacy include the presence of competing initiatives, limited staff availability, the length and complexity of organizational health literacy assessment tools, lack of organizational leadership, prioritization of patient care over implementation, and lack of qualified staff and supervision.148 Yet because health literacy impacts so many components of health and health care access and cuts across departments, organizations, and needs, addressing this comprehensively presents a critical opportunity to meet the Triple Aim and reduce health disparities. Bringing an organizational health literacy mindset to all initiatives is the key goal.
While this article focuses on hospitals and health care systems, many lessons could be relevant to nursing homes, primary care, and other health care settings, which are also under significant logistical and financial strain from COVID-19 pandemic. Although research evidence is building across locations and care settings, a deeper evidence base for strategies and interventions to address organizational health literacy and the cost implications would also be welcome in the field.148–150 More research is needed around measurement of organizational health literacy initiatives and the practical realities of putting organizational health literacy initiatives in place, especially drawing upon implementation theory. While this is an active area of practice, many of these initiatives, like many organizational changes, take place in the context of practice, not research, and thus are not systematically evaluated nor are the results disseminated to peers. Research that considers health information comprehension and longitudinal health outcomes for individuals or populations following the implementation of organizational health literacy initiatives would also be useful.
Organizational health literacy principles and guidelines provide a road map for promoting patient-centered care. In this time of crisis, change, and transformation, health system leaders seeking innovative approaches can have access to well-established tool kits, guiding models, and materials toward many organizational health literacy goals across treatment, diagnosis, prevention, education, research, and outreach. Organizational health literacy can be used as an innovation by a health system to meet the Triple Aim and reduce health disparities.52 We have synthesized existing literature to provide updated guidance for systems looking for a short list and a narrowing of options to inform decisions needed around resource allocation and organizational priorities to best meet the needs of their patient populations even in this uncertain time. As they engage in telehealth, patient-centric organizational health literacy makes it more effective and efficient.
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