June 20

Integrating Health Literacy into Your Organization: Lessons Learned, Best Practices, and New Directions



Susan Cosgrove HCIF Philadelphia, PA

Cindy Hall, Carolinas  Healthcare system, 60k employees

Shelby Chapman, Children’s Hospital, Colorado

Mary Ann Abrams, Ohio State University College of Medicine, Moderator


Understand and identify effective methods for a group focussed on Health Literacy.

This was an extremely informative discussion. We recommend consulting the handouts from each of the presenters. Below are some of the key points made.

Background from each presenter:

Shelby: I was hired specifically to start a HL program. I had some high-level support. I needed to understand how the place works and how to craft messages to different groups. E.G., execs want savings, lowered readmissions and higher patient/family satisfaction. Nurses want to communicate better with patients. I need to figure out how to work with different departments on integrating health literacy.

Susan: I had to get a bunch of hospitals working together.

Cindy: I started in 2008 with no strategic plan, so we failed. So they realized they needed a system. They set a goal to train 10K nurses in 1 year. They met it. Eventually they got their board to support getting to 10 Attributes by 2020. Having champions, support from senior leadership and a plan are all key.

Question: How do you assess/measure progress?

Cindy: See tool kit handout.

  • How many teammates trained
  • Observe staff using teachback & Ask me 3 – You must observe and assess in order to hardwire behaviour.
  • Tie this data to Press Gainey and HCAPS.
  • Tell powerful stories about patients.

Shelby: We simplified discharge instructions and trained staff to use teachback to reduce 72-hour returns to Emergency Department.

It’s harder to tie to outcomes, so tracking readmissions is good to measure. But how much credit can you claim for reduction? It’s harder to measure these higher measures. Stories are also very helpful.

Susan: We gathered tons of process data on how many people trained, and how many trainers have been trained, etc. Again, it’s hard to prove that you’re responsible for this. We collect activity reports on a regular basis that tie in to the 10 Attributes. We share progress with the people who are making it.

Key aspects of your work:

Susan: The partners make success possible. Our program will offer a mix of resources and schedule trainings. We offer webinars and forums to report success. Community based organizations are important partners, such as senior orgs and refugee orgs. They are much smaller orgs than the health system and can really use seed funding. Recognize that they are the experts on the populations they serve.


  1. You really need to use improvement science techniques. Use PDSA cycles. Don’t be afraid of very small change.
  2. Be flexible: What works for one unit may not work somewhere else.
  3. Make things easy: e.g., they use a colourful schedule that mirrors the PDSA. Every project gets a checklist for each team member (trainers, managers, leaders).
  4. Hardwiring is essential. Co-branding is a wonderful thing. “Steal shamelessly but give credit.” Give them tools.

Shelby: Recognizing strengths that already exist in your organization is very important. For example, we are working with medical interpreters on improving discharge instructions.

Pilot test procedures, such as teachback. We worked with a group that was already doing a great job of teaching patients.

Include the right audiences from the start. Include patients and families. Include the clinic director when developing new materials for that clinic.

Get provider buy-in from the beginning.

How do you spread and sustain your efforts?

Shelby: It’s hardest to sustain efforts, e.g. get people to continue using teachback. We are identifying a “health literacy liaison” in the departments. We are offering once a month meetings on progress which the HL liaison attends and reports back twice a year to their department.

Susan: I have been asked to build a statewide HL coalition. We have been working on this for 2 years in addition to our work in our corner of the state. The challenge is balancing growth with continued support to regional partners.

Cyndi: Every month we has another group starting. New groups get interested and suggest things, which creates organic growth.

Right now we are working hard on Attribute #3, preparing workforce. We want to work on #9, high risk transitions, next.

Susan: Spread is inevitable with success.

Why not online?

Role-playing is a critical part of Cyndi’s training, so live training is important, but refresher training can be online.

Shelby used both live and computer-based, but people who did it online had to go through a live check-up of skills.

Susan’s team is developing their own online training modules. They have to cover a large state. They also use train-the-trainer.


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