University of New Mexico Hospitals: Progress Toward Being a Health Literate Organization Audrey Riffenburgh Senior Health Literacy Specialist Office of Diversity, Equity, and Inclusion
Who Are We? 630 beds and 24 off-site clinics providing over 500,000 outpatient visits annually New Mexico's only academicmedical center Region's level 1 trauma center Over 6,000 employees Almost half our patients live in poverty Race/Ethnicity 46% Hispanic or Latino 27% White (non-hispanic) 12% Native American 2% Black 1% Asian 13% other
Where Is Health Literacy Placed? Office of Diversity, Equity & Inclusion Leads the effort to make sure that every patient receives the: Safest Most Effective Most Sensitive Care regardless of their race, ethnicity, or any other group identity... and regardless of their health knowledge and literacy abilities Health literacy is under DEI umbrella
Attribute 6 Interpersonal Communication Interpreter Language Services 20 on-site interpreters 28 different language groups served by video and telephone Encourage use of living room language HL awareness training with providers and staff Plain Language Thesaurus on website Teach back initiative in early stages
Attribute 8 Easy-to-Understand Materials Employ staff with expertise in health literacy Full-time HL position, hired HL expert Freelance editors & designer Make materials reader-friendly Health Literacy Specialist reviews, revises, and oversees revisions Creating gallery of materials so employees know what the goal is Original Revised
Materials Continued Reader-friendly materials continued Designing system for document review Created tip sheets on hospital website Plain Language Thesaurus on website Materials are translated into 2 languages On-site translators check each others work Also use outside vendor
Attributes 1 & 2 Leadership, Planning & Metrics High level leaders set the stage, lead the way Key leaders remind, prod, and enlist support Support resources for full-time HL position Support improving documents even when providers and staff resist Attribute #2 Measurement Conducted an organizational self-assessment
Attribute 3 Prepare Workforce Attribute #3 Educating and training staff Health Literacy Specialist and key physician present to leadership, providers, nurses, other staff, and researchers Intensive 2-day classes taught by health literacy specialist 70 people trained in first year On-line annual competency on HL required of all employees Health Sciences Center library features new HL website with links to resources, research, thesaurus, and more
Attributes 5 & 7 Meets Needs for Access Working to improve environment to better meet the communication and access needs of all patients Improving signage (often available in 3 languages) Provide guidance in getting financial assistance Native American Health Services advocates for and helps patients navigate the system Some text in patient portal was revised to grade level 8. Other text cannot be changed (per vendor).
Attribute 9 Addresses HL in High-Risk Situations Advance Directives Currently revising Advance Directive form and booklet Will completely revamp documents and process later this year Consent Forms Revised Office-Based Procedure Consent Form and working on others Intake/Medical History Forms Revised a few and working on others Original Revised
What Generated Interest? A few leaders became concerned about communication, raised issues with other leaders and managers in many venues Joint Commission, CLAS standards, National Quality Forum, and others provided support for raising issue 2005 lawsuit for language access prompted huge changes Interpreter/translators doubled staff, tripled budget Added interpreter equipment
Interest Continued Office of Diversity, Equity and Inclusion (ODEI) created in 2010 Health Literacy Task Force created to promote organizational changes Senior Health Literacy Specialist position created in 2012
What Strategies Moved HL Forward? Key leaders linked HL to safety, quality, satisfaction, and cost savings Used videos/vignettes on possible negative outcomes Leaders continued to challenge in-patient Leaders continued to challenge in-patient and out-patient units to improve print and spoken communication
What Factors Facilitated Change? Key top leaders in organization provided: Awareness and support Commitment and tenacity Focus on messaging to other leaders Response to the lawsuit Community advocacy and pushing Detailed action plan, progress reported to community Increased awareness of all communication practices Coming health reform, impact of new patients New Medicare readmission policy
What Factors Were Barriers? Resistance to plain language, pride Lack of understanding of mismatch between public s skills and our system s demands Competing priorities, multiple initiatives at same time DOH/CMS/TJC visits back-to-back Implementing electronic health record enhancements Forming a new UNM Health System bringing 4 entities into 1 system
Barriers Continued Employees at all levels on overload Enthusiasm demand for services has surpassed resources, but there is also... Resistance HL team created new consent form and it was used for a time Joint Commission called it best practice Limitations of electronic health record and patient portal system Manual Effort and Work-arounds
How Will Changes Be Maintained? Continued leadership support and commitment Regulatory requirements Maintain Health Literacy Specialist position Resources for document review and revision Recognition and rewards for HL improvements Policies (future)
Call to Action Create additional funding streams to encourage public hospitals to make larger leaps forward Acknowledge importance of communication as a cross-cutting issue devote resources Track impact of HL efforts on safety, quality, cost, and patient satisfaction EHR vendors must partner Need editable text to improve patient communication Must support fonts for multiple languages
Contact Audrey Riffenburgh Senior Health Literacy Specialist Office of Diversity, Equity, and Inclusion University of New MexicoHospitals Albuquerque, NM (505) 272-5101 ariffenburgh@salud.unm.edu