Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, Founder of Health Literacy Month and your host of Health Literacy Out Loud. In these podcasts you get to listen in on my conversations with some really remarkable people, hearing what health literacy is, why it matters and ways all of us can help improve health understanding.

Today I’m talking with Barbara Lambiaso. Barbara is Senior Project Manager for Communications at Massachusetts Health Quality Partners, or MHQP, based in Watertown, Massachusetts.

Building on many years of experience in health and healthcare communications, Barbara oversees all aspects of www.HealthcareCompassMA.org. This is a website where the public can find easy-to-read data and information about quality healthcare in Massachusetts.

I’ve known and worked with Barbara and MHQP for many years, and I am delighted to have this opportunity to highlight all that they’ve accomplished and learned when it comes to reporting about the patient experience. Welcome Barbara.

Barbara Lambiaso: Hi. Thanks for having me, Helen.

Helen Osborne: Well I know some of the inner workings of www.HealthcareCompassMA.org but tell everybody. Can you put this into context? What is this website all about?

Barbara Lambiaso: Sure. Our healthcare system is changing in lots of ways that impact how people get and pay for care. Today, more than ever, people need to be informed in order to make wise healthcare decisions. www.HealthcareCompassMA.org is a website that helps people find primary care in Massachusetts both for adults and children.

People are looking for primary care when they move to a new community, when they get a new job or a change in insurance, when they have a baby and when they experience other life transitions.

Helen Osborne: So is this a place to go find a new doctor? I know it’s more than that. It’s really not just a listing like you could find anywhere. There’s something really special about this. What makes it special?

Barbara Lambiaso: There are a couple of things that are really special about HealthcareCompass. First, people will search and they can find doctor’s offices, not the individual doctor but the office itself.

The thing that is special about HealthcareCompass is that this site shares quality data about primary care doctors to help people decide where they want to get their care. Information that we share with patients and with the public is also the same information that we are sharing with doctors to help them improve their care.

This is what’s known as transparency. It’s when you’re sharing the same information with two different audiences that both use to make sure that care is the best quality.

Helen Osborne: That’s interesting. I hadn’t realized that word transparency meant when there was two very different audiences. That’s a really good point to know.

You also talked about quality data. Quality can be interpreted in many ways but MHQP really looks at this very rigorously. It’s not an arbitrary statement that says “That doctor’s good but that one’s not.” You’re going by real standards for what is quality care, right?

Barbara Lambiaso: That’s right and we share two types of ratings on our site that people can look at. One is ratings that are called Clinical Quality Ratings which include how well doctor’s offices provide things like cancer screenings and care for diabetes. These are national standards of care that are used across the country to rate how well hospitals and primary care doctor’s offices give care.

We also rate patient experience which includes the results of our statewide survey where patients tell us about the type of care they received from their doctor’s offices including how well the doctor communicates, how well the doctor coordinates care and how people are able to access care, like how long until they get a callback, getting timely appointments and what the waiting time is like.

This survey has been developed over the last 20 or 25 years. It’s a national standard in being able to get information from patients about doctor’s offices.

Helen Osborne: Is it the patient experience that you’ve been looking at for so long?

Barbara Lambiaso: The survey has well developed that but we’ve been looking at the patient experience. We’ve been fielding this survey in Massachusetts since 2006.

Helen Osborne: Okay. You have a long history with that and that’s much more subjective than “Did you have this test done within this time frame?” Is that correct?

Barbara Lambiaso: That’s correct.

Helen Osborne: But it’s more subjective and more opinion based.

Barbara Lambiaso: It is more subjective than the clinical quality but what’s really important is that this is about things that should be happening in the doctor’s visit so when you talk about how well your doctor communicates, it’s not really your opinion about how well they communicated but the questions ask about whether you were able to understand what the doctor was saying and did the doctor understand what you were saying?

These are really outcomes to the visit. What actually happened in the visit?

Helen Osborne: So it’s outcomes and it’s quality data. Let’s talk about the website itself. It looks beautiful but please say the name of it again so listeners can be clicking on if they want as we’re talking about it. But if not, we’re going to have to give them a word picture of what this site is all about. The site again is . . . ?

Barbara Lambiaso: It’s www.HealthcareCompassMA.org.

Helen Osborne: Okay. Thanks for that. Let’s go through different parts of it. I want to put on my plain language writing and editing hat and indeed, I have worked with you on this website. There are many components and lessons learned, I think, for people in all kinds of settings.

You talked a little bit about the audience. Before you said that your transparent data is for both the physicians as well as the public. What’s the audience for this website we’re talking about?

Barbara Lambiaso: The audience for this website is the public. They are everyday people who are looking for a primary care provider. Again, it might be people who are in different transitions in their life and looking for a doctor for themselves, for their children or maybe even for an adult they’re taking care of. These are what we sometimes call “healthcare consumers,” but these are people that are using healthcare.

Helen Osborne: You were very clear about who you were doing that for. What about the overarching goals of what you were trying to accomplish?

Barbara Lambiaso: The goal is to be able to really help people be able to understand and use quality information for something that’s really important to them and that is finding a quality primary care provider. The purpose of the site is to help people find a primary care provider using quality ratings that can also help them better understand what to expect from their care and what they can do to help improve their care.

Helen Osborne: That’s very focused and I know from a lot of other projects I’ve worked on that it really helps to be clear as you are that way.

Tell us about the content. What would a person find who goes to this site?

Barbara Lambiaso: There are a couple of things that we really thought hard about in terms of how we wanted to communicate, share the data and make it easy to navigate. When you get to the website you search by zip code or town. You can search right away.

Helen Osborne: I did that. I went recently and the first thing I had to do was put in my zip code. That’s before you tell me stuff. That’s before you tell me about doctor’s practices, before you tell me about quality and before you tell me about MHQP. It’s all about me and my zip code.

Barbara Lambiaso: That’s exactly right. The site is clear that it’s there to help you find a primary care provider so when you get to the site you know what the site is going to help you do.

After you put in the zip code, you get a results page which shows you a number of different doctor’s offices all in order of distance from the zip code that you put in and you can select up to three. When you select up to three and press the compare button, it will bring to a page where you can compare results and ratings across up to three different doctor’s offices.

Helen Osborne: Okay. Describe for our listeners what it looks like when you get to that results page.

Barbara Lambiaso: When you’re looking at the doctor’s offices or their sites, what you’ll see is a page where down the left side are measure names. You’ll see Patient Experience as your tab at the top for patient experience and you’ll see Patient Experience measure names going down the side.

Helen Osborne: A measure name would be like what?

Barbara Lambiaso: How well doctors communicate and how well doctors coordinate care.

Helen Osborne: You’ll see that that’s clearly labeled. There’s not a lot of distracting information there.

Barbara Lambiaso: No.

Helen Osborne: How do you see those ratings? What do they look like?

Barbara Lambiaso: The ratings themselves are shown as icons and they’re circles. They’re called Harvey Balls. They are similar to what Consumer Reports uses but they are not Consumer Reports rating system which is privy to just them.

They are three different circles. A full circle shows the best result. A half-full circle shows that there are doctor’s offices that have done better than that office and some that have done worse so they’re right in the middle. An empty circle means that there are doctor’s offices that mostly have done better than this site and that this site needs some work when you see an empty circle.

Helen Osborne: When I go to buy my books on Amazon or wherever I buy my books or recipes or something there are usually stars. How did you come up with three variations on a circle?

Barbara Lambiaso: We did use stars in the past and they were helpful but if you’re looking across three different organizations, having four stars for one and three stars for another gets very confusing and there’s a lot going on the page. If you’re looking at a circle and whether it’s filled, half-filled or empty across these different sites it makes it really easy for you to compare and be able to see the patterns of care.

You can see much clearer and it’s much easier for your brain to understand. We did some testing with this and it was easier for people to be able to look at that and clearly understand that one site did better or worse than another. With a glance you could see those patterns.

Helen Osborne: That’s interesting. I actually once did a podcast with folks from Consumer Reports. I’ll put a link on your Health Literacy Out Loud web page. They also talked about the role of the width and if you have five stars it takes up a lot of width where if you just have a circle or some variation on it, it’s a narrower column which is kind of neat.

You and I both know that when we go to the doctor all kinds of things can happen. It’s not as easy as good, bad or somewhere in the middle which three stars would be. How do you capture some of that nuance?

Barbara Lambiaso: The really great thing about this site is that it gives you an opportunity to drill down deeper. If you want to know more information like “What does that full circle mean?” you can click on that full circle and a box pops up that tells you exactly what that information tells you so in relation to our survey it gives you the responses to the different questions that go into that measure.

For example, “How well did doctor’s communicate with their patients?” they had about four or five different questions and they have a bar that shows the frequency of results, meaning how many people responded to each of those questions with “Always” or “Almost Always” so you can see how well these doctors did or how well the patients rated these doctors by drilling down deeper and getting numbers or actual statistics.

Helen Osborne: I went there to look at it and you had horizontal bars. You divided that up using colors but you also have numbers and percentages so I was very impressed about all of the quality and quantity of data behind those circles and that’s not hard to find. That’s not meant to be a secret in any way.

The term “layering” is kind of what that’s all about. It’s where you can see the simplest version first but if you want to know more you can keep going and going.

Barbara Lambiaso: That’s right. We did that purposely. This was a real lesson learned when we were developing this site. It’s that you want to keep things simple and you want to help people make the choices about where they want to go further for information.

You have that first layer and then when people want to dig deeper, you give them the opportunity to do that and that way, they make the decision to get more complex or deeper into the information and you’re not overwhelming them with too much all at once.

Helen Osborne: Was it hard to figure out what to let go of?

Barbara Lambiaso: Oh yes, absolutely, which is why we actually worked with healthcare consumers, patients and family members to help really decide “What’s the most important information first and what do we put second? What do we want? What do people want to see when you layer down?”

Not only did we test the site before we went live with it in a couple of different ways but we also worked directly with healthcare consumers—the public—to really get their input on how they would like to see this information shared.

Helen Osborne: That’s wonderful. I want to hear more about that user testing but before we move on to that I want to discuss word choice. You’ve been doing this quality data for a long time. You must have your own set of terms for what that means.

Here you are writing for the lay consumer. What happened about wording to take complicated information and make it very understandable?

Barbara Lambiaso: It’s very challenging for us to take the words that we use every day and change them into something that’s clear and more understandable. We were really fortunate to be able to work with you, Helen, to help translate our everyday language into something that was much clearer, understandable and that helps define certain terms.

Helen Osborne: Thank you.

Barbara Lambiaso: There are some terms that you just can’t get rid of but to help be able to put them into context and define them for the audience is really important, especially if that audience might be seeing them or hearing them moving forward. Again, healthcare is changing so there are lots of things that people need to understand.

Working with a plain language consultant like you was really key for us to be able to translate and share this information in a way that people could find relevant in their day-to-day lives.

Helen Osborne: Thanks, and from my perspective, working with you—and quality is not my area of expertise—I felt it was really very much of a team. Yes, I know the principles of plain language writing but you’re the subject-matter expert so we really went at this collaboratively and then you brought in the voice of the user which was essential. I think it really took a team to do this well.

Tell us now a little bit more about that user testing and how you brought in actual users.

Barbara Lambiaso: We tested the site with a process called usability testing and it’s a pretty standard process for testing web information, websites and applications so lots of different industries use it. We wanted to be able to test some assumptions and make sure that things like our icons and the rating system were clear and understandable. We really did need to test it with people.

We wanted to know if people knew how to navigate the site. Was the navigation clear? Did they understand where they were going from page to page and if they put in their zip code what to expect next?

We in-depth tested. We had this long questionnaire script where somebody sat down with each of these people. We had about 12 people come in and they were people that we recruited broadly from across the state.

They came in and sat for an hour and a half and went through site with these facilitators who asked really in depth questions and really listened to what they had to say. They shared those recommendations back with us.

Helen Osborne: What did you learn? Were there any surprises?

Barbara Lambiaso: Well we were thrilled to learn that the rating system actually was pretty clear. People understood it and people really did like the idea of being able to see the ratings and dig down deeper. There were people that did dig down deeper and some that didn’t.

We learned that it’s kind of challenging to be able to help people understand where the information is coming from. Therefore branding it for MHQP and letting people know who MHQP is was a challenge because there are so many different sorts of entities out there that are sharing information right now in healthcare.

I think what was most important to us is that people did understand the site and they were able to figure out how to use it. They felt like the patient experience information in particular was very useful because these were the things that they want to know.

“Does my doctor know me? Does my doctor understand me? How well does my doctor communicate? Can I get an appointment when I need it?” It felt good to have that confirmed.

Helen Osborne: That’s wonderful. I hear that commitment to it and the pride of putting this together. In the old days it would probably have been all about MHQP, the quality ratings, what they are, how we got our numbers and going from the more complicated to the more simple. You started in the opposite way. Congratulations on a job well done putting this together.

Just in closing for our listeners who probably don’t have access to all the many resources, time and energy that you put into this site, what are just a couple of lessons learned that you’d want to pass on?

Barbara: Keep it simple. I think it’s the hardest thing to really understand that you don’t want to overwhelm people with information so the idea of either layering or letting people click through to find the information that they’re looking for and kind of leading them there with bread crumbs and giving them those opportunities is really important because information can be very overwhelming.

Then I think that talking with your audience is important. There are so many ways you can do that nowadays with social media or even just talking with your neighbors and friends and saying “What do you think about this from your perspective?” If you can get a group of people to volunteer, join in and review your information, materials, website or what have you, it’s so important to have your audience involved in the process.

Helen Osborne: Thank you very much. For our listeners, if you want to go see what Barbara was talking about, please go to www.HealthcareCompassMA.org.

Can they use that as a model as they move forward in their own projects like this?

Barbara Lambiaso: Sure. Absolutely. You can look to the layering. You can see how information is kind of branded and laid out. I’m happy to be able to share any information with people about what we did in the process.

Again, I think the plain language consultant and working with you, Helen, like you said is a collaborative process was really key. I would definitely encourage people to do that.

Helen Osborne: Thank you Barbara for all you do. I hear the strings of collaboration and quality coming together in this. That’s also what Health Literacy Out Loud is all about. Thank you so much for being a guest on our podcast.

Barbara Lambiaso: Thank you for having me.

Helen Osborne: As we just heard from Barbara Lambiaso, it’s important, but also can be a challenge, to post and present complicated information in ways that are clear, simple and that others can understand.

For help clearly communicating your health message, please visit my health literacy consulting website at www.HealthLiteracy.com. While you are there, feel free to sign up for the free monthly e-newsletter, What’s New in Health Literacy Consulting.

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Until next time, I’m Helen Osborne.