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 Christina (Tina) Cordero who is project director in the Department of Standards and Survey Methods, Division of Healthcare Quality Evaluation at The Joint Commission.
Among her many accomplishments, Tina developed the Patient-Centered Communication Standards and the Joint Commission Monograph, Advancing Effective Communication, Cultural Competence and Patient- and Family-Centered Care: A Roadmap for Hospitals.
I met Tina when she and I were speaking at the same health literacy conference. I was so impressed with her presentation that I invited her to be a guest on Health Literacy Out Loud.
Tina Cordero: Thanks, Helen, and thank you so much for the opportunity to participate.
Helen Osborne: It’s a pleasure. I know from my hospital days and all my health literacy work ever since that The Joint Commission has a large influence on practice. That’s why I wanted to hear from you.
Let’s take it from the beginning. How and why did The Joint Commission get interested in health literacy?
Tina Cordero: I think The Joint Commission has been interested in health literacy as part of this patient and provider communication component for several years. We started to do projects that were more focused on health literacy or started to at least infuse the ideas of health literacy into these initiatives back in 2004.
Helen Osborne: It’s more than 10 years now.
Tina Cordero: Yes. We had a grant-funded initiative, our “Hospitals, Language and Culture” study, that focused on language and cultural issues and the different challenges that hospitals were experiencing as they were caring for more and more diverse patients.
Although that study wasn’t focused on health literacy, we did start to see some of the challenges that were bubbling up and our interviews were focused on health literacy issues.
Helen Osborne: Do you frame it as health literacy specifically or is it given a broader view?
Tina Cordero: What we’ve tried to do in the past is group it into the broader context of communication and really focus on that effective communication piece between patients and providers. That would include health literacy as well as language issues, cultural issues and some of those other aspects of communication.
Helen Osborne: You’re setting the stage for this good two-way, understandable communication, or however you phrase it.
The Joint Commission has this influence and you’re setting the tone of good communication and that expectation. Are there specific things that hospitals and clinicians need to do, from The Joint Commission’s perspective, when it comes to communication?
Tina Cordero: As we’ve focused on that communication between patients and providers, we’ve really tried to encourage providers and hospitals to identify patients’ communication needs, including any needs that they have around health literacy, and try to address those needs in the best way possible.
What we’ve tried to do is incorporate health literacy into our requirements around patient education or making sure that patients are participating in their care and understanding the information that’s been given to them that’s appropriate to their learning needs or their communication styles.
We haven’t addressed it as far as the term health literacy specifically, but we have tried to incorporate it into that patient communication interaction.
Helen Osborne: Can you give us some examples? And are these things that are kind of nice-to-do or do you really need to do this to get Joint Commission accreditation?
Tina Cordero: We have specific accreditation standards about patient education and making sure that patients are receiving education materials that they understand and that are appropriate for the patient. Those are things that are required for accreditation.
We have standards about making sure that patients are participating in their care, and that they’re actively participating in their care, so they have opportunities to ask questions and get feedback. Again, it’s focusing on that two-way interaction. Those types of things are required for accreditation.
Then we have a number of other recommendations that go above and beyond what our accreditation standards are, but really are things that we feel that organizations should think about if they’re really hoping to advance communication and better address the needs of their patients.
Helen Osborne: Since our listeners I’m sure are really hungry and want to know this from you, tell us more. Be as specific as you can. Are you talking specifically about hospitals or are you talking about all clinical settings? Who needs to follow these recommendations or standards? Then tell us more specifically about what people need to do.
Tina Cordero: Some of the existing standards that we have for accreditation, the things that are required to get accredited by The Joint Commission, such as the patient education standards about providing information that is appropriate for your patients and participation in care, those standards are in all of our accreditation programs.
That’s for hospitals, behavioral health-care facilities, ambulatory facilities and home care and nursing-care centers.
We also added some standards specific for the hospital setting in 2010 that are focused on making sure that hospitals are effectively communicating with patients when providing care, treatment and services.
That would include requirements around identifying a patient’s oral and written communication needs, which would include preferred language or the need for plain language materials. Again, it’s getting at that health literacy component.
Then the hospitals are required to communicate with patients during that provision of care in a manner that meets those needs that you’ve already identified.
Helen Osborne: Tina, I’m so glad you talked about identifying those communication needs. I hear people come to me and say, “The Joint Commission says…” or they’re thinking that The Joint Commission says that they have to assess every patient in terms of specific health literacy needs. There are some tools out there, but I’m not a fan of them.
Is that what you’re saying? That people need to document for every person and give them a little bit of a literacy or health literacy test?
Tina Cordero: That’s a common question that we’ve heard in the last few years as well. I think what we require is that organizations are identifying health literacy needs as they come up and making sure that patients can get the information that they need in a manner that they understand.
We don’t have a specific requirement that you do any kind of particular health literacy screening tool or that there are specific questions that you need to ask.
Helen Osborne: Thank you for making that clear. What about that framework that is pretty common in health literacy about universal precautions and universal good communication as opposed to individual?
Tina Cordero: That’s one of the things that we recommend. Again, it’s going above and beyond the standards and the accreditation component. They’re the things we recommend and encourage organizations to do to better address the needs of their patients. One of the universal precautions is something that we included in our Roadmap for Hospitals monograph.
Helen Osborne: You’re really supportive of that.
Tina Cordero: Absolutely. I think it’s something that allows you to address needs in advance of specific patients, and you can do that on a larger scale as opposed to doing those individual assessments and things like that for health literacy where you would have to incorporate specific techniques.
Helen Osborne: Thank you, Tina. Are there any other examples? You don’t need to go through the whole list as we’ll talk about how people can find out more information. But are there any other examples or myths you want to dispel about what organizations can do to meet these standards and address these recommendations?
Tina Cordero: In the Roadmap we also talk about “Ask Me 3,” teachback, and things that we encourage organizations to do to address health literacy needs.
Although, again, these are above and beyond what’s in the standards, but just different techniques and different resources that are in the field that we hope organizations will use as they approach health literacy with their patients.
Helen Osborne: Thanks. Let’s move into how people can find these. How can they learn about your Roadmap? Can they see it? Is it widely available? Is it password protected? How can people find out more what The Joint Commission is recommending?
Tina Cordero: Our Roadmap for Hospitals monograph is on our website. We can provide the web link on your website, but it is available for free to download. We posted it in 2010 and I want to say that over the last five years we’ve had over 50,000 downloads so far.
Helen Osborne: Oh my goodness. Wow. What a great resource. I know I have seen it from time to time and it is a true roadmap of what we can be doing, so that’s terrific.
That’s where people can be learning more. The standards they certainly are aware of. Are there other tools and resources that you recommend or is that the place to go when it comes to The Joint Commission and health literacy?
Tina Cordero: What we hoped with the Roadmap was to create a one-stop shop for multiple issues. With health literacy, there is a section in Appendix E where we provide additional resources and link to other groups in the field that are working on health literacy.
That way, you can see the types of resources that we’ve recommended and then go out onto the internet to get better access to those different groups and tools that are available.
Helen Osborne: Tina, as I look back on my 20 years or so with health literacy, I have seen an enormous change, and The Joint Commission is part of it.
It seemed like 20 years ago health literacy was a nice thing to do that a few people heard about. Now that it’s part of federal standards and federal guidelines and recommendations, coupled with what the Joint Commission is putting in for accreditation. It seems to have more staying power and more clout.
I just want to thank you for all the work you’ve done to help move that along. Thank you and thank the Joint Commission for making this a real concept we need to address. Have you seen that change over the years?
Tina Cordero: Absolutely. I think I mentioned our original project in 2004 and then in 2005 we released a public policy initiative about health literacy, prioritizing it as a patient safety issue.
Then as we’ve gone through various initiatives over the years, I think we’ve made an effort to focus on health literacy as part of communication in a way to continue to promote health literacy as an issue and to just better address communication with patients.
Helen Osborne: Let’s look ahead and look into that crystal ball. Ten years has moved us on in a way. It really is making an impact on patient-provider communication. What do you see beyond this? Where would you like this all to go?
Tina Cordero: I think for us we have continued to support the standards that we released in 2010. However, as we’ve seen them come to life in the field and based on the questions that we’ve been receiving over the years, I’d like to think that in the future we may have an opportunity to revise those standards at some point or take a fresh take on looking at what other issues are bubbling up in the field and other aspects that we may need to address in the future.
Helen Osborne: Like what?
Tina Cordero: I think because we’ve gotten a lot of questions, and you asked earlier about assessments, if we had an opportunity to clarify what our requirements are as far as doing patient health literacy assessments, that may be another resource that we might be able to release in the future.
If there are other more specific aspects of health literacy that we would want to incorporate into accreditation, we may have some opportunities to do that in the next few years.
Helen Osborne: Thanks for making it clearer in that way.
As you were talking about that, this image came into my mind. Is The Joint Commission looking to standardize practice so that every organization and every communication is done in pretty much the same way? Or is it just more about that context in which we can individualize it to the situation and the people in that situation?
Tina Cordero: What we’ve tried to do with the majority of our standards is to keep them from being overly prescriptive, so we allow hospitals to work with the requirements to figure out what’s going to work best for them and their patient population.
We do try to provide a little bit of a framework for the types of things that they should be including or how they should be addressing health literacy in a more general way, and then organizations can tailor their practices to the patients that they are seeing.
Helen Osborne: Isn’t that what health literacy is all about?
Tina Cordero: Exactly.
Helen Osborne: It’s knowing what to do, having that sense of the big picture and having that confirmation that this is really important and worth paying attention to. But then also tailoring it and adapting it to the situation and the people involved in it.
Tina, I want to thank you for helping to lead the way, championing the cause and working with us to make health literacy a standard of practice. Thank you for being a guest on Health Literacy Out Loud.
Tina Cordero: Absolutely. Thank you so much.
Helen Osborne: As we just heard from Tina Cordero, it is so important to consider health literacy in all the many ways that we communicate with patients and the public. But doing so isn’t always easy. 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 monthly e-newsletter, What’s New in Health Literacy Consulting.
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Until next time, I’m Helen Osborne.