Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and author of the book Health Literacy from A to Z. I also produce and host this podcast series, Health Literacy Out Loud.

Today, I’m talking with Greg O’Neill, who is Director of Patient and Family Health Education at ChristianaCare in Delaware.

Building on his experience in patient care as a trauma/surgical ICU nurse, Greg has developed a team of professionals who champion health literacy best practices system-wide and support all manner of patient education initiatives and vendor relationships.

Greg is a long-time health literacy advocate, and our paths have crossed many times. I am delighted that he now is a guest on Health Literacy Out Loud. Welcome, Greg.

Greg O’Neill: Hey. Thank you, Helen. I’m so excited to be here. I have to tell you I’ve been a long-time fan of yours. I think anyone that comes into the field is going to encounter your influence on it, so I’m truly honored to be here. Thank you so much.

Helen Osborne: Thank you. You’re adding to our archive of the entire body of knowledge that we refer to as health literacy. We all make a difference.

Greg, you’re Director of Patient and Family Health Education. I had that role at a hospital, but I just worked at a very local level and with the educational groups we were running in the hospital. But you’re looking at this at a much bigger perspective, something you refer to as a systems perspective. Do tell, what is that all about?

Greg O’Neill: If I may, I can start at the beginning for me and kind of illustrate how I got here.

When I was working in the ICU, I really loved caring for people in that complex environment. I tend to be a problem-solver, and being there for people at their greatest time of need was something that I really found fulfilling.

But as I began to become more involved in performance improvement and operational work at the hospital, I felt that I really had more to offer the health system.

When the chance came for me to come into a nursing education role, I jumped at it.

As I started to learn about health literacy in my new role overseeing patient ed, my systems-thinking brain saw a real opportunity to do more for our system to make it a health-literate organization.

All of that is kind of what’s transpired over the last eight years.

Helen Osborne: That’s really interesting, Greg. As you’re building how you came to this place, you brought your clinical skills and patient care commitment, and then you brought your systems thinking, your organizational big-picture thinking, and then you learned about health literacy.

My experience started with, yes, clinical experience, and then health literacy, and then figuring out, “How can I make this happen?” That was not always the easiest path.

Since I’m fairly new to systems thinking, can you describe a little bit what that is?

Greg O’Neill: Yes. For me, it means looking at things from a really high level. When you want to influence the model of care for an entire health system, you need to think big picture.

What I found when I came into this role was a disconnected group of solutions and programs that, to me, really lacked a unified vision and strategy.

Within that, you’re going to find operational inefficiencies, and perhaps some ineffective approaches within that model of care.

That’s exactly what I told senior leadership when I presented a five-year strategic plan for patient ed.

Helen Osborne: You started with a five-year strategic plan. No wonder I’m so wowed by you. I started with, “How are we going to get through today? Maybe we’ll make it a little bit more than that.” It’s inherent to what you do.

What’s the role of health literacy in your big-picture thinking?

Greg O’Neill: To me, improving our approach to health literacy can solve so many of the problems and solutions that we’re trying to bring to bear on patient care.

To try and weave that into everything that we do, I tried to make the case of approaching our vendor strategy differently, aligning the entire system around health literacy best practices, improving collaboration across departments and teams and building a team of experts to champion the work every day within our own system. I’m very lucky now to have four very talented nursing professional development specialists on my team. They’re moving this work forward every day.

I think all of that together is how you have an impact on a bigger picture.

Helen Osborne: I was taking some notes here. You looked at vendor relationships, so I want to hear about that, but not first.

You talked about best practices. That’s the part that I got started with, like, “What can we do?” I think a lot of our listeners to the podcast want to know that, too. We’re not all going to be at a position of influence like you are in the big scheme of things, but we do want to know what we can do. I want to know what you’ve learned about that.

You talked about the power of teams and champions.

That seems like the essential components of this. Where do you want to start in looking at that?

Greg O’Neill: All I know how to do is talk about where I started. For me, that was really looking at three essential elements of this whole thing. Those elements are tools, skills and people.

Helen Osborne: Tools, skills and people. That’s concise.

Greg O’Neill: Each of those areas needed work. In terms of tools, for a health system as large as ours, we’re going to need to rely on a vendor to curate and develop content at scale.

Helen Osborne: You’re using terms that you know: vendor, scale, curate. Make it good for those of us just doing the everyday work. What do you mean by vendor, curate and all of that?

Greg O’Neill: I can’t tell you how much I appreciate that I’m getting plain language advice from you on this. That’s fantastic.

We need to utilize a company, and that’s where the term vendor comes in, to supply us with the thousands and thousands of potential content pieces that we need to use as a tool to help educate our patients and families.

Helen Osborne: At ChristianaCare, you are not writing those patient ed fact sheets.

Greg O’Neill: Correct. For the most part, we chose a vendor for strategy in order to be able to bring in widespread influence and consistency amongst the content that we’re using.

In our experience, when you’re talking about creating custom content, it can get very nuanced and hyper-focused and maybe lose some of that applicability across the entire continuum of care.

Helen Osborne: If I can interrupt there, when you talk about managing the content, I tried to deal with that and then I had files everywhere. Oh my goodness, this one is changing, or that unit was writing their own thing and I never even got to see it.

You’re taking that part away. You’re bringing in some outside company to provide that part of your system and how you distribute that. Is that correct?

Greg O’Neill: Absolutely. I would say that most health systems use some blended version of that. They may have more custom content that they’re generating and curating internally, but most that I’ve encountered will use an outside vendor for their base foundation content.

Helen Osborne: You talked about tools. You talked about the three elements of this system-wide difference. Are the tools the content, or is there more to the tools?

Greg O’Neill: The tools are the content. We want to be able to put the tools that are useful to patients and caregivers right at the point of care. We want to make sure everyone has what they need when they need to be able to carry out this mission of educating our patients and families. That’s the tool piece.

Helen Osborne: Then you’re talking about just printed materials? Are you talking about videos? Are you talking about all formats of providing this content, or the patient handout, as I remember from my hospital days?

Greg O’Neill: It really is all encompassing. If you want to have consistency for your patients as they experience care throughout your system in all the different venues, it’s using all of those modalities.

It’s going to be important from an equity standpoint, as well, to be able to meet people where they are and provide information to them in the way that’s most useful to them.

Helen Osborne: Thanks a lot. You made that so much clearer.

That’s your tools. Another element was skills. What do you mean by skills?

Greg O’Neill: This was determining what simple best practices do we need our caregivers to integrate into their clinical care, and then how do we support that as a system? That skill-building is ongoing. Those are kind of our core missions around trying to make sure that folks are using the tools in the best possible way.

Helen Osborne: I’m going to do my plain language best. You talked about skills, core mission and clinical skills. Tell us a story. Make it very real about what you mean by these skills. Give an example.

Greg O’Neill: What we landed on were a few of the core tenets, and that’s using plain language and eliminating medical jargon. That’s in terms of all of your interactions with patients and families.

We want to make sure folks are using teach-back, and that’s actually one of our pillar behaviors in terms of patient experience as well. We have a strong partnership with that team, so using teach-back is really important to confirm understanding.

Then making sure folks are prioritizing information. We want to avoid volume overload when we’re trying to educate patients and families.

Then including a support person. That’s a recognized best practice.

If we can do those four things consistently over years, we think not only are we going to affect the experience of care positively, but we’re going to really help our patients and families improve their understanding of their health.

Helen Osborne: Wow. You made it so clear, Greg. Four things. You’ve got your three components and now you’ve got four things in the skills. That’s one of the clearest explanations I’ve heard rather than going in many directions.

Aside from the quality of those four items, the plain language, the teach-back, prioritizing information and bringing in a support person, is there any advantage to making it so clear and four things here? Is there any reason you did it with that clarity?

Greg O’Neill: There is a reason. Working in the education field, we see that there is a tremendous amount of change. There’s an enormous amount of complexity in healthcare. Our caregivers are being asked to adapt and integrate new knowledge constantly.

If we’re going to ask them for this aspect of their care model to improve their skill base, we need it to be really easy to understand. We need it to be something that they can refer back to, remember and apply consistently. We thought having a few core tenets that we relied on was the best way to do that.

Helen Osborne: Thanks. You’re making it clear to me. Now the people part.

Greg O’Neill: We’re not going to be able to accomplish any of this without the people, and to me that means winning hearts and minds. For our team, we do that through advocacy.

We are trying to increase our presence throughout the system. We’ve already done that in terms of having more influence in all the areas of care.

We’ve created training, policy, promotional and support activities that help bring health literacy to top of mind for anyone delivering care.

Helen Osborne: You’re talking about health literacy the whole time, or are you talking about patient education? Are you using those terms interchangeably?

Greg O’Neill: Absolutely. I think people need to understand that health literacy is really the how of patient education. Those things are linked. If your goal is to educate your patients and families, you really need to be aware of their health literacy needs and have the skills necessary to address it.

Helen Osborne: From my perspective, I would also say that health literacy is the why.

Greg O’Neill: Yes.

Helen Osborne: Why we continue doing this. The why is important for that very busy staff who needs to do all kinds of other things at the same time, for them to feel deep inside that this is why they chose to go into the helping professions and this is how they can keep going with it.

When you talk about people, are you talking about the clinicians, or are there other people? You used that term team and advocates. Who are you talking about?

Greg O’Neill: It’s really from top to bottom, in my opinion. We need the senior leadership of the organization to recognize the need and the prioritization within all the activities of the health system. We need all of the direct caregivers to also recognize the need and be able to intervene in an appropriate way regarding health literacy.

We try to influence leaders as much as we do direct caregivers so that everyone is paddling in the same direction toward the same mission.

Helen Osborne: What about patients’ families? You talked about support people. What about communities? Are they part of your team?

Greg O’Neill: Yes. We have a patient and family advisory council who we will go to when we want to get the patient’s perspective on our interventions. We know that’s a health literacy best practice.

We also really have a strong partnership with our community education team, and we try to make sure that our community health workers and the folks that they’re interacting with are part of the conversation. We make sure we’re not operating blindly, but getting feedback along the way.

Helen Osborne: Thanks. Again, more clarity from Greg.

Just putting this all together, the listeners of this podcast could be from anywhere in the world. We could be in clinical medicine, in public health or in community agencies. We could be people who are just interested in communicating about health more clearly.

What overall recommendation would you have for us and for listeners? What can we do today to make communication just a little bit better?

Greg O’Neill: It’s really about having a strategy, I think. Until you articulate what your mission is and the steps to get there, it’s going to be really hard to make progress.

The first step, I think, for anyone is finding leadership that is going to understand the mission and support it. That’s critical.

The best way to get that leadership’s attention is to make a business case that illustrates that, with some attention and investment on the health literacy needs of our community, there are savings for the system. There are improved outcomes that are there to be had, so if you can make that case with leadership, you’re off to the races.

Helen Osborne: That sure would have helped me a lot in my early days to be able to do that effectively.

Also, for me, a motivator is the power of story. That’s one reason I do these podcasts, to hear from people like you who are doing the work every day.

People want to hear from you, Greg, what worked and what didn’t perhaps. It sounds like everything just went along swimmingly in this. I’m sure there might’ve been some problem-solving you had to do along the way.

But I think it’s the power of story and, from what I’ve learned, the power of the audio, too, that first-person account. I think it takes all these different ways.

You are an inspiration for all you have done and how you’re bringing in that big-picture thinking. I know you are making a huge difference in Delaware, but also you are really a national leader and a model for this one.

Greg, thank you for all you do. Thank you for being my colleague, and thank you for being a guest on Health Literacy Out Loud.

Greg O’Neill: I really had fun. Thank you so much, Helen.

Helen Osborne: As we just heard from Greg O’Neill, when you think about health literacy it’s important to look at it from the big perspective, too, along with the everyday. But doing so and making a difference in health literacy is not always easy.

For help communicating your health message, please take a look at my book, Health Literacy from A to Z. Feel free to also explore my website, www.HealthLiteracy.com, or contact me directly at helen@healthliteracy.com.

New Health Literacy Out Loud interviews come out the first of every month. You can get them all for free by subscribing at www.HealthLiteracyOutLoud.com, or wherever you get your podcasts.

Please help spread the word about Health Literacy Out Loud. Together, let’s tell the whole world why health literacy matters.

Until next time, I’m Helen Osborne.

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