We must likewise simplify the healthcare 'interface' and make health care more engaging.
The outcome that is being sought from this health literacy plan is a culture and practice which supports:
- equal access
- collaborative working
- self management
This means making it easy for us to access services, have better conversations with our professionals, and be in the driving seat of our health and healthcare.
The specific actions highlighted below will help all of us working in health and social care to cater for the health literacy needs of those we are trying to support. They have been selected for promoting the required change in practice and culture by:
- Raising awareness and the capabilities of professionals to address health literacy.
- Promoting the development and spread of existing and new health literacy tools, innovations and technologies.
- Improving access to these useful enabling health literacy tools and resources.
- Enhancing health literacy at transitions of care, which are key learning and patient safety points in health and social care.
More detail on these actions can be found at www.healthliteracyplace.org.uk
1. Workforce awareness and capabilities activity.
This activity will enable people who work in health and social care services to be aware of the challenge of health literacy, to commit to responding to it, and to have the skills, knowledge and capability to do so.
The full strategic context of the workforce-focused work and specific actions are available at the Health Literacy Place, but call for action on the following:
Leadership, management and team leaders to:
- Address health literacy in order to reduce health inequalities, to uphold people's human rights, as well as safeguarding the achievement of NHSScotland's effective, safe and person-centred ambitions.
- Take responsibility for staff to be aware of health literacy tools, and have access to them.
- Address staff capability to support peoples' health literacy needs (addressing the personal health literacy needs of people working in health and care services is vital, but this is beyond the immediate scope of this plan).
- Develop an organisational culture that promotes health literacy.
Individual clinical staff to:
- recognise people's health literacy needs
- be aware of appropriate resources
- employ a range of communication tools
The workforce-related actions in this health literacy action plan are aimed at establishing a healthy organisational culture, effective leadership and management and most particularly to having a capable workforce. This is in line with Everyone Matters: 2020 Workforce Vision which sets out the shared values of:
- care and compassion
- dignity and respect
- openness, honesty and responsibility
- quality and teamwork.
2. Test and spread health literacy innovations
The Person-Centred Health and Care Collaborative is supporting teams across NHSScotland to use improvement methodology to test, implement and sustain changes to the way care is provided, so that it is reliably person-centred for every person, every time. This 'Collaborative' approach has been successfully used to improve patient safety.
Effective communication - which takes account of people's health literacy needs - underpins person-centred care. This is particularly important at key healthcare interactions and transitions. These include:
- hospital discharge and clinic visits;
- shared decision making and consent for treatments and procedures
- changes in people's medication.
There are several evidence-based health literacy interventions, that will be promoted within the Collaborative, to support teams to test and implement new ways of working. These include:
- Checking understanding using 'Teach Back', a simple technique for confirming that people have understood what has been said
- Sharing jargon-free copies of clinic and discharge correspondence, which use language that the person can understand
- Providing test results in meaningful and accessible formats
- Using clear jargon-free oral communication
- Tailoring information to people's needs
Focusing on these elements is likely to provide big gains in highlighting the health literacy needs of service users to practitioners.
Crucially, it will improve people's understanding and confidence, helping them to sustain their health and to contribute to their own healthcare safely.
3. A National Health Literacy Resource for Scotland, "The Health Literacy Place"
The National Health Literacy Place has been established to:
- provide desktop access to examples of existing good practice, techniques and tools
- generate and disseminate practice-based evidence of emerging effective health literacy innovations, resources and technologies
- provide references and articles that expand on the themes of Making it Easy, including improving access, collaboration and support for self management
- create access to a community of practice, providing support and connection between those engaged with health literacy developments
Ward 19, Royal Alexandra Hospital,
NHS Greater Glasgow and Clyde
In feedback, patients in the ward said that they often forgot the questions they had meant to ask their consultant during ward rounds. As a proactive way of dealing with this, patients were given white boards and marker pens, to write down any questions or concerns they had beforehand.
One patient just drew pictures on the white board. The patient disclosed to the hospital chaplain that he could not write. This information came as a surprise to the staff on the ward.
Issues of health literacy had not emerged through the admission assessment. The staff realised that no account was taken of health literacy in their routine enquiry arrangements, and yet they often provided information about treatment and procedures in writing only. This awareness has led to a change of approach within the ward, where staff now always offer assistance in writing questions down on the white board prior to ward rounds.
Staff now have a raised awareness of the issue of health literacy. They routinely make subtle enquires with patients, to check their understanding, particularly when written information is being shared.
This situation has served as an important reminder that we should not expect people to be health literate and able to read and write - and that we need to behave in ways that more effectively meets people's health literacy needs.
A quick guide to 'Making It Easy' has also been produced - it highlights the following ways to make it easy;
- Use the 'Teach-back' type techniques: check that you have explained everything in ways people understand, by asking them to explain in their own words the information you have given.
- Chunk and check: break what you need to discuss into small chunks, and check understanding using teach-back before continuing.
- Use pictures: draw or show a picture to help convey a complex concept or body part.
- Use simple language: avoid jargon and use language that is easy for the person in front of you to understand, both when you speak to them and in any written information you provide.
- Literacy awareness: routinely ask people if they would like help in filling out forms.
"I'm a great believer that any tool that enhances communication has a profound effect in terms of how people can learn from each other..."
4. Establish a national demonstrator site
The route map for the delivery of the quality strategy includes the deliverable 'Information and Support to enable people at home and during times of transition'.
A national demonstrator site will develop and display an integrated way of working with people, making successful communication at transitions of care a routine experience.
Health Boards will be offered the opportunity to host the national demonstrator site. The aim is to meet the health literacy needs of people at transitions of care in specific settings over the next 18 months. This work will include an evaluation of the effectiveness of the approach to enabling people to stay well and to self manage. It will also assess the impact this has on service delivery. This will be taken forward using the Person-Centred Health and Care Collaborative approach, to take the learning and improvement forward reliably across the country.
Email: Graham Kramer