Week 6, Attribute 6!

We are thrilled to inform you that our series on the Ten Attributes of Health Literate Health Care Organizations will live beyond its original Health Literacy Month lifespan, and continue into the holiday season.

We are celebrating with an important interview on how to ensure the sustainability of health literacy.

This week we corresponded with Juanita Lyde, the senior project manager leading the Cultural Competency/Health Literacy efforts at Finger Lakes Performing Provider System (FLPPS), to learn about how to lay a strong foundation for Attribute 6.

As always, these interviews are meant to spark discussion. Please join Health Literacy NY and be part of the conversation. Thank you!

Attribute 6: A Health Literate Health Care Organization Uses Health Literacy Strategies in Interpersonal Communications and Confirms Understanding at All Points of Contact.

Say Ah!: The Finger Lakes PPS covers an incredibly diverse region, both by population and geography. Can you give us an overview of the populations served, and how the PPS is organized to meet their needs.

Juanita: The Finger Lakes PPS covers a 13-county region that includes 300,000 Medicaid members and an additional 100,000 individuals that are uninsured. To meet the needs of the various populations, the Finger Lakes PPS is divided into five geographic sub-regions, termed Naturally Occurring Care Networks (NOCN). These Networks represent the full continuum of care and organizational leadership within a shared geographic service area.  Each NOCN is led by a participant workgroup that represents the healthcare providers and community based organizations in their area. Within each NOCN region we have identified vulnerable populations based on the community needs assessment. Those vulnerable groups consist of: African Americans, Latino(a), Deaf/Hard of Hearing, LGBT, Those Living in Poverty, Mothers, Infants and Children, and the Mental Emotional and Behavioral Health Population, Migrants, Refugees, Mennonites and the Amish.

Say Ah!: How do you work across these NOCN, et al, to promote health literacy to both medical and non-medical staff?

Juanita: The Finger Lakes PPS is taking a multi-pronged approach to promoting health literacy within our network.  Our approach includes education and training that targets the organizational infrastructure, workforce, patients/consumers and community stakeholders.  We are taking this approach because we believe it to be the most effective with ensuring successful outcomes and sustainability.

Organizational: The Finger Lakes PPS is devoted to ensuring that the health literacy practices that we employ are sustainable. To ensure sustainability the entire organization must have an understanding of health literacy, be educated on health literacy practices, and operationalize those practices within the organization.  The understanding and education must include the leadership team (including the board of directors) and all other staff, even staff that may have no direct contact with patients.  Our health literacy goals include operationalizing health literacy practices in 100% of our contracted partner organizations.  We aim to accomplish this by offering an organizational assessment that evaluates the cultural competency and health literacy standards and practices of the organization. We will then work with our partner organizations to develop a 3-year strategic plan and workplan that builds on their identified strengths and areas of improvement. Many of the assessment questions encompass health literacy components and there is an entire section dedicated to health literacy practices in the assessment. Examples of this are:

  • Asking if the practice/organization has a consumer advisory board: Consumer advisory boards are important to providing feedback to the practice/organization. Examples: reviewing patient/consumer documentation for literacy levels.

  • Knowledge of Communities and data collected: Knowing the race/ethnicity of those you serve can help you understand your patient needs and respond appropriately. Example: large Hispanic/Latino(a), Asian, Russian, African, Refugee, Migrant, Deaf/Hard of Hearing, etc. these patient populations may indicate a need to ensure that documents are translated into these languages and that providers have access to appropriate translation services. How the cultural diet, cultural taboos (related to taking certain meds/other medical practices) and other cultural nuances may affect the recommended treatment plan.

To alleviate the burden that this work may place on many of our partners that are small, have limited resources and time, the Finger Lakes PPS has teamed up with approximately 10 CBO across the NOCN regions to hire and train Cultural Competency and Health Literacy (CCHL) Operation Specialists to support the work that we are asking of our partners.  This work has already started and approximately 40% of our contracted partners are engaged in the work to operationalized health literacy practices in their organization. The remaining partners will begin the work in 2018.

Workforce: The Finger Lakes PPS will work with each of our contracted partners to ensure that CCHL training plans are in place and includes CCHL training for each staff in the organization. Training also includes board members. The Finger Lakes PPS will offer in-person and online health literacy trainings to meet the needs of the various staff in each organization. These include:

  • Trainings for Organizations: Best Practices of a Health Literate Organization (universal precautions approach, data collection, language access, how to assess health literacy/red flags for low literacy, etc.)

  • Trainings for the Workforce: Teach Back Method/Use of Visuals/Need to Know, Motivational Interviewing (promotes successful 2-way communication, the training helps trainees to adopt in interview style that is conducive to making  individuals feel comfortable enough to disclose information that is critical to their care, e.g., low literacy level, disclose reason for not taking medication, other health and health literacy needs)

The Finger Lakes PPS understands that in order to improve health literacy and health outcomes training the workforce and ensuring health literacy practices are operationalized in organizations will not be enough. The patients/consumers must also receive education and training. Education promotes awareness and awareness promotes empowerment. The Finger Lakes PPS has a Cultural Competence Health Literacy (CC/HL) committee that was established in 2014. There are 25 members from various health and community-based organizations and two patient/consumer representatives.  We will use the input from our patient/consumer representatives, the other members of the CC/HL committee and our partner organizations to determine the best way to implement the curriculum developed for the patients/consumers in our region. We have also conducted community forums and patient focus groups to gain insight into the needs of patients/consumers and found communication to be one of the most significant challenges.

Say Ah!: What are the top three lessons you have learned working in health literacy that you would pass along?

Juanita: (1) Staff, especially those working directly with patients should receive ongoing and up-to-date training in health literacy.  Clinicians and other staff should be familiar with the various tools and methods that promote health literacy and 2-way communication.

(2) Every patient should have access to interpreting services if needed but because of the expense associated with the service this does not always take place. More should be done in this area to support health care and non-health care providers to ensure that they are able to offer interpreting and other language access services to their patient/consumer population.  Using family, friends and untrained staff is not appropriate.

(3) Workflows should be designed to support health literacy practices. Physicians have limited time with the patient so other members of the medical team should be trained on health literacy practices and these practices should be incorporated into the workflow to maximize efficiency and ensure that health literacy practices are taking place.

About Juanita Lyde

Juanita Lyde, M.S., is the project manager for cultural competency and health literacy at the Finger Lakes Performing Provider System. She has over 15-years of experience working with low-income, at-risk and vulnerable populations and managing programs and services for healthcare and community based organizations.

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