Say Ah! is celebrating Health Literacy Month with an interview and discussion series on the Ten Attributes of Health Literate Health Care Organizations. Below you will find the third interview of the series. This interview is meant both to inform and spark discussion. Please feel free to comment, question or contribute! Thank you!

Week 3’s Attribute: A Health Literate Health Care Organization Prepares the Workforce to be Health Literate and Monitors Progress.

We emailed Migna Taveras, Director of Cultural Competency and Health Literacy at Advocate Community Providers (ACP), to find out how ACP ensures a health literate workforce. 

Say Ah!: Even before you prepare your workforce to be health literate, how does health literacy factor into your hiring process both for patient facing – and non-patient facing – positions?

Migna: For all our positions, we look to recruit individuals who reflect our populations and understand the communities that we serve.  For example, many of the patients cared for by physicians in our network are Spanish-speaking Latinos, and that is reflected in our workforce in both patient and non-patient facing positions.  We recently hired two multi-lingual individuals who have both provider and patient-facing responsibilities to assist in supporting doctors from the South Asian community; our staff speaks Urdu, Bengali, Punjabi, and Hindi, the languages most widely spoken by patients in those practices.These staff members are key to facilitating collaboration within the South Asian communities and to further connect our local doctors to the greater community.

Say Ah!: What kind of health literacy training have you found to be effective and why? What have you tried that has not worked?

Migna: We like to use as many modes of communication as possible because people learn in different ways.  By offering learning opportunities in-person through workshops with applied practice, providing online resources to support learning, and hands-on-training, we find that people are better able to retain the information longer than just one-time activities.  By creating an online community, where Cultural Competency and Health Literacy issues can be raised via ticklers, videos, and animations, we will be able to more readily increase awareness and reinforce learning throughout the network.

Say Ah!: What have been your successes and challenges in establishing a “culture in which everyone works toward the unified goal of promoting successful communication.”

Migna: We train our doctors to use the “Teach Back” method in their clinical interactions to promote patient understanding.  We also train providers to encourage patients to ask questions. Through our direct patient interactions, we promote the “Ask Me 3” model for clear and concise communications.  This very week we are hosting remote trainings for our providers and practice staff on these tools and arming them with tool kits to enhance the patient experience within their practices.

About Migna Taveras
Migna focuses on improving communications between physicians and patients to promote understanding across ACP’s network of physicians, partners, and collaborators.  By promoting patient understanding, patients become empowered to learn healthy lifestyles which improves health and wellness; a fundamental key to transforming avoidable emergency room visits.

With 15 years of experience successfully managing and devising strategic public policy agendas and government affairs programs to produce positive results, Migna has served as an advisor to impactful leaders locally and nationally.  She has assisted in negotiating New York City’s $70-billion-dollar budget, managing appropriations programs for three NYC councilmembers, and generated over $20 million in revenues for the New York City Housing Authority including a small $50,000 multi-year grant from a private foundation to fund literacy programs in Harlem.

Migna currently serves as an adjunct professor in Health Education at the Borough of Manhattan Community College.  She is a Barnard graduate with a Bachelor of Arts in Political Science and Sociology, and a Masters in Advanced Management and Finance from Columbia University’s School of International and Public Affairs.

Say Ah! is celebrating Health Literacy Month with an interview and discussion series on the Ten Attributes of Health Literate Health Care Organizations. Below you will find the second interview of the series. This interview is meant both to inform and spark discussion. Please feel free to comment, question or contribute! Thank you!

Week 2, Attribute 2: A Health Literate Health Care Organization Integrates Health Literacy into Planning, Evaluation Measures, Patient Safety, and Quality Improvement.

We caught up with Melissa Davey, Social Marketing & Community Engagement Coordinator, to find out how the Adirondack Health Institute (AHI) operationalizes health literacy.

Say Ah!: In what areas does AHI excel in integrating health literacy into its planning, evaluation measures, patient safety and quality improvement – and in what areas would it like to improve?

Melissa: Our strengths in this arena include our strategy and vision for increasing awareness and implementation of best practices to promote health literacy in our service area, as well as internally.  Our cultural competency and health training and education strategy for partner organizations is robust and multifaceted.  AHI has begun to reassess community education materials being distributed at community events, local peer advocacy groups, and advertisements in the media. We are extremely considerate of low health literacy needs that occur in the population we serve and tailor our communication materials as such. Incorporating health literacy into planning events and these materials has definitely been a top priority of ours. We could use improvement in internal processes related to health literacy, and engagement of physicians/clinical providers in health literacy initiatives.

Say Ah!. How do you assess the health literacy of AHI?

Melissa: Internally, AHI is currently evaluating our own health literacy through a Cultural Competency and Health Literacy Task Force. Using a standardized tool, we will begin to internally assess our organizational levels of health literacy and cultural competence.  The standardized assessments incorporates frameworks from both the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS standards) and 10 Attributes of a Health Literate Health Care Organization.

Say Ah!: In terms of patient safety and quality improvements, what has been your experience good and bad with implementing health literacy best practices for effective communication?

Melissa: While AHI doesn’t work directly with patients, as an organization we have worked hard in the past year to speak to the importance of health literacy best practices to our partners. Health literacy and effective communication work hand-in-hand and can really be tied to so many positive outcomes for patients and communities as a whole. While it may be time consuming to look through materials, website content and flyers, we have communicated that for our partners to achieve the outcomes they desire, doing so is a necessary step. The only “bad” we have experienced is some resistance to achieving ‘buy in’ to the concept of health literacy and its importance.  We often hear from provider organizations especially that they do not have time to attend health literacy trainings, assess their organizational health literacy, or adopt/implement interventions and practices to promote health literacy amongst their patient population.

Melissa Davey is the Social Marketing & Community Engagement Coordinator at AHI. In addition, Melissa is the project lead for the Cultural Competency and Health Literacy (CCHL) workstream. She coordinates all aspects of CCHL training from material development to marketing and public relations. She has developed a strong enthusiasm for this impactful work.

Say Ah! is celebrating Health Literacy Month by launching an interview and discussion series on the Ten Attributes of Health Literate Health Care Organizations.

We are kicking off the series with Celina Ramsey, MShc, Director of Health Literacy, Diversity and Outreach for Staten Island Performing Provider System, to learn more about the first attribute: Leadership that makes health literacy integral to its mission, structure, and operations.

Say Ah!: It is still unusual for leadership to prioritize and emphasize health literacy, yet Staten Island Performing Provider System (SI PPS) does this. Can you tell us about how the leadership came to see the importance of health literacy?

Celina: At Staten Island PPS, Health Literacy is integral to the foundation of our DSRIP work and mission. NY State’s DSRIP initiative was bold in dedicating an entire ‘workstream’ to health literacy and cultural competency (CCHL), mandating each of the 25 PPSs work on health literacy initiatives. One of our parent hospitals, Staten Island University Hospital, had a robust internal Health Literacy program focused on increasing provider awareness through training and promoting plain language patient education and health communication. The island had a Health Literacy Collaborative dedicated to integrating health literacy health education into adult ed programs run by local community based organizations across the borough.  

SI PPS leadership valued these existing partnerships and sought to expand them, knowing that improving health communication and community health literacy would increase quality and health outcomes for those in our community.

Say Ah!: How was health literacy ‘baked’ into the structures of SI PPS at the beginning?

Celina: Health Literacy is integrated into all facets of our work- from the 11 projects to all population health initiatives and trainings. Health Literacy is a priority for everyone on our team- from our Executive Director to our project managers- and they can certainly walk-the-talk. We’ve had a solid group of CCHL ‘Site Champions’ from each of our partner sites working together to bring resources, training and support back to their organizations. We’ve coined 2017 as the ‘Year of Health Literacy’ and are working with each partner site to implement a compilation of the 10 Attributes and AHRQ’s Universal Precautions Toolkit to support our journey to becoming more health literate healthcare organizations.

At SI PPS, we understand that improvements to policy and provider communication isn’t a total solution for addressing health literacy needs. Community Health Literacy is also a priority for us- we are working with the New York Public Library and other CBO’s on Staten Island to bring Health Literacy programming to their constituents, helping to increase skills and knowledge through health education.

Say Ah!: Can you give us some examples of how the leadership has supported health literacy, in terms of allocating resources (human and financial), integrating it into systems/processes, sets goals, and establishes accountability and evaluation procedures?

Celina: Leadership has supported health literacy with human and financial resources. We have a Director of Health Literacy, Diversity and Outreach with years of experience implementing both organizational and community health literacy initiatives who oversees these programs for Staten Island PPS. We’ve allocated funding for health literacy training for all partner employees, especially for providers, frontline staff, community health workers and health coaches and are financially supporting the community health literacy program.

All NY PPSs are now measured and paid based on performance measure outcomes (pay for performance). SI PPS acknowledges that there are 16 measures impacted by health literacy which are tied to millions of at-risk dollars*. We are using these performance measures and a set of key performance indicators to track and measure partner performance relating to health literacy improvements. Our Health Literacy workgroup meets monthly and are tasked with integrating health literacy universal precautions at their facility.

*These measures include: potentially preventable ER visits, potentially preventable readmissions, children’s access to primary care (ages 12mos-19 years), discharges with diabetes short term complications, smoking cessation, among others.

About Celina Ramsey, MShc:

Celina is an advocate for improving health communication and sharing health knowledge. She combines her love for teaching with her passion for balancing social injustices while working on the Cultural Competency and Health Literacy (CCHL) workstream at SI PPS. Celina oversees engagement with Community Based Organization partners, assists with Communications and Marketing and works on the Healthy Neighborhood project. She is currently a lead for the DSRIP NYS CCHL committee and is proud to support this important work.

Celina completed her Master Of Science in Health Communication from Boston University. She comes to the PPS with over 10 years experience teaching Health Literacy and English as a second language, and previously developed and implemented innovative programs for language access, medical interpreting, health literacy, diversity and inclusion and LGBTQ healthcare equality.