Organizational Health Literacy: Quality Improvement Measures with Expert Consensus

Abstract

Background: Organizational health literacy (OHL) is the degree to which health care organizations implement strategies to make it easier for patients to understand health information, navigate the health care system, engage in the health care process, and manage their health. Although resources exist to guide OHL-related quality improvement (QI) initiatives, little work has been done to establish measures that organizations can use to monitor their improvement efforts. Objective: We sought to identify and evaluate existing OHL-related QI measures. To complement prior efforts to develop measures based on patient-reported data, we sought to identify measures computed from clinical, administrative, QI, or staff-reported data. Our goal was to develop a set of measures that experts agree are valuable for informing OHL-related QI activities. Methods: We used four methods to identify relevant measures computed from clinical, administrative, QI, or staff-reported data. We convened a Technical Expert Panel, published a request for measures, conducted a literature review, and interviewed 20 organizations working to improve OHL. From the comprehensive list of measures identified, we selected a set of high-priority measures for review by a second expert panel. Using a modified Delphi review process, panelists rated measures on four evaluation criteria, participated in a teleconference to discuss areas of disagreement among panelists, and rerated all measures. Key Results: Across all methods, we identified 233 measures. Seventy measures underwent Delphi Panel review. For 22 measures, there was consensus among panelists that the measures were useful, meaningful, feasible, and had face validity. Five additional measures received strong ratings for usefulness, meaningfulness, and face validity, but failed to show consensus among panelists regarding feasibility. Conclusions: We identified OHL-related QI measures that have the support of experts in the field. Although additional measure development and testing is recommended, the Consensus OHL QI Measures are appropriate for immediate use. [ HLRP: Health Literacy Research and Practice . 2019;3(2):e127–e146.] Plain Language Summary: The health care system is complex. Health care organizations can make things easier for patients by making changes to improve communication and to help patients find their way around, become engaged in the health care process, and manage their health. We identify 22 measures that organizations can use to monitor their efforts to improve communication with and support for patients.

Which criteria characterize a health literate health care organization? – a scoping review on organizational health literacy

“… 13 experts (13 health org.) Brega et al, 2019, USA [ 88 ] Journal article (Delphi std.) 18 experts (20 org.…”

“…Engagement & support of service users 55 5.1 Consultation & engagement of service users 30 5.2 Support for self-management 18 5.3 Family & caregivers 7 6. Information & qualification of staff 39 6.1 Organizational and individual health literacy of staff 19 6.2 Communication techniques 16 6.3 Professional development 4 Total number of criteria (including four duplicates) 494 60 records screened [ 1 , 2 , 10 , 12 , 17 – 19 , 22 – 26 , 29 , 47 – 52 , 54 – 94 ]; 30 unique sets of criteria [ 1 , 2 , 12 , 17 , 19 , 24 , 29 , 30 , 48 , 49 , 55 – 57 , 59 , 62 , 65 , 67 , 69 – 71 , 76 , 77 , 87 , 88 , 93 – 98 ] …”

“… 60 records screened [ 1 , 2 , 10 , 12 , 17 – 19 , 22 – 26 , 29 , 47 – 52 , 54 – 94 ]; 30 unique sets of criteria [ 1 , 2 , 12 , 17 , 19 , 24 , 29 , 30 , 48 , 49 , 55 – 57 , 59 , 62 , 65 , 67 , 69 – 71 , 76 , 77 , 87 , 88 , 93 – 98 ] …”

Cancer Screening and Prevention in Lesbian, Gay, Bisexual, and Transgendered Community and Asian Lesbian, Gay, Bisexual, and Transgendered Members

“…reports 22 quality improvement measures that can improve organizational literacy which are likely to improve screening, immunizations, and positive behavior changes. [35]…”

Special Supplement: Health Literacy and Adult Basic Education

“…Over the past few years, the field of health literacy appears to have shifted focus somewhat to promoting the attributes of health organizations that help ameliorate health literacy barriers (Brega et al, 2019). This is an important evolution in the field, but such organizational improvements need not forestall efforts to advance partnerships with ABE.…”