1. The System Telana Fairchild
As a class we have developed knowledge about health literacy and now we can start developing opinions about what affects health literacy. Today, I want to share with you the facts that support my opinion. The factors of the system affect health communication.

2. The System
The factors of the health care system causes challenges with the health care communication.
Our system much like health literacy is multifaceted and to expect patients to understand and respond appropriately through this cob web while they are suffering from illness, emotions and lack of resources is a bit too much. It is time to move the blame off the patient onto the system.
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According to the 2003 National Assessment of Adult Literacy survey shows that just 12 percent of Americans are proficient in completing tasks considered essential to successfully navigating the health system and acting on health information. Let’s think about the 12 percent, which may not even include all the health care providers in the sample. So if our system is even difficult for those who are educated about health care, then here lies the problem and it has nothing to do with a patient’s literacy level. Now, the factors that make our health care system complicated. First, navigation of the system and I’m not just talking about the layout, maps, entrances I’m including understanding when to call or see PCP vs. ER, when a specialist may be needed and how to get in to see specialist, or when ancillary care is need and how to have those services provided. Second factor are the resources. I imagine that even 12 percent don’t know all the resources they have available to help their health. There is what seems like an unlimited amount of resources available, including but not limited to physical/occupational/speech therapy, housing assistance, transportation, pharmaceutical deliveries, and the list goes on. Third and most important is the communication. The system communicates with the patients in multiple ways, verbally, visually, prose, numeracy, electronically, etc.

3. Care Model System Health Outcome AHRQ Toolkit Patient Navigation
The framework, Care Model exemplifies a system approach to health that could maximize patient engagement and improved health care outcomes. This model is centered on the fact the health care system develops leadership, a culture, and mechanism which lead to safe, high quality care. This model promotes clinical care based on scientific evidence and patient-centeredness. Finally, the Care Model calls for health care organizations to forge partnerships within its community to provide resources that can help meet patients’ needs. Let me help break this down in to those factors I mentioned previously. The Care Model has integrated tools from the 2010 Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit that will cause system changes. The tool kit suggests developing a team with a leader and reviewing the navigation of your system by use of Rudd’s evaluation, The Health Literacy Environment of Hospitals and Health. Then, correct areas of issue found with the evaluation and this will improve the ability of a patient to navigate the system. Second, is the communication portion which the tool kit spends a lot of time and effort because as I mentioned it is the most important for success. Use of the brown bag, teach back, decision support are just a few options from the tool kit list that will help the communication between system and patient. Let’s face it; it is our problem and our responsibility to make sure the “consumer”, our patients, understands what we are communicating to them. Next, the tool kit suggests we, “the system”, need to develop partnership with community resources in order to be able to refer our patients to the help they need to improve their health. So, you see the system is the problem because we are the gear that turns the patient and the health outcome. Now, let’s take this toolkit, repair and grease our gear, “the system”, and get the patient‘s in gear to improve health outcomes.
Partnership
Communication
AHRQ Toolkit
Resources

4. Don’t Blame the Patient
I have diabetes. I’m going to lose my toes, feet, legs. Oh no, I better get my will written. I just received a death sentence.
Chronic Illness
DM, HTN, CAD, COPD, CHF
Transportation
How to I get to my appointments when I can’t drive and I don’t have any family close by?
Navigation
“I need to see my heart doctor.”
“Cardio-what?”
The opposing thought is the patient factors affect health outcome, but as I’ve shared with you the system affects the patient and their outcomes. Remember only 12 percent of the Americans surveyed can proficiently navigate the system and act on health information. They will say that patient literacy is one of the contributing factors to affect health care outcomes. I challenge them to think what if the system changed their communication so that literacy has no effect, then it doesn’t matter what literacy level a patient has. Also, they will say the impact of stress and emotions affects health communication. I would agree, but there is no change a patient can make quickly enough to change the outcome. This is why if the system change, ensuring the patients are supported with their decisions, understands the information, and has the control to act on the best option for them. They may also say that limiting factors such as income, transportation, assistance i.e. “resources” are factors affecting health outcomes. Again, I would have to agree but patients may not have the awareness of available resources or know how to illicit these resources which prove my point that the system needs to be the gear to help. Though we may agree on similar factors I believe the system has the largest impact and if the system is changed it won’t matter what factors the patients have because they will be corrected through the improved system.

5. SYSTEM SYSTEM SYSTEM Partnership with resources Better communication
In closing, if system navigation, communication, and partnership with resources are improved the patients no matter literacy level, emotional status, socioeconomic status will be able to have a successful encounter and be able to proficiently act on health information and improve their health outcomes. If the gear analogy doesn’t work for you perhaps a similar concept might, the trickle-down effect. If we can change the system factors we can have this trickle-down effect and cause growth among the patient and health care outcomes. I’m trying to convey the system is like a culture, a culture is inclusive. Improve the culture “the system” and everyone within the culture “our patients” will benefit “have better outcomes”. Also, changing the system takes away demands on the patient, and don’t the patients already have enough to worry about I mean it is their health that is affected.
Better navigation
PATIENTS
OUTCOMES
PATIENTS
OUTCOMES
PATIENTS
OUTCOMES
PATIENTS

6. References
Koh, H.K., Brach, C., Harris, L.M., & Parchman, M.L. (2013). A proposed ‘health literate care model' would constitute a systems approach to improving patients' engagement in care. Health Affairs, 32 (2), doi: /hlthaff
Passche-Orlow, M.K., Schillinger, D., Greene, S.M., & Wagner, E.H. (2006). How health care systems can begin to address the challenge of limited literacy. Journal of General Internal Medicine, 21, doi: /j x
United States Department of Health and Human Services: Agency for Healthcare Research and Quality. (2010). Health literacy universal precautions toolkit. AHRQ Publication No EF. Retrieved from