1. Health literacy and patient safety: Help patients understand Removing barriers to better, safer care

2. Today’s objectives Define the problem Define the problem Compare Taiwan experience with US Compare Taiwan experience with US Barriers faced by patients Barriers faced by patients Improve communication skills Improve communication skills Create a shame-free environment Create a shame-free environment

3. Health Literacy Refers to the ability of individuals to access and use health information to make appropriate health decisions and maintain basic health

4. World Health Organization Worldwide problem and a global challenge for the 21 st Century Major determinant of health outcome Calls on all countries to implement strategies to improve health literacy

5. Taiwan’s Experience Health literacy, health status, and healthcare utilization of Taiwanese adults: results from a national survey - 2008 Mandarin Health Literacy Scale 1493 adults surveyed in 2008 50 questions (health and numeracy) Approximately 30% - Low HL Total Population: 23+ Million LHL Population: 7 Million

6. Mandarin Health Literacy Survey -2008

7. Taiwan Study Findings Patients asked to self-rate health Low HL skills = poor mental health & good physical health Good HL skills= general health rated good

8. Taiwan Study Findings No correlation between health literacy and healthcare system use No apparent increased use of ER No health system access issues so all patients receive timely care Questioned the impact of LHL patients when universal access to health care available

9. America’s Experience National Literacy Survey – 2003 Every 10 years 19,000 surveyed Tested Health, Prose, Document, Numeracy 36% - inadequate HL Total Population: 310+ Million IHL Population: 93 Million

10. 2003 National Literacy Survey

11. 2003 National Adult Literacy Survey

12. Sample Health Question Use the 1980 World Almanac to copy 3 food sources that contain Vitamin E

13. Low Health Literacy in America Expense ($50+ Billion)Expense ($50+ Billion) Poor health outcomesPoor health outcomes Mistakes and MisunderstandingsMistakes and Misunderstandings Excess hospitalizationsExcess hospitalizations LawsuitsLawsuits

14. Patients with Low Literacy More Likely to be Hospitalized Baker, Parker, Williams, et al. JGIM 1999

15. Predictors of health literacy Predictors of health literacy Education level Education level Socio-economic level Socio-economic level Age Age Geographic location Geographic location Race/ethnicity Race/ethnicity Cognitive ability Cognitive ability

16. Research also shows that: Health literacy is the single best predictor of health status Health literacy is the single best predictor of health status It is a stronger predictor than age, income, employment status, education level, or racial and ethnic group It is a stronger predictor than age, income, employment status, education level, or racial and ethnic group

17. VIDEO

19. Healthcare Mine Field Forms (registration, insurance) Questionnaires Appointment instructions Prescriptions

20. Recognizing the Signs Incomplete registration forms Incomplete registration forms Frequently missed appointments Frequently missed appointments Follow through on tests or referrals Follow through on tests or referrals Non-compliant with medications Non-compliant with medications Unable to explain medication usageUnable to explain medication usage Not getting the desired response from medications or treatments Not getting the desired response from medications or treatments Behavioral cover-ups Behavioral cover-ups

21. Strategies to improve COMMUNICATION

22. 1. Create Shame Free Culture 1. Create Shame Free Culture Patient-Centered Visits Patient-Centered Visits Team approach Team approach Make a good first impression Make a good first impression Staff call patient by name Staff call patient by name Respectful, caring Respectful, caring A helpful attitude by all providers/staff A helpful attitude by all providers/staff Help patients with forms Help patients with forms ** Treat all patients as if they are your parents.

23. The Shame of Low Literacy

24. 2. Improve your communication skills Plain language Focus on key messages and repeat Use visual aids Use teach back technique

25. 3. Provide patient friendly written materials Brochures Pre-op instructions Self care instructions Maps to appointments Medication use guide

26. System Caused Barriers

27. TIME !!!

28. System Strains – “The Reality” Insufficient staffing levels for volume Poor Fee for Service Reimbursements Historical expectations for service from payer/government Low patient expectations

29. Ask-Me-3 questions What is my main problem ? What is my main problem ? What do I need to do (about the problem)? What do I need to do (about the problem)? Why is it important for me to do this? Why is it important for me to do this?

30. “Xie Xie”