Featured Guest Bloggers: Andrew Jager, MA & Matthew Wynia, MD, MPH, FACP
- Do patients at your organization understand what doctors tell them?
- Are staff members adequately trained in using plain language with patients?
- Do leaders and policymakers know the range of patients’ literacy levels and so they create an environment in which patients of all levels feel comfortable asking questions?
Do you know the answers to these questions? The truth is, valid data on these issues aren’t easy to gather. Yet knowing the answers to these questions is increasingly urgent to practitioners and leaders in health care organizations.
In the Institute of Medicine’s landmark report, Crossing the Quality Chasm, there is a call for systems to be “designed to serve the needs of patients, and to ensure that they are fully informed, retain control and participate in care delivery whenever possible, and receive care that is respectful of their values and preferences.”
Clinicians are being encouraged to engage patients more in care decisions. And many patients expect this participation, as they should — and often must — to get good outcomes.
But what should organizations do to create an environment in which it’s easier to get patients involved in care decisions?
To help organizations get a handle on these questions, the AMA worked with leaders from hospitals, nursing, patient organizations, purchasers, employers and more to identify a set of practical performance expectations for high-quality communication and care, including factors such as health literacy and patient engagement in decisions. We asked a national panel of experts to come to consensus on what it would mean for a care facility like a hospital to fully support patient engagement in care decisions. To help in this work, we also went out to the field and visited hospitals that were doing an exemplary job, to see what steps they were taking.
These hospitals had programs to help communication-vulnerable populations navigate the health care system, they provided educational and notification materials at appropriate literacy levels, they trained their staff on use of teach-back, and, perhaps most important, they sought out and celebrated staff members who went out of their way to provide clear information to patients.
Our visits to hospitals also showed, however, that even top-performing organizations have opportunities for improvement. This is no surprise given the complexity of issues like shared decision making.
But building a better communication climate requires knowing where to start.
When valid data are collected in a baseline assessment of the communication climate, organizations can then decide where best to invest their resources. Sometimes the data suggest addressing deficient areas; other times it might make more sense to use an appreciative inquiry approach and build on areas of success. One tool for performing such an assessment is the Communication Climate Assessment Toolkit, or C-CAT, which was the result of the AMA-led work described earlier in this post.
While we believe the C-CAT is an especially good tool, the point of this post is not to promote it. Rather, the aim is to encourage health care facilities — whether hospitals, clinics, group practices, ACOs or others — to systematically collect data regarding organizational performance and processes, and use these data to work toward the creation of an organizational climate that makes it easier for professionals to consistently deliver high-quality care to all patients, including involving folks in decisions about their own care.
This table at the end of this post lays out some of key consensus performance expectations in the domains of health literacy and patient engagement that came from the AMA’s multi-stakeholder process, along with how these expectations have been translated into the different instruments that make up the C-CAT. You can find all the performance expectations behind the C-CAT measures in our full consensus report, Improving Communication—Improving Care.
Despite the challenges of doing a comprehensive organizational assessment of communication climate, we believe the outcome — improved patient understanding of health information and greater patient empowerment in their health decisions — makes the effort worth it.
About the Authors:
Andrew Jager, MA is a Research Associate at the American Medical Association’s Institute for Ethics. Mr. Jager’s research interests include looking at interventions to improve health care communication and reduce disparities and developing measures of the ethical environment in health care. Additionally, Mr. Jager manages the Communication Climate Assessment Toolkit (C•CAT) program, which provides health organizations with a 360-degree assessment tool for organizational performance on communication that is effective and patient-centered. Mr. Jager has worked on numerous research projects on topics ranging from teen obesity to corporate governance in Latin American and European markets. Mr. Jager is fluent in Portuguese and Spanish and holds an MA in Latin American, Caribbean and Iberian Studies from the University of Wisconsin-Madison and a BA from BeloitCollege.
Matthew Wynia, MD, MPH, FACP, Director, Institute for Ethics & Center for Patient Safety at the American Medical Association is an internist and specialist in infectious diseases. At the American Medical Association, he oversees projects on topics including learning from medical errors, physician professionalism, ethics and epidemics, medicine and the Holocaust, and inequities in health and health care. The author of more than 125 published articles and a book on fairness in health care benefit design, his work has been published in leading medical and health policy journals and he has been a guest on ABC News Nightline, the BBC World Service, NPR and other programs. Dr. Wynia cares for patients at the University of Chicago.
- Do patients at your organization understand what doctors tell them? http://www.ama-assn.org/resources/doc/ethics/patient-survey.pdf
- Are staff members adequately trained in using plain language with patients? http://www.ama-assn.org/resources/doc/ethics/staff-survey.pdf
- Do leaders and policymakers know the range of patients’ literacy levels and do they create an environment in which patients of all levels feel comfortable asking questions? http://www.ama-assn.org/resources/doc/ethics/organization-survey.pdf