Rice takes steps to narrow literacy gap

WILLMAR -- The old brochure for Rice Memorial Hospital's cardiac health and rehabilitation service used multi-syllable words and phrases such as "angioplasty" and "cardiovascular efficiency."

The new brochure uses simpler language -- "high cholesterol," for instance, instead of "abnormal lipid levels."

No longer do patients need at least a high school-level reading ability to understand it; it's readable to anyone with fifth- or sixth-grade reading skills.

Revising its written handouts for patients is one of the strategies the city-owned hospital is taking as it reaches out to patients and families with limited literacy.

"It's really changed the whole fabric of Rice Hospital and how we do things," said Maureen Ideker, chief nursing officer.

Literacy, long overlooked in health care, is finally emerging from the shadows.

As many as 40 percent of Americans have trouble reading. The implications go far beyond their ability to read a magazine or decipher a bus schedule.

They might not be able to understand the labels on their pill bottles, or fill out forms, or know when and where to show up for a doctor's appointment.

At a time when patients are being asked to take ever greater responsibility for managing their health care, health literacy -- the ability to read, understand and act on health information -- is more critical.

There's a cost to low health literacy: These patients are at greater risk of mistakes in their medication or treatment. They're at higher risk of being hospitalized and they tend to stay in the hospital longer.

Increasingly, hospitals are becoming aware of the literacy gap and taking steps to narrow it, said Pat Berg, director of outreach and community relations at Rice Hospital.

"It's something that is being discussed in a lot of arenas," she said.

Rice Hospital launched a formal approach to the issue last year, with the formation of a steering committee to tackle literacy hospital-wide.

"It really was an effort to pull all our resources together and become more focused," Berg said.

It's a huge task, Ideker said.

"Eventually we'll need to permeate the whole organization," she said. "It's ongoing work. To catch up is going to take some time."

To start with, the hospital is addressing the printed material that's handed out to patients.

Is it easy to read? Does it use living-room language?

It's now hospital policy for written materials -- such as patient brochures and post-surgery instructions -- to meet readability standards. A layperson has been added to the hospital's education committee to help review printed material, said Berdelle Ingeman of the Rice education department.

At times it has been eye-opening, she said. "We thought some of our material was understandable and it was not."

Although it might seem the information is being "dumbed down," there can be legal issues at stake, Ingeman said. There have been cases of patients undergoing a surgery or treatment without understanding what was happening to them -- and some courts later have ruled that informed consent wasn't properly obtained.

Even more, the hospital has been working to raise awareness among its staff.

It's easy for health care workers to get into the habit of using technical terms, said Teri Beyer, chief quality officer. "We all understand each other. We're speaking the same language."

To patients and families, however, it's often unfamiliar and intimidating.

"Even if their literacy overall is high, their health literacy may not be," Ideker said.

Furthermore, any patient, regardless of health-care savvy, can have trouble comprehending when he or she is sick, in pain or under stress, she said.

As hospital staff become more sensitized to the patient's perspective, it's starting to change the way they communicate with patients, Ideker said.

"It's been just a huge thing to slow down," she said. "Slow down in the pace you're speaking. Slow down in the amount of information you're trying to give. There's so much verbal information we give."

There's been a more conscious effort to let patients and families know it's OK to ask questions, Beyer said.

"I think the biggest thing is to ask questions. Anytime you feel you don't understand what's been said, ask the question," she said.

Easy-to-read materials have been added to the shelves of the hospital's consumer health library. If patients or family members want to go online, they're directed to Web sites such as Medline Plus, where there's a link to easy-to-read information.

People with poor reading skills often aren't who you think, said Kathy Dillon, director of inpatient care for adult health.

Many of them are well-spoken, and they're often skilled at covering up and compensating for their below-average reading ability, she said. "These are people who you would never guess or never assume."

That's why it's important for hospital staff to have a high awareness of the literacy issue, Dillon said.

"We need to respect that individual coming to our door and where they're at," she said. "It becomes that individual care plan."

It will likely take months -- if not years -- to fully address literacy in the health care setting, Ideker said.

Many materials, such as those for advance directives, contain statutory language and are not easily revised. Change also is needed in nonclinical areas such as hospital billing and payment.

Nationally, there's ongoing research on best practices for reaching out to patients with low literacy, and on the social and emotional components of literacy.

"We'll probably be learning more about that -- what blocks people's learning and ability to listen," Ideker said.

In recent months, Rice Hospital added representatives of the two local medical clinics to its literacy steering committee, to help create continuity between hospital and clinic.

In time, it's hoped that these efforts will begin to pay off, Dillon said.

"People are going to feel better about their care, about their safety," she said. "We may not move mountains, but little things are going to happen that truly improve the understanding for the patient and family."