Brach Cindy
Agency for Healthcare Research and Quality.
Stud Health Technol Inform. 2017;240:203-237.
A health literate health care organization is one that makes it easy for people to navigate, understand, and use information and services to take care of their health. This chapter explores the journey that a growing number of organizations are taking to become health literate. Health literacy improvement has increasingly been viewed as a systems issue, one that moves beyond siloed efforts by recognizing that action is required on multiple levels. To help operationalize the shift to a systems perspective, members of the U.S. National Academies of Sciences, Engineering, Medicine Roundtable on Health Literacy defined ten attributes of health literate health care organizations. External factors, such as payment reform in the U.S., have buoyed health literacy as an organizational priority. Health care organizations often begin their journey to become health literate by conducting health literacy organizational assessments, focusing on written and spoken communication, and addressing difficulties in navigating facilities and complex systems. As organizations' efforts mature, health literacy quality improvement efforts give way to transformational activities. These include: the highest levels of the organization embracing health literacy, making strategic plans for initiating and spreading health literate practices, establishing a health literacy workforce and supporting structures, raising health literacy awareness and training staff system-wide, expanding patient and family input, establishing policies, leveraging information technology, monitoring policy compliance, addressing population health, and shifting the culture of the organization. The penultimate section of this chapter highlights the experiences of three organizations that have explicitly set a goal to become health literate: Carolinas Healthcare System (CHS), Intermountain Healthcare, and Northwell Health. These organizations are pioneers that approached health literacy in a systematic fashion, each exemplifying different routes an organization can take to become health literate. CHS provides an example of how, even when the most senior leadership drives the organization to become health literate, continued progress requires constant reinvigoration. At Intermountain Healthcare, the push to become a health literate organization was the natural consequence of organizational adoption of a model of shared accountability that necessitated patient engagement for its success. Northwell Health, on the other hand, provides a model of how a persistent champion can elevate health literacy to become a system priority and how system-wide policies and procedures can advance effective communication across language differences, health literacy, and cultures. The profiles of the three systems make clear that the opportunities for health literacy improvement are vast. Success depends on the presence of a perfect storm of conditions conducive to transformational change. This chapter ends with lessons learned from the experiences of health literacy pioneers that may be useful to organizations embarking on the journey. The journey is long, and there are bumps along the road. Nonetheless, discernable progress has been made. While committed to transformation, organizations seeking to be health literate recognize that it is not a destination you can ever reach. A health literate organization is constantly striving, always knowing that further improvement can be made.
一个具备健康素养的医疗保健机构，是指能让人们轻松获取、理解并利用信息与服务来维护自身健康的机构。本章探讨了越来越多的机构为具备健康素养所经历的过程。健康素养的提升日益被视为一个系统问题，它超越了各自为政的努力，因为认识到需要在多个层面采取行动。为推动向系统视角的转变，美国国家科学院、工程院、医学院健康素养圆桌会议的成员定义了具备健康素养的医疗保健机构的十个特征。诸如美国支付改革等外部因素，已将健康素养提升为机构的一项优先事项。医疗保健机构通常通过开展健康素养组织评估来开启其具备健康素养的征程，评估重点在于书面和口头沟通，并解决在设施和复杂系统中导航的困难。随着机构努力的成熟，健康素养质量改进工作让位于变革活动。这些活动包括：机构高层接受健康素养理念，制定启动和推广具备健康素养实践的战略计划，建立健康素养工作队伍和支持结构，在全系统提高健康素养意识并培训员工，扩大患者和家属的参与度，制定政策，利用信息技术，监测政策合规情况，关注人群健康，以及转变机构文化。本章倒数第二部分重点介绍了三个明确设定具备健康素养目标的机构的经验：卡罗莱纳医疗系统（CHS）、山间医疗保健公司和诺斯韦尔健康。这些机构是先驱，它们以系统的方式对待健康素养，每个机构都例证了机构在迈向具备健康素养过程中可以采取的不同路径。CHS展示了即便最高层领导推动机构具备健康素养，持续进步仍需要不断注入活力的情况。在山间医疗保健公司，推动成为具备健康素养的机构是机构采用共同问责模式的自然结果，而该模式的成功需要患者的参与。另一方面，诺斯韦尔健康提供了一个模式，说明一位坚持不懈的倡导者如何能将健康素养提升为系统优先事项，以及全系统的政策和程序如何能促进跨越语言差异、健康素养水平和文化的有效沟通。这三个系统的简介清楚表明，提升健康素养的机会巨大。成功取决于是否存在有利于变革性变化的完美条件组合。本章最后总结了健康素养先驱者的经验教训，这些经验教训可能对正在踏上这一征程的机构有用。这一征程漫长，途中会有坎坷。尽管如此，但已取得了明显进展。致力于变革的机构在追求具备健康素养时认识到，这不是一个能真正抵达的终点。一个具备健康素养的机构始终在努力，始终明白还能进一步改进。
