Ten Attributes of Health Literate Health Care Organizations

Health literate healthcare organizations make it easier for people to navigate, understand, and use information and services to take care of their health. This page displays the many AHRQ resources that can assist healthcare systems address health literacy and each of 10 attributes of health literate healthcare organizations.

To achieve good health outcomes, people need understandable health information and easy access to health services. The complexity of the health system, however, confuses even those with adequate health literacy, and endangers those with limited health literacy – over one-third of U.S. adults. Healthcare organizations increasingly recognize that delivering safe, patient-centered care requires addressing health literacy. A paper published by members of the National Academies of Science, Engineering, and Medicine’s Roundtable on Health Literacy identifies 10 attributes of health literate organizations. You can access the full paper "Ten Attributes of Health Literate Health Care Organizations."

The Ten Attributes

A health literate healthcare organization:

1. Has leadership that makes health literacy integral to its mission, structure, and operations.
2. Integrates health literacy into planning, evaluation measures, patient safety, and quality improvement.
3. Prepares the workforce to be health literate and monitors progress.
4. Includes populations served in the design, implementation, and evaluation of health information and services.
5. Meets the needs of populations with a range of health literacy skills while avoiding stigmatization.
6. Uses health literacy strategies in interpersonal communications and confirms understanding at all points of contact.
7. Provides easy access to health information and services and navigation assistance.
8. Designs and distributes print, audiovisual, and social media content that is easy to understand and act on.
9. Addresses health literacy in high-risk situations, including care transitions and communications about medicines.
10. Communicates clearly what health plans cover and what individuals will have to pay for services.

1.  Has leadership that makes health literacy integral to its mission, structure, and operations

Being a health literate organization is more than initiating a few projects that address health literacy; it means that health literacy is an organizational value. Health literacy leaders: make it clear that effective communication is a priority across all levels of the organization; cultivate health literacy champions throughout the organization; and set goals for health literacy improvement, provide incentives to achieve those goals, and establish accountability for outcomes at every level of the organization.

AHRQ resources that can help health systems with Attribute #1 include:

• AHRQ's Making Informed Consent an Informed Choice: A Training Module for Health Care Leaders
• Championing Change: Developing and Implementing an Action Plan to Improve Informed Consent (request PowerPoint from Healthliteracy@ahrq.hhs.gov)
• Improving Patient Safety Systems for Patients With Limited English Proficiency: A Guide for Hospitals
• The Importance of Communication for Strong Leadership

2. Integrates health literacy into planning, evaluation measures, patient safety, and quality improvement

Health literate healthcare organizations ensure that health literacy is fully integrated into all of their activities, and that health literacy informs both strategic and operational planning. Appropriate measures to evaluate specific health literacy initiatives are developed and used. In addition, measurement of overall organizational performance assesses success with vulnerable populations such as those with limited health literacy.

AHRQ resources that can help health systems with Attribute #2 include:

• CAHPS^® surveys of patient experience
• CAHPS Item Sets for Addressing Health Literacy
• CAHPS Interpreter Services Item Set
• Consensus Organizational Health Literacy Quality Improvement Measures
• Creating a Health Literacy Quality Plan (includes Primary Care Health Literacy Assessment)
• Guidelines for Translating CAHPS Surveys
• Health Literacy and Patient and Family Engagement: Strategic Tools to Prevent CAUTI
• Pharmacy Health Literacy Assessment Tool
• Strategies for Improving Patient Experience with Ambulatory Care

3. Prepares the workforce to be health literate and monitors progress

Health literate healthcare organizations recognize that everyone, not just clinicians, needs health literacy training – from front and back office staff (e.g., receptionists, billing clerks) to leadership. Health literate organizations set and meet goals for initial and ongoing formal and informal health literacy training for all staff and members of governing bodies.

AHRQ resources that can help health systems with Attribute #3 include:

• “Health Literacy Knowledge Self-Assessment Module” and “Improve Health Literacy Performance Improvement Modules.”  Available from the American Board of Pediatrics, the American Academy of Family Physicians, and OptumHealth Education (moreinfo@optumhealtheducation.com). Contact Healthliteracy@AHRQ.HHS.gov if you would like to host these modules.
• Advancing Pharmacy Health Literacy Practices Through Quality Improvement: Curricular Modules for Faculty
• AHRQ's Making Informed Consent an Informed Choice: Training Modules for Health Care Leaders and Professionals
• Strategies To Improve Communication Between Pharmacy Staff and Patients: Training Program for Pharmacy Staff: Curriculum Guide
• The SHARE Approach (training on shared decision making)

4. Includes populations served in the design, implementation, and evaluation of health information and services

Health literate organizations include members of the populations they serve, especially those with limited health literacy, on governing boards, advisory groups, and design teams. This increases the chances that materials, programs, and services will meet the needs of patients and families.

AHRQ resources that can help health systems with Attribute #4 include:

• A Community Engagement Method to Design Patient Engagement Materials for Cardiovascular Health
• Audience Testing Quality Reports
• EvidenceNOW Tools for Change: Involving Patients in Integrating Evidence (Under Key Driver 5, select: "Involve Patients in Integrating Evidence.")
• Guide for Developing a Community-Based Patient Safety Advisory Council
• Patient and Families as Advisors Implementation Handbook
• Tools for Forming Quality Improvement (QI) Teams that Include Patients

5.  Meets the needs of populations with a range of health literacy skills while avoiding stigmatization.

Health literate organizations simplify all communication to the greatest extent possible and verify comprehension with everyone, because they do not make assumptions about who understands or needs extra assistance. They also “go the extra mile” for individuals who have the greatest difficulty with understanding or navigation.

AHRQ resources that can help health systems with Attribute #5 include:

• Accessible Health Information Technology (IT) for Populations With Limited Literacy: A Guide for Developers and Purchasers of Health IT
• AHRQ Health Literacy Universal Precautions Toolkit
• Designing Consumer Health IT: A Guide for Developers and Systems Designers
• Explicit and Standardized Prescription Medicine Instructions
• Health Literacy Tools for Providers of Medication Therapy Management
• Toolkit to Engage High-Risk Patients In Safe Transitions Across Ambulatory Settings

6. Uses health literacy strategies in interpersonal communications and confirms understanding at all points of contact.

Effective spoken communication between patient and families and healthcare professionals and staff is a cornerstone of health literacy. Health literate healthcare organizations create an environment that promotes and supports the adoption of evidence-based communication strategies, including strategies to be culturally and linguistically competent.

AHRQ resources that can help health systems with Attribute #6 include:

• Building Rapport with Patients: OARS Communication Skills
• Communicate Clearly
• Communicating to Improve Quality
• Consider Culture, Customs, and Beliefs
• Encourage Questions
• Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families
• Integrating Decision Aids into Primary Care: Toolkit
• Questions To Ask Your Doctor and the QuestionBuilder App
• The SHARE Approach (training on shared decision making)
• Use the Teach-Back Method

7. Provides easy access to health information and services and navigation assistance.

Health literate healthcare organizations make it easy to find and understand health information, find the way to and around facilities, and move among healthcare and community providers.

AHRQ resources that can help health systems with Attribute #7 include:

• Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era
• Community Connections: Linking Primary Care Patients to Local Resources for Better Management of Obesity
• Coordinated Care
• Form Primary Care-Community Partnerships to Fill Care Gaps
• Link Patients to Non-Medical Support
• Make Referrals Easy
• OpenNotes from The CAHPS Ambulatory Care Improvement Guide
• The AHRQ Academy Playbook on Integrating Behavioral Health in Primary Care
• Toolkit to Engage High-Risk Patients In Safe Transitions Across Ambulatory Settings
• Warm Handoff Plus

8. Designs and distributes print, audiovisual, and social media content that is easy to understand and act on.

Health literate healthcare organizations establish a process to ensure that all information they distribute – not just educational materials – is clear and effective for their diverse audience, both in terms of health literacy and language.

AHRQ resources that can help health systems with Attribute #8 include:

• Address Language Differences
• Assess, Select, and Create Easy-to-Understand Materials
• Talking Quality: Reporting to Consumers on Health Care Quality (including Guidelines and Other Resources To Fine-tune Your Writing)
• The Patient Education Materials Assessment Tool (PEMAT) (including PEMAT Tool for Audiovisual Materials (PEMAT-A/V))

9. Addresses health literacy in high-risk situations, including care transitions and communications about medicines.

High-risk decisions, situations, and transitions demand more attention to health literacy. Health literate healthcare organizations identify which situations merit heightened safeguards and have standards and processes in place to ensure there is no miscommunication.

AHRQ resources that can help health systems with Attribute #9 include:

• AHRQ's Making Informed Consent an Informed Choice: Training Modules for Health Care Professionals
• Care Transitions From Hospital to Home: IDEAL Discharge Planning
• Communication and Optimal Resolution (CANDOR) Toolkit
• Conduct Brown Bag Medicine Reviews
• Create a Safe Medicine List Together
• Designing and Delivering Whole-Person Transitional Care: The Hospital Guide to Reducing Medicaid Readmissions
• How To Create a My Medicines List
• Improving Medication Safety in High-Risk Medicare Beneficiaries Toolkit
• Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation: High-Risk Situations for Medication Reconciliation
• Poorly Advanced Directives
• The Re-Engineered Discharge (RED) Toolkit
• Toolkit to Engage High-Risk Patients In Safe Transitions Across Ambulatory Settings

10. Communicates clearly what health plans cover and what individuals will have to pay for services.

Before making healthcare decisions, consumers need information about their out-of-pocket costs. Health literate healthcare organizations inform consumers about the costs of care in advance, and refer people to programs that can help make care affordable.

AHRQ resources that can help health systems with Attribute #10 include:

• All-Payer Claims Databases to advance the goal of improving healthcare affordability, efficiency, and cost transparency
• Direct Patients to Medicine Resources
• Price Transparency from The CAHPS Ambulatory Care Improvement Guide