As the coordinator of patient education with University of Colorado Hospital, Monique McCollum, RN, MPH, knows a thing or two about the language of health care.
That’s not only the product of her schooling and years in the field. McCollum’s father died of cancer at age 49, leaving her at 16 to serve as interpreter for her French mother. None of that experience prepared McCollum years later for the challenge of securing mental health services for one of her adopted sons.
She suddenly found herself dealing with complex Medicaid rules and regulations and struggling to get her son help in a world that sharply limits care for individuals with mental health issues.
“I had to fight for services,” McCollum said.
Coming together. That experience and others led McCollum to investigate ways to arm patients with the skills and knowledge to negotiate the often bewildering health care system. After attending a health literacy conference in Nebraska two years ago, she returned to UCH “charged up” to create change. She joined with Shelby Chapman, health literacy program manager at Children’s Hospital Colorado, to form the Colorado Health Literacy Coalition, which now includes more than a dozen representatives from other hospitals and health care organizations.
The work led to the first annual Colorado Health Literacy Conference, which drew nearly 200 people to the Bruce Schroffel Conference Center at UCH on Oct. 2. The event was sponsored by UCHealth, Children’s Colorado, and the CU Health Sciences Library. Saint Joseph Hospital, the Colorado Hospital Association, and the Spring Institute for Intercultural Learning were co-sponsors.
Mary Mancuso, patient education development assistant, and Amy Searls, executive director of the hospital’s Service Excellence team, also played key roles in preparing for and staging the event. McCollum said the coalition members are now discussing how to build on the success.
Making a connection. The conference featured a pair of keynote speakers and a variety of breakout sessions. All of them focused on what Jeff Glasheen, MD, chief quality officer for UCH, called in his welcoming statement “a topic of resounding interest” that goes to the root of effective health care delivery – that is, the responsibility of health care providers to do everything possible to ensure that patients understand the information they receive and that their concerns are listened to and addressed.
“We need to equip people in the hospital to recognize from the patient’s side how difficult that can be,” McCollum said. “Much of the frustration and anger we see from patients stem from a lack of understanding, combined with fear.”
McCollum acknowledged that it can be challenging for busy health care providers to take the extra time with patients to explain complex information in plain language and to elicit questions from them. But it’s worth the effort, she said.
“In the long run, taking that time could help to reduce hospital readmissions and make our interactions with patients more satisfying and empowering for all of us,” McCollum said. What might appear to be resistance by patients to, say, taking medications, might also be overcome with extra effort and explanation, she added.
“We can be quick to label patients as ‘non-compliant,’ but chances are they don’t understand what we are telling them or understand the value of the care we provide,” she said.
What’s in a word? “It takes a lifetime to become fluent in the ‘hows’ and ‘whys’ that are part of the conversations of health care,” noted Helen Osborne, founder of Health Literacy Month, and one of the conference’s keynote speakers. Terms that are second nature to health care providers can fill a patient with fear, she noted.
To illustrate, she asked the audience to think of the possible meanings of the word “positive.” Most answers suggested good things, such as “encouraging.” Then Osborne said the word as it is often used in the health care setting, such as to inform a woman that her breast biopsy result was positive.
“Those of us in health care often speak a whole other language than those who are ill or injured,” Osborne said. She encouraged providers to “create a welcoming and supportive environment” that encourages patients to “think, disagree, and ask questions.”
Listening post. The core of any supportive environment is listening, said Mike Hess, founder of the Blind Institute of Technology (BIT), the conference’s second keynote speaker. Hess, who lost much of his eyesight at an early age, established BIT as a nonprofit staffing agency to reduce what he called “an epidemic of unemployment” among the vision-impaired.
Countering the notion that the loss of vision is a handicap, Hess told the audience while “the eyes dominate conversation,” they also create distraction and “a noisy brain.” Without eyesight, Hess said, he has trained himself to use his other senses, especially his hearing. “By using more than one sense, our retention and recall can increase exponentially,” he said, noting that neuroscience supports that idea.
Hess illustrated this point by asking the audience to put on blinders. He then played a short video in which a man without arms or legs reeled off a series of facts. When Hess asked the audience to recall the facts, most were able to do so without hesitation. The main reason for that, he said, is that they weren’t distracted by his physical features.
“When you put blinders on, you can truly listen to what is being said,” Hess said in a phone interview.
Health care providers can use simple techniques to bolster their understanding of their patients, Hess said. For example, simply closing one’s eyes during a phone conversation can block the distractions like computers, cell phones, and pads of paper for doodling. Rephrasing the words of the patient is another effective communication tool.
“That makes the patient truly know you are trying to understand what is being said, and you can catch misunderstandings right away,” Hess said.
Hess acknowledged it’s not a great idea for providers to close their eyes during face-to-face conversations with patients. But they can still create connections with patients by committing to listening intently and without distractions, then simply checking periodically with the patient to confirm understanding.
A larger challenge to communication, in Hess’s view, is society’s heavy reliance on technology and the multitasking that it enables.
“No matter how smart we think we are,” he said, “it’s very difficult to concentrate on more than one item at a time. Yet we’re always going in different directions, and keeping 16 plates spinning. When it’s time to physically stop and listen to another person, it’s almost contrary to what our bodies have become used to.”
With a successful first conference in the rearview mirror, McCollum and her coalition colleagues are pondering how to use the insights of Hess and many others to improve health literacy in many segments of society. To illustrate the challenge, she noted the attendance at the conference of Sarah Coleman, a nurse with a teaching certificate on special assignment with Aurora Public Schools. Coleman is responsible for teaching sex education using medically correct, culturally sensitive, age-appropriate terminology.
“Using medically correct terminology might be the easiest part of that assignment,” McCollum said.
Bringing people like Coleman together with the Colorado Health Literary Coalition could help to meet that challenge and many others, she added.
“In the audience there were plenty of people tasked with pieces of health literacy,” McCollum said. “If we can be a guiding organization, that would be great.”