Addressing Health Literacy: An Always
Nearly half of all American adults - 90 million people - have
difficulty understanding and using health information, according to
the Institute of Medicine. 1
Low health literacy affects people from all walks of life. Even
many college graduates don't have the health literacy skills needed
to navigate the health system and actively participate in their
care. Holding an MBA does not necessarily mean a person understands
the medical jargon physicians - or nurses - often use. In fact,
well-educated people may be at an even greater disadvantage because
embarrassment about not understanding instructions they think they
should understand may prevent them from asking
The impact of low health literacy on rural hospitals and
Low health literacy can contribute to outmigration as confused
and helpless patients feel their needs aren't being respected or
met. They'll drive a little further, when possible, if the nearest
urban teaching hospital's communication style resonates with them.
Not addressing low health literacy can also lower your HCAHPS
scores and thus, reimbursements. And here's the kicker:
higher rates of hospitalization and avoidable use of emergency
services associated with low health literacy wastes billions of
Does your hospital have room for
Do your patients routinely answer these HCAHPS questions with
- During this hospital stay, how often did doctors treat you with
courtesy and respect?
- During this hospital stay, how often did doctors listen
carefully to you?
- During this hospital stay, how often did doctors explain things
in a way you could understand?
Make effective communication an "Always"
- Teach providers to lose the medical jargon -
Communicating in plain language won't undermine their authority; in
fact, clear communication enhances the perception of value of the
encounter and helps create trust.
- Create an environment free of shame and blame
- It works both ways: caregivers and patients should feel
there are no dumb questions.
- Use the teach-back method - Educate physicians
and staff in this tried-and-true method of testing whether they
have communicated in a way patients understand.
Getting started is easier than it sounds!
There are an overwhelming number of resources out there,
including solid information curated by the NIH. If you're brave
enough and have time to do some heavy reading, look here.
Or, for a quick start, check out these reliable, user-friendly
- The AHRQ Health Literacy Universal Precautions Toolkit has
everything you need to know to assess your current performance on
health literacy issues and begin to make significant changes. Download it for free.
- The "Always use Teach-Back!" training tool kit is a free
interactive online learning module for providers developed by the
University of Iowa, The Picker Institute, Des Moines University and
Health Literacy Iowa. Access it here.
If you are not already aggressively addressing low health
literacy in your community, getting started is not as difficult as
you may think. And it's the right thing to do for hospitals and
Wherever you stand on the Affordable Care Act (ACA), I think we
can all agree that preventive care is in the air. The ACA and
many of its programs, parts and parcels focus on care coordination,
prevention and wellness. That has both employers and health
insurance providers placing greater emphasis on wellness. And
consumers are following suit.
SymphonyIRI (a market research company) found that:
- ¾ of all consumers are trying to eat healthier today to save
money on health care later.
- 30% of all adults (on average) are concerned about weight
- 29% are worried about stress management.
- As people grow older, their health concerns become more focused
on problems associated with aging instead of weight and stress. The
top two health concerns of seniors, aged 68 and older, are:
- Heart-related issues.
OK, so I think we're clear on why your rural hospital
needs to take note of these facts and stats. But that leads to an
even more important question: How can your CAH leverage
these trends? I'll give you some examples:
- Develop a campaign around preventative care, such as mammograms
- Don't waste consumers' time by telling them what it takes to be
healthy and all the reasons it's important. They already know what
and why, and will just tune you out.
- Focus on making it easy and "nonthreatening" for them to take
action, like holding a "Mani and Mammogram" event.
- Offer a farmer's market on your hospital's grounds to increase
physical activity and promote healthy eating.
- Leverage the ACA by partnering with local businesses offering
employee wellness programs.
- Employers know that wellness programs help reduce absenteeism,
employee turnover and insurance premium costs.
- The ACA supports workplace wellness programs, such as those
that provide incentives for attending a weight loss, nutrition or
smoking cessation program.
- Building strong business partnerships can ultimately result in
stronger consumer/patient relationships for your CAH.
- Get involved in the community to promote preventive care. WEPAC Hoops for
Hope Weekend is a great example. Ashland Health Center and
Comanche County Hospital put on an annual event with 90% of the
proceeds going to pay for mammograms, pap smears and colonoscopies
for women in those five small towns.
These health and wellness initiatives can lead to more revenue,
increased volume and stronger patient relationships for your CAH.
That's a fact. I'd be happy to share some proof points with you.
Give me a call or shoot me an email if you'd like a professional
perspective on what your CAH is doing - or could do - to leverage
health and wellness trends in 2014.
Patients want to take a more active role in their healthcare,
sometimes they just don't know how. Improved engagement
not only benefits the patient, but also can lead to increased
satisfaction scores, greater quality and safety and a higher
likelihood of patient compliance. Here are a few ways you can
begin to improve patient engagement:
- Create an environment for shared decision
making. Involving patients in the decision making process,
or making sure their voices are heard will make them feel as though
they are an integral part of the hospital (which they are).
- Develop a powerful patient portal. The world
is going digital, and patients want access to their information
wherever they are, 24/7. A patient portal can give them this access
and improve their overall engagement in their health needs.
- Create a strong web presence. A website can
create the first impression your patients have of your facility and
staff. Having useful and relevant information will frame you as a
- Generate a strong patient feedback program.
Most hospitals have places for patients to give feedback. The key
is what you do with that information.
- Traditional advertising. Though some
traditional advertising, like newspaper or direct mail, may seem
outdated, they actually still have a strong effect on patient
engagement. People want to be affiliated with a respected
organization; traditional advertising can help show patients that
your organization is just that.
Want to learn more? Join the Rural Healthcare Marketer on
April 2 to delve deeper into this topic and see how rural hospitals
across the country are leveraging their marketing efforts to engage
patients and help them be an active partner in their
Wednesday, April 2
12 - 1 p.m. (central time)
Presented by the National Rural Health Association Partnership
According to a Pew Internet Project (2012 survey) related to
health and healthcare, 72% of U.S. Internet users searched online
for health information during the past year. Think of what this
could mean to your hospital if even a fraction of these consumers
looked to your physicians as thought leaders in their fields!
Problem is, one five-letter acronym may keep your docs from
taking advantage of social media. You guessed it: HIPAA.
While that could be the end of the story-it shouldn't
be. Your CAH and its providers can use social media without
breaching patient confidentiality and other HIPAA rules. One way to
do this is to connect with patients collectively-rather than
individually. Here are some tips to keep in mind:
- Keep it general. For example, discuss "healthcare topics in the
news." Providers can share their perspectives, addressing potential
benefits as well as concerns about specific procedures, medical
"break-throughs," medications, etc.
- If a consumer responds with a specific health-related question,
do not answer it using social media. Direct the person
offline, using a standard response to call your office and make an
appointment, or if it's an emergency, call 911 or go to the
- Include a disclaimer that directs consumers to consult with
their physician and that your recommendations are not substitutes
for actual medical assistance.
You might want to check out this video, "The Doctor is Online: Physician Use,
Responsibility and Opportunity in the Time of Social Media." It
includes insights from a pediatric gastroenterologist at Texas
Children's Hospital who blogs at 33Charts, along with several
experienced physicians who are also active in social media. While
it was originally developed for medical students just beginning
their residency program, your CAH and docs can benefit from these
quick tips and guidelines.
Be sure to Like us on Facebook and Follow us on Twitter to learn more about using social
media in healthcare.
"Hospital Consumer Assessment of Health Providers and Systems"
survey (HCAHPS), even the acronym is a mouthful! No wonder
hospitals are in a quandary about how to use HCAHPS survey results
to improve patient satisfaction scores. But quandary or not,
there's little time for debate.
Today, low scores not only threaten your hospital's ability to
gain - or even maintain market share - they can result in a lack of
reimbursement. Under the current value-based purchasing program, a
hospital may even face financial penalties if its scores are too
As your hospital takes steps to attain sustainable
patient-centered excellence, here are some considerations to keep
Know it all: Before you can effectively improve
your HCAPHS scores, you need to "know what you need to know." For
- What are your hospital's strengths and gaps, based on patients'
perception of the care they receive?
- What units are performing at a high, low or mid-range
- What specific, measurable goals (and stretch goals) do you want
to achieve and by what dates?
Communication could be your differentiator: The
better you are at clearly communicating - and listening - to your
patients, the better your chances of receiving a higher score.
- The HCAPHS survey includes several questions related to how
well doctors, nurses and other staff explained things to a patient
and how well they listened to the individual.
- Today, consumers expect to receive safe, quality care from
whatever hospital they choose. No difference there. But … effective
communication could help your CAH stand out from your
Don't overlook key influencers: From the nurses
who provide care to patients every day of their stay to the
environmental service workers who clean patients' rooms - frontline
employees are integral to the patient experience. Be sure to:
- Share survey results with frontline staff. This will help them
understand the importance of their role and align their behavior
with your hospital's patient-centered focus.
- Give credit where credit is due. Positive reinforcement can go
a long way in keeping employees motivated to continue the journey
Above all, don't let the nebulous challenge of "improving
patient satisfaction" overwhelm you. You can start by zoning in on
specific areas and "quick wins." Here's one to get you started:
Some hospitals have found that when doctors sit down to talk
with patients vs. standing, it positively affects a patient's
satisfaction score. This simple nuance gives the impression that
the doctor is less rushed and more focused on the individual
With the advent of digital media, most forms of print
communications have lost their luster as effective forms of
marketing. Or have they?
In today's mobile world, many hospitals have focused their
efforts on Internet and social media marketing. But don't be too
quick to take your eyes off the prize when it comes to "slow
A recent J.
Walter Thompson (JWT) survey indicates that consumers are
beginning to have a greater appreciation for slower, more mindful
communications, i.e., physical mail. In fact:
- 81% of survey respondents agreed that receiving a handwritten
card is more meaningful than an e-card, email or text, even if the
message is the same.
- 78% agreed that physical cards/letters make them feel more
connected to people than digital notes (emails, SMS, etc.).
- 84% said they're excited when they receive a letter or card in
Given these facts, it makes sense to take another look at how
physical mail fits into your 2014 marketing strategy. Consider:
- Handwritten thank-you notes to patients or personalized
invitations to special events, presentations or open houses.
Personal notes can help you distinguish your CAH from larger, more
- Adding a QR code to billing statements or envelopes. Recipients
who scan them can be prompted to call a dedicated phone number to
learn about a new service, view a special video message from a new
- Sending patients and other consumers things they'll want to
hold, touch and keep.
Seven out of 10 JWT survey respondents also said they feel
nostalgia for things from the past. Remember when doctors made
house calls? Evoke a similar one-on-one connection with your
physicians, specialists and other staff through personalized
publications and newsletters.
Direct mail has a unique ability to engage, inform and motivate
consumers. Get creative. Get personal. Blend social with
snail. For example, Kleenex selected Facebook members who had
posted updates about getting sick, acquired their addresses from
friends and surprised them with a hand-delivered care package.
OK, so your marketing budget is far from Kleenex-sized - but
this gives you an idea of how to think outside of the box.
As many of your healthcare competitors continue to
perceive physical mail as a thing of the past, it's your
opportunity to fuse digital with physical - and reap the
You say "snail mail." I say "escargot." It's all about
As competition increases and patient safety becomes even more
critical, hospital executives are literally "making the rounds" to
make sure patient satisfaction is on the upswing. If your
C-suite team and senior managers aren't doing the same, it could be
sending the wrong message to your patients and your staff.
An Executive Rounds Program can help build trust, promote change
and establish meaningful relationships between frontline staff and
top management. When your senior leaders are seen on the
frontlines, they're visibly demonstrating that patient safety is a
top priority - to everyone.
Here are six tips for developing and implementing a program in
- Get everyone on board: Get commitment from
executive leadership as well as the board. Also be sure to inform
all staff of the purpose and process of the "executive rounds
program" so they feel comfortable sharing information with
- Schedule rounds in advance: (e.g., up to six
months) so they are completed on a consistent basis. If a scheduled
round is cancelled, it can give frontline staff the impression that
patient safety is not a priority. Also, try to schedule rounds to
avoid high activity times or shift changes.
- Provide execs with a template: Develop a
template that allows executives to communicate in their own style
but provides a format that helps keep each round/session on
- Document key findings: Create a standard form
for documenting issues and feedback during conversations with
staff. Also consider developing a database that includes feedback
by category, date, time, location and other pertinent information.
This can be used to help track events and follow-up steps.
- Implement a process for timely feedback: This
critical component of the rounds program is often overlooked.
Strategies for communicating feedback could include emails to
individual staff members; thank-you cards for staff who
participated; newsletter articles; monthly departmental reports;
town hall meetings; celebrations to highlight successes related to
the executive rounds program.
- Measure effectiveness: Use evidenced-based
tools to help you measure the effectiveness of your executive
rounds program, e.g., perceptions of management, safety,
willingness to report errors or fear of reporting errors.
Now more than ever, it pays (in the form of patient safety and
satisfaction scores) for executives to see - and be seen - making
I like to keep up on the latest studies and trends in rural
healthcare, even those that are state-specific. My philosophy is,
the more you know - the more you know.
That said, I was reviewing a study by
BlueCross BlueShield of Tennessee Health Institute that
compared the use of rural vs. non-rural healthcare facilities. The
results showed that more than 43 percent of consumers surveyed do
not use the rural hospital closest to them. They prefer to
get care from larger, non-rural hospitals - even when the same
services are available locally.
Even though the study was limited to data from BlueCross
BlueShield of Tennessee's commercial membership, rural hospitals
across the country are experiencing similar challenges. This bodes
the question, "How will your CAH compete in the years ahead?" More
specifically, how will you:
- Differentiate your CAH from bigger hospitals when it comes to
quality of care and treatment options?
- Promote your patient satisfaction scores and other strengths to
- Promote service lines that are as good as - or better than -
larger hospitals in your area?
The common denominator for all of the above is: Brand. So before
you start developing your 2014 marketing plan, take a good hard
look at brand. It may be time to refresh it if:
- It's no longer relevant or outdated - logo, colors, tagline,
- There are inconsistencies in how you brand yourself (e.g.,
different logo used on print materials than on your website).
- Your brand messaging no longer reflects who you are or the
expanded services you offer.
- You're preparing for growth, a merger, partnerships or other
- You're not reaching your target audience. For example, have
demographics changed in the communities you serve? Have you added
service lines that target a broader or different audience?
Only after careful review can you determine if it makes sense to
refresh - or stand with your brand.
There's good news for men with benign prostatic hyperplasia
(BPH). For those of us who are not trained medical professionals -
that's an enlarged prostate, which can lead to frequent urination
or urination retention.
Recent data presented at the American Urological Association
(AUA) Annual Meeting indicate that treatment for BPH with
GreenLight™ laser therapy, instead of transurethral resection of
the prostate (TURP), "results in significantly shorter
hospitalization, catheterization, and recovery times for patients,
while maintaining equivalent safety and efficacy."
That's great news for the millions of men suffering from BPH.
But what does it mean for your rural hospital? OPPORTUNITY - but
you have to give your marketing team the green light to be creative
with this one.
Let's face it, BPH can be embarrassing - even scary - for most
men to talk about. So whatever you do, make them feel comfortable.
Develop a marketing campaign that puts prospective patients at ease
so they take the next step.
You might start with direct mail that targets men age 50+. Keep
in mind, we men have a very short attention span, so your message
needs to cut to the chase. Then, give 'em the chance to get answers
- now (we can be impatient, too).
Direct them to an online risk assessment they can complete right
in the privacy of their own man cave. (That's in addition to
encouraging them to talk with their doctor.) Sweeten the deal
by giving them a chance to win some great "guy thing" if they
complete the assessment by a certain date. In other words, get 'em
while they're hot (aka, "logged on and tuned in"). Here's examples
to get your creative juices flowing:
Don't wait to jump on this opportunity. And when I say
"opportunity," I'm talking about an estimated 10 million men who
suffer from BPH. Many of them are over the age of 60.
With an aging rural population, I'd say your rural hospital has
the green light to start marketing this service line … now.
Posted on September 4, 2013
"Making the grade" in a pay-for-performance environment is
important for hospitals of all sizes. But gaining the trust of
prospective patients goes beyond report cards.
In the eyes of consumers, grades, stats and facts aren't the
only indicators of quality. There's a "human element" that is
easily overlooked as hospitals train their sights on performance
scores. That spells opportunity for your rural hospital.
Add a human element to your internal quality model -and your
marketing efforts - and it can become a powerful, persuasive and
pivotal tool in positioning your hospital for revenue growth and
success. See for yourself.
Check out this case
study (pages 1 - 3) featured in the September/October 2013
issue of Spectrum (produced by the Society for Healthcare
Strategy and Market Development®). It shows how Holy Family
Memorial (HFM), in Manitowoc, WI, (population 33,000) developed a
Right Care Model®, along with a comprehensive marketing campaign,
to bring quality to life.
HFM's "experience our quality through others" strategy and its
overall organizational transformation led to some unparalleled
results. I'll give you an example.
Cardiology was the first consumer service line HFM promoted.
Five months after the campaign launched in February 2013, HFM had
185 new Heart and Vascular Clinic (HVC) patients. The
study provides important details and other impressive
In an era of informed consumerism, hospitals' quality scores
will continue to be compared and scrutinized by prospective
patients. That means your rural hospital needs to continue to focus
on making the grade. But what your hospital does beyond that may be
the final factor in a consumer's decision to use you - or lose you
- when it's time to seek care.
The ball's in your court …