​ ​
Clear as Mud: Improving Communication at the Bedside



“The single biggest problem in communication is the illusion that it has taken place.”
– George Bernard Shaw

When setting up an email server, you need to decide if you’d rather use IMAP or POP3. You should also demilitarize the server or minimally forward the correct ports. And don’t forget to configure the DDNS.

Don’t know what I’m talking about?

In full transparency, neither do I, because I've never studied information technology. Yet, when we talk to patients using medical jargon, we expect them to understand exactly what we are saying even though they've likely never studied medicine.

Health literacy is a person’s “ability to find, understand, and use information and services to inform health-related decisions and actions.”1 Not surprisingly, many Americans do not have levels of health literacy that allow them to truly understand their care or take appropriate actions to improve their health. According to the Centers for Disease Control and Prevention (CDC), 9 out of 10 adults have difficulty understanding health information when it is complex or unfamiliar.2

And just because a person can read well or has a good grasp on numbers, it doesn’t mean they understand health information. People with low literacy skills overall are even more negatively impacted.

Health literacy has a direct impact on outcomes and patient safety.

Not only do patients with low health literacy have difficulty understanding their diagnosis and treatment, they may also have a more difficult time navigating the healthcare system and services. In addition, they may be less inclined to ask questions or engage with their providers, may have limited access to the healthcare system, or may seek emergency care in lieu of preventative measures.3,4

Improving health literacy is an overarching goal of Healthy People 2030, and healthcare organizations play a major role in achieving it.

“Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others."1

What steps can your organization take to fulfill its role in closing the gap on health literacy?

Engage all staff in training on health literacy. Provide appropriate information to set the stage for successful patient encounters. Training points include:                      

  1.  Approach each patient encounter with the mindset that the patient may not have adequate health literacy or overall literacy skills. Watch for red flags such as frequently failing to complete forms or missing appointments, rarely asking questions, having difficulty explaining medical concerns, lacking follow-through, or failing to comply with medication.
  2. Speak using plain language. Keep terms and phrases as simple as possible while still providing enough information for the patient to make informed decisions about their care. Even common terms like “cardiac” may not be understood. The word “heart” is just as accurate and is understood by almost everyone.
  3. Include the patient in the teaching plan. Ask the patient or their family how they learn best. Do they prefer written materials, recordings, discussions, or a combination? Highlight the most important information when using written materials, and speak slowly and clearly during discussions.
  4. Employ teach-back. Teach-back is more than asking someone if they understood what you said or can repeat it back to you. It includes demonstrating the skills necessary to comply with their treatment: for example, having them draw up the correct amount of insulin and practicing injection, reading and verbalizing understanding of a nutrition label, or showing you how to take their child’s temperature.

Want more? The Patient Safety Authority (PSA) provides comprehensive education on health literacy to Pennsylvania healthcare facilities and providers upon request and at no additional charge.

If you would like PSA to provide training on health literacy at your facility, request a speaker here

About this blog

Regina Hoffman serves as the  executive director of Pennsylvania’s Patient Safety Authority and editor-in-chief of Patient Safety, its award-winning journal.  Ms. Hoffman was recognized by Becker’s Hospital Review as one of the top 50 experts leading patient safety in both 2018 and 2020. This blog serves as a source for her to share her insights in patient safety and leadership with Pennsylvania’s healthcare leaders.


1. https://health.gov/our-work/healthy-people/healthy-people-2030/health-literacy-healthy-people-2030

2. https://www.cdc.gov/healthliteracy/shareinteract/TellOthers.html

3. Jayasinghe UW, Harris MF, Parker SM, et al. The Impact of Health Literacy and Lifestyle Risk Factors on Health-Related Quality of Life of Australian Patients. Health Qual Life Outcomes. 2016; 14:68. Published 2016 May 4. doi:10.1186/s12955-016-0471-1/a>

4. Berkman ND, Sheridan SL, Donahue KE, Hapern DJ, Crotty K. Low Health Literacy and Health Outcomes: An Updated Systematic Review. Ann Intern Med. 2011;155(2):97-101. [PMID: 21768583)

***​ The views and opinions expressed at or through this blog are the opinions of the author alone and may not reflect the opinions or positions of the Patient Safety Authority or the Commonwealth of Pennsylvania, nor do these views represent in any way medical or legal advice. ​ 

​  < ​​Patient Safety Awareness Week: Make it Count                      
                                  ​​​ ​