Towards a Health Literate System

Problem Statement

CM Health is striving to become a health literate organisation, i.e. one which “makes it easier for people to navigate, understand, and use information and services to take care of their health”, and to lead the health system in becoming health literate.

What are we trying to achieve?

CM Health’s vision is to develop a health literate system, i.e. one which supports wellness through building understanding. For CM Health this can be expressed as:

• everyone in Counties Manukau can find their way into and around the health services they need
• every interaction builds understanding between patients, whaanau and staff
• appropriate health education resources are used when needed to support understanding.

What have we done?

During the 2018/2019 year we achieved the following.

• Staff development through:

Rauemi Atawhai: a guide to developing health education resources in New Zealand – one cohort completed in 2018/2019.

e-learning health literacy modules – available to all staff, with the shorter of the two modules now being mandatory, i.e. staff must complete it within 6 months of starting employment. 

• Hospital services independently running regular health literacy presentations and training for staff, e.g. Kids First Hospital.
• Health literacy components routinely included in various learning and development programmes, e.g. Communicating Effectively, Leading Quality Care.
• Health literacy segment documented within the Registered Medical Officers Handbook.
• Health education resources now classified as ‘controlled documents’, which sit under the auspice of the local document controllers (service quality managers)
• Policies and procedures reviewed: ‘Developing and managing Patients Education and Information Resources’.

A stocktake of health literacy activity commissioned by the Population Health directorate (in progress).

What did we find?

It is vital to include health literacy in system and process change and development. For example, since the short e-learning health literacy module became mandatory, there has been a significant increase in the numbers of staff completing it.

It is apparent that there are different levels of training required across the organisation to enable staff to support each other, to aid the transference of health literacy knowledge and skills, and consequently to develop the desired change in culture and practice. However, this cannot be achieved within the current allocated resource (which is sub-optimal).

How did we make a difference?

By completing the above activities, we are making progress in achieving health literate and culturally competent staff (via workforce development), health literate and culturally competent resources (via patient education, policies and procedure review) and supportive systems and processes (via monitoring of health education document development by local document controllers) etc.

It is difficult to ascertain if we have made a measurable difference, although anecdotally there have been reported changes in behaviour and practice. We are required to evaluate the impact of these activities using both qualitative and quantitative means. However, this would take more resources than are currently available. (We are exploring a possible solution to this shortfall through a ‘summer studentship’: see below).

Where to from here?

We anticipate that the following activities will help emphasis and support greater health literacy within CM Health.

• An increased human resource specific to health literacy, i.e. a 0.6 FTE project manager from the Population Health directorate.
• A stock-take and gap analysis of health literacy in CM Health: available in September 2019.
• Exploration of using a ‘summer studentship’ to gather evidence of the impact of health literacy training, and the translation of this into a change of practice in Kids First Hospital.

Publication in a journal of the Rauemi Atawhai programme evaluation.