Innovative BC doctors embrace patients as partners Part I
Dr. Hii’s practice has 4000 patients (really!) but he spends at least 1 1/2 hours with each patient. Dr. Hii is one of BC’s innovative doctors who are embracing patients as their partners. Too often, health literacy is a noble intention that is seldom translated into actionable strategies. In BC, primary health care practices are making measurable improvements to meaningfully involve patients in their care. The Patients as Partners Health Literacy Prototype was an 8 month initiative sponsored by the British Columbia Ministry of Health Service, Primary Care Division; Legacies 2010; and Impact BC with support of the British Columbia Medical Association.
On December 10, they invited the health literacy community to the Get Real: Partnerships for Moving Health Literacy Forward event to show case what this initiative has accomplished. It was fascinating to learn how different teams had worked together to accomplish significant health literacy outcomes. There are excellent videos showcasing the work done so far. The title of the video Nothing about me without me captures the spirit and lofty goal of the PAP program.
Below, are a few highlights that are instructive to anyone seeking to develop and inform health literacy interventions.
- The Patients as Partners(PAP) program is underpinned by BC’s primary health charter. The charter identifies one of the seven priority areas for primary health care system change as “building supports for patients as partners.” The charter provides a clear contextual framework and lends important legitimacy, credibility and potentially, resources to health literacy initiatives.
Key lesson: isolated health literacy efforts not backed by such a broader framework are unlikely to accomplish system-wide improvement.
- The PAP program created integrated teams that sought to improve health literacy in their practice settings. Each team consisted of a physician’s office practice and an adult literacy program. The adult literacy program included instructors and adult learners.
- Four teams from four different communities participated. They were from Vancouver/Burnaby, the TriCities, Victoria and Hazelton/Gitsegukla. These teams represented common challenges faced in health literacy, such as immigrant populations, a First Nations community, a rural site and three urban locations.
Key lesson: It takes integrated teams to address health literacy issues.
- One of the greatest challenges in the PAP project was bridging the huge cultural disconnect between the literacy & health care communities. This is telling (and not too surprising) because it implies that the primary health care community is not attuned to literacy issues which underscores the value of the partnership.
Key lesson: Bringing the medical and literacy cultures together can be a challenge and requires flexibility, adaptability, trust and openness.
The PAP program enhances health literacy through the 3 pronged change package strategy cleverly illustrated by an umbrella that protects patients from health problems and risks.
- Build relationships: Take patients’ values and preferences into account; Provide a relaxed, friendly, respectful atmosphere
- Ensure understanding: Use plain words, clear and culturally relevant pictures; Encourage clear dialogue between patients and health care team; Follow-up after a new diagnosis, medication or planned chronic care; Use technology; Make health care setting easy to navigate
- Partner to support better health: Provide peer support; Use meaningful community resources; Provide health literacy education
Key lesson: A successful health literacy strategy needs to entail action-oriented effort
- Collaborative improvement approach prompted teams to think critically about what changes would bring about improvement and how they could be measured. They asked 3 questions:
- What are we trying to accomplish? (Aim is to improve health literacy)
- How will we know that a change is an improvement? (Measures)
- What changes can we make that will result in an improvement? (Good ideas for improving health literacy comprised the “change package”)
- The teams used the PDSA cycle to test the change ideas:
- Plan: who, what, where, data collection
- Do: carry out plan, document problems and observations, collect data
- Study: complete analysis, summarize lessons learned
- Act: What changes should be made; next cycle
Key lesson: The ideal approach encourages small scale experimentation with imperfect ideas; eliminates fear of failure as emphasis is on learning; identifies measurable changes, supports data collection and recognizes that the improvement journey is not smooth.
It is very inspiring to learn that the Patients as Partners program teams explored at least three changes some of which led to outstanding and sustained health literacy improvements. Team results are presented in another blog posting.
Image credit: Developed by the Health Literacy in Communities Prototype Faculty.