The Joint Commission Update for Infection Control

Loud and clear: Plain language protects patients

White paper on improving health literacy

As part of an increasing emphasis on patient empowerment and education, infection control professionals have seen arcane terms such as "nosocomial" de-emphasized in favor of clearer language.

That same trend is cutting across all fields of medicine, which has a long tradition of obscure nomenclature that seems increasingly out of touch with today's patient safety movement. In that regard, the Joint Commission warns that far too often, ordinary citizens are placed at risk for unsafe care because important health care information is communicated using medical jargon and unclear language that exceed their literacy skills, according to a call to action released by The Joint Commission in its newest public policy white paper, "'What Did the Doctor Say?:' Improving Health Literacy to Protect Patient Safety." The paper frames the existing communications gap between patients and caregivers as a series of challenges involving literacy, language, and culture, and suggests multiple steps that need to be taken to narrow or even close this gap.

"Effective communication is a cornerstone of patient safety," says Dennis S. O'Leary, MD, president of The Joint Commission. "If patients lack basic understanding of their conditions and the whats and whys of the treatments prescribed, therapeutic goals can never be realized, and patients may instead be placed in harm's way." The detailed solutions developed by a special Joint Commission Expert Roundtable focus on making effective communications a priority in protecting the safety of patients; addressing patient communications needs across the spectrum of care; and pursuing public policy changes that promote better communications between health care practitioners and patients. Failure to provide patients with information about their care in ways that they can understand, The Joint Commission report warns, will continue to undermine other efforts to improve patient safety. "Breakdowns in communication between patients and caregivers can significantly impair the ability of physicians to diagnose and treat medical problems," says Ronald M. Davis, MD, chair of the Joint Commission expert roundtable on health literacy and director of the Center for Health Promotion and Disease Prevention at Henry Ford Health System, Detroit. "Everyone who has a role in health care — specifically including practitioners, employers, and regulators — must work together to pursue strategies for improving communications with patients that will result in safer, more effective care."

The Joint Commission already promotes the involvement of patients in their care through its ongoing Speak Up™ educational campaigns. In addition, expectations regarding patient engagement and involvement in care decisions are stipulated in Joint Commission accreditation standards and its National Patient Safety Goals. But health literacy problems, which often go unrecognized and unaddressed by health care practitioners, undermine the ability of health care organizations to comply with the intents of the accreditation standards and safety goals that seek to protect patients' safety.

"What is clear to you is clear to you," says Toni Cordell, expert panel member and nationally known speaker on the topic of health literacy, who struggles with dyslexia. "Every patient should be a full partner in his or her medical decisions. This requires crystal-clear communication that is done with compassion and mutual respect," she says.

The Joint Commission report on strategies for addressing health literacy and protecting patient safety contains 35 specific recommendations that cover a wide range of important improvement opportunities including, among others:

  • The sensitization, education and training of clinicians and health care organization leaders and staff regarding health literacy issues and patient-centered communications.
  • The development of patient-friendly navigational aids in health care facilities.
  • The enhanced training and use of interpreters for patients.
  • The redesign of informed consent forms and the informed consent process.
  • The development of insurance enrollment forms and benefits explanations that are "client-centered."
  • The use of established patient communication methods such as "teach-back."
  • The expanded adaptation and use of adult learning centers to meet patient health literacy needs.
  • The development of patient self-management skills.
  • Health care organization assessment of the literacy levels and language needs of the communities they serve.
  • The design of public health interventions that are audience-centered and can be communicated in the context of the lives of the target population.
  • The integration of the patient communication priority into emerging physician pay-for-performance programs.
  • The provision of medical liability insurance discounts for physicians who apply patient- centered communication techniques.

(Editor's note: A complete copy of The Joint Commission white paper, "'What Did the Doctor Say?:' Improv-ing Health Literacy to Protect Patient Safety" is available at