Slow down and keep it simple

Make sure patients understand instructions

As a case manager, your job isn’t done just because you told a patient something. Your job is done when the other person understands it, says Helen Osborne, MEd, OTR/L, president of Health Literacy Consulting, a Natick, MA-based firm.

Use the teach-back method to find out if people understand what you are telling them, whether you’re working with them in person or over the phone, Osborne recommends. Remember that teach-back is not a test of the other person. It’s about whether you have explained the information in ways others can understand it, she says.

The teach-back method is much more effective than asking questions that can be answered with yes or no, adds BK Kizziar, RN, CCM, owner of BK and Associates, a case management consulting firm based in Southlake, TX. When you ask your patients to repeat their instructions, phrase the question in language that isn’t judgmental or insulting so they don’t feel inadequate if they don’t understand, she suggests. Say something like “I want to find out if I have done a good job of teaching you.”

Improve communication by speaking slowly and distinctly and spending a little more time with each patient, suggests Catherine M. Mullahy, RN, BS, CRRN, CCM, president and founder of Mullahy and Associates, a case management consulting firm based in Huntington, NY. Sit rather than stand when you see patients in person, listen more than speak, and encourage patients to ask questions.

Whether you are talking to patients or writing out materials, include only key information that people need to know rather than including information that would be nice to know, Roland says. For instance, if you are educating people with diabetes on how and when to monitor blood sugar, there’s no need to overwhelm them with the causes of diabetes. Instead, teach them how to insert the needle, how many times a day they should monitor the blood sugar level and when they should do it, and what to do if the level is elevated.

“It’s better not to overwhelm people with too much information. Give them small chunks at a time and build on that,” she says.

Work on a few key points during each visit or telephone conversation and reinforce them with patient-friendly handouts, Mullahy says. If you’re seeing patients in person, follow up with telephone calls to clarify the information and correct any misunderstandings.

Whether you’re speaking or writing, use active voice, suggests Sandy Roland, senior communications coordinator for Passport Health Plan, a Medicaid HMO with headquarters in Louisville, KY. “It’s much more straightforward than passive voice and tends to take fewer words to explain things,” she says. Use short sentences and words with only one or two syllables. “It’s all about organization and putting information in the right format and the right order so people understand it,” she says.

Roland recommends that clinicians use bullet points and graphics to make health promotion materials more readable. Use “living room language” — words anyone can understand — rather than clinical terms. Keep the information short and to the point. Remember that every word you add is a layer that has the potential to complicate the process, Roland says. For instance, if the medication label instructs patients to take the medication three times a day, make sure they realize it means morning, noon, and night. Take a few additional seconds to explain that they should take it with breakfast, lunch, and dinner, she says.

Remember that for some patients, a picture is like a thousand words and use pictures or diagrams to illustrate your point.

When patients have trouble understanding and don’t have a caregiver to help, Kizziar suggests using illustrations to demonstrate what patients should do. For instance, create a daily schedule on a small piece of posterboard with the times of day they are supposed to take their medication and glue an actual pill next to the time they should take it.

As you work with patients and uncover written information they have trouble understanding, share it with the rest of your team and organization and work together to make it more understandable, Osborne says. Ask people who represent the intended audience if they understand your materials and use focus groups to get their input, she suggests.

“In any organization, case managers are the ones who are working directly with people, and they are in a great position to bring information to everyone else on the team about how to better communicate with patients,” she says.

For more information on health literacy in general, including links to articles, see, the Institute for Healthcare Advancement at, and the National Patient Safety Foundation at

To download free podcasts about health literacy, see