Background Document on Literacy and Health

1.7 Communication and health organization accreditation

In the United States, the Joint Commission on Accreditation of Health Organizations (JCAHO), a private accrediting agency that inspects all licensed health care facilities and establishes minimum standards for hospitals and other health care institutions, now requires that instructions be given at a level understandable to the patient. JCAHO emphasizes affording each individual the care and attention that is necessary to his/her particular situation. This includes the recognition of the psycho/social, spiritual and cultural values that affect a patient's response to care given (Brandes, 1996). Hospitals and other health organizations are required to assess how well their patients understand their health care instructions and to provide education specific to the patient's assessed needs, ability and readiness (quoted in Mayeaux, 1996).

In Canada, hospitals and health care facilities are involved in the AIM (Achieving Improved Measurement) accreditation program of the Canadian Council on Health Services Accreditation. The basic principles of AIM are: client focus, quality improvement, teams, leadership, process and outcomes, recognizing the continuum of care and service provision (each health service organization must ensure that the client can easily access all the components of health care services), a population health approach and better measurement.

The AIM program calls on health teams to evaluate how AIM standards are being met through a process of self-assessment. The standards assess the quality of the services provided by the organization and incorporate the philosophy of quality improvement. Many of the AIM standards touch, directly or indirectly, on the issue of patient literacy. The standards focus on the need for patients and their families to be well informed and involved as active participants, and to demonstrate that they understand the information provided. Standards deal with the whole spectrum of health intervention: health prevention, promotion and early detection, assessment, integrating services with external partners, process used to initiate service, informed consent, developing a service plan, etc. The term patient literacy is not used, but rather client's abilities, clients with special needs, and client's level of education. The standards state that health information must be based on the client's and families' information needs, and that it must be easy to read and use. A separate section of the AIM standards checks that clients and families receive appropriate education and support regarding medication and other therapeutic technologies.