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Challenges
This project was complex and challenging. A gap between the
funder's fiscal year and the project structure, and delay in release of funds
can create challenges for many organizations in the not-for-profit sector and
for funding consultants overseeing projects. Trying to carry out the project
for best outcomes was often difficult within the strictures of the time line.
The evaluator talked about the need for greater flexibility in the next phases
of this project. This can be hard to achieve when working within a rigid
funding mechanism.
Additional challenges were created by the project being based in
a hospital which was undergoing structural change and reeling under the
stresses in the healthcare system, including a severe shortage of skilled
professionals, especially nurses. This meant that committee members could
sometimes not get to meetings, or in one case, could not travel to a training
session. It has also meant that people are changing jobs and moving between
institutions more than normally, so knowledgeable people are regularly being
lost. The shifting structures plus the extreme lack of physical space made it
difficult for an outside coordinator to find working space inside the hospital.
Although the level of commitment from the Nursing Department was very strong,
the coordinator was often frustrated and overwhelmed by bureaucracy when she
needed a telephone or a desk.
Despite these challenges, this project was engaging and achieved
more than anticipated, opening new questions about patient interventions that
should resonate across the Canadian health care system.
The Next Steps
The Health Literacy Project is continuing at a slower pace while
the Steering Committee awaits response to funding proposals for the next phase.
In the fall of 2002, the Steering Committee has already acted on some
recommendations:
- They have begun to formalize the meeting procedures of the
committee and are discussing its mandate and membership.
- They have put the development and maintenance of the Health
Education Committees on hold because there is no paid coordinator. The
Committees have been included in the new proposals, and the recommendations
regarding the composition and function will be taken into account when they are
revived. The model of participatory health committees is one of the
achievements of this project, even if the model is not yet perfected.
- They have voted to allocate the MGH Foundation grant to hire
a researcher to do in-depth evaluation of the materials that were created in
Phase 2.
- The Director of Nursing Research has agreed to help with the
design of the research.
- The Director of Communication for the MUHC has indicated
interest in training around health literacy and clear communication for the
entire organization.
Conclusion
This innovative project is being cited in Canada and
internationally as a groundbreaking example of a professional-community
partnership that is crucial to our understanding of the complexities in patient
communication and the relationship between literacy and health. The integration
of participatory health committees and the process of continuous evaluation are
fundamental to the outcomes that were achieved and are being shared.
The Steering Committee began by presuming that the
"hard-to-reach" were only a minority, and now think that these individuals may
represent a significant proportion of the Canadian population. They believe
that projects such as this one will eventually help change the nature of
communication in the health care system and heighten awareness of the links
between literacy and health. |