Terminology

The use of nomenclature in health care has long been problematic for industry stakeholders, let alone patients. Terms like “Otolaryngology” and “Hematology” require studies in ancient languages, and then we have a habit of shortening the terms – like “Gyn-Onc” (pronounced “guy-knee-onc”) to further complicate matters. Even experts stumble upon the vast array of acronyms that pepper the health care landscape – from ACO to MSP to QPP. As we center our efforts on improving access for patients, there may be opportunity to examine how shifts in our communication can prove beneficial.

The words we select send powerful messages – consider, for example, “waiting room” and “waitlist.” The terms themselves convey meaning; waiting is certainly the outcome when the patient hears these phrases. Consider instead the “reception area” or the “ready list.” The reference is to the same object, but the meaning has now changed. There are many examples of this opportunity in health care, but perhaps none more prominent than our traditional communications about clinicians. “Ms. Woodcock, thank you for calling about an appointment with Dr. Famous. He is not available for six months, but his mid-level provider can see you next week.” (Or, worse yet, “his extender” is the reference.) Not only do we use inherently demeaning terms for non-physician clinicians, but we reference our physicians as “Dr. Famous” and our advanced practice providers as “Sally” or “Joe.” When we commiserate about why our patients don’t want to see a non-physician clinician, perhaps it’s time to consider how we are contributing to the problem. 

Language

According to the US Census Bureau, one out of every five Americans speak another language at home, and most experts agree that may be underreported. Consider, then, the efficacy of after-visit summaries, discharge instructions or even basic appointment reminders in English. If a patient can’t read the instructions, then they can’t act upon them. The vast majority of both verbal and written communication in health care is in English; as we consider options for text, email and chats, the solution must include the languages that are used predominantly in our communities.

Literacy  

Health literacy is a concern for health care organizations keen to provide educational and other resources for patients. Historically, we have distributed materials for patients and caregivers to read; however, few efforts are extended to address whether they could be understood. A simple (and free!) tool to help your endeavors to address health literacy may be right under your nose. The Flesch Reading Ease score – and the accompanying Flesch-Kincaid Grade Level – can be calculated in Microsoft© Word. The scoring system for readability is used by many other industries to promote comprehension; Pennsylvania, for example, requires automobile insurance policies to be presented in a format with a maximum reading score of 9^th grade. Researchers have published a multitude of studies to illuminate the significance of the problem in health care; see this link for a recent article. Consider also the impact on persons with visual or hearing disabilities; improvements in other areas of health care are leading the way. 

Alternative Cues

Communication doesn’t necessarily need to be via language. In Japan, for example, each train station stop has a unique “jingle” when the train pulls up to the stop; iconic brands like Nike use a symbol to convey their meaning. But cues don’t need to be limited to trains or swooshes. Consider sound, light, colors, shapes, or symbols to promote a patient-centered design. Design elements may include a red carpet in front of the surgery scheduler, or a series of circles that lead a patient to the lab. Paint the exam room doors a different color, or use a theme for each (e.g., mountain, river). For a large facility, associate a color with each floor. If patients are registering at a central station, give the patient a green folder, clipboard or form for the second floor, for example.  

Communication is an important consideration in patient access. Opening ourselves to new possibilities may offer simple solutions to complex problems.