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10 Attributes of a Health Literate Health Care Organization

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To Prepare a Commissioned Paper

Identifying Measures of the 10 Attributes of a Health Literate Health Care Organization

The IOM Roundtable on Health Literacy, with funding from the Agency for Healthcare Research and Quality, has allocated $10,000 for a commissioned paper that identifies measures for each of the 10 attributes of a health literate health care organization. The goal is to obtain a set of measures that support quality improvement, reporting, transparency, and management.


While health literacy is often defined as an individual trait, there is growing appreciation that health literacy is a product of the interaction between individuals’ capacities and the health literacy-related demands and complexities of the health care system. Addressing health literacy is necessary to deliver patient-centered, high-quality health care and public health services. Measurement can drive improvement in health literacy, thereby improving health care.

A health literate health care organization makes it easier for people to navigate, understand, and use information and services to take care of their health (Brach et al, 2012). In early 2012, members of the Institute of Medicine (IOM) Roundtable on Health Literacy Collaborative on Implementation published a discussion paper that focused on the attributes of a health literate health care organization.  That paper detailed 10 attributes of such an organization.  Those 10 attributes are:

  1. Has leadership that makes health literacy integral to its mission, structure, and
  2. Integrates health literacy into planning, evaluation measures, patient safety, and quality improvement.
  3. Prepares the workforce to be health literate and monitors progress.
  4. Includes populations served in the design, implementation, and evaluation of health information and services.
  5. Meets the needs of populations with a range of health literacy skills while avoiding stigmatization.
  6. Uses health literacy strategies in interpersonal communications and confirms understanding at all points of contact.
  7. Provides easy access to health information and services and navigation assistance.
  8. Designs and distributes print, audiovisual, and social media content that is easy to understand and act on.
  9. Addresses health literacy in high-risk situations, including care transitions and communications about medicines.
  10. Communicates clearly what health plans cover and what individuals will have to pay for services.

Statement of Task

The paper should identify measures for each of the 10 attributes of a health literate health care organization.  It is not anticipated that the list of measures be exhaustive, rather the measures need to be examples of measures that can evolve in a process of continuing performance improvement. The paper should build on previous work in organizational health literacy measurement (e.g., Dewalt and McNeil, 2013; Weaver et al, 2012; Groene and Rudd, 2011), as well as take advantage of measurement innovation in organizations striving to be health literate.

For each measure identified, the paper should:

  • Discuss the relationship of the measure to the characteristics of a good measure. [Lists of such characteristics have been developed by several organizations including the Physician Consortium for Performance Improvement (PCPI), the National Quality forum (NQF), the National Committee on Quality Assurance (NCQA), and the Joint Commission.]
  • Discuss the extent to which each measure can be used for
    • Quality improvement
    • Reporting
    • Accountability
    • Research
    • Management
  • Discuss at what level of the system each measure might be useful, for example, at an individual institutional level, at a system level, or at the national level.
  • Describe use of the identified measures, if any, by health care organizations, quality improvement collaboratives, or others.

To the extent possible, describe what kind of global measure could be used to provide an overall assessment of implementation of all attributes.


Individuals interested in writing the paper should submit 1-2 pages by November 20, 2013 to Lyla M. Hernandez at describing:

  • Why they are interested?
  • What process (including research methods) they would use to prepare the paper?
  • What training, experience, and expertise they have that demonstrate ability to complete the task.

The Attribute Measurement Planning Committee will review submissions. Prior to making its selection the committee may choose to engage in a discussion with potential authors via telephone.


  • Author will be selected and paper will be commissioned by December 15, 2013
  • The author will submit a draft paper by March 8, 2014
  • The draft paper will be circulated to selected individuals/organizations for comment. Comments will be provided to the author by April 8, 2014
A revised paper will be submitted by June, 8 2014.  It is not required that all comments be accepted and incorporated into the paper.

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