 Is that okay? Okay. All right, so quick, very quick overview of health literacy. The degree to which individuals have the capacity to obtain, process, and understand health information and services needed to make appropriate, and let's X out appropriate, and put in informed instead, informed health decisions, because who's to say what's appropriate? And we know that it's a shared responsibility. So, Terry Davis, Dr. Davis was talking about earlier how it started as all of the skills and responsibility was on the patient. And now we know that it's a system issue. We know that providers need to communicate effectively. So, health literacy is a shared responsibility in which the healthcare providers and the patients and the system all need to be working together to improve health outcomes and health understanding. You've heard this, has anyone, you've heard this several times today, are there any thoughts or questions or comments about this? Does everyone, do you recognize kind of what I'm talking about when I say this shared responsibility and we've got the patients and the system and the providers all need to work together? Okay, so that's kind of the, this idea is kind of the foundation of health literacy forward. We at the Literacy Coalition are working with to improve the health literacy of central Texans through our literacy programs. We go out and we teach literacy instructors how to teach health literacy, how to teach patient empowerment in their, English as a second language, adult basic education or GED classrooms. And then we also work on that other side with healthcare providers. And we do trainings on effective communication and we do assessments of communication and health literacy and cultural competency. So, we're trying to address it from both sides. Yes? Mm-hmm. Yeah. Yeah, well, in this sense, when we talk about health literacy, we're actually talking about, maybe that's a good segue. No, it's not. So, when we talk about health literacy and we talk about the individual, it's health literacy, low health literacy is such a perverse problem. There's so many people struggling with health literacy. Agency for Healthcare Research and Quality says nine out of 10 American adults struggle with, struggle to understand and act on health information. So, to manage their disease and prevent disease. Nine out of 10 people are struggling with low health literacy. So, when we say individual, this is all individuals. You know, this is everyone, all of you, all of me, I mean, the 1% or the 10% that nine out of 10 are struggling, the 10% that actually are understanding are probably doctors and nurses and people that are totally wrapped up in that world and that medical ease every day. So, I think who is the individual? The individual is everyone. It's not, it's all of the people that we run into every day. I love this. We saw a quote from him earlier today and it goes to show that he's a champion of health literacy. Health literacy is the currency of success for everything we do in health, wellness and prevention. That's bold. I like that. And just some quick literacy facts. Most health information is written at the 10th grade reading level, whereas the average Americans reading at the eighth grade level, 40 to 50% of African-Americans, Latinos and senior citizens are reading at the fifth grade level or below. There's that disconnect. That's where I'm talking about the system. That's a huge system issue right there. With the nine out of 10 Americans struggling with low health literacy, I was in a training on disparities, on health disparities, and the person said they were talking about, specifically she was talking about African-American access to the system. And she said, when one fish goes belly up in the lake, you ask what happened to that fish? So what happened to that individual? But when 90% of the fish are going belly up in the lake, you have to ask what happened to that system? What happened to that lake? So this is a very much a system issue. You know that now. This is a good introduction though. These things right here, when you are framing your argument, are really great talking points to get people engaged. American Medical Association, throw around names like American Medical Association and ARC, says that low health literacy is a stronger predictor of a person's health than age, income, employment status, education level, and race. That's huge. Okay, so we're gonna talk today more specifically about making your case for all of you today. No matter what agency you represent, no matter if you're a clinic, a hospital, a farm agency, there's some implications of health literacy that are across the board important for all of us to think about. Health implications, financial implications, legal risks, and adverse medical events, sentinel events, and then also quality of care and trust in your organization. That's huge. For specifically hospitals, we're gonna talk about preventable readmissions, which is a major buzz right now. Everyone's probably heard of preventable readmissions. 30 day preventable readmissions. And then we're also gonna talk about new joint commission requirements. So just this summer, the joint commission passed new requirements that are very explicit towards health literacy and improving effective, improving communication. And then finally, at the end here, I wanna talk about recipients of federal dollars. So what can you look out for, and how can you craft your argument if you seek federal dollars? Getting cut off a little bit at the right, but that's okay. Health outcomes, health implications, huge. In peer reviewed research, and so if you'd like to, if any of these speak specifically to you and your agency, I'm very happy to send out a follow up email actually on that note. I'm gonna pass around a sign up and I'll plan on emailing you all with some resources that we talk about and everything if you'd like that. So yeah, so if you want more information on any one of these, I'm happy to share the study. But just take a look at how severe these are. More hospitalizations, greater use of ED, worse overall health status, higher mortality among elderly, shorter life expectancy in general, less preventative care. These are all things where we just need to say it's just right to think about health literacy and to address health literacy and low health literacy. It's just, this is kind of all agencies. It's just the right thing to do. We need to improve health outcomes. That's what we're here to do in the healthcare field. So look at this and just think it's just right. Any questions about any of these in particular or anything I've said so far? Are any of these shocking to you? Do you see these? Any, who's in hospitals in this room? Who's in clinics? Who's in farm? Nobody in farm. What about just like case, community health workers and promotoras? Great. So be thinking about this. As I'm saying these things, I challenge you to be thinking about your specific situation and what you can pull from this that's really relevant for your specific situation. And then challenge me on this stuff and make me think about it more so that I can explain better, particularly for your interest. There's also huge financial implications. And so many of our clients, probably people that are community health workers and promotoras and if you're in the ED department, you see a lot of people that come in and are low income, are living paycheck to paycheck. A low health litter individual has increased healthcare costs, annual increased healthcare costs of 7,500 a year. So if you're worried about your client's financial stability, you must address health literacy. That's $7,500 in additional spending each year that's coming out of their pocket or when you get down to this one, 238 billion annual on the US healthcare, on the system, on us, or out of our pockets as taxpayers. Yeah. This is actually, these top two numbers are a study out of University of Connecticut Economics Department. There's a guy named John Dr. Vernon. Dr. John Vernon. And he put this study and it's actually interesting. This number, this 238 billion only takes into account low literacy. So the number of low literate adults. It doesn't actually take into account the circumstances when someone might be highly literate but then struggle with health literacy. So these are actually an underestimate likely. And I took these numbers and extrapolated them down to our central Texas region and found that 685 million is what we spend in our region annually on low health literacy. Why is this the case? Why would someone with low literacy spend low health literacy, excuse me, spend this much more on healthcare? So one thing, the first thing I heard is they're not aware of the resources that are out there to make healthcare more affordable, including preventative services. So they lack preventative health services. They don't take those. They don't do screenings. And then the second thing I heard is increased use of emergency services. And that's huge. That's the second one. So then once they get in and they're in the healthcare system, they're generally coming in through the ED department. They come in through the ED and then they have a longer hospital stay because they haven't been doing screenings and they don't have a solid medical history. And so they have a longer hospital stay. And then they're educated and the provider checks the box. Did you explain to the patient? Yes, I explained. And they leave the hospital and they make medication errors and treatment errors. Low-health litter individuals make more medication errors. And then finally, they come right back into the hospital. So lack of preventative health, overuse of emergency services, longer hospital stays, inability to follow treatment instructions, and hospital readmittance. This hospital readmittance. We'll focus on this a little bit more, but this is a huge one if you're a hospital talking about low-health literacy and the linked hospital readmittance. Any questions about these? And I can absolutely send out this study with that follow-up email if you're interested. So we've got legal risks. And this is all, again, all agencies should be concerned with legal risks and sentinel events. Communication problems are the most common cause of medical errors. Communication problems are the most common cause of medical errors. And then also, miscommunication is the leading cause of patient dissatisfaction. So if you're talking about improving satisfaction within your agency, improving patient-reported quality of care, say miscommunication is a huge barrier to that. This information, by the way, comes from the American Medical Association. Increased malpractice cases ruled in favor of patients who are not appropriately informed about their health decisions. So people are starting to say, this isn't just non-adherence, non-compliance. They weren't given the tools, they weren't given the resources or the conversation to actually accurately help them make these decisions. And then this is just another example of cases being one in favor of patients. Patients who miss appointments have a viable lawsuit. If the failed appointment results in harm and they say that the doctor didn't appropriately get them to that next appointment. So this kind of speaks more towards the change in healthcare or what we're seeing in the change of healthcare is around that patient-centered medical home, the nurse extensionist positions, the nurse navigators, supporting the patient and not just saying, here are your instructions and here's the number you need to call. 65% of sentinel events reported to the Joint Commission have their root cause in miscommunication. So they're rooted in miscommunication. And then this final one, I just wanted to say this is from a JAMA report that communication issues are amongst the most cited causes underlying medical malpractice lawsuits. So if you're worried about medical malpractice, if you're worried about adverse medical effects on your patients, you need to be thinking about health literacy. I wanted to show, and some of you may have seen this, and this is actually a little section of the video that, or a different section of the video that Dr. Davis showed this morning, but this is an example of the sentinel events, the, let's see where am I going, computer. So check this video, it is a shocker and some of you may have seen it. At approximately 30 or 31, I went into the gynecologist and complained about part of this not working correctly. And he said, we can repair that. Great, I didn't ask all the right questions. When I showed up two weeks later at the admissions office at the hospital, they put enough papers in front of me. I'll bet there were five papers that I needed to sign. Well, I wasn't gonna say, excuse me, but I don't read really well and I certainly don't read fast. And I'm concerned with some of these words. To me, it was lines and circles over sheets and sheets and sheets. And I wasn't gonna reveal my sense of stupidity. So I signed everywhere they told me to sign. Never read it. And then a couple of weeks later in the follow-up office visit, the nurse said, how are you feeling since your hysterectomy? Now I acted as normal as I could. Inside my mouth fell open and I thought to myself, how could I be so stupid as to allow somebody to take part of my body and I didn't know it? A patient signs a consent form that they don't understand. He goes on to say that this is a malpractice suit and that the hospital and doctors are liable for that because the consent form, it wasn't actually informed consent. It was completely uninformed consent and that's not the fault of the patient. So that kind of leads back to the points where I was saying that more and more cases are being won in favor of patients. How many people have seen this video before? Couple. So what are some reactions to the people that it's new to or that have seen it before? Very realistic. Have you seen similar things? We're uninformed. That's seen but that's heard of. Heard of, yeah, yeah. Seen it? Yeah. This comes from that same video that Dr. Davis put out and that's the thing is that in that video and in this one, we've seen it. We know it. We know these patients, we know these clients. We see them every day. I see it, the woman at the end of that video that Dr. Davis showed where she says, I don't know, he just puts me on him, I just take him. And she's talking about the medicine that she do not drive and that's my grandmother. Absolutely to a T. She has so many pills and she doesn't know what they are but he just puts me on him and I just take him. Yeah, absolutely. It looks like they acted a little bit. Yeah. I heard it. Yeah. Yeah. Mm-hmm, yeah. Yeah, it's valuable. Thank you for sharing that. Yes, mm-hmm, yeah. It gets, it's more outrageous when we're talking about healthcare and our health and operations and things that we're gonna do to our body but to put it in perspective, how many people read the agreement on whatever internet thing that you signed? You said, yes, I agree. How many people in this room can say that they've actually read a full agreement? How would that be? I just heard an NPR story just last week. It was so relevant, it said, they said, that's the big, I have read and understand or I have read and agree with these guidelines. That's the biggest lie on the internet right now. No, every single person in this room lies that they have read and understand those instructions. Right, mm-hmm, so it gets scarier when we talk about health but it's an issue everywhere and every day. This legal jargon, this jargon in general and I just sat in on Sage words' presentation on plain language and this plain language and the use of plain language is so important, not only in healthcare but everywhere. Yes. And when we don't understand, we need to ask questions. A lot of people of my age and older have never been given permission to take part of the healthcare. Right, right. And we're still in the sense that you're the doctor, you're the nurse, you know more about it than I do, but if you make this decision, I'll talk about what you said. That's a great point and that's a huge cultural change that's going on in medicine right now. If you look at some national campaigns by people like ARC or the Center for Clear Communication, I think it is, they have national campaigns going on right now that are saying, ask questions, be engaged, you know, get a second opinion and that's to change that culture that we have of this is the healthcare provider and who am I, I don't know about this and who am I to ask questions and second guess. Right, well healthcare is business and that's why we're gonna start talking about the bottom line. That's what I mean. People are, you know, most agencies will claim that they're at least hospitals and you know, they're mission oriented and we care about our patients but it's the bottom line when you get down to it. Yeah, right, absolutely. Yes, yeah, absolutely. Health literacy and cultural competency are very connected and you'll see people when people talk about health literacy, they talk about cultural competency, when people talk about cultural competency, they talk about health literacy, they're very much connected. They're different but very much connected. We need to provide, you know, effective communication is culturally sensitive communication, it is all of these things so it's a great point. Quality of care and trust in your organization. Reported quality of care is huge for hospitals, clinics, community health workers, I'm assuming, you know, whoever you are, I'm assuming you care if your patients, clients are reporting high quality. So this is a very non-plain language table, jargony table from the American Medical Association's Communication Climate Assessment Toolkit. So Communication Climate Assessment Toolkit and they take these nine domains, these nine domains of effective communication over here. You've got organizational commitment, data collection, workforce development, community engagement, individual engagement, health literacy, language service, cross-cultural, so cultural competency and evaluation, performance monitoring. They say that these are the nine domains, the AMA as well as the National Quality Forum and this huge ethical force division of AMA developed these nine domains as the leading indicators of effective communication within an agency. And what these, this mumbo jumbo over here means is these are the, so I receive high quality care. It's the odds ratio and confidence interval so how closely those are correlated to these different domains. So they've recognized that these different domains are very highly correlated with reported quality of care, reported trust in the agency so they ask patients, I believe my medical records are kept privately and then they switch to the last question and they say if a mistake were made in my health care, thank you, the system would try to hide it from me and so they switched the question there and made it negative so you can see these are a lot lower and then these are all one or higher pretty much. Health literacy here is very highly correlated with reported trust in the agency and reported quality of care, very high correlation. So if you're improving health literacy, you will inevitably be improving the patient reported quality of care and trust in your agency is where I'm going with all of this. I had to talk to, I haven't taken a stats course in a very long time so I had to run this by interns and other colleagues and say tell me about this, what does this mean again? So patient, so the communication climate assessment toolkit is an assessment that there's 10 nationwide AMA certified consultants that go in and administer these surveys and it's a 360 degree evaluation process. No, yes, there's a short survey for the patient and then but it's just a sampling. So you get a sample of patient surveys, a sample of provider surveys. No, no, no, yeah, sorry. The questions aren't, you wouldn't ask the question, you wouldn't ask the patient how well the hospital performs or how, you know, like, sorry, measures and that kind of thing. You would ask the patient types of questions that lead you to these answers that are related to, so it's something like the workforce, you know, my nurses and doctors that I saw today represent my background and that would mean that workforce development is that they're bringing in people from the community who represent the population. So it's, they ask questions that lead to this, these domains, does that make sense? Yeah, luckily for us, we don't need to develop this algorithm because the AMA already did. But who's, so patients are, so this reporting comes from a random sampling of patient surveys throughout the assessment process when the CTAT is going on. Yeah, there's guidelines around like to make sure that it is random sampling and I think that we're getting a little bit off course right now, but I'd love to continue this conversation with you after. Yeah, yeah, but do know that this is American Medical Association developed National Quality Forum endorsed. It's kind of the tippy top of effective communication measuring. Yeah, okay, so I respect that. I'd love to continue that conversation with you after. Okay, so a case for hospitals. What do you present to your hospital leadership? What do you present to your chief medical officer to get him on board to make that policy change within the hospital? In my role at the Literacy Coalition with Health Literacy Forward, one of the things I've been doing is going out to try to use these strategies and these techniques to get people engaged and to get the large healthcare agencies throughout Texas behind this issue of health literacy. So one of the main things that I come back to all the time are preventable readmissions for hospitals. That's one of the biggest things that people are worried about right now within the hospital systems. A preventable readmission is a readmission when a patient is in the hospital with some given condition and then they leave the hospital and they come back with the same or similar condition within 30 days, is a 30-day readmittance. And then preventable readmissions, those are a little bit more, there's a debate around what exactly is a preventable readmission. But generally, we found that 18.7%, that's the national level, of patients are readmitted to the hospital within 30 days. And CMS, so Medicare and Medicaid Services, says that 75% of readmissions are preventable. The JCO, the Joint Commission, went on to say that 75% of preventable readmissions are a result of miscommunication. So there's two credible sources, preventable readmissions, yes, they are debatable, but we've got generally 75% of readmissions are preventable, 75% of those preventable readmissions are linked to miscommunication. And that's kind of my bang-bang when I go into a hospital leadership and I say, look it, we need to be dressing, in fact, we need to be working on communication, we need to be working on health literacy. And this is kind of the go-to that I would use, so please do use that with your agencies. And then I get into what that means in terms of money. So one patient who's uninsured and one patient who's Medicare, the mean charge per stay, so the average charge per stay is 22,000 for an uninsured patient, 38,000 for a Medicare patient. So taking those numbers into consideration, if we work on health literacy and effective communication within our hospitals and we reduce these rates of preventable readmissions by 1%, we'll be saving Texas $440 million annually. So I try to connect the dots here, like, look at how high preventable readmission rates are, or readmission rates are, look at how many of them are preventable, and how we know why most of them are happening. It's miscommunication. It's that easy, so we'll just, even just think about, if you're thinking, because it always comes back to money, right? We don't have that in our budget right now. And I'll say, well, you don't have that in your budget right now, how are you, how do you do that? How are you, you say, you improve communication with one Medicare patient who isn't readmitted, and you've just paid for your entire intervention. So this seems to make, this is kind of hospital jargon. This makes sense to them, to the leadership. Before I go into that, what questions do I have about preventable readmissions? I wanted to give that kind of as a summary, but yeah. Yeah, that's a good question. What I've found is that there's certain departments within hospitals who really get behind this, and certain champions who really get behind it. And so you need to find your champions or your department, and then work from the inside. So an example would be with Seaton Healthcare System, Seaton Healthcare Family in Austin area, in Central Texas. I'm working with their Office for Diversity and Inclusion. So they're the department that really got behind it. And then I've found different champions throughout the different departments that I've joined the Health Literacy Task Force, are really getting engaged, and are pushing it throughout their levels. So it's kind of like that trickle down. Find your champions up top, and have them share the word, because not everyone's gonna listen to me. Any other questions? Is this good, is this making sense? I don't know what you're gonna say. Good. Joint commission requirements. That's another huge thing for hospitals. We've got a new, so hospital effectively, these are all, so up on the, I'm gonna go through four different new requirements that I thought were especially relevant to this conversation. So that little number up top would be the reference number, if you wanna write that down and look into this specific requirement more. So the hospital effectively communicates with patients when providing care, treatment, and services. That is a new requirement that went into place this summer. And then underneath that, we've got sub-strategies, I guess, they're strategies. Hospital identifies patients' oral and written communication needs. And hospital communicates in a matter that meets the patient's oral and written communication needs. So this is so big, this is so big for our field of health literacy, that hospitals are now required, they'll get pinged by joint commission if they aren't meeting the patient's oral and written communication needs. The hospital respects the patient's right to receive info in a manner he or she understands. Provides info tailored to age, language, and ability to understand. I love these. There's different, there's, I don't know all the ins and outs of it, but there's different surveys and evaluation tools that they use. And that's, I'm gonna put that on the parking lot. I, parking lot question. And I do totally believe in that. And someone else might be able to answer that question better than me, so I'd love for someone to, yeah. Yeah, so that's a challenge, definitely. And I will, to hear straight from the joint commission on that, I'll refer you to a resource called the Joint Commission Roadmap for Hospitals. So I actually listed it, the full name at the end of this, but Roadmap for Hospitals, Road to Path to Effective Communication and Culturally Competent Care, or something along those lines. And they talk about limited English proficiency and language access programs. There's things like the language line, but all I hear are complaints about the language line. So we gotta find a new way to circumvent that. This became effective end of June, beginning of July. Yeah, and they've been talking about these strategies since 2010. It's just that no one pays attention to them until they're actually standards. One of, a great resource. Yeah, thank you. A great resource to get you started just in terms of plain language materials in many different languages that are written in a health literate, using health literacy principles, is Healthy Roads Media, healthyroadsmedia.org. It's a nonprofit that does tons. They put out so many different diseases, conditions, and materials around those conditions. Oh, healthyroadsmedia.org. Yeah, absolutely. And so you would learn that from identifying patient oral and written communication needs. No, generally no. So that's where we're trying to go. That's where the system lacks the needs of where it doesn't meet the needs of the patient population. So, mm-hmm, language line. Yeah. And I actually, oh, that's great. What I've heard is that most of the time interpreters, most of the time interpreters don't really, don't really feel comfortable telling a doctor that they didn't understand what you just said. So that's one thing, one piece of empowerment that we're doing within the hospitals in our trainings is we're trying to get interpreters to start speaking up when they recognize that instance is a miscommunication. The third joint commission requirement is a medical record contains info that reflects patient care, treatment, and services, including patient communication needs. And then the last one that I wanted to highlight was the hospital respects, protects, and promotes patient rights. And that includes the right to a need for effective communication. So, effective communication is a new thing that's gonna start, people are gonna be talking about and people are gonna be required to start addressing in hospitals. So if you're a hospital-based person in here and you wanna go talk to your leadership, just say, what are you doing about the new joint commission requirements? Yeah, you're on it, that's great. University Health System is on it, that's great. A case for recipients of federal dollars. And here I wanted to talk about any time you're applying for federal grants right now as of the passing of the Affordable Care Act. Here's some things you can be doing. So this is the implications of the Affordable Care Act. They explicitly state health literacy several times throughout the Affordable Care Act, one of which says, training grants will be made available, preference for awards to those who provide training and enhanced communication with patients, cultural competence, and health literacy. So if you explicitly state health literacy in your federal proposals, you'll be giving preference. You'll be giving preference as a recipient of that grant. The need for plain language materials and effective oral communication are mentioned explicitly and woven throughout much of the Affordable Care Act. So the Affordable Care Act is really forward-thinking or just, I guess, not as far behind the curve as general thinking about this need for effective communication, plain language. So it's exciting and it's a sign of things to come. So right now, as a recipient of federal dollars, you can really be at the front of the curve by starting to address these things in your proposals. And then the third main implication, main health literacy implication of the Affordable Care Act is for like FQHCs and different people that serve Medicaid populations because you are gonna see a huge influx in low health literate patients coming through your doors. So under the Affordable Care Act, Medicaid is expanding quite a bit. And so those populations will start accessing preventative health measures, screenings, hospital care. And so there's gonna be a much larger need for health literacy services coming down the road. There's, how are we doing on time? Okay, here I just wanted to, you might see up here any one of these areas that you have particular interest, that your leadership have particular interest, but these are other areas where you can really craft health literacy into the conversation as a pivotal piece of this conversation. So when you talk about health disparities in equity, the National Quality Forum just endorsed health literacy as a leading indicator and measure of equitable health and cultural competency in health care. So that's huge. So if you're talking about health disparities, a lot of people are worried about health disparities right now as we should be. And health literacy is massive, is a massive part of that. But we also can think back to that quote I said from the American Medical Association earlier, in that low health literacy, poor health literacy is a stronger indicator of a person's health outcomes than these other social factors that we often think of when we think of health disparities. Health information, HIT, health information technology. So this is, HIT is, we're going towards electronic medical records. We're doing these kind of health exchanges and that's where we're headed with patient-centered medical homes and with communities that are all connected. So in Austin, I'm working with the City of Austin Health Department, the City of Austin and Travis County Public Health Department and we're talking about goals through 2016 and everyone is super excited about the HIT that's coming down the road where all the safety net providers are gonna be linked and they're gonna be able to really be electronically linked to access patient records across the board. So I might go here for mental health and then I come here for my physical health and right now that my primary care physician or my physician who's seeing me for my physical health has no idea about these mental health issues. Well, under the new HIT system there's gonna be more collaboration and integration of that and so there's health literacy is a major part of that because it's also identifying communication needs and then allowing us to better craft the conversation when we get to people because we can look at the patient holistically. Patient-centered medical homes that's coming through the Affordable Care Act as well as other sources where people are looking again at the patient holistically and trying to engage the patient in their care throughout the entire continuum. So a lot of space for health literacy in there and if anyone has particular questions about any of these I'm happy to go into them more. Patient-centered medical home, is that what you're talking about? A medical home, I believe the official what people have coined it is just that it is an integrated care delivery system for you as a patient. So you would have a home which it could be a couple different places, I don't think, and if anyone has more knowledge on this correct me if I'm wrong but it doesn't necessarily need to be one physical doctor's office but it's an idea of all of your care, your healthcare is integrated. So it's part of the HIT, it's part of patient-centered experience and it's looking at you as a patient holistically. Right, right, right, mm-hmm, yep. National health, oh yeah, thank you, that's great. So it sounds like you can go to Liz for more information on the patient-centered medical home. It's a huge movement and it's definitely an important one. So thank you for sharing that. I mentioned the Medicaid expansion under the Affordable Care Act, specifically dig into that in terms of opportunities for health literacy. With that, they're creating consumer assistance programs which have to be inherently health literate if they're assisting the consumers of Medicaid. And the national health goes, I skipped that one. That is the Department of Health and Human Services put out a national action plan to improve health literacy. So that's one of the resources that I'll send out to you if you include your email on that sign-in sheet but it's a really great resource and something that you can look at and say, look at our nation, as a nation, we are working to address these goals of health literacy. Let's do our part as an agency, as a hospital, whatever you may be. And then the final one is there's a lot of buzz right now around patient-centered care, person-centered care, patient empowerment, engaged patients, and health literacy is intrinsic in providing patient-centered care. If you're not identifying the patient's communication needs, if you're not communicating with the patient that in a way that creates a shame-free environment, in a way that's culturally competent, in a way that's understandable and actionable, there's no way that it's gonna be patient-centered. So thoughts on these things, and this was kind of just to say, dig into this more, there's a lot of opportunity here to include health literacy in all of these things. Okay, or if you think of questions later, email me, call me, and let's talk about this because I love that. Some great resources to get you started. Attributes of a health litter organization. I've given that to some leadership throughout Austin, Central Texas area, and they've used that as a tool to go to their leadership. So I've given it to a health literacy champion and whatever, maybe she's a nurse manager and she gets behind health literacy and she loves it, and then she goes to her chief nursing officer and says, hey, I found this attributes of a health litter organization. It lists 10 attributes that an organization should be to provide health litter care. And she said, I think we're missing this one and this one, I think we could really improve this one. So that's a great tool put out by the Institute of Medicine, is that correct? That can get that conversation started with your leadership. The second one, the CDC put out Making Health Literacy Real Organization Action Plan, and that's really just the template that they created that says who do we need to get involved? How are we gonna get them involved? It's relatively simple, but it's a nice way to plan out your, I guess your strategic plan for health literacy and how you're gonna get people engaged within your agency. The Joint Commission Roadmap for Hospitals is huge. All of those effective communication principles that I was talking about, or requirements rather, are outlined in there and they give guidelines on how to meet those requirements. National Action Plan to Address Health Literacy, I mentioned that one. That's the Department of Health and Human Services put that out as our goals as a nation, what we need to do and how we can contribute to this movement. Agency for Health Care Research and Quality put out Universal Health Literacy Precautions Toolkit, which is a very comprehensive tool. It could be a great place to start where it introduces the issue and then gives you a lot more resources and ideas to get you started on health literacy. And then down here I put, if you wanna stay local and here in Texas, we are a resource to you all. And the Communication Climate Assessment Toolkit is available to you all. Solly is a great resource. There are plenty of other people. Sage Words is a resource. Health Literacy in Texas is coming and we're really doing a lot in the area. So please feel empowered to start doing stuff in your agency and be that champion. That's all for me and I just thank you all very much for listening. Good luck becoming the Health Literacy Champion at your agency. Hey, if you'd like to stay in touch, please fill out the registration form. Hey, how's it going?