National Academy of Medicine

Ten Attributes of Health Literate Health Care Organizations

By Cindy Brach, Debra Keller, Lyla M. Hernandez, Cynthia Baur, Ruth Parker, Benard Dreyer, Paul Schyve, Andrew J. Lemerise, Dean Schillinger
June 19, 2012 | Discussion Paper


This paper describes 10 attributes of health literate health care organizations, that is, health care organizations that make it easier for people to navigate, understand, and use information and services to take care of their health. Having health literate health care organizations benefits not only the 77 million Americans who have limited health literacy, but also the majority of Americans who have difficulty understanding and using currently available health information and health services (ODPHP, 2008).

Although health literacy is commonly defined as an individual trait—the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (Ratzan and Parker, 2000)—there is a growing appreciation that health literacy does not depend on the skills of individuals alone (IOM, 2003). Health literacy is the product of individuals’ capacities and the health literacy-related demands and complexities of the health care system (Baker, 2006; Rudd 2003). System changes are needed to align health care demands better with the public’s skills and abilities (Parker, 2009; Rudd, 2007).

Health literacy has been identified as a priority area for national action, first by the Department of Health and Human Services as an objective for Healthy People 2010 (HHS, 2000), and again in the 2003 Institute of Medicine report Health Literacy: A Prescription to End Confusion (IOM, 2004). The following decade saw the achievement of many milestones that marked health literacy’s ascendency in both the public and private sectors (Parker and Ratzan, 2010), including a National Action Plan to Improve Health Literacy (ODPHP, 2010). Health literacy has now reached a possible tipping point, the place where paying attention to it could quickly become the norm for health care organizations (Koh et al., 2012).

Recognizing that addressing health literacy is critical to delivering person-centered health care, a wide range of organizations have emphasized the need to tackle system-level factors to ensure that consumers can make informed health care decisions (AHIP, 2011; AMA, 2007; NQF, 2009; ODPHP, 2010; DeWalt et al., 2012; ). This is particularly urgent for adults with limited health literacy (Martin and Parker 2011). They experience more serious medication errors (Schillinger et al., 2005), higher rates of emergency room visits and hospitalizations (Baker et al., 2002), worse preventive care and health outcomes for their children (Sanders et al., 2009), and increased mortality (Sudore et al., 2006; Bostock and Steptoe, 2012; Yaffe et al., 2006) compared with individuals with adequate health literacy. Health literacy has also become recognized as an important component to delivering culturally and linguistically appropriate services. A
forthcoming enhancement of the National Standards for Culturally and Linguistically Appropriate Services acknowledges that addressing health literacy is integral to providing quality health care to diverse populations (HHS OS, 2000).

Health literate health care organizations recognize that miscommunication that negatively affects patient care and outcomes is very common. Misunderstandings occur not only in clinical situations, such as when treatment options and medicine instructions are discussed, but also when receptionists ask for a signature on a form and billing staff discuss covered services and financial responsibilities. Health literate health care organizations also recognize that individuals who ordinarily have adequate health literacy may have difficulty processing and using information when they are sick, frightened, or otherwise impaired. Systems must therefore be redesigned to accommodate the unpredictability of limited health literacy skills (Rudd, 2010). Finally, health literate health care organizations recognize that literacy, language, and culture are intertwined, and their health literacy efforts augment efforts to reduce disparities and improve the organization’s linguistic and cultural competence (Andrulis and Brach, 2007; Sudore et al., 2009). Under the stewardship of health care organizations that are committed to being health literate, everyone benefits from communication that is clear and easy to understand.




Suggested Citation

Brach, C., D. Keller, L. M. Hernandez, C. Baur, R. Parker, B. Dreyer, P. Schyve, A. J. Lemerise, D. Schillinger. 2012. Ten Attributes of Health Literate Health Care Organizations. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. doi: 10.31478/201206a


Disclaimer: The views expressed in this paper are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The paper is intended to help inform and stimulate discussion. It is not a report of the NAM or the National Academies. Copyright by the National Academy of Sciences. All rights reserved.