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Stand Up Standout: Improving Communication, Engaging Patients

Posted By Administration, Wednesday, April 5, 2017
Updated: Wednesday, April 5, 2017

Stand Up Stand Out is an occasional feature on the blog highlighting the work of organizations that belong
to the NPSF Stand Up for Patient Safety program. In this post, read how one New York City health center
is making strides to overcome low health literacy.

by Patricia McTiernan, MS


The National Patient Safety Foundation has long advocated for patients and family members to be regarded as integral members of the health care team. When patients are actively engaged, they can help improve patient safety and experience better outcomes.


Yet getting patients engaged in their care is more challenging than it might appear. Barriers to engagement are still common at many levels of the health care system, with a 2014 report from the NPSF Lucian Leape Institute citing low health literacy as one of the chief barriers.


Health literacy has been defined as “the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions.”

The most commonly cited data suggest that only 12% of English-speaking adults in the U.S. are at a proficient level of health literacy. That means many of us struggle to comprehend care plans, medication regimens, and follow-up instructions.


To ensure that patients are able to understand important health care information, it is critical that providers recognize the nature of patients’ health literacy challenges and implement strategies to promote clear health communication. Ask Me 3, a program of NPSF, is designed to improve the lines of communication among patients, families, and health care professionals. The program encourages patients to ask the following three specific questions of their health care providers to better understand their health conditions and what they need to do to stay healthy.  The program encourages health care providers to use this framework to be prepared to answer the questions.


The Ask Me 3 program is one of the
tools being used at NYC Health +
Hospitals/Cumberland to improve
communication between patients and
health care providers.

1.     What is my main problem?

2.     What do I need to do?

3.     Why is it important for me to do this?

Through the use of these questions, Ask Me 3 empowers patients to become more involved in their health care, organize the provider-patient conversation, focus discussion on the answers to key questions, and help patients acquire the information they need to take care of their health. 


Staying Focused in Brooklyn

NYC Health + Hospitals/Cumberland, a Gotham Health Center, in Brooklyn, NY, is one of many health care organizations that have implemented the Ask Me 3 program to address health literacy. As part of NYC Health + Hospitals, the largest public health care system in the country, Cumberland has more than 57,670 patient visits every year from all walks of life and cultural backgrounds. Marlene Dacken, RN, patient safety officer, points out that “empowering patients to be active members of the patient/provider relationship and ensuring that communication is clear are essential components of patient safety.”

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The hospitals under the auspices of NYC Health + Hospitals have been long-time members of the NPSF Stand Up for Patient Safety program. As part of a larger effort to engage patients in their care, Cumberland introduced the Ask Me 3 program in adult primary care clinics, specialty care departments, and pediatrics.


Overall, approximately one-third of patients at Cumberland have used the program, according to Cynthia Boakye, MD, medical director. “For adult medicine, we try to give it to every patient,” she says. “Those who choose to use it fill out the form and organize their thoughts before they see the provider.”


Before rolling out the program, the Cumberland team ensured that all staff members were on board by providing training on health literacy and the program. The program has become a part of the culture of care at Cumberland with ongoing training of staff and all new hires.


A nurse or nursing assistant explains the program to the patients and provides them the questions on a form. Physicians refer to the form during the visit and are able to correlate the information they want to tell the patient to the patient’s questions.


“Staff members believe that the program really helps the patient get focused on what they want to ask the physician during the encounter,” says Ms. Dacken. “This helps outline their process to keep focused on what their concerns are.


“I started to use it myself, because even as a nurse, sometimes you do forget or you lose focus,” she adds. “As a patient, the communication is often physician-directed, the provider asking all the questions, but there are questions not on the health provider’s radar that may be on the minds of patients.”


The team has also developed a program called Take the Pledge, Take Your Meds, to improve medication adherence, another common issue in outpatient care.


Results of these efforts are so far anecdotal, with patients and staff both reporting positive feedback. “The patients think that it’s a good idea,” said Dr. Boakye. “It helps them focus on what they have to ask the physician and keeps everything in alignment so they are not diverted.”


NPSF offers complimentary Ask Me 3 materials and resources to organizations interested in implementing the program. Posters and fliers in English and Spanish are provided, along with an implementation guide and other materials. In addition, a new educational module is now available to help educate clinicians and staff regarding health literacy and the Ask Me 3 program.


Some 2,000 individuals have downloaded the materials in the past year, and the Ask Me 3 program continues to be one of the most frequently visited areas of the NPSF website.


“We are very pleased with the growing interest and use of this program over the past few years,” said Patricia McGaffigan, RN, MS, senior vice president for program strategy and management and chief operating officer of NPSF. “We see it as a very useful addition to other tools organizations may be using with both patients and health care professionals to better engage and communicate with their patients.”


To learn more and download complimentary materials, please visit


Ask Me 3 is a registered trademark licensed to the National Patient Safety Foundation.

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What steps does your organization take to improve communication between patients and health care providers? Comment on this post below. Note: to post a comment you must be logged in. Register or log in.

Patricia McTiernan is editor of the P.S. Blog. Contact her at

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Tags:  ask me 3  health literacy  Stand Up for Patient Safety 

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Health Literacy’s Impact on Patient Safety

Posted By Administration, Wednesday, September 21, 2016

October is Health Literacy Month. Find out what you can do to be part of the solution to low health literacy.

by Patricia McTiernan, MS

The most frequently referenced survey of health literacy in the U.S., the National Assessment of Adult Literacy (NAAL), found that only 12% of English-speaking adults are at the “proficient” level of health literacy. That leaves an awful lot of us who sometimes struggle with common tasks such as reading and following directions for the use of prescription medications or adhering to other care plan activities.

Health literacy has been defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Proficiency is dependent on much more than the ability or read. The ability to use numbers, communication and reasoning skills, and cultural backgrounds all contribute to health literacy.

October is Health Literacy Month, so there is no better time to learn more about the problem of low health literacy and what you can do to be part of the solution.

An Equal Opportunity Problem

The NAAL found that health literacy is an issue for all racial and ethnic groups. Although health literacy increases with higher levels of education, 44% of those with a high school education are at basic or below basic levels. Among age groups, those 65 years of age or older are more likely to have health literacy skills at the basic or below basic levels.

The National Action Plan to Improve Health Literacy (2010) lays out goals for improvement. Among them, a call to the health care system and health practitioners to simplify complex language and present information in ways that make it more easily understandable.


Lea Anne Gardner, PhD, RN,
senior patient safety analyst
at the Pennsylvania Patient
Safety Authority, will discuss
health literacy in the NPSF
Professional Learning Series
Webcast on September 27.

Read details and register.

Health Literacy and Adverse Events

Recently, the Pennsylvania Patient Safety Authority has been involved in a statewide initiative to provide health care practitioners with strategies they can use to help their patients understand and be involved in their care. Researchers at the Authority searched the Pennsylvania Patient Safety Reporting System and found 265 event reports over a 10-year period that were potentially related to low health literacy.

The most frequent outcomes of patients misunderstanding instructions or information were delayed or cancelled procedures, surgeries, treatments, or tests; or patients leaving without being seen, according to an advisory issued by the Authority in June.

The advisory also discusses ways that practitioners can recognize low health literacy and some of the tools and strategies they can use to communicate more effectively. Among the recommendations are using teach-back methods, plain language, and open-ended inquiry, such as “What questions do you have?” rather than “Do you have any questions?”

Another method included in the advisory is the Ask Me 3 program run by NPSF. A cornerstone of health literacy communications, the Ask Me 3 program is designed to facilitate open dialog between patients and providers by encouraging patients to ask three key questions when receiving care:

  1. What is my main problem?
  2. What do I need to do?
  3. Why is it important for me to do this?

During Health Literacy Month and beyond, NPSF urges organizations to adopt these strategies to communicate more effectively with patients. Ask Me 3 is easy to implement and materials and guidance information can be downloaded on this website.

Take Action

Even with a recognition of the problem, it takes time for clinicians and organizations to retool the information and methods they use to communicate with patients. Resources are available to help.

A wealth of information about health literacy, including links to state organizations, is available via the Centers for Disease Control and Prevention. Visit, and use Health Literacy Month as an opportunity to educate yourself, your colleagues, your family, or your patients.

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Do you have tips or strategies for clear communication with patients? Are you a patient who has used Ask Me 3 or another resource? Comment on this post below. Note: to post a comment you must be logged in. Register or log in.

Patricia McTiernan is editor of the P.S. Blog. Contact her at

Tags:  Ask Me 3  health literacy 

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June Is National Safety Month

Posted By Administration, Friday, June 10, 2016
Updated: Friday, June 10, 2016

Patients and families can play a critical role in preventing medical errors and helping to reduce the risk of medical harm. For National Safety Month, we focus on a few key actions.

by Joanna Carmona


Mark your calendars—and with good reason this time. In a world of National Chocolate Macaroon Day and Put a Pillow in Your Fridge Day, National Safety Month is something worth talking about.


The National Patient Safety Foundation (NPSF) this month, and every month, aims to empower patients to ask the critical medical questions that can make a difference in their care. The National Patient Safety Foundation's stance is that while patients and families can play a critical role in preventing medical errors and reducing harm, the responsibility for safe care lies primarily with the leaders of health care organizations and clinicians and staff who deliver care.


Even with the onus on health care practitioners to make care safe, here’s how you can take charge of your own safety:


1. Ask questions about the risks and benefits of recommendations until you understand the answers.

“The best advice I can give is to be your own advocate. Question, question, question until things are explained in a way you understand. A health care system that doesn't address your concerns is a risky one,” said Peter Pronovost, MD, PhD, director of Adult Critical-Care Medicine and a patient-safety researcher at the Johns Hopkins University School of Medicine in Baltimore in a recent article. If you aren’t sure what questions to ask, check out our Ask Me 3 program.



2. Don’t go alone to the hospital or to doctor visits.


Bring a sibling, spouse, friend, or neighbor— anyone you trust to be your ally.


According to a 2011 article in the American Family Physician journal, an advocate can:

  • Speak up for the patient who may not be expressing all of their medical concerns.
  • Help to keep track and remember all instructions.  
  • Provide emotional support, even if they don’t interact directly with medical staff.

3. Always know why and how you take your medications, and their names.

In a 2015 study published in the Journal of the American Medical Association (JAMA), researchers found that from 1999 to 2012, the percentage of adults taking five or more prescription drugs doubled from 8% to 15%.


With prescription medications on the rise and with patients juggling multiple prescriptions, a two-way conversation around drug safety is needed.


Here’s what you should ask, according to a 2014 article from the Agency for Healthcare Research and Quality (AHRQ):


  • What is the medicine for?
  • How am I supposed to take it and for how long?
  • What side effects are likely? What do I do if they occur?
  • Is this medicine safe to take with other medicines or dietary supplements I am taking?
  • What food, drink, or activities should I avoid while taking this medicine?

4. Be sure you understand the plan of action for your care plan.

“Limited health literacy is a hidden epidemic. It can affect health status, health outcomes, health care use, and health costs,” according to 2008 article in The Permanente Journal. Oftentimes, medical information and terminology is complex, so if you don’t understand something, don’t hesitate to ask.


5. Say back to your clinicians in your own words what you think they have told you.

By practicing this step on a regular basis, it may help you remember the instructions after you leave and helps clinicians know if you’ve understood. For example, “Just so I understand, I need to take X medication, X times per day, for the next X days?”


6. Arrange to get any recommended lab tests done before a visit.

The advantage of getting lab tests completed before seeing a doctor is that the results can be discussed during the visit, instead of during a follow-up or having the results explained over the phone.


7. Determine who is in charge of your care.

Many health care settings are moving toward team-based care. If admitted into a teaching hospital, for example, you may find that multiple clinicians are involved in your care. There may be interns, a hospitalist, nurses, and doctors taking care of you at any given time. You can ask: “Who is the key person in charge of my care?”


For more information on patient safety for patients and families, visit our website.


Looking for more patient resources? 

  • Download this report of the Informed Patient Institute, done in conjunction with Consumer Reports, which evaluates what type of information is available to consumers on medical board websites nationwide. 

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Comment on this post below. Note: to post a comment you must be logged in. Register or log in.


Joanna Carmona is communications coordinator at the National Patient Safety Foundation. Contact her at


Tags:  Ask Me 3  national patient safety foundation  national safety month  patient and consumer  patient safety 

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