• Stephen Harden

7 Simple Steps to Reduce Hospital Readmissions

...and provide better care to your patients while saving your hospital a lot of money.




In the past Medicare has rewarded hospitals with more money and reduced payments to others, based on their readmission rates. For hospitals with lots of Medicare patients, hundreds of thousands of dollars are at stake, money that could be spent on safety and quality. In all, the CMS penalties tie almost $1 billion in payments to hospitals to the quality of care provided to patients as measured by readmission rates.


Beyond the penalties imposed by CMS, hospitals waste almost $73 billion a year simply because patients do not understand what physicians and nurses are saying to them. If we could just fix the communication breakdowns, we would dramatically improve readmission problems.


Here are seven low cost, or no cost, simple things you can do to improve your readmission issues:


1. Take responsibility for your patients’ health literacy.

This is a small change in thinking with huge implications for safety. Most hospitals I work with approach the problem as if it were solely the patients’ responsibility to make themselves smart about their care. I say this because I see them make no attempt to communicate on the patient’s level or to make sure the patient understands what they have just been told.


What would you do differently if you assumed the patient knew nothing about healthcare and it was totally your responsibility as the health care provider TO MEET THEM WHERE THEY ARE - NOT WHERE YOU WISH THEY WERE in terms of health literacy?


If a nuclear physicist read us a paragraph from a very complicated academic article on nuclear physics and then asked us what it meant and why it was important to us, I bet 99% of us wouldn’t have a clue. And, we’d all be thinking, “Hey dude, you’d better explain it to me in terms that I can understand. After all, you are the expert in nuclear physics - not me!” It is the expert’s (yours) responsibility to make sure the listener (the patient) understands. If patients can’t understand what you’re saying, they won’t follow through properly, and you’ll have more readmissions, thus less money for safe, high-quality care.


2. Write all instructions about the plan of care and medications at the 5th-grade level.

Analysis of health care literature for patients reveals that almost all of it is written at the eleventh-grade level. We can wish that all our patients had better reading skills, but the truth is that 93 million Americans read between the third and fifth-grade level. Thirty-four percent have low literacy when it comes to reading forms or documents. An astonishing 55% have low literacy when it comes to numbers.


3. Use a 14-point type or larger. Most health care instructions are written in 10-point type.

This is too small for most patients and they don’t even try to read it. If you have ever tried to read the small type on the shampoo bottle in your hotel room while standing in the shower without your glasses, to make sure you are not about to put skin lotion on your hair, you can get a sense of how your patients, who read at a fifth-grade level, feel when you give them a form or instructions written in 10-point type.


4. Use plain English words - avoid medical jargon.

Why would you use the term “otitis media” instead of “earache?” Or the word “vomit,” instead of “throw up?” Use “living-room language;" the level of conversation you might have among family or friends on a daily basis. Nobody in your family says something like, “The medication capsule should be ingested with generous quantities of a hydrating liquid.” We say, “Be sure to take these pills with lots of water.” If your 12-year-old can’t understand your discharge instructions, it’s a good bet most of your patients can’t either.


5. Always tell your patients “Why.”

I once heard a nurse tell a patient, after their follow-up visit, “Take two of these pills every day for the next year.” She offered no other explanation than the patient had elevated cholesterol. I was pretty sure the patient didn’t leave the office inspired to take two pills per day for a whole year. What if she had said, “Your doctor wants you to take these pills because this medicine has helped hundreds of thousands of people with conditions like yours to live much longer and feel much better.” A longer and healthier life? That’s a strong dialogue that draws patients into the cause of better health and gets better compliance.


6. Get a “read-back” from your patients.

Explain the discharge instructions to the patient. Have them repeat back in their words what you told them. Go back and forth until you are confident the patient understands. I hear more “read-backs” at the local Chinese food take-out than I do in health care. Sure, it takes more time. But less time than you will take with them when you see them again after an unnecessary re-admit. Limit your instructions to three “need to know” messages.


7. Use the phrase, “What questions do you have?”

Don’t ask, “Do you have any questions,” as patients are likely to simply say “no,” even if they don’t understand. This is a technique used by professional pilots in the cockpit after their crew briefing. We also teach surgeons to use this question after their WHO Safe Surgery Checklist briefing. We have discovered that using the phrase, “What questions do you have?” always generates more questions and discussion than “Do you have any questions?”


Why don’t hospitals do these simple things already to improve readmissions?


I believe it is because they fall prey to the four biggest health literacy myths:

• Writing at a low grade reading level or using plain language is “dumbing down.”

• Using plain language that is easy to read is unprofessional and insulting.

• Writing at a lower grade level is easy to do.

• There’s no need to do this. Most people understand what we say to them or they would be asking us more questions.


Bust these myths with these 7 simple steps and you will be providing safer, higher quality care to your patients, and protecting your hospital’s bottom line.




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