Executive Summary

Health literacy is the degree to which people can find, understand, and use health information and services to make decisions about their care. When communication is too complex, patients miss instructions, take medicines incorrectly, skip follow-up, and end up confused or harmed — often without anyone realizing the breakdown was a communication problem.

This toolkit gives leaders a practical system to make communication clearer across the organization: a plain language checklist, a patient-instruction rewrite checklist, a teach-back implementation guide, visual and digital communication checklists, a staff education toolkit, an organizational self-assessment, and a 30/60/90-day roadmap. Everything is editable and ready to put to work.

The core idea: clear communication is a system, not a talent. Organizations that standardize plain language, confirm understanding, and design for the patient — not the expert — see fewer errors and more confident patients.

Why Health Literacy Matters

Most patients — including educated ones — struggle with health information at some point, especially when they are sick, stressed, or hearing something for the first time. Limited understanding is linked to worse outcomes: more difficulty managing chronic conditions, more medication errors, and more avoidable visits. The problem usually isn’t the patient’s intelligence; it’s the way information is written and delivered.

National guidance reframes this as a shared responsibility. The U.S. definition of health literacy now distinguishes personal health literacy (an individual’s ability to use information) from organizational health literacy (how well an organization enables people to understand and use information). That shift matters for leaders: it makes clarity an organizational design choice, not just a patient trait.

Organizational Health Literacy Overview

An organization with strong health literacy makes it easy for people to navigate, understand, and act on health information. Leadership sets the tone and the standards. Practical hallmarks include:

• Leaders make clear communication an explicit priority and standard.
• Written materials are routinely reviewed for plain language and reading level.
• Staff are trained in plain language and teach-back.
• Signage, forms, and digital tools are easy to navigate.
• Interpreter and translation services are available and used.
• Patients are involved in designing and testing materials.
• High-risk communications (medicines, discharge, consent) get extra attention.

National frameworks describe attributes of a health-literate organization; confirm current guidance and definitions at time of use.

Common Communication Mistakes

• Using medical jargon and acronyms without explanation.
• Writing at a reading level far above what most patients can use.
• Giving too much information at once instead of focusing on what to do.
• Assuming “Do you understand?” confirms understanding (it doesn’t).
• Relying on dense text where a simple image or step list would work better.
• Ignoring language, vision, and accessibility needs.
• Designing forms and portals for staff convenience, not patient clarity.
• Never testing materials with actual patients.

Plain Language Checklist

• Lead with what the patient needs to do, then explain why.
• Use common, everyday words; define or replace medical terms.
• Keep sentences short (aim for one idea per sentence).
• Use “you” and active voice (“Take one pill,” not “One pill should be taken”).
• Limit each document to a few key messages.
• Use headings, short lists, and white space to make it scannable.
• Spell out numbers and instructions clearly (times, doses, dates).
• Aim for an accessible reading level for the audience.
• Avoid double negatives and vague terms (“regularly,” “as needed”).
• End with what to do if there’s a problem and who to call.

Patient Instruction Rewrite Checklist

Use when revising existing instructions (discharge, prep, medication, post-procedure).

• Identify the 3–5 actions the patient must take.
• Rewrite each action as a simple, numbered step.
• Replace jargon with plain words; add a short definition only if essential.
• State exact timing and amounts (e.g., “at 8 a.m. and 8 p.m.”).
• Add a “warning signs — call us if…” section in plain language.
• Add a “who to call and when” line with real contact info.
• Add a simple visual or icon where it aids understanding.
• Confirm reading level and accessibility (font size, contrast, translation).
• Test the rewrite with a patient or non-clinical reader.

Teach-Back Implementation Guide

Teach-back is asking patients to explain, in their own words, what they need to know or do — to confirm your explanation was clear. It checks the system, not the patient.

How to do it well:

• Frame it as your responsibility: “I want to be sure I explained this clearly.”
• Ask open-ended: “Can you tell me how you’ll take this medicine at home?”
• If there’s a gap, re-explain differently — don’t repeat the same words.
• Check again until the patient can teach it back comfortably.
• Use for high-risk topics: new medicines, discharge, self-care, consent.

Implementation steps for leaders:

1. Train staff with examples and practice, not just a definition.
2. Identify the few moments where teach-back is required.
3. Observe and coach; recognize staff who do it well.
4. Reinforce in huddles; make it a normal habit, not an extra task.

Visual Communication Checklist

• Use images, icons, or diagrams to support (not replace) key instructions.
• Keep visuals simple and directly tied to the action.
• Use real-world, respectful, inclusive imagery.
• Pair every important image with a short text label.
• Ensure adequate size, contrast, and legibility.
• Avoid clutter; one main idea per visual.
• Provide text alternatives for accessibility.
• Test visuals with patients to confirm they’re understood as intended.

Digital Health Literacy Checklist

• Patient portals and apps use plain language and clear navigation.
• Instructions for logging in and using features are simple and visible.
• Key actions (messages, results, scheduling) are easy to find.
• Content meets accessibility standards (contrast, font size, screen-reader support).
• Materials are available in patients’ preferred languages.
• Support is offered for patients with limited digital access or skills.
• Results and messages are explained in understandable terms, not raw data.
• Digital tools are tested with a range of real patients.

Staff Education Toolkit

Use these elements to build staff skills and make clear communication routine:

• Core concepts: what health literacy is, why it matters, personal vs. organizational.
• Plain language practice: rewrite real materials together as a team exercise.
• Teach-back practice: role-play with feedback, not just lecture.
• Jargon swap: build a shared list of plain-language alternatives.
• Coaching: observe interactions and give specific, supportive feedback.
• Reinforcement: short refreshers in huddles; recognize good examples.
• Measurement: track use of teach-back and patient understanding over time.

Health Literacy Self-Assessment

Rate your organization or unit: Not yet / In progress / Established.

• Leaders treat clear communication as a stated priority and standard.
• Written materials are reviewed for plain language and reading level.
• Staff are trained in plain language and teach-back.
• Teach-back is used for high-risk communications.
• Forms, signage, and portals are easy to navigate.
• Interpreter/translation services are available and used.
• Patients help design and test materials.
• We measure patient understanding and act on what we learn.

Reflection: pick the lowest-scoring area as your first focus.

30 / 60 / 90 Day Implementation Roadmap

Days 1–30 — Assess & prioritize:

• Complete the organizational self-assessment.
• Pick 2–3 high-risk materials to rewrite first (e.g., discharge, a common med instruction).
• Introduce plain language and teach-back to staff.

Days 31–60 — Redesign & train:

• Rewrite priority materials using the checklists; test with patients.
• Run staff education with practice and coaching.
• Define where teach-back is required and begin observing.

Days 61–90 — Embed & measure:

• Apply visual and digital checklists to portals and key materials.
• Reinforce in huddles; recognize strong examples.
• Re-assess, measure understanding, and plan the next set of materials.

References

1. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2030 — definitions of personal and organizational health literacy.
2. Centers for Disease Control and Prevention (CDC). Health Literacy resources and plain language guidance.
3. Agency for Healthcare Research and Quality (AHRQ). Health Literacy Universal Precautions Toolkit (includes teach-back).
4. National Academy of Medicine (formerly Institute of Medicine). Attributes of a Health Literate Organization.
5. PlainLanguage.gov — U.S. federal plain language guidelines.

Health literacy definitions, toolkits, and guidance are updated periodically; verify the current version and URL of each source at time of use.

Related Care Experience Lab Resources

• Healthcare Communication Transformation
• Hospital & Home Health CAHPS Leadership Toolkit
• Explore the full Resource Library

Version 1.0 · Review date: [set at publication] · Care Experience Lab · Patient & Family Communication. This toolkit is provided for general informational purposes and is not legal, compliance, or clinical advice; adapt it to your organization’s policies and context.