ten attributes of an organization that supports …...attributes of an organization that supports...

J O Frempong amp Associates Inc

Plain Language and Cross-Cultural Communications

Janet Ohene-Frempong MS

Ten Attributes of an Organization

That Supports Health Literacy and Health Equity

Broadening the Model to Include Fields Outside of Healthcare

Institute for Healthcare Advancement

IHArsquos 15th Annual Conference

ldquoCreating a Vision for Health Literacyrsquos Futurerdquo

May 4 2016

httpswwworegongovohaPagesabout_usaspx

2 J O Frempong amp Associates Inc


httpswwworegongovOHAoeipagesindexaspx

httpswwworegongovohaoeiPagesdeltaaspx


Oregonrsquos Approach to Medicaid Cost Control

5


Can Oregon save American health care

Sarah Kliff 11813 - The Washington Post

httpswwwwashingtonpostcomnewswonkwp20130118can-oregon-save-american-health-care


6



Ezra Klein 52013 - The Washington Post

httpswwwwashingtonpostcomnewswonkwp20130520is-the-future-of-american-health-care-in-

oregon

Inside Oregonrsquos Medicare lab

Joe Rojas-Burke 52013 ndash Modern Healthcare

httpwwwmodernhealthcarecomarticle20130907MAGAZINE309079891


Controlling costs

Steven Ross Johnson 11713 ndash Modern Healthcare



The Fall of John Kitzhaber Who Was Supposed to Save Healthcare Reform

21315 ndash Newsmax

httpwwwnewsmaxcomNewsfrontOregon-John-Kitzhaber-healthcare-reform-

save20150213id624743


httpswwworegongovohaOHPBPageshealth-reformccosaspx






In keeping with Oregonrsquos Coordinated Care initiative

To reduce the cost of health care by finding ways to

improve the quality of care

And to promote effective communication as one of

those ways



DELTA is a health equity and inclusion leadership program

that includes training coaching and networking to health

community and policy leaders in Oregon

This 9 month program trains 25-members committed to

advancing health equity and diversity throughout Oregon

DELTA Developing Equity Leadership through Training and Action


DELTA Cohorts

Who is Being Trained


Fields Positions Professions

Health Related Administrators Public Health

Education Coordinators Clinical Care

Social Service Managers Mental Health

Law Enforcement Graphic Designers Aging

State Government Teachers Early Childhood Education

A Sheriff Public Relations



bull Diversity in Recruitment Hiring and Retention

bull Race Ethnicity and Language Data amp

Health Equity Metrics

bull Effective Community Engagement

bull Power and Oppression

bull Health Literacy amp Language Access

bull Health Equity Strategic Planning

bull Leadership for Health Equity

bull Cohort Project Presentations

DELTA Curriculum for Spring - 2014








bull Using the Equity amp Empowerment Lens

bull Health Equity Leadership and Strategic Planning

DELTA Curriculum for Spring - Summer 2016



The DELTA program

bull provides 40 hours of classroom training

bull provides10 hours of individualized technical assistance

bull facilitates opportunities for cross-sector partnership

Each participant submits a project prior to graduation that drives

and institutionalizes best practices in their organizations that

promotes health equity and inclusion




1 Oregon is including health literacy issues in the

development of equity leadership as well as in their

attempt to reduce the cost of providing healthcare to

those who have been most vulnerable to inequitable

treatment

Health Literacy and Health Equity


2 Issues of marginal literacy and effective communication

have importance that the for organizations that focus

not only on health but on education social services

law enforcement and even on art and entertainment

Effective Communication and Health Equity


3 We can possibly expand the use of the Institute of Medicinersquos

Ten Attributes of a Health Literate Organization for use

outside of the healthcare industry to indirectly improve

the health and well being of those people who are most

vulnerable to inequitable treatment

Ten Attributes

Health Literacyrsquos Possible Contribution


Ten Attributes of

a ldquoHealth Literate Organizationrdquo

A 2012 Institute of Medicine (IOM) Discussion Paper

A seminal document prepared by participants on

the IOMrsquos Roundtable on Health Literacy

Ten Attributes of Health Literate Health Care Organizations

A Disussion Paper

Institute of Medicine June 2012

httpiomedu~mediaFilesPerspectives-Files2012Discussion-

PapersBPH_Ten_HLit_Attributespdf



httpwwwahealthyunderstandingorgPortals0Documents1IOM_Ten_Attributes_HL_Paperpdf

Rationale for Referring to This Source

The document is

presented as a living document to be updated

accurate

thoughtful and very comprehensive

well-organized

well-documented

motivational

historically significant


Organizational Change

The Vision and the Journey

Aims beautifully stated

To provide an ldquoaspirational visionrdquo in attempt to

ldquolaunch health care organizations on their journeyrdquo

to becoming health literaterdquo

To ldquoprovide travelers with some guidepostsrdquo


The Destination

Becoming a ldquoHealth Literaterdquo Organization

This means becoming an organization that makes it

easier for people to

navigate

understand information

use information and services to take care of

their health

hellipin other words becoming an organization that is

ldquohealth literacy supportiverdquo


A Brief Summary

Implied Calls-to-Action for Organizations

1 Make health literacy integral to your mission structure

and operations

2 Integrate health literacy into planning evaluation measures

patient safety and quality improvement

3 Prepare your workforce to be health literate and monitor

your progress at doing so

4 Include populations served in the design implementation

and evaluation of health information and services

5 Meet the needs of populations that have a range of health

literacy skills while avoiding stigmatization



A Brief Summary


6 Use health literacy strategies in interpersonal communication

and confirm understanding at all points of contact

7 Provide easy access to health information and services and

navigation assistance

8 Design and distributes print audiovisual and social media

content that is easy to understand and act on

9 Address health literacy in high-risk situations including

care transition and communications about medicines

10 Communicate clearly what health plans cover and

what individuals will have to pay for services


30

Attribute 1



31

Attribute 1



32

Attribute 1 - Attribute 2



33

Attribute 3







36

So based on this original documenthellip



37

hellipthis checklist was adapted


This document was drafted for use with the Oregon Health

Authority Office of Equity amp Inclusionrsquos DELTA Program

which stands for Developing Equity Leadership through Training

and Action

It was designed to support their efforts to develop equity

leadership - both within and beyond the health care system -

through training and action

38

Origin of the Checklist Introduction to the Tool


Healthcare and Beyond

bull Healthcare

bull Education

bull Social Work

bull Law Enforcement

Who else needs to be added

httpsccohealthoregongovDocumentstransformationTP-Guidance-Item6-2012-12-18-intropdf

39


Federal Highway Administration - 2006

httpwwwfhwadotgovplanningpublicationslow_limitedlowlim03cfm

41

The Transportation Barrier


ldquoMany low-income people in urban and suburban areas

struggle to find reliable transportation The result is missed

appointments and poor illness management even when care

is readily availablerdquo


Imran Cronk

The Atlantic 2015

httpwwwtheatlanticcomhealtharchive201508the-transportation-barrier399728

42

Dwelling Disparities


ldquoLow-income andor ethnic minority communities - already

burdened with greater rates of disease limited access to

health care and other health disparities - are also the

populations living with the worst built environment conditions

Studies have shown that negative aspects of the built

environment tend to interact with and magnify health

disparities compounding already distressing conditionsrdquo

Dwelling Disparities How Poor Housing Leads to Poor Health

Ernie Hood

Environ Health Perspect 2005 May 113(5) A310ndashA317

httpwwwncbinlmnihgovpmcarticlesPMC1257572

Health care organizations have an obvious role to play in

the quest for health equity and many have embraced that role

However when people fail to function effectively within

educational social service and legal systems it can

and often does have an indirect and negative effect on

their health and the health of their families

43

A Multidisciplinary Approach

to the Quest for Health Equity Introduction to the Tool

Attributes of an Organization that Supports Effective Communication and Health Equity

Adapted from Ten Attributes of a Health Literate Organization

By J O Frempong amp Associates Inc April 2015

With Permission from the National Academy of Science

Courtesy of the National Academies Press Washington DC

Therefore there are roles for other professions to play as well

in communicating effectively across diverse literacy levels

languages cultures and in achieving health equity

The goal of this session today which has its origins in the field

of health care is to support their efforts

44








Communication is the process of sharing information

thoughts and feelings between people through speaking

writing or body language

Effective communication extends the concept to require that

transmitted content is received and understood by someone in

the way it was intended The goals of effective communication

include creating a common perception changing behaviors and

acquiring information

45

Effective Communication Introduction to the Tool

What is Effective Communication

httpwwwlivestrongcomarticle69309-effective-communication

Health equity means that everyone has a fair opportunity

to live a long healthy life

It implies that health should not be compromised or

disadvantaged because of an individual or population

grouprsquos race ethnicity gender income sexual orientation

neighborhood or other social condition

46

Health Equity Introduction to the Tool



47

Achieving health equity requires creating fair opportunities

for health and eliminating gaps in health outcomes between

different social groups

It also requires that public health professionals look for

solutions outside of the health care system (emphasis

added) such as in the transportation or housing sectors

to improve the opportunities for health in communities

48




ldquoHealth 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

49

The Role Being Undertaken

by Health Care Organizations

Introduction to the Tool


Cindy Brach Debra Keller Lyla M Hernandez Cynthia Baur Ruth Parker Benard Dreyer Paul Schyve

Andrew J Lemerise and Dean Schillinger

httpiomedu~mediaFilesPerspectives-Files2012Discussion-PapersBPH_Ten_HLit_Attributespdf

ldquoHealth 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)rdquo

50








ldquoFinally 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 organizationrsquos 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 understandrdquo

51








ldquoResearch suggests that school-to-parent communication can

promote productive parental involvement and that productive

parental involvement in schools can in turn have a positive

impact on student achievement (Henderson amp Mapp Jeynes)

Because of limitations in financial and human resources and

because ineffective attempts at parental communication may

result in educators abandoning rather than refining their

efforts it is important for every school-to-parent

communication effort to be as effective as possiblerdquo

52

Communication with Parents to Enhance Learning

httpwwweducationcomreferencearticlecommunication-with-parents-to-enhance

A Role for Organizations

that Focus on Education Introduction to the Tool

ldquoLow health literacy is a potential driver of health disparities

and its alleviation is central to the values and concerns of

the social work profession Despite the extensive knowledge

and skills that social workers can bring to bear to assist

patients with low health literacy the concept of health literacy

is underused in social work scholarship

This gap reflects missed opportunities for social workers to

contribute their expertise to the evolving field of health literacy

and to strategically align their work with organizational and

national prioritiesrdquo

53

Health literacy critical opportunities for social work leadership in health care and research

See comment in PubMed Commons below

Liechty JM1 - Health Soc Work 2011 May36(2)99-107


that Focus on Social Services Introduction to the Tool

ldquoHealth experts and practitioners have long understood the

connection between promoting health and preventing

violence They understand epidemiologically how violence

spreads like a disease how it is transmissible from person to

person until whole communities are affected

What they also understand is that systemic preventative

interventions aimed at targeting root causes are critical to

keeping our communities safe healthy and wholerdquo

54

Law Enforcement and Public Health

Robert V Wolf - Center for Court Innovation

httpric-zai-inccomPublicationscops-p226-pubpdf


that Focus on Legal Issues and Law Enforcement Introduction to the Tool

55

Attribute 1


ldquoA Health Literate Health Care

Organization Has Leadership

That Makes Health Literacy

Integral to Its Mission Structure

and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1


12 points that spell out in helpful

detail what organizational leaders

would need to do to be described

as having that particular attribute

58

59

Original says

Establish advisory groups that involve individuals with limited health literacy

adult educators and experts in health literacy

This adapted versionsays

Establishes advisory groups that involve individuals with limited literacy

adult educators and experts in health literacy or experts in effectively

communicating about organizationrsquos field (eg education social service or law)

Lack of time and money

A persistent barrier to implementation


Health Literacy for all

A Worthy Goal

ldquoIf health care organizations adopt most of the 10 attributes

in even a modest way they will not only be more responsive

to individualsrsquo needs and especially those with limited health

literacy they will also make a substantial contribution to

improved population healthrdquo


A Disussion Paper



Effective Communication and Health Equity for all

An Even Broader Goal

If health education human service and law enforcement

organizations adopt most of the 10 attributes in even

a modest way they may not only be more responsive

to individualsrsquo needs and especially those with limited

fundamental literacy skills they will also make a substantial

contribution to improved population health


63

Year Resources on the Link Between

Health Communication and Health Equity 2001 Scott Ratzan

Health literacy communication for the public good

httpsheaprooxfordjournalsorgcontent162207abstract

2009 IOM

Toward Equity and Patient Centeredness

Integrating Health Literacy Disparities Reduction and Quality

Improvement Workshop Summary (2009)

httpwwwnapeducatalog12502toward-health-equity-and-patient-

centeredness-integrating-health-literacy-disparities

2012 US National Oral Health Alliance

Oral Health Literacy as a Pathway to Health Equity

httpwwwusalliancefororalhealthorgsitesdefaultfilesstaticThird

ColloquiumSummaryUSNationalOralHealthAllianceJune2012_0pdf

2014 Yi Guo et al

Health Literacy A Pathway to Better Oral Health

httpajphaphapublicationsorgdoiabs102105AJPH2014301930

64


Health Communication and Health Equity 2012 UCL Institute of Health Equity

The Impact of the Economic Downturn and Policy Changes on Health

Inequalities in London

httpswwwinstituteofhealthequityorgprojectsdemographics-

finance-and-policy-london-2011-15-effects-on-housing-employment-

and-income-and-strategies-to-reduce-health-inequalities

2013 Emee Vida Estacio

Health literacy and community empowerment Itrsquos more than just reading

writing and counting

httphpqsagepubcomcontentearly201301241359105312470126

2013 Rima Rudd

Needed action in health literacy

httphpqsagepubcomcontent1881004short

2014 Yi Guo et al



65


Health Communication and Health Equity 2015 National Academy of Medicine

Health Literacy A Necessary Element for Achieving Health Equity

httpnameduwp-contentuploads201507NecessaryElementpdf

The Oregon Health Authority

Transformation Plan Element 6

Addressing Membersrsquo Cultural Health Literacy and Linguistic Needs

Transformation Plan Guidance and Technical Assistance

Oregon Health Authorityrsquos technical assistance is designed to

provide Coordinated Care Organizations (CCOs) with

bull Guidance on specific areas each plan should address

bull Examples of approaches and outcomes that can help inform

discussions and strategies as the CCO develops its plan

bull Other resources and additional technical assistance

available to CCOs and

bull Staff assistance to answer specific questions through

an assigned OHA contact


66




Implementation Issues Addressed

bull Needs assessment

bull Expectations

bull Standards

bull Accountability

bull Transformative activities

bull Measurement

bull Quality improvement


67

httpswwworegongovohaPagesabout_usaspx







5






6





oregon





Controlling costs





21315 ndash Newsmax


save20150213id624743












those ways










DELTA Cohorts


































The DELTA program














treatment














Ten Attributes



Ten Attributes of






A Disussion Paper








The document is


accurate


well-organized

well-documented

motivational











The Destination




navigate



their health




A Brief Summary



and operations











A Brief Summary













30

Attribute 1



31

Attribute 1



32




33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67






5






6





oregon





Controlling costs





21315 ndash Newsmax


save20150213id624743












those ways










DELTA Cohorts


































The DELTA program














treatment














Ten Attributes



Ten Attributes of






A Disussion Paper








The document is


accurate


well-organized

well-documented

motivational











The Destination




navigate



their health




A Brief Summary



and operations











A Brief Summary













30

Attribute 1



31

Attribute 1



32




33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67


6





oregon





Controlling costs





21315 ndash Newsmax


save20150213id624743












those ways










DELTA Cohorts


































The DELTA program














treatment














Ten Attributes



Ten Attributes of






A Disussion Paper








The document is


accurate


well-organized

well-documented

motivational











The Destination




navigate



their health




A Brief Summary



and operations











A Brief Summary













30

Attribute 1



31

Attribute 1



32




33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67





Controlling costs





21315 ndash Newsmax


save20150213id624743












those ways










DELTA Cohorts


































The DELTA program














treatment














Ten Attributes



Ten Attributes of






A Disussion Paper








The document is


accurate


well-organized

well-documented

motivational











The Destination




navigate



their health




A Brief Summary



and operations











A Brief Summary













30

Attribute 1



31

Attribute 1



32




33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67


21315 ndash Newsmax


save20150213id624743












those ways










DELTA Cohorts


































The DELTA program














treatment














Ten Attributes



Ten Attributes of






A Disussion Paper








The document is


accurate


well-organized

well-documented

motivational











The Destination




navigate



their health




A Brief Summary



and operations











A Brief Summary













30

Attribute 1



31

Attribute 1



32




33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67











those ways










DELTA Cohorts


































The DELTA program














treatment














Ten Attributes



Ten Attributes of






A Disussion Paper








The document is


accurate


well-organized

well-documented

motivational











The Destination




navigate



their health




A Brief Summary



and operations











A Brief Summary













30

Attribute 1



31

Attribute 1



32




33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67








DELTA Cohorts


































The DELTA program














treatment














Ten Attributes



Ten Attributes of






A Disussion Paper








The document is


accurate


well-organized

well-documented

motivational











The Destination




navigate



their health




A Brief Summary



and operations











A Brief Summary













30

Attribute 1



31

Attribute 1



32




33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67

























The DELTA program














treatment














Ten Attributes



Ten Attributes of






A Disussion Paper








The document is


accurate


well-organized

well-documented

motivational











The Destination




navigate



their health




A Brief Summary



and operations











A Brief Summary













30

Attribute 1



31

Attribute 1



32




33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67





treatment














Ten Attributes



Ten Attributes of






A Disussion Paper








The document is


accurate


well-organized

well-documented

motivational











The Destination




navigate



their health




A Brief Summary



and operations











A Brief Summary













30

Attribute 1



31

Attribute 1



32




33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67












Ten Attributes



Ten Attributes of






A Disussion Paper








The document is


accurate


well-organized

well-documented

motivational











The Destination




navigate



their health




A Brief Summary



and operations











A Brief Summary













30

Attribute 1



31

Attribute 1



32




33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67

Ten Attributes of






A Disussion Paper








The document is


accurate


well-organized

well-documented

motivational











The Destination




navigate



their health




A Brief Summary



and operations











A Brief Summary













30

Attribute 1



31

Attribute 1



32




33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67




The document is


accurate


well-organized

well-documented

motivational











The Destination




navigate



their health




A Brief Summary



and operations











A Brief Summary













30

Attribute 1



31

Attribute 1



32




33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67









The Destination




navigate



their health




A Brief Summary



and operations











A Brief Summary













30

Attribute 1



31

Attribute 1



32




33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67

A Brief Summary



and operations











A Brief Summary













30

Attribute 1



31

Attribute 1



32




33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67

A Brief Summary













30

Attribute 1



31

Attribute 1



32




33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67

30

Attribute 1



31

Attribute 1



32




33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67

31

Attribute 1



32




33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67

32




33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67

33

Attribute 3







36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67





36




37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67

37






and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67




and Action




38




bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67


bull Healthcare

bull Education

bull Social Work




39




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67




41








Imran Cronk

The Atlantic 2015


42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67

42











Ernie Hood









43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67







43













44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67






44
















45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67









45










46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67







46




47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67

47








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67








48












49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67









49














50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67







50













Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67






Sudore et al 2009)




51

















52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67










52















53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67











53














54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67









54






55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67

55

Attribute 1






and Operationsrdquo

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67

56

Attribute 1






and Operationsrdquo

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67

57

Attribute 1






58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67

58

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67

59

Original says











A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67





A Worthy Goal







A Disussion Paper












63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67










63





2009 IOM










2014 Yi Guo et al



64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67

64












2013 Rima Rudd



2014 Yi Guo et al



65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67

65



















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67















66






bull Expectations

bull Standards

bull Accountability


bull Measurement



67






bull Expectations

bull Standards

bull Accountability


bull Measurement



67