By Stefanie A. Manack

Incalculable amounts of time, energy and resources have been spent on improving communication between imaging departments and their patients. Appointment reminders through texts, access to test results in real time, and a myriad of informational and instructional documents and websites are shared with patients in an effort to close the information gap. Patients are given detailed instructions on a host of topics when they schedule their imaging appointment. This is often followed up with a reminder call and a repeat of exam and prep instructions, appointment time confirmations, and other information to ensure a successful exam. Imaging departments spend an inordinate amount of time in the creation and upkeep of patient facing documents and websites to inform patients about their imaging exams.

And yet, imaging leaders are still managing almost daily schedule gaps and delays in care because patients arrive at their appointment unprepared for the exam, late for their appointment or with an incorrect understanding of what the procedure entails. Leaders endeavor to improve and refine the processes by which information is shared, often adding more layers of information from text reminders and emails to phone calls from a knowledgeable team member.

There is no shortage of tools or creative efforts undertaken to solve patient communication challenges by addressing access to information and the communication process itself (how information is transmitted or exchanged). Leaders and process improvement professionals alike have worked tirelessly to improve patient access to information and internal processes for disseminating that information.

But it’s not enough to simply make information available. It must be clear and easily understood by patients. All the process improvement efforts and new shiny tools won’t make a difference if we don’t understand exactly why our efforts in this area are less successful than we had hoped. Improving access and communication processes can be part of a solution to be sure. But by setting our sights solely on improving processes and tools, we overlook a basic but critically important piece of the puzzle – are patients getting information they can truly understand and use?

The definition of health literacy was updated in August 2020 with the release of the U.S. government’s Healthy People 2030 initiative. This update addresses, for the very first time, personal health literacy and organizational health literacy. It defines organizational health literacy as “the degree to which organizations equitably enable individuals to find, understand and use information and services to inform health-related decisions and actions for themselves and others.” This puts the onus on healthcare organizations to ensure that the information patients receive can be clearly understood so they can use it to make decisions about their care. This is where the unique challenge – and opportunity – to focus our attention on health literacy comes in.

According to a report from the Literacy Project released last year, 45 million Americans are functionally illiterate, meaning they cannot read above a 5th grade level. What’s more, a full 50% of adults cannot read and understand a book written above an 8th grade level. Per the Joint Commission, patient education materials – like imaging exam instructions – should be written at a 5th grade reading level. This helps to ensure comprehension and understanding of the information, so patients can use that information to inform their health-related decisions.

Gaining access to imaging information is not the problem. Having access to information patients can “find, understand and use” is the problem. Imaging leaders can help solve this problem – and it’s easier than you think.

There is an index that allows written text to be analyzed to determine the number of years of U.S. based education required to comprehend the information. The SMOG index may have a funny name (Simple Measure of Gobbledygook), but it is a time-tested, scientifically proven way to assess patient scheduling and exam prep instructions for readability. Various free online tools are available to use for readability tests – just be sure that the SMOG index is one of the measures it uses. The CDC, researchers and medical academic communities have relied on the SMOG index for years. You can too!

Simply copy and paste the text from your patient facing information into the tool. Is the SMOG index at a 5th grade level? Or is it much higher? If it’s higher, simply edit the text, and process again until you achieve your goal. The SMOG index measures all facets of the text, from word length to sentence structure to comprehension.

For example, according to one popular patient-facing website: “Computed tomography (CT) is a diagnostic imaging test used to create detailed images of internal organs, bones, soft tissue, and blood vessels. The cross-sectional images generated during a CT scan can be reformatted in multiple planes and can even generate three-dimensional images which can be viewed on a computer monitor, printed on film, or transferred to electronic media. CT scanning is often the best method for detecting many different cancers since the images allow your doctor to confirm the presence of a tumor and determine its size and location. CT is fast, painless, noninvasive, and accurate. In emergency cases, it can reveal internal injuries and bleeding quickly enough to help save lives.”

We can measure the SMOG index by cutting and pasting this text into a readability tool. Several indices are displayed in most tools, including SMOG. This is the result from one reputable tool:

Approximate representation of the U.S. grade level needed to comprehend the text:
Coleman Liau index: 12.80
Flesch Kincaid Grade level: 14.83
ARI (Automated Readability Index): 13.89
SMOG: 16.19

A SMOG index score of 16.19 indicates that the text requires the reader to have comprehension equal to grade 16 – a college graduate. This score indicates the information is out of reach for the average American.

Revising your imaging exam instructions may seem like a small solution to a large problem. But the Joint Commission encourages hospitals to use readability tests to revise written materials in order to address the health literacy needs of all patients. By ensuring exam instructions are easy for your patients to comprehend, and that they meet the readability and health literacy guidelines, your department can dramatically reduce same-day cancellations that occur because patients misunderstood imaging instructions. One IR department took on this challenge and reduced its same-day cancellation rates from 13% to 2% in just 2 months. This seemingly small but exponentially impactful change can do more than improve operational utilization metrics. It can improve patient satisfaction, reduce delays in care, and even reduce overtime by keeping your department running on schedule.

It's ingrained in leaders to focus on improving processes to solve challenges. Fixing a broken process can yield exponentially positive results. But in the case of communication problems, the answer doesn’t always lie in processes or even in tools used for facilitating communication. Reducing your operational scheduling challenges, increasing patient satisfaction, and reducing delays can be as simple as updating your patient facing communications for readability and comprehension using a simple readability tool. Try it. You’ll be surprised how much impact this simple step can have – and what you will learn in the process.

About the author: Stefanie Manack, MS, CRA, R.T. (R)(M)(VI) has more than 18 years’ experience in the imaging industry. She currently works as the Director of Operational Excellence at 3DR Labs, an Accumen company.