Table 4.

Supplemental Measures with Unclear Feasibility

Measure Title and Description	Measure Source,a Data Source, Measure Computation Specifications, and Health Care Settingb	Psychometric Testing and National Endorsement
OHL Domain: Communication
Measurement theme: Health literacy-related training for staff
Title: Impact of Health Literacy Training on Skill Development Description: Percentage of staff members attending health literacy training who are able to role play health literacy strategies (e.g., use of Teach Back)	Measure source: Health care organization Data source: Process data collected by implementation staff Numerator: Number of staff members who are able to adequately role play health literacy strategies (e.g., use of Teach Back) Denominator: Number of staff members attending health literacy training Setting: Measure is relevant across settings	None identified
Title: Communication Climate Assessment Toolkit Workforce Development Domain Description: Computed score based on staff responses to 21 questions assessing whether organization provides adequate training in spoken communication	Measure source: Wynia, Johnson, McCoy, Griffin, and Osborn (2010) Data source: Staff Survey (University of Colorado Center for Bioethics and Humanities, 2018). Must obtain responses from at least 50 clinical and nonclinical staff members Computation: Responses to each item are coded using a 0–1 scale, with 1 being the desirable response. For each respondent, the average score across survey items addressing this domain is calculated. The average of these scores across respondents is then calculated and multiplied by 100, resulting in a score between 0 and 100 Exclusions: Staff members who do not have direct contact with patients are excluded from questions that target patient contact Setting: Hospitals and clinics	A version of this measure has been endorsed by the National Quality Forum (Measure 1888) (National Quality Forum, 2012d). The endorsed measure includes both patient and staff survey data. Because we focused on measures derived from clinical, administrative, quality improvement, or staff-reported data, the measure presented here only includes staff survey data. Although the staff survey items have shown strong internal consistency reliability (α = 0.93) (Wynia et al., 2010), psychometric testing of a measure using only staff survey data is recommended
Measurement theme: Monitoring and improvement of communication
Title: Communication Climate Assessment Toolkit Performance Evaluation Domain Description: Computed score based on staff responses to 7 questions about the degree to which the organization regularly monitors and seeks to improve the quality of communications with patients and among hospital/clinic staff	Measure source: Wynia et al. (2010) Data source: Staff Survey (University of Colorado Center for Bioethics and Humanities, 2018). Must obtain responses from at least 50 clinical and nonclinical staff members Computation: Responses to each item are coded using a 0–1 scale, with 1 being the desirable response. For each respondent, the average score across survey items addressing this domain is calculated. The average of these scores across respondents is then calculated and multiplied by 100, resulting in a score between 0 and 100 Exclusions: Staff members who do not have direct contact with patients are excluded from questions that target patient contact Setting: Hospitals and clinics	A version of this measure has been endorsed by the National Quality Forum (Measure 1901) (National Quality Forum, 2012e). The endorsed measure includes both patient and staff survey data. Because we focused on measures derived from clinical, administrative, quality improvement, or staff-reported data, the measure presented here only includes staff survey data. Although the staff survey items have shown strong internal consistency reliability (α = 0.84) (Wynia et al., 2010), psychometric testing of a measure using only staff survey data is recommended
Measurement theme: Serving patients with limited English proficiency
Title: Communication Climate Assessment Toolkit Data Collection Domain Description: Computed score based on staff responses to 9 questions assessing whether organization collects information on patient demographics and interpretation needs	Measure Source: Wynia et al. (2010) Data Source: Staff Survey (University of Colorado Center for Bioethics and Humanities, 2018). Must obtain responses from at least 50 clinical and nonclinical staff members. Computation: Responses to each item are coded using a 0–1 scale, with 1 being the desirable response. For each respondent, the average score across survey items addressing this domain is calculated. The average of these scores across respondents is then calculated and multiplied by 100, resulting in a score between 0 and 100 Exclusions: Staff members who do not have direct contact with patients are excluded from questions that target patient contact Setting: Hospitals and clinics	A version of this measure has been endorsed by the National Quality Forum (Measure 1881) (National Quality Forum, 2012c). The endorsed measure includes both patient and staff survey data. Because we focused on measures derived from clinical, administrative, quality improvement, or staff-reported data, the measure presented here only includes staff survey data. Although the staff survey items have shown strong internal consistency reliability (α = 0.90) (Wynia et al., 2010), psychometric testing of a measure using only staff survey data is recommended
Title: Interpreter Use During Inpatient Stay Description: Number of encounters per inpatient stay for which a patient with a language preference other than English had the necessary/appropriate interpreter present	Measure Source: Health care organization Data Source: Electronic health record/medical chart Numerator: Number of encounters involving on-site, telephone, or video interpreters Denominator: Number of inpatient stays of patients with a language preference other than English Setting: Hospitals and other inpatient facilities	None identified

Note.

^aMeasures identified through interviews with health care organizations working to improve their organizational health literacy are identified as having a Measure Source of “health care organization.” Because we assured participants in the organization interviews that their responses would remain confidential, we do not identify health care organizations by name.

^bSetting refers to the health care settings for which a measure is believed to be relevant (e.g., hospitals).