Table 5.

Perceived limitations of the Org-HLR tool and process.

Limitation	Description	Example Quote
Terminology	The term health literacy is not used by some organisations, as it is not well understood by all staff and/or they perceive it to be jargon and abstract.	“One of the limitations of the words health literacy is that it very much points to literacy, to words and language, and I think that is its biggest handicap as a notion, as a concept.” “We don’t use the terminology health literacy, so everyone’s got a slightly different take on it or they take it very literally as literacy—reading and writing skills, rather than thinking broader than that.”
Length of the tool	The Org-HLR tool was too long and repetitive in some assessment dimensions	“I did find it a bit drawn out.” “I’d like to see it simplified… from a usability point of view I tend to think shorter is better.”
Global rating system and criteria of self-rating tool	The global rating system was perceived as confusing, complicated, and as not allowing for an accurate assessment of each performance indicator. The rating criteria were also perceived as overly complicated and as not applying well against some assessment areas.	“I think it is easier for each statement to have a rating rather than just the overall (sub-dimension) rating.” “Make that a bit clearer around how to rate.”
Criteria of priority setting tool	The rating criteria for the priority-setting tool were perceived as complicated.	“We did also talk about the priority setting tool rating system being two pronged—importance versus urgency.”
Duplication with other self-assessment tools and processes	Participants reported that this Org-HLR tool and process overlapped with other self-assessment tools and quality improvement processes (e.g., cultural competence and accreditation). This is may lead to the duplication of effort and action plans.	“Another issue is the overlap with existing accreditation (processes) and existing evaluation tools, and the fact that we’ve already been through this process and evaluated a whole stack of things.” “The risk there is, if we have action plans coming out of a number of different self-assessments that are looking at the same thing, we end up having different people approaching the same problem in different ways.”
Time required	Some participants perceived the time required to complete the assessment to be prohibitive. As a result, some staff would not be able to participate (i.e., clinical staff) and it would be difficult to ensure consistent representation throughout the assessment process.	“At the beginning (of planning the assessment) I thought the time commitment was going to be a really hard ask.”
Staff roles and representation	Some participants perceived that parts of the tool were not relevant to their role or work area; therefore, they could not make an informed judgement about organisational performance in that area.	“It assumes, and this is why it’s important to have representation from across the organisation, that we know as individuals what’s going on (in other parts of the organisation) and we just don’t.” “I think for it to work here, chunking (breaking sections down) by who was responsible and their work group, rather than health literacy titles might make it easier to get it done.”