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The ability of a reader to understand the information in a performance report depends upon many factors, including:

• The simplicity of words and sentence structure.
• The clarity and cohesiveness of explanatory text.
• The reader’s background knowledge and cultural perspective.

Consider working with a professional writer or editor who is experienced in communicating with your audience and (ideally) has some knowledge of the topic of health care quality. However, remain "hands-on" to maintain the accuracy of the information and to ensure that the writer doesn't miss any nuances that may be important to your audience.

Anticipate the Possibility of Misinterpretation

Your audience may interpret (and misinterpret) words and phrases in ways that you never intended. You may use the word “average,” for instance, to explain a statistical concept, but people do not necessarily interpret it that way. Research on consumers’ reactions to report cards has shown that many readers perceive a score of “average” as indicating that performance is not very good.

Even highly skilled readers may be unfamiliar with many common health care terms, especially those related to quality measurement. Unfamiliar terms common in report cards include accredited, affiliated, options, providers, respondents, specialty, and utilization.^[1]

Use Familiar Words

It is critical to use words that are familiar to readers and as simple as possible. Use words that your readers would use themselves. For example, say:

• “Doctor” rather than “physician.”
• “Get” rather than “obtain.”
• “Use” rather than “utilize.”

For a list of simple word substitutes, see . This government Web site also offers tips on writing clearly.

Explain New Terminology

In some situations, you can replace a technical term with a nontechnical label. Consider the term “coronary artery bypass graft,” which is often shortened to “CABG.” Both the term and its acronym are difficult language. It’s better to use a label that is simpler and more familiar to consumers, such as “heart bypass surgery.” If it seems important to include the full technical term or acronym, you could include it in parentheses when the simpler label is first mentioned or put it in a section with the technical details on measures.

When a simple word won’t do, and you need to use a term that might be unfamiliar, define it right away and explain its implications for the reader. Health care quality reports offer good opportunities to educate consumers about concepts they need to know.

For example, to explain health plan accreditation, you can say:

“Accreditation means that a national, independent organization has approved the quality-related structures, processes, and performance of a health plan. It is like a stamp of approval, letting you know that the health plan meets national standards related to quality.”

Rather than relegating definitions to a glossary, provide them wherever you use the terms. Many consumers—especially those with lower literacy skills—will not bother referring to a glossary.

Be Cautious About Using Acronyms

It takes extra effort for readers to learn and remember a new acronym, so don’t use acronyms just out of habit. Use acronyms only when the acronym is more familiar to consumers than the full term (such as HIV/AIDS) or when your audience really needs to know the acronym.

Unfamiliar acronyms can also be intimidating to many readers. They stand out from ordinary text because of the capitalization, and it’s often unclear how to pronounce them.

Use a Conversational Tone

Most readers will be more engaged in your report if you:

• Address them directly using a conversational tone.
• Periodically invite them to think about particular issues or questions.
• Try to avoid language that seems overly formal or “academic;” you want your readers to feel like the report card was written for people “like them.”

Learn more about engaging the reader in Tip 4. Use Devices that Engage Your Readers.

Use Active Voice

Many performance reports use passive sentence structures that can sound impersonal and be hard to understand. Readers prefer text in the active voice. Active voice is simpler and more direct. You can write the vast majority of sentences in an active voice, which makes it much easier for readers to understand and act upon the information.

Here are a few examples:

• Passive: The patient is referred by the doctor to a specialist.
• Active: The doctor refers the patient to a specialist.
• Passive: The cost is calculated by multiplying X by Y.
• Active: You can estimate the cost by multiplying X by Y.

Use Simple Sentence Structures

Sentences should be easy for readers to interpret. Research has found that readers often interpret complex sentences by picking out the subject, verb, and object.^[2] If that task is too hard, all but the most motivated readers will give up.

To make it easy for your readers:

• Don’t pack too much information into a single sentence.
• Keep most of your sentences relatively short.
• Use simple conjunctions such as “and,” “or,” and “but.”

Be Consistent

Keeping your language and writing style consistent will help readers follow and comprehend the material. Here are tips:

• Use consistent terminology. Define terms clearly and use them in the same way throughout the text. For example, don't discuss "measures of experience" in the introduction, then use only the term "satisfaction" in an accompanying chart.
• Maintain a consistent tone. Tone is the attitude implied by the language. For instance, a chatty tone suggests that the document is intended to be friendly and helpful, while a more formal tone may make the document seem more serious and important. Whatever tone you choose, keep the same "voice" throughout; some readers may skip critical material that feels different (e.g., a very academic-sounding explanation of measures in an otherwise chatty report), assuming that it doesn't apply to them.

Also in "Tips on Writing a Quality Report"

• Why Good Writing Matters
• Tip 1. Write Text That’s Easy for Your Audience To Understand
• Tip 2. Be Concise and Well-Organized
• Tip 3. Make It Easy to Skim
• Tip 4. Use Devices That Engage Your Readers
• Tip 5. Make the Report Culturally Appropriate
• Tip 6. Be Cautious About Using Readability Formulas
• Tip 7. Test the Report With Your Audience
• Guidelines and Other Resources To Fine-tune Your Writing