as the field of health literacy expands in scope and breadth, the term health literacy continues to have a plethora of meanings depending on whom you are speaking to and the context of reference. It can have an extremely broad reference, such as when referring to the health literacy environment of a health care organization or health care system. Health literacy can also have a very specific reference, such as when referring to an individual's health literacy skills when visiting a physician's office for the first time or accessing an erner• gency department for acute chest pain.Historically, many felt health literacy skills were dependent purely upon individual skills and abilities while others expressed that they were dependent upon the skills or abilities of the "system" or health care organization. Fortunately, there has been a recent shift toward the understanding that health literacy is about the relationship between the skills of persons receiving care or treatment and the professionals or systems that are providing the care and treatment. An individual's health literacy skills are dynamic and change over time depending on the context, changes in individ• ual skills and experiences, or changes in the health care system. Health literacy continues to be an evolving concept that has more recently been viewed as a crosscutting priority in the delivery of safe, quality health care.