HPH TF MFH Task Force on Migrant-Friendly Hospitals and Health Services

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1 HPH TF MFH Task Force on Migrant-Friendly Hospitals and Health Services DEVELOPING MIGRANT-FRIENDLY HEALTH CARE ORGANISATIONS: FROM ASSESSMENT TO IMPLEMENTATION Antonio Chiarenza Leader of HPH-TF MFH AUSL di Reggio Emilia, Italy 6 th December 2013, Bruxelles HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 1

2 Challenges for the health system IMPACT OF NEW MIGRATION ON WELFARE PROVISION HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 2

3 Marked rise in migration 80 Total number of migrants in Europe, Migrant stock (millions) Year HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 3

4 Diversification in countries of origin too many, too fast, too diverse s Large numbers from a few places to a few places 1980s onward, small numbers from many places to many places NEW MIGRANTS ALONGSIDE LONG-STANDING ETHNIC GROUPS (Vertovec, 2012) HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 4

5 Reggio Emilia 14.1% of the population - non-national residents More than 140 nationalities Others; 25,2 Morocco; 14,7 Albania; 10,7 Moldova; 4,2 Tunisia; 4,3 Ghana; 4,3 Ukrania; 5,7 Romania; 6,9 Pakistan; 7 China; 7,6 India; 9,4 More than 200 languages HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 5

6 Diversity and diversification Intra-group diversity: diversity within the same national or ethnic group. Increased diversity: different ethnicity, migration category, legal status, language, gender, age, social status,..) Different immigration status and legal status: Economic migrants Spouses and family Asylum seekers Migrants held in reception and detention centres Refugees Undocumented migrants Unaccompanied minors Involuntary migrants Students HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 6

7 Differentiation of rights and complexity of regulations Being migrant puts extraordinary stress on individuals and their families also in the health care system HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 7

8 Problems facing migrant patients and health staff in health care Language barriers have adverse effects on the quality and safety of treatment received and patient outcomes. Low level of patients information and health literacy have adverse effects on effective utilisation of health services and participation in prevention and health promotion programmes. Low levels of intercultural competence have adverse effects on the ability of health staff to elicit patients explanation of illness and to negotiate effective treatment with the patient. Organisational barriers have adverse effects on effective access and quality of health care services. HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 8

9 Measures to tackle these problems Interpreting and intercultural mediation services Information and education programmes Staff education and training Adapted service organisation and delivery HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 9

10 Obstacles to effective implementation HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 10

11 Interpreting and intercultural mediation: obstacles to effective implementation Limited availability of interpreters and cultural mediators because of lack of (government) subsidies. Integrating interpreter-assisted consultations into existing organisational routines. Reliance on patient relatives and bilingual employees for linguistic assistance. Lack of monitoring and evaluation systems to assess interpreting performance. HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 11

12 Information and Health Literacy: obstacles to effective implementation Lack of adequate information about migrants rights to health care. Lack of effective information and signage to access and use health care services. Low migrants involvement in the production of information material. Low access to appropriate health education and prevention programmes (e.g. vaccination, screening, diabetes, ). HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 12

13 Health staff education & training: obstacles to effective implementation Limits of cultural competence training if it focuses only on culture. The content used to educate staff focuses mainly on gathering information about cultural groups. Difficulty to respond to multiple identity needs (ethnicity, gender, age, legal status, social status,..) Focusing on cultural differences has detracted attention from the role of socio-economic factors in determining inequities. HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 13

14 Organisation and service delivery obstacles to effective implementation Lack of migrant policies and programmes in the organisation Entitlements to health care Accessibility of health services Quality and person-centred care for all Lack of involvement of migrant groups HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 14

15 Aim: PROJECT TO DEVELOP STANDARDS FOR EQUITY IN HEALTH CARE (started in 2011) The project aims at developing a comprehensive framework for measuring and monitoring the capacity of healthcare organisations to improve accessibility to appropriate and effective health services for migrants and other vulnerable groups. 15

16 Why develop standards? To strengthen the evidence base of measures addressing diversity in health care organisations. To define effective criteria for diversity responsiveness (in the new context of migration). To favour effective implementation of interventions addressing barriers in healthcare. What gets measured gets done. 16

17 Standards for equity in healthcare Five main domains EQUITY IN POLICY EQUITABLE ACCESS AND UTILISATION EQUITABLE QUALITY OF CARE EQUITY IN PARTICIPATION PROMOTING EQUITY 17

18 1 Standard Equity in Policy Objectives of the standard TO ADOPT A SPECIFIC EQUITY POLICY IN THE ORGANISATION TO ASSESS THE IMPACT ON EQUITY OF ORGANISATIONAL PROGRAMMES AND PROCEDURES. TO MONITOR EQUITY IN HEALTH AND HEALTH CARE ACCESS. TO PROMOTE EQUITY IN HUMAN RESOURCES POLICIES. 18

19 2 Standard Equitable Access and Utilisation Objectives of the standard TO ADDRESS PHYSICAL, FINANCIAL AND GEOGRAPHICAL BARRIERS TO REDUCE LANGUAGE AND COMMUNICATION BARRIERS TO PROVIDE INFORMATION TAKING INTO ACCOUNT THE HEALTH LITERACY LEVEL AND LANGUAGE OF PATIENTS TO FIND SOLUTIONS WHERE ELIGIBILITY RULES COMPROMISE HUMAN RIGHTS 19

20 3 Standard Equitable Quality of Care Objectives of the standard TO PROVIDE PERSON AND FAMILY-CENTRED CARE TO ENSURE THE WORKFORCE HAS THE COMPETENCE NEEDED TO DELIVER PERSON-CENTRED CARE. TO CREATE AN ENVIRONMENT WHERE PATIENTS FEEL SAFE AND THEIR IDENTITY ARE RESPECTED. 20

21 4 Standard Equity in participation Objectives of the standard TO ENSURE USER PARTICIPATION IN THE DECISION-MAKING PROCESS. TO IDENTIFY AND OVERCOME BARRIERS TO EFFECTIVE PARTICIPATION. TO MONITOR AND EVALUATE PARTICIPATORY PROCESSES. 21

22 5 Standard Promoting Equity Objectives of the standard TO PROMOTE RESEARCH AND INNOVATION TO BUILD INTER-SECTORAL COLLABORATIONS TO DEVELOP NETWORKS AND PARTNERSHIPS 22

23 Pilot test of the preliminary standards in 45 organisations from 12 countries (April-September 2012) COUNTRY N. organisations AUSTRALIA 5 CANADA 10 FINLAND 2 IRELAND 3 ITALY 9 NORWAY 4 SCOTLAND 1 SLOVENIA 1 SPAIN 5 SWEDEN 1 SWITZERLAND 1 THE NETHERLAND 3 TOTAL 45 Aims: To assess the clarity, relevance and applicability of the standards To assess compliance with the standards in pilot-organisations To collect comments and suggestions from pilotorganisations

24 Final equity standards Plenary HPH Conference Final standards were presented at the international HPH conference Workshop HPH Conference Pilot test findings were discussed with an international audience. General Assembly of WHO-HPH A new work plan and its duration was agreed with WHO-HPH ( ) 24

25 New project for development of a SELF-ASSESSMENT TOOL ( ) Aim To allow healthcare organisations to assess structures, processes and results, to identify gaps, and develop improvement plans based on the findings from self-assessment 25

26 SELF-ASSESSMENT TOOL: THREE MAIN COMPONENTS 1. Standards-based assessment: to evaluate whether appropriate structures and processes are in place and functioning. Measurable element Assign a score 26

27 SELF-ASSESSMENT TOOL: THREE MAIN COMPONENTS 1. Standards-based assessment: to evaluate whether appropriate structures and processes are in place and functioning. 2. Indicators-based assessment: to evaluate whether service performance leads to results, such as healthcare outcomes, health status, patient satisfaction. Standard 2: Equitable access and utilisation 3 example indicators provided by TF Indicator INTERPRETING SERVICES ARE PROVIDED TO USERS WHO REQUIRE ONE HEALTH LITERACY Description/Rationale % INTERPRETER USE IN HEALTH CARE ORGANISATION % OF NEW HEALTH INFORMATION LITERATURE DEVELOPED THAT IS PLAIN LANGUAGE PROOF ACCESS AND UTILISATION OF SERVICES BY THE POPULATION GROUPS % BREAKDOWN OF THE DEMOGRAPHIC PROFILE OF SERVICE USERS ACCESSING SERVICES Additional Indicators: Indicators already used in your organisation; New indicators you may want to consider for the action plan. 27

28 SELF-ASSESSMENT TOOL: THREE MAIN COMPONENTS 1. Standards-based assessment: to evaluate whether appropriate structures and processes are in place and functioning. 2. Indicators-based assessment: to evaluate whether service performance leads to results, such as healthcare outcomes, health status, patient satisfaction. 3. Guidance for action plan development: to identify areas for improvement and to develop an action plan based on the information gathered through the assessment process. 28

29 PILOT TEST IMPLEMENTATION February October Complete self-assessment to benchmark organizational performance on each of the standards; 2. Select indicators useful to assess progress and report on current or potential availability of data sources 3. Analyse the results of self-assessment to identify areas of improvement for each of the standards; 4. Select one or two areas of improvement for the development of a draft plan to achieve quantifiable improvement. 29

30 PILOTING COUNTRIES AND PHASES February October 2014 Participating countries 1. Australia 2. Belgium 3. Canada 4. Finland 5. Ireland 6. Italy 7. Norway 8. The Netherlands 9. Scotland 10. Slovenia 11. Spain 12. Sweden 13. UK 14. USA Five phases: 1. Phase. Preparation (November 2013-January 2014) 2. Phase. Assessment of standards and selection of indicators (February-June 2014) 3. Phase. Identification of improvement areas (July 2014) 4. Phase. Development of action plan (July September 2014) 5. Phase. Reporting of results (October 2014) 30

31 TF MFH HPH TASK FORCE ON MIGRANT FRIENDLY HOSPITALS AND HEALTH SERVICES REGIONAL AZIENDA UNITÀ SANITARIA LOCALE DI REGGIO EMILIA 31

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