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

Transcription

1 HPH TF MFH Task Force on Migrant-Friendly Hospitals and Health Services Standards for equity in health care for migrants and other vulnerable groups A Self-Assessment Tool Elizabeth Abraham and Dr. Antonio Chiarenza Institute for Healthcare Advancement May 6, 2016

2 Overview 1. Background and rationale of Standards project 2. Conceptual framework 3. Presentation of the Standards 4. Results of international pilot tests 5. Exercise 1: Identification of vulnerable populations 6. Exercise 2: Application of one of the five equity domains (identify strengths and gaps) 7. Identify one priority area (or more) to address inequity and reduce disparities in access and outcomes 8. Group discussion

3 Learning Objectives 1. Develop and/or present a proposal to Senior Management to conduct the free Standards for Equity self-assessment tool to improve health equity and reduce disparities in your organization 2. Strike a diverse Assessment Team including all levels of staff, patients and community leaders 3. Lead or support the Standards Project, submit and report on results, and identify one or more priority areas for improvement

4 Key Challenges for Health Service Providers How do we make health care services accessible, responsive and appropriate to all patients? How do we ensure that health care services are effectively utilized? How do we ensure that health care staff have the appropriate skills and knowledge to deliver sensitive and equitable services? How do we reduce health-related inequalities in access, quality and outcomes

5 Background and rationale of Standards project

6 Migrant-Friendly Hospitals ( ) 12 European Pilot Hospitals AT DE DK EL ES FI FR IR IT NL SV UK Kaiser-Franz-Josef-Spital, Vienna, Austria Immanuel-Krankenhaus GmbH, Rheumaklinik Berlin-Wannsee, Berlin, Germany Kolding Hospital, Velje-Kolding, Denmark Hospital Spiliopoulio Agia Eleni, Athens, Greece Hospital Punta de Europa, Algeciras-Cádiz, Spain Turku University Hospital, Turku, Finland Hôptial Avicenne, Paris, France James Connolly Memorial Hospital, Dublin, Ireland Azienda Unità sanitaria Locale di Reggio Emilia, Reggio Emilia, Italy Academic Medical Centre, Amsterdam, The Netherlands Uppsala University Hospital, Psychiatric Centre, Uppsala, Sweden Bradford Hospitals NHS Trust, Bradford, U.K. 6

7 PROJECT OUTCOMES OUTCOMES For hospitals 12 national models for MFH: how to do it interventions: 1. Whole organisational development 2. Interpreting/mediation services 3. Patient information and education 4. Staff training on cultural competence OUTCOMES For health policy OUTCOMES For networking WHO-HPH TASK FORCE MIGRANT FRIENDLY AND CULTURALLY COMPETENTE HEALTH CARE 7

8 Task Force MFH The HPH Task Force is co-ordinated by HPH Regional Network Emilia Romagna TF web site: To create a framework for continuity after the conclusion of the MFH project To share and disseminate best policies and practice To foster co-operation and alliances between healthcare organisations and other networks To support health care organisations in the HPH in becoming MF & CC organisations as indicated in the Amsterdam Declaration 8

9 PROJECT TO DEVELOP STANDARDS FOR EQUITY IN HEALTH CARE (started in 2012) Aim: The project aims at developing a framework for measuring and monitoring the capacity of healthcare organisations to improve accessibility and quality of care for migrants and other vulnerable groups. International Network Health Promoting Hospitals & Health Services Task Force MFH Migrant Friendly Hospitals & Health Services

10 CONCEPTUAL FRAMEWORK: CRITERIA ADOPTED FOR THE DEVELOPMENT OF THE STANDARDS Target groups Not only immigrants and minorities, but all socially excluded or vulnerable groups liable to inequities in health/or health care. Dimension of diversity The intersection of variables (individual characteristics and situations) that tend to lead to unequal access to health care provision Organisation policies and plans They should not focus on single target groups (or variables), but on all factors (or differences) that put vulnerable groups at risk of exclusion and inequities in health care 10

11 Standards for equity in healthcare 1. EQUITY IN POLICY 1. The organisation has an equity strategy and plans 2. Monitoring systems measure equity performance 3. The organisation s plans and policies promote equity in all activities 4. Staff knowledge and competence is able to address inequities in health care 5. Workforce policies are fair and equitable 2. EQUITABLE ACCESS AND UTILISATION 1. Provision of equitable access to and availability of health services 2. Implementation of measures to reduce communication and information barriers 3. Health care is provided where eligibility rules compromise human rights 3. EQUITABLE QUALITY OF CARE 1. Individual characteristics and experience are taken into account in the assessment of patient s needs. 2. Individual characteristics and experience are taken into account in the delivery of patient s care. 3. The organisation creates an environment where patient s dignity and identity is respected 4. Individual characteristics and experience are taken into account to ensure effective continuity of care 4. EQUITY IN PARTICIPATION 1. The organisation support user participation in planning, delivery and evaluation 2. The organisation identifies and overcomes barriers to participation 3. The organisation monitors and evaluates its participatory processes 5. PROMOTING EQUITY 1. The organisation participates in networks and research that promote equity 2. The organisation disseminates the results of research and practice relating to equity 3. The organisation ensures that equity is reflected in partnership agreements and service contracts 11

12 Pilot Test Results 2012 and 2014

13 Pilot tested the preliminary standards in 45 organisations from 12 countries (April-September 2012) Aims: To assess the clarity, relevance and applicability of the standards To assess the compliance with the standards in pilotorganisations To collect comments and suggestions and effective practices from pilot-organisations 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

14 Results of the 1 st pilot-test of preliminary standards: clarity, relevance, applicability QUANTITATIVE ANALYSIS General evaluation of the measurable elements was positive: no negative results < 70% for clarity and applicability no negative results < 80% for relevance 10 MEs out of 58 were identified for revision: Standard 4 (User involvement) proved to be somewhat problematic; to a lesser extent, standard 3 (Equitable quality of care) and 5 (Promoting equity externally). QUALITATIVE ANALYSIS CLARITY: suggestion to improve wording, ordering, meaning RELEVANCE: inclusion, exclusion, revision of some MEs APPLICABILITY: Concerns on local barrier related to legislation, organisation, social context

15 Revision of the standards based on the results of the 1 st pilot-test Some elements were eliminated, others changed or added: (STD 1): a new substandard with two measurable elements on Equity into Human Resources policies and Recruitment Practices was added. (STD 2): two new Measurable Elements on Informed Consent and Health Literacy were added. (STD 4): the title was changed to: Equity in Participation Suggestions made at the Reggio Emilia workshop (October 2013): Develop a glossary with explanation of terms and definitions. Investigate the implementation of the standards in order to explore effective uptake and connection with existing practices. Develop a manual for implementation containing assessment tools and guidance for action plans.

16 Final equity standards 5 Main standards 18 Sub standards 50 Measurable elements

17 Standard Sub-standard Measurable element Problems, goals, details on evidence and follow-up actions Evidence Score

18 Theoretical framework of Equity standards Cattacin, S. et al (2013). Equity Standards for Health Care Organisations: a Theoretical Framework. Diversity and Equality in Health Care 10(4):

19 2nd PILOT-TEST (2014) Standards implementation Aim: To evaluate how health care organisations can utilize the standards and self-assessment process, as well as to explore challenges and opportunities for effective uptake in connection with existing policies and practices.

20 STANDARDS FOR EQUITY IN HEALTH CARE Self-Assessment Tool for pilot implementation AIM To allow healthcare organizations to selfassess their capacity to provide equitable care, to identify gaps, and develop improvements based on the findings from self-assessment

21 Pilot implementation process 16 pilot countries 54 organisations 1. Australia (7) 2. Belgium (6) 3. Canada (5) (Ontario 1; Quebec 4) 4. Finland (1) 5. France (1) 6. Ireland (1) 7. Italy (11) (Piemonte 7; Emilia-Romagna 3; Valle d Aosta 1) 8. Malta (1) 9. Netherlands (1) 10. Norway (6) 11. Slovenia (1) 12. Spain (6) (Catalonia 3; Andalusia 3) 13. Sweden (1) 14. Switzerland (1) 15. Turkey (1) 16. UK (2) Seven phases: 1. General information of the pilot organisation is collected 2. Assessment team is established 3. Compliance with the standards is measured indicators are selected and described 5. Areas of improvements are identified and described 6. Action plan addressing at least one priority is developed 7. Feedback on the pilot is provided 21

22 How to use the Standards for Equity in Healthcare

23 1.Establish an assessment team to oversee the assessment process. Assessment team

24 General information about the organisation 1. General information of the organisation is collected

25 1. Compliance with the standards: the self-assessment tool contains for each standard and substandard a number of measurable elements and indicates evidence that may be used to assess the standard as being fully, mostly, partially, hardly or not fulfilled. STD1: 12 MEs STD2: 12 MEs STD3: 11 MEs STD4: 9 MEs STD5: 6 MEs Assess compliance with the standards

26 Selection of indicators 1. Selection of 1-3 indicators for each standard to measure results that could be achieved if compliance with a standard had been in place consistently. Three options: select and describe 1 to 3 indicators from indicators already in use in your organisation select and describe 1 to 3 indicators newly developed according to local priorities select and describe 1 to 3 indicators from the sample indicators provided

27 Identify improvements areas 1. Identify and describe areas of improvements based on the assessment of compliance with the standards Consider both hindering and facilitating factors: Policy Legislative Organisational Administrative/economic

28 1. Describe an action plan: to address at least one of the priority areas identified N.B. It is important that actions of the plan relate to local priorities and should be integrated into existing management system of the organisation to monitor developments Develop an action plan

29 For information regarding the Standards for Equity in Healthcare for Migrants and other Vulnerable Populations, contact: Antonio Chiarenza, Ph.D. Coordinator. HPH Task Force on MFCCH Regional HPH Network of Emilia-Romagna Direzione Generale AUSL of Reggio Emilia Via Amendola, 2 I Reggio Emilia Antonio.Chiarenza@ausl.re.it