Migrant-Friendly Hospitals - A EU Initiative
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- Winfred Nicholson
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1 Migrant-Friendly Hospitals - A EU Initiative Assessing Migrant Friendliness of Hospitals Experiences and Results from a European Project Ursula Karl-Trummer, Karl Krajic, Sonja Novak-Zezula, Jürgen M. Pelikan Ludwig Boltzmann Institute for the Sociology of Health and Medicine, University of Vienna 13 th International Conference Health Promoting Hospitals Dublin, May 2005 LBIMGS
2 mfh 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 Presidio Ospedaliero della Provincia di Reggio Emilia, Reggio Emilia, Italy Academic Medical Center, Amsterdam, The Netherlands Uppsala University Hospital, Psychiatric Centre, Uppsala, Sweden Bradford Hospitals NHS Trust, Bradford, U.K. 2
3 Moving migration and cultural diversity higher up on the agenda of European hospitals and health policy Identifying problems and solutions Review, Needs Assessment, MFQQ Assessment Implementing and evaluating model solutions Interpreting Services, Health Promotion in Mother and Child Care, Staff Training Developing European recommendations Amsterdam Declaration Disseminating experiences, results, recommendations 3
4 A definition of MFH A migrant friendly hospital uses the principles/criteria of migrant friendly or being sensitive to, accepting and compensating for ethnic/cultural diversity in every managerial and clinical decision for that to happen management has to provide the necessary strategic decisions and support everybody by adequate structures and instruments of quality management 4
5 Components of a quality assured (Quality-) Management System for MFH MF QAS - Structures MFQ goals, targets and rules MFQ plans, programs, projects MFQ management structure: committee, team, network of contact persons MFQ Marketing MFQ Budget MF QAS- Processes Define MFQ Evaluate MFQ Develop MFQ MF QAS- Outcomes MF Quality Assurance and Development 5
6 The MFQQ an assessment instrument developed by LBSHM and pilot hospitals for assessing Migrant friendliness of services and settings in hospitals Part A: MF characteristics of services Part B: MF support system Used in 2 surveys (2003/2004) 6
7 The overall project: MFQQ 2 nd Assessment Part A MF Services: Measures to facilitate communication with migrant patients I Range: 1 4 Communication - Interpreting services available at the hospital Kind of professional interpreting service Interpreting service implemented at hospital Telephone interpreting service Co-operation with external interpreting service Who can request an interpreter? Interpreting service available on request of staff Interpreting service available on request of patients and/or relatives Utilisation of language and cultural competencies of staff members with migrant and/or diverse backgrounds Cultural mediation services DI-EU Diff. T2-T1 1,2 0,8 1,9 1,2 2,6 1,6 3,2 2,4 1,9 1,9 1,5 1,3 0,9 0,7 7
8 H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 mfh The overall project: MFQQ 2 nd Assessment Measures to facilitate communication with migrant patients II 5. Communication - Interpreting services available at the hospital Kind of professional interpreting service 1. Interpreting service implemented at hospital 2. Telephone interpreting service 3. Co-operation with external interpreting service Who can request an interpreter? 4. Interpreting service available on request of staff Interpreting service available on request of patients and/or relatives 6. Utilisation of language and cultural competencies of staff members with migrant 7. and/or Cultural diverse mediation backgrounds services Sumscore T2 Sumscore T1 H-Score of changing in quartiles (T1 to T2) T2 q1 q1 q3 q3 q2 q4 1,2 T1 q1 q1 q1 q2 q1 q4 0,8 T2 q2 q2 q3 q4 q3 q4 q1 q4 1,9 T1 q4 q1 q2 q4 q1 q2 1,2 T2 q1 q1 q4 q4 q3 q4 q3 q4 q3 q4 2,6 T1 q4 q1 q2 q2 q4 q3 q3 1,6 T2 q2 q2 q4 q3 q4 q4 q4 q3 q4 q4 q4 3,2 T1 q2 q1 q4 q1 q4 q2 q3 q4 q4 q4 2,4 T2 q2 q2 q3 q1 q4 q3 q4 q4 1,9 T1 q2 q2 q4 q1 q3 q3 q4 q4 1,9 T2 q4 q2 q1 q1 q2 q2 q2 q1 q1 q1 q1 1,5 T1 q3 q1 q1 q1 q1 q2 q1 q1 q1 q3 1,3 T2 q1 q2 q3 q1 q4 0,9 T1 q1 q1 q1 q1 q4 0, DI-EU Diff. T2-T1 8
9 H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H1 H2 H3 H4 H5 H6 H/ H8 H9 H10 H11 H12 mfh The overall project: MFQQ 2 nd Assessment Part B: Quality system and budget General quality system in hospital Does your hospital use a comprehensive quality system? Are MF criteria integrated in this quality system? Sumscore T2 Sumscore T1 H-Score of changing (T1 to T2) T T T T SC-EU Diff. T2- T1 MF budget 65. Does your hospital have an explicit MF budget? Source of funds 66. regular hospital budget 67. external public funds 68. private sponsoring SC-EU Diff. T2- T1 T T T T T T1 + 1 T
10 Experiences and Conclusions Assessment of MF of services and MF quality/support system is useful for raising awareness can monitor changes can be developed further selection of main indicators for regular use with standardised procedures and responsibilities 10
11 11
12 MFQQ selected results Part A: Services Communication - Interpreting Services Improvements in 6 out of 7 indicators Co-operation with external interpreting service with highest DI-EU (2,6) No change in availability of service in request of clients Information concerning access to hospital and at hospital Improvements in 5 out of 6 indicators more information material translated into community languages (DI-EU 1,3 access and 1,7 at hospital) patient education, health promotion and empowerment Improvements in 5 out of 5 indicators with DI-EU of max. 0,9 in 2nd assessment consistent lower level compared to other service areas Rating: quartiles 12
13 Selected results Part B: Quality Structures Increased integration of MF criteria in quality system (6 H/04-2 H/03) Improvements in written MF-Policies, esp. how to handle discrimination (7 H/04-4 H/03) and action plans (6 H/04-3 H/03) Increase of activities to make issue visible list of contact persons available to staff members (9 H/04-3 H/03) annual MFH presentations (8 H/04-3 H/03) MFH communication policy (6 H/04-3 H/03) Press releases (5 H/04-2 H/03) Rating: yes/no 13
14 Selected results Part B: Quality Structures Stable MF management structure conc. involvement of relevant stakeholders, and involvement of migrant representatives in organisational change Budgets available only in 3 (4) hospitals Explicit MF budget (3 H/04-2 H/03) Regular hospital budget (4 H/04-2 H/03) Monitoring of clinical outcome, health literacy, health behaviour remains low, as well as monitoring of clients and staff satisfaction Rating: yes/no 14
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