THE LOCAL HEALTH AUTHORITY OF REGGIO EMILIA. an integrated approach to the development of culturally competent healthcare services

Transcription

1 THE LOCAL HEALTH AUTHORITY OF REGGIO EMILIA an integrated approach to the development of culturally competent healthcare services Antonio Chiarenza Azienda USL di Reggio Emilia RICERCA E INNOVAZIONE 1

2 Why has migration become an important issue for Reggio Emilia? 2

3 The MF strategy of the Local Health Authority of Reggio Emilia: a global approach to reduce inequalities in health and barriers in the access to services for migrants 3

4 Reducing health inequalities and inequities in the access of health services Inequalities in health Occupational health Mother and child health Mental health Diabetis (nutrition, smoke, alchool..) Infectious diseases Socio-economic status Condizioni di lavoro Condizioni di vita fisica e sociale Condizioni abitative Carenze nutrizionali Emarginazione Inequities in the health services Communication problems Inappropriate use of services Lower level of quality of care Inadequate organisation and delivery of health care services Disparities in the access and quality of care Legal barriers Lingiustic barriers Cultural barriers Lack of adequate information Organisational barriers 4

5 Key challenges The challenge for public service providers is to ensure that services are accessible, responsive and appropriate to all patients We need to respond to a changing patient/user profile with differing perceptions & expectations of how health & social services are organised and delivered. We need to ensure that we have a workforce with the right skills and knowledge to deliver sensitive and equitable services. We need to provide leadership and plan how to integrate diversity into the transformation of the health system 5

6 OUR STRATEGY: a global approach IMPROVE KNOWLEDGE ON MIGRANTS HEALTH AND CONDITION. Collect data on migrants living condition that have an impact on health (Community health profile) Collect data on migrants health status (Migrants health profile) Qualitative research on migrants needs and priorities. DEVELOP CULTURAL COMPETENCE FOR THE STAFF AND THE ORGANISATION (whole organisational approach) Ensuring the implementation of human rights (irregulars, asylum seekers, Roma) Improving equity of access and quality of care (Communication, Information and Education) COMMUNITY DEVELOPMENT (Health System Approach) Prevention (vaccinations, screening..) and health promotion interventions (to tackle the social determinants of health) Improve migrants engagement and participation Develop partnership in the community: Local Authority, Networking, NGOs and Migrants communities. 6

7 Adoption of a whole organisational approach: to develop Migrant-friendly and culturally competent health care in Reggio Emilia Effective interventions: Develop and implement MFCC specific policy and strategy (Top-management commitment; provide for resources) Integrate principles of cultural competence in the quality management system (specific standards and indicators) Establish a management structure for MFCC (mainstreaming) Develop specific MFCC services (cultural mediation) and adapt organisational processes and procedures Systematic training of staff on migration and cultural competency Monitor health and access to care across diverse groups Include community in priority setting, planning and evaluating 7

8 Migrant-Friendly Hospitals ( ) A European Initiative to Promote Health and Health Literacy Migrants and Ethnic Minorities 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. 8

9 Migrant-friendliness What does it mean? 1. Acceptance of people with diverse backgrounds as principally equal members of society formal equality 2. Sensitivity to different needs of people with diverse backgrounds; service development to take account of specific needs related to diverse backgrounds equal opportunity 3. Compensation for particular differences hindering participation and integration (in an empowering and enabling way) substantial equality 9

10 What is a migrant-friendly hospital? Accepting migrant-friendliness (MF) as an essential principle of the hospital s quality policy Sensitivity and responsiveness to diversity in the needs of patients in the needs of staff Utilising and developing specific competencies among hospital staff for working with a diverse clientele (cultural competence) for staff members with a migrant and/or ethnic minority background MFH = Patient Orientation MFH = Staff Orientation MFH = Improving Quality of Care Starting with a specific target group developing strategies, routines and competencies of benefit for all 10

11 WHOLE ORGANISATIONAL APPROACH MIGRANT-FRIENDLY HOSPITAL Top-management Include migrant-friendliness into policy Establish a management structure for MF Monitor health status and accss to services -Migrant-friendly Interpreting and intercultural mediation services Adapted Information and education interventions Staff training on cultural competence 11

12 HEALTH SYSTEM APPROACH MIGRANT-FRIENDLY COMMUNITY Partnerships between health services and local authorities Integrated policies and shared social responsibility Engagement and participation of migrant communities WHOLE ORGANISATIONAL APPROACH MIGRANT-FRIENDLY HOSPITAL Top-management Include migrant-friendliness into policy Establish a management structure for MF Monitor health status and accss to services -Migrant-friendly Prevention and health promotion interventions Interpreting and intercultural mediation services Adapted Information and education interventions Staff training on cultural competence Integration of health status and sociodemographic data Partnership with the voluntary sector 12

13 Example of integrated activity in the community Health care provision for irregular migrants in Reggio Emilias AUSL Reggio Emilia Punti di accesso Approccio MFH Servizio di Mediazione Culturale Informazioni in lingua Formazione operatori Servizio dedicato CSFS Dip. Sanità Pubblica Distretto sanitario Ambulatorio CARITAS OSPEDALE Servizi Sociali dei Comuni Terzo Settore 13

14 Implementation of a Linguistic & Cultural Mediation service for all health care services of Reggio Emilia SET UP OF A LCM service for the whole province of Reggio Emilia by: Community-based intercultural mediation as a shared resource for all healthcare services Connecting the needs of hospitals, primary care and social services Using professional intercultural mediators Developing partnerships in the community with local authorities 14

15 Intercultural mediation services provided Languages: Arabic, Chinese, Hindi, Urdu, Punjab, Albanian, Russian, Ukrainian, Turkish, Romanian.. 20 intercultural mediators Type of interventions for clinical encounters and health promotion activities: On site presence of the intercultural mediator (in hospital) Weekly scheduled intervention Urgent intervention (within 2/3 hours) Intervention over the phone Written translations Patient information and education Community information and education 15

16 Information and education for migrant patients and communities Information is provided in a simple and culturally adequate way in order to better respond to migrants health literacy. INFORMATION Translated leaflets and Information material in various languages Information events with the communities (i.e. how to access and use the healthcare services) EDUCATION Healthcare education courses addressed to target groups of the population (i.e. pre and post natal courses) 16

17 Systematic training of staff on migration and cultural competency Variazione % della popolazione immigrata residente a Reggio Emilia per genere e classe di età - Anni < Maschi Femmine 1 Module: Migrants health status and access to services 2 Module : Intercultural communication CONTENTS 3 Module: Cultural competence in healthcare practice 4 Module: Patients information and education 17

18 Task Force Migrant-Friendly and Culturally Competent Healthcare of the Health Promoting Hospitals and Health Services International activities MEDIAZIONE LINGUISTICO CULTURALE NEI SERVIZI SANITARI DELLA PROVINCIA DI REGGIO EMILIA 18

19 Migrant-Friendly Hospitals ( ) PROJECT OUTCOMES OUTCOMES For hospitals OUTCOMES For health policy OUTCOMES For networking 12 national models for MFH: how to do it interventions: 1. Interpreting/mediation services 2. Staff training on cultural competence 3. Patient information and education 4. Whole organisational development WHO-HPH TASK FORCE MIGRANT FRIENDLY AND CULTURALLY COMPETENTE HEALTH CARE (coordinated by Reggio Emilia) 19

20 The aims of Task Force on MFCCH The HPH Task Force is co-ordinated by HPH Regional Network Emilia Romagna, AUSL Reggio Emilia ( 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 becoming MF & CC organisations as indicated in the Amsterdam Declaration 20

21 Partnerships & Research projects European Cooperation in the field of Scientific and Technical Research HOME Health and Social Care for Migrants and Ethnic Minorities a COST/Action project ( ). NOWHERELAND: To improve equity of access to healthcare for UDM in Europe (DG SANCO) ( ) 21

22 TASK FORCE MFCCH WEBSITE 22

23 TASK FORCE MFCCH WORKPLAN PROJECT TO DEVELOP STANDARDS FOR ASSESSING EQUITY OF ACCESS AND QUALITY OF HEALTH CARE FOR MIGRANTS AND ETHNIC MINORITIES Time frame 1. November 2010 Establishment of the project group 2. November 2010 January Development of the conceptual model 3. November 2010 January 2011 Review of the literature and existing standards 4. March Identification of 5-6 primary domains 5. April May 2011 Development of preliminary standards 6. June 2011 Presentation of the preliminary standards and Identification of pilot institutions (HPH conference) 7. July December 2011 Pilot testing 8. June 2012 development of the final standards (end of the project) 23

24 Information and documents Azienda Unità Sanitaria Locale di Reggio Emilia Direzione Generale Ricerca e Innovazione Via Amendola, Reggio Emilia Antonio.chiarenza@ausl.re.it 24

25 A Whole Organisation Approach to migrant-friendliness ensures inclusive, diversity sensitive strategies are developed and practiced Leadership and commitment from Top Management Establish a management structure for MFCC Whole Organisation Approach Implement MFCC specific policy and strategy Partnership between health service and MEC groups Staff training through learning strategies Integrate cultural competence in the quality management system Services that respond to Migrants needs 25