Meeting of the HPH-Task Force on the Migrant-friendly and Culturally Competent Healthcare ASSESSING MIGRANT-FRIENDLINESS AND CULTURAL COMPETENCE IN EUROPEAN HOSPITALS AND HEALTH SERVICES Dr Antonio Chiarenza 17 International HPH Conference 6-8 May 2009, Crete
Aims Migrant-Friendly Hospitals: A an Initiative to Promote Health and Health Literacy Migrants and Ethnic Minorities To identify, develop and evaluate models of good practice promoting the health and health-related knowledge and competence of migrants and ethnic minorities improving hospital services for these patient groups Strategies: Establish a network of an pilot hospitals Overall organisational development process Implement and evaluate effective models addressing specific aspects of migrant health care needs -HPH TASK FORCE ON MIGRANT-FRIENDLY HOSPITALS COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY - LOCAL HEALTH AUTHORITY (AUSL) OF REGGIO EMILIA 2
AT DE DK EL ES FI FR IR IT NL SV UK MFH 12 an Pilot Hospitals 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. -HPH TASK FORCE ON MIGRANT-FRIENDLY HOSPITALS COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY - LOCAL HEALTH AUTHORITY (AUSL) OF REGGIO EMILIA 3
Developing migrant-friendly hospitals How to put diversity competence/ cultural competence / migrant-friendliness on the agenda of hospital organisations and how to keep it there? FOUR STEPS: 1. Assessment: Health care needs; the delivery system 2. Planning: Develop an action plan 3. Implementation: Interventions in specific areas 4. Evaluation: of interventions and overall organisational development -Collaborating Centre for Health Promotion in Hospitals and Health Care Ludwig Boltzmann-Institute for the Sociology of Health and Medicine Institute for Sociology - University of Vienna, Austria 4
Assessment of Migrant Friendliness of hospital services An assessment tool was used for assessing Migrant Friendliness of hospital services and for benchmarking: The Migrant Friendliness Quality Questionnaire (MFQQ) Part A: Assessment of MF characteristics of services in core processes. Access, (pre)entry into hospital / In-patient care / discharge / Information / communication / empowerment Part B: Assessment of the presence of MF support system as dimension in quality system Policy / Budget / management structure / monitoring / Staff training / involvement of stakeholders -Baseline assessment -Assessment after improvements implementation -HPH TASK FORCE ON MIGRANT-FRIENDLY HOSPITALS COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY - LOCAL HEALTH AUTHORITY (AUSL) OF REGGIO EMILIA 5
Assessment of health needs Stakeholder approach: The needs from the perspective of the most important stakeholders were assessed at local level: - patients - staff - (representatives of key partners in the community) Mixed methods approach: Focus groups, in-depth interviews, short discharge interviews (patients) Group interviews at department level (staff) Results of local needs assessment: The 10 most frequent problems from the point of view of each stakeholder (patients, staff) were compared LOCAL HEALTH AUTHORITY (AUSL) OF REGGIO EMILIA, ITALY COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY - -HPH TASK FORCE ON MIGRANT-FRIENDLY HOSPITALS 6
Results needs assessment an cross analysis: The six most important problem areas Language and Communication Patient info + educ.(linguistically and culturally adequate) 12 12 Cultural barriers/lack of cultural competencies 10 Family visits Lack of culturally adequate food 6 7 Spirituality and social support 5 0 5 10 15 number of hospitals where problem was mentioned (NA results from 12 pilot hospitals) -Collaborating Centre for Health Promotion in Hospitals and Health Care Ludwig Boltzmann-Institute for the Sociology of Health and Medicine Institute for Sociology - University of Vienna, Austria 7
Three main areas of concern Language and communication: Migrant patients do not receive complete information about their care Clinical staff is not able to understand patients needs Frequent communication problems and misunderstandings Migrant patients and information and education Not being able to effectively utilise health services Not understanding explanations on treatments Not being able to ask questions and discuss implications Staff cultural competence Not being able to elicit patients explanations of illness Not being able to explain illness in a language accessible to patients Not being able to recognise the role of health beliefs in effective care -HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA ROMAGNA AZIENDA USL DI REGGIO EMILIA DIREZIONE GENERALE 8
Results an Cross Analysis + decisions on interventions Problems identified concerning MF characteristics of services AT DE DK EL ES FI FR IR IT NL SV UK Language and communication + + + + + + + + + + + + Patient information and education + + + + + + + + + + + + Access to services + + + + + + Family visits + + + + + + + Lack of culturally adequate food + + + + + + Spirituality and social support + + + + + Cultural barriers and differences + + + + + + + + + + Cultural competence: staff knowledge and attitudes + + + + + + + + Lack of continuity of care after discharge + + + + = SP A: Improving interpreting in clinical communication = SP B: Culturally and linguistically adequate info+ education in mother + child ca = SP C: Improving cultural competence: Training hospital staff for cross-cultural he LOCAL HEALTH AUTHORITY (AUSL) OF REGGIO EMILIA, ITALY COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY - -HPH TASK FORCE ON MIGRANT-FRIENDLY HOSPITALS 9
Planning of interventions Improving Quality of Services in Selected Areas Selection of 3 model interventions guided by: Review on effective models (what are effective measures) Results from needs assessment (case for action) Selected intervention areas: Improving interpreting services in clinical communication Migrant-friendly information and training in mother and child care training towards cultural competence: enabling hospital staff to better handle cross-cultural encounters -HPH TASK FORCE ON MIGRANT-FRIENDLY HOSPITALS COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY - LOCAL HEALTH AUTHORITY (AUSL) OF REGGIO EMILIA 10
Implementation and evaluation SET UP OF PROJECT GROUP relevant stakeholders NEEDS ASSESSMENT statistical data and staff & patient survey IDENTIFICATION OF MODEL DEPARTMENTS (i.e. Gynaecology, Paediatrics, A&E...) IMPLEMENTATION OF MEASURES Establishment of new (optimization) service Organisational improvement Production of specific resources (training, information material ) Guidelines, procedures PROJECT MEASURES EVALUATION Staff survey (pre / post) Patient survey (pre / post) LOCAL HEALTH AUTHORITY (AUSL) OF REGGIO EMILIA, ITALY COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY - -HPH TASK FORCE ON MIGRANT-FRIENDLY HOSPITALS 11
Project outputs Supporting tools for health care organisations: Pathways for implementation and evaluation Resource kits Quick guides Outline for staff training courses Useful web links -HPH TASK FORCE ON MIGRANT-FRIENDLY HOSPITALS COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY - LOCAL HEALTH AUTHORITY (AUSL) OF REGGIO EMILIA 12
Migrant-Friendly Hospitals (2002-2005) www.mfh-eu.net PROJECT OUTCOMES AT DE DK EL ES FI FR IR IT NL PT SV UK OUTCOMES For hospitals 12 national models for MFH: how to do it interventions 1. Organizational development 2. Interpreting services 3. Staff training on cultural competence 4. Patient information and education OUTCOMES For health policy OUTCOMES For networking -HPH TASK FORCE MIGRANT FRIENDLY AND CULTURALLY COMPETENTE HEALTH CARE -HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA ROMAGNA AZIENDA USL DI REGGIO EMILIA DIREZIONE GENERALE 13
Outcomes for Networking MFH has been established as permanent issue in the HPH network: Task Force Presentations, posters, workshops at International/national HPH conferences MFH project in National/ Regional Networks Networking with other experts in Comprehensive Action Plan of the Task Force to secure ongoing input for international, national and regional HPH networks -Collaborating Centre for Health Promotion in Hospitals and Health Care Ludwig Boltzmann-Institute for the Sociology of Health and Medicine Institute for Sociology - University of Vienna, Austria 14
The aims of Task Force on The HPH Task Force is co-ordinated by HPH Regional Network Emilia Romagna, AUSL Reggio Emilia (Agreement signed June 2008 for 4 years) To create a framework for continuity after the conclusion of the MFH project To share and disseminate best policies and practice and initiate the development of quality tools 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 -HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA ROMAGNA AZIENDA USL DI REGGIO EMILIA DIREZIONE GENERALE 15
HOW THE TASK FORCE SUPPORTS THE DEVELOPMENT OF MFCC HEALTH CARE? To develop ways of improving the delivery of high quality, linguistically appropriate, culturally sensitive, equitable and accessible heath care services To review and summarise the example of good policies and practices to date To identify obstacles to progress and to propose the development of effective interventions and quality tools (guidelines, standards, indicators..) -HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA ROMAGNA AZIENDA USL DI REGGIO EMILIA DIREZIONE GENERALE 16
AREAS OF WORK To achieve these objectives it was decided to organise activities around selected areas of concern: SERVICE QUALITY AND POLICY DEVELOPMENT STAFF TRAINING AND DEVELOPMENT INTERCULTURAL COMMUNICATION PATIENT AND COMMUNITY EMPOWERMENT -HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA ROMAGNA AZIENDA USL DI REGGIO EMILIA DIREZIONE GENERALE 17
ORGANISATION OF THE TASK FORCE 1.Coordinating team (decision making level): to lead and coordinate actions; to decide and organise activities (workshops, conferences...). 2.Advisory board (strategic level): to discuss ideas and developmental activities to inform the coordinator decisions. 3.Work groups (operative level): to collect practice and develop knowledge in the four areas of concern (Service and policy quality Staff and organisational development Intercultural communication Patient and community empowerment) 4.Hub of networks (partnership level): to facilitate connections between other networks and projects 5. web-site (communication level): to share ideas, to promote and disseminate best practice. -HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA ROMAGNA AZIENDA USL DI REGGIO EMILIA DIREZIONE GENERALE 18
Activities May 2008 May 2009 AREAS OF WORK ACTIVITIES OUTPUTS SERVICE QUALITY AND POLICY DEVELOPMENT EU Research on Quality of healthcare services for UDMs. DG SANCO (2008-2011) Workshop on an recommendations on accessibility and quality of care for migrants (September 2007) EU project Ethnic Minorities a COST HOME Health and Social Care for Migrants/Action project (2007-2010). Development of a questionnaire and strategy for collecting practices in hospitals and NGOs (April 2008) Publication by the Portuguese presidency of EU 2008 Collecting EU research on accessibility and quality of care for migrants in EU for final publication INTERCULTURAL COMMUNICATION Workshop on Intercultural mediation in Reggio Emilia (12-13 March 2007) Background documents and papers on website
Activities May 2008 May 2009 AREAS OF WORK ACTIVITIES OUTPUTS STAFF TRAINING AND DEVELOPMENT Workshop on Cultural competence in Barcelona (8-9 November 2008) Workshop on Outcomes measurement in Reggio Emilia (6-7 March 2009) Workshop on Intercultural competencies by the Social Cohesion Department Council of EU) Background documents and papers on Website Recommendations for the Council of PATIENTS AND COMMUNITY EMPOWERMENT Workshop on Patients and community involvement in Brighton (6-7 November 2007) Background documents and papers on website
Future activities 2009-2010 1. THEMATIC WORKSHOP AND ADVISORY BOARD MEETING 26-27 November 2009, Geneva, University Hospital, Red Cross and University of Geneva on Migration of health workers Migrants as a resource. Discussion and agreement on annual work plan April 2010, Manchester, HPH international conference, meeting to discuss products and tools for health care organisations. 2. RESERCH PROJECT NOWHERELAND Collection of practices for the provision of health care services for UDM in 17 countries. HPH national network indicate a contact person to facilitate the process. Collection starts end of May 2009 (8-15 questionnaires per country) 3. POSSIBLE FINAL PRODUCTS for the 4 years plan (2008-2011) Publication on good practice on Accessibility and quality of care for migrants containing the outcomes of the four areas of work of the. Development of a minimum set of indicators for a MF hospital or health service
MFH Project and Activities Information and documents at: mfh project: www.mfh-eu.net :www.ausl.re.it -HPH TASK FORCE ON MIGRANT-FRIENDLY & CULTURALLY COMPETENT HEALTH CARE COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY - LOCAL HEALTH AUTHORITY (AUSL) OF REGGIO EMILIA 22