Mfh WHO-Collaborating Centre for Health Promotion in Hospitals and Health Care Ludwig...

WHO-Collaborating Centre for Health Promotion in Hospitals and Health Care Ludwig Boltzmann-Institute for the Sociology of Health and MedicineInstitute for Sociology - University of Vienna, Austria

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mfh

© LBIMGS2003

Migrant-Friendly Hospitals: A European Initiative to Promote Health and Health Literacy Migrants and Ethnic Minorities

Karl Krajic, Beate Schulze, Ursula Trummer, Jürgen Pelikan

11th International Conference on Health Promoting Hospitals Firenze, May 18-20, 2003


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mfh Overview

Why migrant-friendly hospitals? - new challenges

MFH - A European initiative - 13 pilot hospitals

Who is a migrant? - definition and terminology issues

What is a migrant-friendly hospital? - focus on diversity +

patient orientation

What are the concrete challenges? - European cross analysis of

the mfh needs assessment

MFH interventions and evaluation - overall project + 3 sub-projects


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mfh – 13 European Pilot Hospitals

Kaiser-Franz-Josef-Spital, Vienna, AustriaImmanuel-Krankenhaus GmbH, Rheumaklinik Berlin-Wannsee, Berlin, GermanyKolding Hospital, Velje-Kolding, DenmarkHospital ”Spiliopoulio Agia Eleni”, Athens, GreeceHospital Punta de Europa, Algeciras-Cádiz, SpainTurku University Hospital, Turku, Finland Hôptial Avicenne, Paris, FranceJames Connolly Memorial Hospital, Dublin, IrelandPresidio Ospedaliero della Provincia di Reggio Emilia, Reggio Emilia, ItalyAcademic Medical Center, Amsterdam, The NetherlandsHospital Nossa Senhora do Rosário (HNSR) Barreiro/Lisbon,PortugalUppsala University Hospital, Psychiatric Centre, Uppsala, SwedenBradford Hospitals NHS Trust , Bradford, U.K.


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mfh Who is a migrant? – Definition and terminology issues

Migration situation differs across European countries:Diversity with regard to immigration legislation and policies,

geographical or historical connections, transit migration vs. established

ethnic communities, etc.)

Agreeing on a common European definition at the technical level

becomes difficult: pragmatic definition of the mfh target group:Focus on those patient groups with a migration background who

most frequently attend the hospital

are causing the greatest difficulty in providing effective care

Diversity is also evident for preferences around the terminology

on migration and ethnic diversity.mfh policy: local terms for „mfh“ can be chosen in such a way as to

facilitate local project marketing and acceptance


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mfh Migrant friendliness – What does it mean?

1. Acceptance of people with diverse backgrounds as principally equal members of society

2. Attention to / sensibility for different needs of people with diverse backgrounds and 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) – equal opportunity


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mfh What is a migrant-friendly hospital? Accepting “migrant friendliness (MF)” as an essential principle of the hospital’s quality policy

Sensitivity for 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 (T&D, progression within the organisation)

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


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mfh Needs assessment – Strategies

Stakeholder approach: assessing need from the perspective of the most important stakeholders- patients- staff- (representatives of key partners in the community)

Mixed methods approach:In-depth interviews, short discharge interviews, focus groups, surveys (patients)Expert interviews, group interviews at department level, surveys (staff)

Results of local needs assessment:Lists of the ten most frequent problems from the point of view of each stakeholder (patients, staff)

European cross analysis:Qualitative approach: inductive + deductive strategies(1) Identifying problem areas for patients+ staff; (2) Integration into a general list(3) Categorisation of problem areas in line with the MFQQ*; (4) identification +quantification of countries where each problem area was defined as relevant

*Migrant-Friendliness Quality Questionnaire: Instrument for overall project evaluation


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mfh Needs assessment – Diversity

Migrant patients from 43 countries (in the following regions: North and Sub-Saharan Africa, Asia, The Carribean, Former Yugoslavia, the Former Soviet Union, Eastern + Central Europe, The Middle East, South America, Turkey) with different migration backgrounds: members of established ethnic communities, labour migrants, recognised refugees, asylum seekers, undocumented migrants with different religious backgrounds: Buddhist, Christian, Hindu, Muslim, no religious confession

Staff all relevant professional groups: medical and nursing staff, other health professionals [midwives, physio- therapists, X-ray technicians], social workers, receptionists, pastoral caretakers; members of hospital management different levels of hierarchy at the hospital (Heads of Department [medical and nursing], medical and nursing staff at ward level, auxiliary personnel in different areas) staff members with diverse ethnic backgrounds


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mfh Needs assessment - Common themes

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Language and Communication

Patient info + educ.(linguistically and culturally adequate)

Cultural barriers/lack of culturalcompetencies

Family visits

Lack of culturallyadequate food

number of hospitals where problem was mentioned (NA results from 12 pilot hospitals)

Spirituality and social support

European cross analysis: The six most important problem areas


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mfh The Overall Project - Ensuring structures and sustainability

Intervention

Improve MF within core processes of hospital servicesAccess, (pre)entry into hospital / In-patient care / discharge

Information / communication / empowerment

Establish a MF-Support System by integrating MF into the quality system

Policy / Budget / management structure / monitoring

Staff training / involvement of stakeholders

Evaluation

Assessment of MF characteristics of services in core processes and presence of of MF support system as dimension in quality system

Baseline May 2003 – final assessment June 2004

Instrument

The Migrant Friendliness Quality Questionnaire MFQQ


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mfh 3 sub - projects – improving quality of services in selected areas

Interventions

Selection of 3 model interventions guided by

Results from needs assessment (case for action)

Review on effective models (what are effective measures)

Evaluation

Tailored to selected interventions

Assessing effectiveness according to aims of

Promotion of health-related knowledge, health behaviour and health of migrants/ethnic minorities by empowerment measures – health literacy

Promotion of cultural sensitivity of hospital staff by empowerment measures – cultural literacy

InstrumentsTo be developed


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mfh MFH – Questions

www.mfh-eu.netFurther info at:


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mfh Health Literacy as an outcome of Health Promotion and a determinant of Health Behaviour and Health

Health Literacy

Health/ Illness/ Patient Behaviour

Health Outcome

short / long term

Social and cultural settings

Health Promotion Action

Personal variables

empowerment

Enabling/ supportive

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