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TF MFH
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
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
Elizabeth Abraham and Dr. Antonio Chiarenza
Institute for Healthcare Advancement
May 6, 2016
TF MFH
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
TF MFH
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
TF MFH
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
TF MFH Background and rationale of Standards project
TF MFH
6 HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
Migrant-Friendly Hospitals (2002-2004)
12 European 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
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.
AT
DE
DK
EL
ES
FI
FR
IT
NL
SV
UK
IR
TF MFH
7 7 HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
PROJECT OUTCOMES
OUTCOMES
For health policy
WHO-HPH
TASK FORCE
MIGRANT FRIENDLY
AND CULTURALLY
COMPETENTE
HEALTH CARE
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 hospitals
OUTCOMES
For networking
TF MFH
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
Task Force MFH
The HPH Task Force is co-ordinated by HPH Regional Network Emilia Romagna TF web site: www.hphnet.org
• To create a framework for continuity after
the conclusion of the MFH project
• To foster co-operation and alliances between
healthcare organisations and other networks
• To share and disseminate best policies and
practice
• To support health care organisations in the
HPH in becoming MF & CC organisations as
indicated in the Amsterdam Declaration
TF MFH PROJECT TO DEVELOP STANDARDS FOR EQUITY IN
HEALTH CARE (started in 2012)
Task Force MFH Migrant Friendly Hospitals & Health Services
International Network Health Promoting Hospitals & Health Services
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
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.
TF MFH
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
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
TF MFH
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
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
TF MFH
Pilot Test Results
2012 and 2014
TF MFH
Pilot tested the preliminary standards in 45 organisations
from 12 countries (April-September 2012)
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
Aims:
• To assess the clarity,
relevance and
applicability of the
standards
• To assess the
compliance with the
standards in pilot-
organisations
• 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
TF MFH
Results of the 1st pilot-test of preliminary
standards: clarity, relevance, applicability
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
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
TF MFH
Revision of the standards based on the results of
the 1st pilot-test
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
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.
TF MFH 5 Main standards
18 Sub standards
50 Measurable elements
Final equity standards
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
TF MFH
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
Standard
Measurable
element
Evidence
Score Problems,
goals, details
on evidence
and follow-up
actions
Sub-standard
TF MFH
Theoretical framework of Equity standards
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
Cattacin, S. et al (2013).
“Equity Standards for Health
Care Organisations: a
Theoretical Framework.”
Diversity and Equality in
Health Care 10(4): 249-258
TF MFH
2nd PILOT-TEST (2014)
Standards implementation
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
• 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.
TF MFH
STANDARDS FOR EQUITY IN HEALTH CARE
Self-Assessment Tool for pilot implementation
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
AIM
To allow healthcare
organizations to self-
assess their capacity
to provide equitable
care, to identify gaps,
and develop
improvements based
on the findings from
self-assessment
TF MFH
21 HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
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
4. 1-3 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
TF MFH How to use the Standards for Equity in Healthcare
TF MFH
1.Establish an assessment team to
oversee the assessment process.
Assessment team
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
TF MFH
1. General information of the
organisation is collected
General information about the organisation
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
TF MFH
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
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
TF MFH
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
Selection of 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
TF MFH
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
Identify
improvements areas
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
TF MFH 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
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
TF MFH 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 - 42100 Reggio Emilia [email protected]