tf mfcch

TF
MFCCH
HPH TF MFCCH
Task Force on Migrant-Friendly and
Culturally Competent Health Care
INTERNATIONAL STANDARDS FOR ASSESSING
EQUITY IN HEALTH CARE:
The project of the HPH-Task Force MFCCH
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
1
Migrant-Friendly Hospitals (2002-2005)
www.mfh-eu.net
TF
MFCCH
PROJECT OUTCOMES
OUTCOMES
For hospitals
AT
DE
DK
EL
ES
FI
FR
IR
IT
NL
PT
SV
UK
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
WHO-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
2
The aims of Task Force on MFCCH
TF
MFCCH
The HPH Task Force is co-ordinated by AUSL
Reggio Emilia (HPH Regional Network Emilia
Romagna). TF web site: www.ausl.re.it
•
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
3
TF
MFCCH
PROJECT TO DEVELOP STANDARDS FOR
EQUITY IN HEALTH CARE
Project aim:
• The project aim at developing a comprehensive framework for
measuring and monitoring the capacity of healthcare organisations to
improve accessibility to appropriate and effective health services;
health promotion and preventive care for migrants and other
vulnerable groups.
Principles and values:
• acknowledge that inequities in health care must be redressed;
• promote the principle of universal coverage;
• focus on prevention and health promotion as well as treatment across the
continuum of care;
• acknowledge and value multiple diversity and the existence of differences as
well as commonalities across all populations;
• acknowledge the uniqueness of all individuals, the right to self-determination
and respect for individual identity.
• aim at reducing inequity in access to services and quality of 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
4
PROJECT GROUP
TF
MFCCH
1.
2.
3.
4.
5.
6.
7.
ITALY: Antonio Chiarenza (coordinator) HPH EmiliaRomagna
UK (Scotland): James Glover and James Robinson (NHS
Lothian)
NORWAY: Bernadette Nirmal Kumar (NAKMI, Oslo)
THE NETHERLANDS: Conny Seeleman and Marie-Louise
Essink-Bot (Amsterdam Medical Centre)
SWEDEN: Manuel Fernandez Gonzales (Uppsala
University Hospital)
CANADA: Elisabeth Abrahams (University Health Network,
Toronto) and Marie Serdynska (Montreal Children's
Hospital ,The McGill University Health Centre)
SPAIN: Manuel Garcia Ramirez (University of Seville)
EXPERTS: David Ingleby; Sandro Cattacin; Dagmar Domenig
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
5
TF
MFCCH
DEFINITIONS
Health inequality and inequity (WHO)
Health inequalities can be defined as differences in health
status or in the distribution of health determinants between
different population groups. E.g.:, differences in mortality
rates between people from different social classes.
Health inequities
Some health inequalities are attributable to the external
environment and conditions mainly outside the control of the
individuals concerned. In this case, the uneven distribution
may be unnecessary and avoidable as well as unjust and
unfair, so that the resulting health inequalities also lead to
inequity in health.
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
MFCCH
DEFINITIONS
• Equity in Health: is concerned with creating
equal opportunities for health and with bringing
health differentials down to the lowest possible.
• Equity in Health Care: is defined as equal
access to available care for equal need; equal
utilization for equal need; equal quality of care
for all.
M. Whitehead, (2000). The concepts and principles of equity and health,
WHO-Copenhagen
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
Five main standards
(domains)
TF
MFCCH
1.
EQUITY IN POLICY
2.
EQUITABLE ACCESS AND
UTILISATION
3.
EQUITABLE QUALITY OF CARE
4.
INCLUSIVE USER AND COMMUNITY
INVOLVEMENT
5.
PROMOTING EQUITY
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
A self-assessment tool
TF
MFCCH
standard
definition
Sub-standard
definition
measurable
element
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
MFCCH
5 Main standards
18 Sub standards
51 Measurable elements
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
MFCCH
Standard
1
Equity in Policy
Objective of the standard
To define how the organisation should
develop policies, governance and
performance monitoring systems which
promote equity.
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
Standard
1
TF
MFCCH
Equity in Policy
4 Sub-standards
1.
The organisation can ensure that its plans, policies and decisions
promote equity in all aspects of its activities.
2.
The organisation’s research, monitoring and evaluation systems
can measure equity performance.
3.
The organisation has a plan, resources and budget to promote
equity.
4.
The organisation ensures that staff at all levels has awareness
and competence to address inequities in 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
12
TF
MFCCH
Standard
2
Equitable Access and
Utilisation
Objective of the standard
To encourage the health organisation to
address barriers which prevent people
from accessing and benefiting from
health care 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
13
Standard
2
TF
MFCCH
Equitable Access and
Utilisation
4 Sub-standards
1.
The organisation ensures that accessibility and availability of health
services are equitable.
2.
The organisation develops initiatives to reduce communication and
information barriers
3.
The organisation develops initiatives to increase user trust.
4.
The organisation is able to ensure that healthcare is provided
where eligibility rules compromise human rights.
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
14
TF
MFCCH
Standard
3
Equitable Quality of Care
Objective of the standard
To assist the organisation in developing
the following areas so that they respect
the uniqueness of patients: patient
assessment; staff / patient interactions;
safe environment; discharge and
continuity of 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
15
TF
MFCCH
Standard
3
Equitable Quality of Care
4 Sub- standards
1. The organisation ensures that individual characteristics, experiences and
living conditions are considered alongside the assessment of health
needs.
2. The organisation’s workforce is able to deliver care that takes into
account individual patients’ ideas and experiences of health and illness.
3. The organisation is able to create an environment that makes the patient
feel safe, where there is no threat to his/her dignity or denial of individual
identity.
4. The organisation takes into account individual patients’ characteristics,
experiences and living condition to ensure effective discharge and
continuity of 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
16
TF
MFCCH
Standard
4
Inclusive User and
Community Involvement
Objective of the standard
To support the organisation in
developing involvement processes
sensitive to the needs and preferences
of individuals and groups so that
everybody has an equal opportunity to
benefit from these processes.
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
Standard
4
TF
MFCCH
Inclusive User and
Community Involvement
3 Sub- standards
1.
The organisation is able to identify and involve users and groups
who have an interest in the focus of its involvement process.
2.
The organization identifies and overcomes barriers to effective
involvement.
3.
The organization has an empowering evaluation system of
participatory processes in which users and community groups
are involved.
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
TF
MFCCH
Standard
5
Promoting Equity
Objective of the standard
To support the organisation in promoting
equity externally in its wider environment
through: advocacy and lobbying;
capacity building; disseminating
research; developing education and
promotional work.
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
19
Standard
5
TF
MFCCH
Promoting Equity
3 Sub- standards
1.
The organisation is an active participant in networks, think tanks
and research initiatives which promote equitable approaches.
2.
The organisation actively disseminates the results of research
and practice which relates to equity.
3.
The organisation ensures that equity is reflected in all
partnership agreements and relationships, including contracted
services, and partnerships.
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
20
PROJECT WORKPLAN 2011 – 2013
TF
MFCCH
Project roadmap:
• To revise the 1° draft of the standards after the feedback received at the
workshop held at the XIX HPH Conference in Turku, (September 2011)
• To develop the measurable elements for each sub-standard (November
2011-March 2012)
• To present and discuss the 2nd draft of the preliminary standards at the
International HPH Conference in Taipei, Taiwan (April 2012)
• To validate the preliminary standards through a consensus process
addressed to WHO and other key players. (April-May 2012)
• To pilot test the preliminary standards in order to assess their clarity
and ensure they meet the actual needs of people and services.
(April-July 2012)
• To collect and analyse the findings of the pilot test (September 2012)
• To discuss the findings of the Pilot-test and Consensus Process at the Task
Force meeting in Reggio Emilia (October 2012)
• To produce the final standards, develop indicators for each sub-standard and
implement the final self-assessment tool in pilot organisations. (January 2013)
• To present and discuss the final self-assessment tool at the international
HPH conference in Sweden (May 2013)
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
21
TF
MFCCH
PILOT TESTING THE STANDARDS IN HEALTH
CARE ORGANISATIONS (April-July 2012)
Aims:
• To assess the applicability and
clarity of the standards
• To establish if the standards are
accessible and understandable
• To collect examples of
demonstrable evidence
(effective practices relating to
the measurable elements)
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
MFCCH
EVALUATION OF SUB-STANDARDS AND
MEASURABLE ELEMENTS
• COMPREHENSIBILITY: is the formulation
sufficiently clear?
• APPLICABILITY: is the sub-standard and the
measurable element applicable to the
organisation?
• RELEVANCE: is the sub-standard and
measurable element related to an important
patient-care issue?
• COMPLETENESS: are important items
missing?
PILOT-TEST:
the role of national/regional HPH coordinators
TF
MFCCH
Countries who offered
to host the pilot-test
•
•
•
•
•
•
•
•
Italy
Norway
Scotland
Canada
Sweden
The Netherlands
Spain
Other WHO countries
•
•
•
Denmark (TBC)
England (TBC)
Ireland (TBC)
1.
Identify and contract with 2 – 4
test hospitals / health
services.
2.
Identify a responsible contact
person for each pilotinstitution.
3.
Provide guidance to
organisations taking part in the
pilot test implementation.
4.
Translate the test material into
the national language, where
necessary.
5.
To collect the completed review
forms and send them to the TF
coordinator.
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
24
TF
MFCCH
PILOT-TEST:
the role of pilot-organisations
It is suggested that the following staff should be involved
in the multidisciplinary review team:
• A contact person responsible for the local pilot-test
(responsible for Equality and Diversity or Migrant-friendly initiatives)
• Hospital/health service management, and staff
representatives (nurses, medical doctors, administrative
staff)
• Specific relevant departments/professionals such as
quality management, human resources, communication,
community health, social work, health promotion.
• Representatives of service users and the community,
selected to ensure coverage of target vulnerable groups.
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
25
PILOT-TEST: REVIEW FORM
TF
MFCCH
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-TEST: REVIEW FORM
TF
MFCCH
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
MFCCH
Information and material
The guidelines and the review form can be
downloaded from the
TF MFCC website http://www.ausl.re.it
The Review Form can be filled in on line at the
HPH website: http://www.hphnet.org/
E-Mail: [email protected]
HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE
HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA
AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE
28