THE MIGRANT-FRIENDLY HOSPITAL IN THE LOCAL HEALTH AUTHORITY OF REGGIO EMILIA Antonio Chiarenza

1. THE MIGRANT-FRIENDLY HOSPITAL IN THE LOCAL HEALTH AUTHORITY OF REGGIO EMILIA Antonio Chiarenza Coordinating Centre of the Health Promoting Hospitals Network of Emilia-Romagna, Italy 12th International Conference on Health Promoting Hospitals, Moscow, May 26-28, 2004 COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY AUSL DI REGGIO EMILIA - LOCAL HEALTH AUTHORITY OF REGGIO EMILIA

2. The Local Health Service of Reggio Emilia Part of the Regional Health System 2,291 square kilometers Population of 456,000 people 6 Health Districts (Primary care) 5 Hospitals 3,500 employees 470 medical doctors COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY AUSL DI REGGIO EMILIA - LOCAL HEALTH AUTHORITY OF REGGIO EMILIA

3. A province under transformation • 5.6% of population non-national residents • Up to 6-10% of population in certain areas • Nearly 4 times as many in 9 years • Diverse origins: from over 115 countries • Main countries of origin: Morocco, Albania, India, China, Pakistan, Ghana, Yugoslavia • Regional policy fostering social integration: • Family regrouping • Increasing number of women • 25% of children 0-2 are non-national COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY AUSL DI REGGIO EMILIA - LOCAL HEALTH AUTHORITY OF REGGIO EMILIA

4. Impact on healthcare and initial actions • Irregular migrants health • Overload of emergency departments • Poor communication and understanding • Mother and child care • Control infectious diseases Specific health care centre for migrant families Specific antenatal pathways Production of multi-lingual information Use of ad hoc interpreting Free health care COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY AUSL DI REGGIO EMILIA - LOCAL HEALTH AUTHORITY OF REGGIO EMILIA

5. MFH – Kicking off: needs assessment Staff problem list Migrant patients problem list • Information and communication • Understanding different cultures • Language services • Specific hotel services • Integrated care at various levels • Procedures at admission and discharge Cooperation in treatment Health education and prevention Professional language and cultural mediation Continuity of care Staff awareness of different cultures Appropriate use of hospital services COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY AUSL DI REGGIO EMILIA - LOCAL HEALTH AUTHORITY OF REGGIO EMILIA

6. Interventions - Overall project: to create a culturally adequate hospital setting and policy • Developing a minimum level mfh policy for migrants • Establishing organisational structures to manage cultural diversity • Facilitating access to hospitals thanks to specific written material and multilingual signs; • Developing adequate procedures for admission; • Overcoming language barriers through the set up of a structured and coordinated intercultural mediation service; • Improving comfort and welcome in hospitals (providing suitable menus and support for spiritual and religious requirements); • Ensuring appropriate discharge procedures to guarantee continuity of care through territorial services and by providing information on treatment and appropriate life styles; • Providing staff training towards cultural competence and awareness. COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY AUSL DI REGGIO EMILIA - LOCAL HEALTH AUTHORITY OF REGGIO EMILIA

7. Interventions - 3 Sub-Projects:Improving Quality of Services in Selected Areas Pilot project objectives: • To ensure responsive and effective communication in care and clinical encounters • To improve migrant patients’ empowerment and community involvement • To provide culturally competent staff and organisation in health care COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY AUSL DI REGGIO EMILIA - LOCAL HEALTH AUTHORITY OF REGGIO EMILIA

8. Sub-project A – Improving clinical communication – Project pathway SET UP OF SUB PROJECT GROUP relevant stakeholders LANGUAGE NEEDS ASSESSMENT statistical data and staff & patient survey IDENTIFICATION OF MODEL DEPARTMENTS Gynaecology, Paediatrics and A&E IMPLEMENTATION OF MEASURES • New intercultural mediation service • Service coordination • Written materials • Guidelines PROJECT MEASURES EVALUATION Staff survey Patient survey COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY AUSL DI REGGIO EMILIA - LOCAL HEALTH AUTHORITY OF REGGIO EMILIA

9. Sub-project A – Improving clinical communication –Effective measures SET UP OF AN INTERCULTURAL MEDIATION SERVICE in 3 model hospital wards by means of: • Employing bilingual staff to form a core group of cultural mediators • Co-operating with an external “social cooperative of trained cultural mediators” • Co-operating with a community project (EQUAL) aimed at creating work opportunities for migrants ESTABLISH COORDINATION of intercultural mediation services at central and district level DEVELOP GUIDELINES AND DOCUMENTATION on clinical interpreting TRAINING and education • For hospital staff on how to work with cultural mediators • For cultural mediators to work in clinical communication TRANSLATION OF WRITTEN MATERIALS (hospital info, multilingual questionnaires, discharge/follow-up…) COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY AUSL DI REGGIO EMILIA - LOCAL HEALTH AUTHORITY OF REGGIO EMILIA

10. Sub-project B – Culturally and linguistically adequate information and education in mother and child care –Project pathway SET UP OF SUB PROJECT GROUP relevant stakeholders in the hospital and primary care IDENTIFICATION OF PARTICIPANT MOTHERS AND NEEDS ASSESSMENT Meeting participant mothers and interviews IDENTIFICATION OF MODEL DEPARTMENTS AND SERVICES Gynaecology, Paediatrics and Women’s clinics IMPLEMENTATION OF MEASURES • First contact with women by mail and at services • 10 hour course for parents-to-be on post-natal topics • Information materials PROJECT MEASURES EVALUATION • Staff survey to assess improvements • Patient survey to assess quality of training courses COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY AUSL DI REGGIO EMILIA - LOCAL HEALTH AUTHORITY OF REGGIO EMILIA

11. Sub-project B – Culturally and linguistically adequate information and education in mother and child care –Effective measures SET UP A LIST OF MOTHERS FOR THE COURSE by contacting them: • with a culturally and linguistically adequate letter • with a telephone call by a cultural mediator • through health care staff (during hospital visits and paediatrics checks) • through the organisation of a specific meeting in the paediatrics clinic INFORMATION AND TRAINING COURSE • On health services information • Mother and child health • Breastfeeding and weaning DEVELOP SPECIFIC INFORMATION MATERIAL On organisation of services On specific topics COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY AUSL DI REGGIO EMILIA - LOCAL HEALTH AUTHORITY OF REGGIO EMILIA

12. Sub-project C – Training hospital staff for providing cross-cultural health care–Project pathway SET UP OF SUB PROJECT GROUP relevant stakeholders in the hospital NEEDS ASSESSMENT Staff survey IDENTIFY MODEL DEPARTMENTS AND SERVICES Gynaecology, Paediatrics and A&E IMPLEMENTATION OF MEASURES • Training team (University of Bologna) • 14 hour course for hospital staff • Information materials PROJECT MEASURES EVALUATION • Pre- and post- training staff survey COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY AUSL DI REGGIO EMILIA - LOCAL HEALTH AUTHORITY OF REGGIO EMILIA

13. Sub-project C – Training hospital staff for providing cross-cultural health care-Effective measures SET UP A LIST OF STAFF FOR THE COURSE 30 people (doctors, nurses, midwives and support staff) TRAINING COURSE • Focus on two ethnic groups: Indians and Pakistanis OBJECTIVES: • Develop knowledge: Migration and health, Inequalities, Health socio-anthropology, Policy and legislation • Develop skills: how to handle cross-cultural encounters, how to elicit information, • Develop awareness: how to act in a culturally sensitive manner. METHODS • Case study, Role-playing DEVELOP SPECIFIC INFORMATION MATERIAL On specific topics: culture, religion, menus, diets COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY AUSL DI REGGIO EMILIA - LOCAL HEALTH AUTHORITY OF REGGIO EMILIA

14. MFH - First positive outcomes of the pilot project • a MFH task force has been established within the HPH Italian network with the aim of developing national recommendations; • a regional working group has been established with the aim of developing standards to define a “Migrant-friendly hospital”; • partnerships have been established with social cooperatives at community level to manage a cultural mediation service; • co-operation with the Local Community Plans for Migration involving relevant stakeholders and aiming at fostering social integration; • job opportunities have been created for the migrant population of the community. COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY AUSL DI REGGIO EMILIA - LOCAL HEALTH AUTHORITY OF REGGIO EMILIA

15. MFH – Questions antonio.chiarenza@ausl.re.it COORDINATING CENTRE OF THE HEALTH PROMOTING HOSPITALS REGIONAL NETWORK OF EMILIA-ROMAGNA - ITALY AUSL DI REGGIO EMILIA - LOCAL HEALTH AUTHORITY OF REGGIO EMILIA