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

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The migrant friendly hospital in the local health authority of reggio emilia antonio chiarenza

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


The local health service of reggio emilia
The Local Health Service of Reggio Emilia 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


A province under transformation
A province under transformation OF REGGIO EMILIA

  • 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


Impact on healthcare and initial actions
Impact on healthcare OF REGGIO EMILIA 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


Mfh kicking off needs assessment
MFH – Kicking off: needs assessment OF REGGIO EMILIA

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


Interventions overall project to create a culturally adequate hospital setting and policy
Interventions - Overall project: OF REGGIO EMILIAto 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


The migrant friendly hospital in the local health authority of reggio emilia antonio chiarenza

Interventions - 3 Sub-Projects: OF REGGIO EMILIAImproving 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


Sub project a improving clinical communication project pathway
Sub-project A – Improving clinical communication OF REGGIO EMILIA – 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


Sub project a improving clinical communication effective measures
Sub-project A – Improving clinical communication – OF REGGIO EMILIAEffective 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


The migrant friendly hospital in the local health authority of reggio emilia antonio chiarenza

Sub-project B – OF REGGIO EMILIACulturally 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


The migrant friendly hospital in the local health authority of reggio emilia antonio chiarenza

Sub-project B OF REGGIO EMILIA– 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


Sub project c training hospital staff for providing cross cultural health care project pathway
Sub-project C – OF REGGIO EMILIATraining 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


Sub project c training hospital staff for providing cross cultural health care effective measures
Sub-project C – OF REGGIO EMILIATraining 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


Mfh first positive outcomes of the pilot project
MFH OF REGGIO EMILIA - 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


The migrant friendly hospital in the local health authority of reggio emilia antonio chiarenza

MFH – Questions OF REGGIO EMILIA

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