HPH TF MFH - Amazon S3€¦ · hph task force on migrant friendly and culturally competent healthcare 7 health promoting hospitals network of emilia – romagna azienda usl di reggio

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



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

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TF MFH

7 7 HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE



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




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




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




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




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)




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




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




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




TF MFH




Standard

Measurable

element

Evidence

Score Problems,

goals, details

on evidence

and follow-up

actions

Sub-standard

TF MFH

Theoretical framework of Equity standards




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




• 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




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



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




TF MFH

1. General information of the

organisation is collected

General information about the organisation




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




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


indicators newly developed

according to local priorities


indicators from the sample

indicators provided

Selection of indicators




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




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




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]

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HPH TF MFH - Amazon S3€¦ · hph task force on migrant friendly and culturally competent healthcare 7 health promoting hospitals network of emilia – romagna azienda usl di reggio