Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems The experience at Hospital Punta de Europa, Algeciras, Cádiz SPAIN

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems TOTAL Europa Africa Asia América Oceanía Fuente: Estadística de Variaciones Residenciales. INE.

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems

Área de gestión sanitaria del Campo de Gibraltar MFH EU NETWORK 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 Presidio Ospedaliero della Provincia di Reggio Emilia, Reggio Emilia, Italy Academic Medical Center, Amsterdam, The Netherlands Hospital Nossa Senhora do Rosário (HNSR) Barreiro/Lisbon, Portugal Uppsala University Hospital, Psychiatric Centre, Uppsala, Sweden Bradford Hospitals NHS Trust, Bradford, U.K. AT DE DK EL ES FI FR IT NL PT SV UK IR

Área de gestión sanitaria del Campo de Gibraltar Common issues differences in hospital's ownership differences in demography of the clientele differences in degree of settlement of populations... Some areas were common concern all over the EU

Área de gestión sanitaria del Campo de Gibraltar Problem Areas Communication Austria Denmark Finland France Germany Greece Ireland Italy Portugal Spain Sweden The Netherlands United Kingdom

Área de gestión sanitaria del Campo de Gibraltar Problem Areas Understanding cultural differences Austria Finland France Germany Ireland Italy Portugal Spain Sweden

Área de gestión sanitaria del Campo de Gibraltar Problem Areas Lack of structures for migrant health Austria Denmark Finland Germany Greece Italy Sweden The Netherlands

Área de gestión sanitaria del Campo de Gibraltar Problem Areas Lack of adequate patient information Austria Denmark Finland Germany Greece Ireland Portugal Spain Sweden

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems Our health authority district Geography 234,000 inhabs. Two hospitals 10 primary health care centers 10 primary health care centers Located at the very south of Europe Located at the very south of Europe At only 18 Km from Africa At only 18 Km from Africa

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems Our Health authority district demography We attend more than 120,000 emergencies/year two million people cross the Strait of gibraltar from Spain to Morocco and backwards. We attend people that irregularly entered our country Population in transit Population with irregular entrance Settled population

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems Why did we get involved in MFH? answers to the challenge of a growing diversity in clinical settings service must be sensitive to the demands of social forces adapted to the population it serves

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems WHAT OBSTACLES WILL HAVE TO BE OVERCOME IN ORDER TO MEET THE NEEDS OF THESE PATIENTS?

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems EQUITABLE IS NOT ALWAYS EQUAL

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems LANGUAGE CULTURAL KNOWLEDGE ORGANIZATION

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems LANGUAGE CULTURAL KNOWLEDGE ORGANIZATION

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems LANGUAGE CULTURAL KNOWLEDGE ORGANIZATION

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems LANGUAGE CULTURAL KNOWLEDGE ORGANIZATION

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems LANGUAGE CULTURAL KNOWLEDGE ORGANIZATION

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems in addressing this issue, have in mind The response Managerial Staff Clientele National non nationals

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems in addressing this issue, have in mind Local policies hospital ownership integrate within the political framework of the health system on equality, diversity and access to it equality in access public ownership free health care - even in irregular entrance

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems EQUITABLE IS NOT ALWAYS EQUAL

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems Different geographical context administrative situations language Culture Religion economic situation Demography geographical distribution

Área de gestión sanitaria del Campo de Gibraltar WHAT IS (ARE) YOUR LOCAL POPULATION(S) LIKE?

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems WHAT CHANGES IN WORK ROUTINE WILL BE NECESSARY?

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems BAD NEWS! there are no magic recipes, tailor to your local situation

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems GOOD NEWS!! LEARN WERE YOU ARE LEARN FROM THE EXPERIENCES INCLUDE CULTURAL DIVERSITY AS A TOPIC TO BE ADDRESSED OVERCOME THE BARRIERS LOOK FOR AN ORGANISATIONAL CHANGE DEVELOP PARTNERSHIP STRATEGIES DEVELOP A SUPPORTING GROUP

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems GOOD NEWS!! LEARN WERE YOU ARE LEARN FROM THE EXPERIENCES INCLUDE CULTURAL DIVERSITY AS A TOPIC TO BE ADDRESSED OVERCOME THE BARRIERS LOOK FOR AN ORGANISATIONAL CHANGE DEVELOP PARTNERSHIP STRATEGIES DEVELOP A SUPPORTING GROUP

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems Part A: MF characteristics of service General resources to facilitate communication and information Accessibility, pre-entry and entry into hospital Whilst in hospital Hotel services Medical / nursing treatment Discharge MF patient education / health promotion / empowerment

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems Part B: MF Support System General quality system in hospital Does your hospital have a written MF policy ? MF budget Is a specific MF management structure in place? Involvement of migrant representatives in organisational change Marketing of MF internal marketing of MF (at the hospital) External marketing of MF (to the public) MF training and education for staff

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems Part B: MF Support System Monitoring of migrant clientele Monitoring of migrant-specific service outcomes Method/approach used for monitoring migrant data Monitoring of MF impact on organisational quality Reporting system on MF activities and impact Partnerships and partner alliances

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems GOOD NEWS!! LEARN WERE YOU ARE LEARN FROM THE EXPERIENCES INCLUDE CULTURAL DIVERSITY AS A TOPIC TO BE ADDRESSED OVERCOME THE BARRIERS LOOK FOR AN ORGANISATIONAL CHANGE DEVELOP PARTNERSHIP STRATEGIES DEVELOP A SUPPORTING GROUP

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems GOOD NEWS!! LEARN WERE YOU ARE LEARN FROM THE EXPERIENCES INCLUDE CULTURAL DIVERSITY AS A TOPIC TO BE ADDRESSED OVERCOME THE BARRIERS LOOK FOR AN ORGANISATIONAL CHANGE DEVELOP PARTNERSHIP STRATEGIES DEVELOP A SUPPORTING GROUP

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems GOOD NEWS!! LEARN WERE YOU ARE LEARN FROM THE EXPERIENCES INCLUDE CULTURAL DIVERSITY AS A TOPIC TO BE ADDRESSED OVERCOME THE BARRIERS LOOK FOR AN ORGANISATIONAL CHANGE DEVELOP PARTNERSHIP STRATEGIES DEVELOP A SUPPORTING GROUP

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems GOOD NEWS!! LEARN WERE YOU ARE LEARN FROM THE EXPERIENCES INCLUDE CULTURAL DIVERSITY AS A TOPIC TO BE ADDRESSED OVERCOME THE BARRIERS LOOK FOR AN ORGANISATIONAL CHANGE DEVELOP PARTNERSHIP STRATEGIES DEVELOP A SUPPORTING GROUP

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems GOOD NEWS!! LEARN WERE YOU ARE LEARN FROM THE EXPERIENCES INCLUDE CULTURAL DIVERSITY AS A TOPIC TO BE ADDRESSED OVERCOME THE BARRIERS LOOK FOR AN ORGANISATIONAL CHANGE DEVELOP PARTNERSHIP STRATEGIES DEVELOP A SUPPORTING GROUP

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems GOOD NEWS!! LEARN WERE YOU ARE LEARN FROM THE EXPERIENCES INCLUDE CULTURAL DIVERSITY AS A TOPIC TO BE ADDRESSED OVERCOME THE BARRIERS LOOK FOR AN ORGANISATIONAL CHANGE DEVELOP PARTNERSHIP STRATEGIES DEVELOP A SUPPORTING GROUP

Área de gestión sanitaria del Campo de Gibraltar MFH EU NETWORK 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 Presidio Ospedaliero della Provincia di Reggio Emilia, Reggio Emilia, Italy Academic Medical Center, Amsterdam, The Netherlands Hospital Nossa Senhora do Rosário (HNSR) Barreiro/Lisbon, Portugal Uppsala University Hospital, Psychiatric Centre, Uppsala, Sweden Bradford Hospitals NHS Trust, Bradford, U.K. AT DE DK EL ES FI FR IT NL PT SV UK IR

Área de gestión sanitaria del Campo de Gibraltar Common issues differences in hospital's ownership differences in demography of the clientele differences in degree of settlement of populations... Some areas were common concern all over the EU

Área de gestión sanitaria del Campo de Gibraltar The 5 most frequent problem areas Communication Cultural differences Lack of structures for migrant health Lack of documentation + research Lack of adequate patient information number of mentions in all interviews (n=97, including multiple mentions)

Área de gestión sanitaria del Campo de Gibraltar The Amsterdam declaration –December 04 The Amsterdam declaration Towards migrant friendly hospitals in an ethno-culturally diverse Europe

Área de gestión sanitaria del Campo de Gibraltar The Amsterdam declaration –December 04

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems WHAT BENEFITS CAN BE EXPECTED FOR PATIENTS?

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems Increased quality of service For staff For patients For the organisation

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems For staff Reduce staff workload Increase staff skills to manage congflict Reduce the stress of staff during cross cultural encounters Reduce the opportunities to malpractice Increase level of comfort Increase level of knowledge

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems For patients A more person oriented service Reduce the opportunities of inadequate use of service Increase the level of comfort during hospital stay

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems For the organisations Integrate the hospital in a networking process Increase effectiveness Send a clear message to all stakeholders A less expensive and more sustainable health system

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems IN SHORT… LEARN NETWORK MARKETING

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems

Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems THANK YOU!.