1. mfh WHO-Collaborating Centre for Health Promotion in Hospitals and Health Care Ludwig Boltzmann-Institute for the Sociology of Health and Medicine Institute for Sociology - University of Vienna, Austria 1 © LBIMGS 2003 Migrant-Friendly Hospitals: A European Initiative to Promote Health and Health Literacy Migrants and Ethnic Minorities Karl Krajic, Beate Schulze, Ursula Trummer, Jürgen Pelikan 11 th International Conference on Health Promoting Hospitals Firenze, May 18-20, 2003

2. mfh WHO-Collaborating Centre for Health Promotion in Hospitals and Health Care Ludwig Boltzmann-Institute for the Sociology of Health and Medicine Institute for Sociology - University of Vienna, Austria 2 Overview Why migrant-friendly hospitals? - new challenges MFH - A European initiative - 13 pilot hospitals Who is a migrant? - definition and terminology issues What is a migrant-friendly hospital? - focus on diversity + patient orientation What are the concrete challenges? - European cross analysis of the mfh needs assessment MFH interventions and evaluation - overall project + 3 sub-projects

3. mfh WHO-Collaborating Centre for Health Promotion in Hospitals and Health Care Ludwig Boltzmann-Institute for the Sociology of Health and Medicine Institute for Sociology - University of Vienna, Austria 3 AT DE DK EL ES FI FR IT NL PT SV UK IR mfh – 13 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 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.

4. mfh WHO-Collaborating Centre for Health Promotion in Hospitals and Health Care Ludwig Boltzmann-Institute for the Sociology of Health and Medicine Institute for Sociology - University of Vienna, Austria 4 Who is a migrant? – Definition and terminology issues Migration situation differs across European countries: Diversity with regard to immigration legislation and policies, geographical or historical connections, transit migration vs. established ethnic communities, etc.) Agreeing on a common European definition at the technical level becomes difficult: pragmatic definition of the mfh target group: Focus on those patient groups with a migration background who most frequently attend the hospital are causing the greatest difficulty in providing effective care Diversity is also evident for preferences around the terminology on migration and ethnic diversity. mfh policy: local terms for „mfh“ can be chosen in such a way as to facilitate local project marketing and acceptance

5. mfh WHO-Collaborating Centre for Health Promotion in Hospitals and Health Care Ludwig Boltzmann-Institute for the Sociology of Health and Medicine Institute for Sociology - University of Vienna, Austria 5 Migrant friendliness – What does it mean? 1.Acceptance of people with diverse backgrounds as principally equal members of society 2.Attention to / sensibility for different needs of people with diverse backgrounds and service development to take account of specific needs related to diverse backgrounds - equal opportunity 3.Compensation for particular differences hindering participation and integration (in an empowering and enabling way) – equal opportunity

6. mfh WHO-Collaborating Centre for Health Promotion in Hospitals and Health Care Ludwig Boltzmann-Institute for the Sociology of Health and Medicine Institute for Sociology - University of Vienna, Austria 6 What is a migrant-friendly hospital? Accepting “migrant friendliness (MF)” as an essential principle of the hospital’s quality policy Sensitivity for and responsiveness to diversity in the needs of patients in the needs of staff Utilising and developing specific competencies among hospital staff for working with a diverse clientele (cultural competence) for staff members with a migrant and/or ethnic minority background (T&D, progression within the organisation) MFH = Patient Orientation MFH = Staff Orientation MFH = Improving Quality of Care Starting with a specific target group – developing strategies, routines and competencies of benefit for all

7. mfh WHO-Collaborating Centre for Health Promotion in Hospitals and Health Care Ludwig Boltzmann-Institute for the Sociology of Health and Medicine Institute for Sociology - University of Vienna, Austria 7 Needs assessment – Strategies Stakeholder approach: assessing need from the perspective of the most important stakeholders - patients - staff - (representatives of key partners in the community) Mixed methods approach: In-depth interviews, short discharge interviews, focus groups, surveys (patients) Expert interviews, group interviews at department level, surveys (staff) Results of local needs assessment: Lists of the ten most frequent problems from the point of view of each stakeholder (patients, staff) European cross analysis: Qualitative approach: inductive + deductive strategies (1) Identifying problem areas for patients+ staff; (2) Integration into a general list (3) Categorisation of problem areas in line with the MFQQ*; (4) identification + quantification of countries where each problem area was defined as relevant *Migrant-Friendliness Quality Questionnaire: Instrument for overall project evaluation

8. mfh WHO-Collaborating Centre for Health Promotion in Hospitals and Health Care Ludwig Boltzmann-Institute for the Sociology of Health and Medicine Institute for Sociology - University of Vienna, Austria 8 Needs assessment – Diversity Migrant patients from 43 countries (in the following regions: North and Sub-Saharan Africa, Asia, The Carribean, Former Yugoslavia, the Former Soviet Union, Eastern + Central Europe, The Middle East, South America, Turkey) with different migration backgrounds: members of established ethnic communities, labour migrants, recognised refugees, asylum seekers, undocumented migrants with different religious backgrounds: Buddhist, Christian, Hindu, Muslim, no religious confession Staff all relevant professional groups: medical and nursing staff, other health professionals [midwives, physio- therapists, X-ray technicians], social workers, receptionists, pastoral caretakers; members of hospital management different levels of hierarchy at the hospital (Heads of Department [medical and nursing], medical and nursing staff at ward level, auxiliary personnel in different areas) staff members with diverse ethnic backgrounds

9. mfh WHO-Collaborating Centre for Health Promotion in Hospitals and Health Care Ludwig Boltzmann-Institute for the Sociology of Health and Medicine Institute for Sociology - University of Vienna, Austria 9 Needs assessment - Common themes Language and Communication Patient info + educ.(linguistically and culturally adequate) Cultural barriers/lack of cultural competencies Family visits Lack of culturally adequate food number of hospitals where problem was mentioned (NA results from 12 pilot hospitals) Spirituality and social support European cross analysis: The six most important problem areas

10. mfh WHO-Collaborating Centre for Health Promotion in Hospitals and Health Care Ludwig Boltzmann-Institute for the Sociology of Health and Medicine Institute for Sociology - University of Vienna, Austria 10 The Overall Project - Ensuring structures and sustainability Intervention Improve MF within core processes of hospital services Access, (pre)entry into hospital / In-patient care / discharge Information / communication / empowerment Establish a MF-Support System by integrating MF into the quality system Policy / Budget / management structure / monitoring Staff training / involvement of stakeholders Evaluation Assessment of MF characteristics of services in core processes and presence of of MF support system as dimension in quality system Baseline May 2003 – final assessment June 2004 Instrument The Migrant Friendliness Quality Questionnaire MFQQ

11. mfh WHO-Collaborating Centre for Health Promotion in Hospitals and Health Care Ludwig Boltzmann-Institute for the Sociology of Health and Medicine Institute for Sociology - University of Vienna, Austria 11 3 sub - projects – improving quality of services in selected areas Interventions Selection of 3 model interventions guided by Results from needs assessment (case for action) Review on effective models (what are effective measures) Evaluation Tailored to selected interventions Assessing effectiveness according to aims of Promotion of health-related knowledge, health behaviour and health of migrants/ethnic minorities by empowerment measures – health literacy Promotion of cultural sensitivity of hospital staff by empowerment measures – cultural literacy Instruments To be developed

12. mfh WHO-Collaborating Centre for Health Promotion in Hospitals and Health Care Ludwig Boltzmann-Institute for the Sociology of Health and Medicine Institute for Sociology - University of Vienna, Austria 12 MFH – Questions www.mfh-eu.net Further info at:

13. mfh WHO-Collaborating Centre for Health Promotion in Hospitals and Health Care Ludwig Boltzmann-Institute for the Sociology of Health and Medicine Institute for Sociology - University of Vienna, Austria 13 Health Literacy as an outcome of Health Promotion and a determinant of Health Behaviour and Health Health Literacy Health/ Illness/ Patient Behaviour Health Outcome short / long term Social and cultural settings Health Promotion Action Personal variables empowerment Enabling/ supportive