Migrant Friendly Hospital Project

1. Migrant Friendly Hospital Project Fiona McDaid RGN, MSc, PGDip, ENB 199 Emergency Department Nurse Manager James Connolly Memorial Hospital Dublin

2. MFH: Background • MFH project is a European initiative to promote health and health literacy for migrant and ethnic minorities Particpating Hospitals • There are 12 hospitals participating in the MFH Project across Europe • UK, Spain, France, Italy,Sweden, Denmark, Finland, Greece, Austria, Germany, Ireland & The Netherlands • JCM Hospital is the Irish representative • The Ludwig Boltzmann Institue for the Sociology of Health & Medicine based in Vienna is co-ordinating the project and funding is from the European Commission

3. Objectives: • Aim: to identify, develop and evaluate models of good practice for hospitals in the participating member states of the EU • To promote the health and health related knowledge & competence of migrants & ethnic minorities • To improve hospital services for these patient groups

4. Who is involved? • The rationale for JCMH participation • 17% of admissions non-nationals • Focus on Emergency Dept in the project as 80% admissions via Emergency Dept. • The Migrant Friendly Steering committee was established • Wide multidisciplinary respresentation across JCMH incl… Social Work Dept, Patients Services Officer, Consultant Emergency Dept, Emergency Dept Nursing Manager, Nursing Reps, Catering Dept, Clinical Placement Co-ordinator, Health Promotion, Human Resources Dept etc.

5. Process: • First task…MFQQ & Needs Assessment • To provide a first intervention in the overall development of Migrant Friendliness into the hospital • To provide a knowledge base to enable the committee to identify priority areas of intervention and target groups • To provide an opportunity to consult with migrant service users to assess their needs • To provide a baseline for overall project evaluation

6. Needs Assessment (NA) Process • 11 Depts were included in the NA • Indepth interviews with Heads of Dept • Interviews with medical and nursing staff • Indepth interviews with Migrant Patients who had experience as an inpatient in JCMH

7. European Cross Analysis • Results from the NA were submitted to LBI for European cross analysis • Issues identfied were as follows: • Language/communication barriers • Lack of timely access to translators • Cultural barriers • Lack of written information in common foreign languages

8. Three areas of intervention: • Sub project A: • Improving Interpretation in Clinical Communication • Sub project B: • Culturally and Linguistically adequate Information and Education in Mother and Child Care • Sub project C: • Improving Cultural Competence: Training Hospital Staff for Providing Cross Cultural Health Care

9. JCMH Selection: Sub Project A (SP A):Improving Interpretation in Clinical Communication • Sub group was established with MTD representation from the main steering committee and reps from participating depts. • Use 4 models depts- Emergency Dept, Patients Accounts, Out-Patients Depts, Diabetic Day Centre • Various strategies presented: • In-house employee language bank • Professional interpreters • Employment of interpreters • Contracting interpreters through an outside agency - JCMH

10. Focus of SPA in JCMH:To improve our working processes with professional interpreting services • Implementation of SP A commenced in Jan ’04 Pre- intervention evaluation: • 160 pre-intervention questionnaires were disseminated to staff in participating depts. • 115 questionnaires returned to date. • Completed questionnaires were sent to LBI for analysis, results were fedback to each individual hospital and used in the overall European analysis

11. SP A: The Intervention • To optimise processes in existing interpreting services the SP A Group decided to: • Assess the quality of the interpreting services we use in JCMH – representatives from the SP A group conducted interviews with both agencies. • Review recruitment procedures, screening of interpreters, language proficiency testing, training provided, code of conduct and confidentiality contracts

12. SP A Contd… • To develop a resource file for each participating department which comprised of: • Guidelines for staff to access the interpreting service • Evaluation forms to assess the effectiveness and quality of the interpeter • Confidentiality forms • Point to talk sheets for staff in three languages • Point to talk sheets for patients in 19 languages • Pictographs with text in 11 languages • The JCMH Resource file will be accompanied by ‘Access Ireland’ Intercultural Resource file

13. SP A Contd…evaluation • The pilot phase of SP A is from March 24th - May 7th 2004 • Post intervention questionnaires were disseminated to staff using the same method as the pre evaluation • Completed questionnaires were sent to the LBI for analysis, the results of which are awaited

14. SP A Contd…evaluation • Issues identified with pre-evaluation analysis • Most common languages • Interpreting service accessibility • Availability of written translations for “everyday” interactions

15. Anticipated outcomes: Indicators for project success: • An increase in the number of encounters provided with assistance of a medical interpreter • A decrease in the use of ad hoc interpreters (family members, friends, other patients, non-qualified staff) • An improvement in the timely delivery of interpreting services due to an increase in the number of qualified medical interpreters, better access to services, improvement to the current services offered or better co-ordination with outside agencies

16. Sub project C (SP C): • Improving Cultural Competence: Training Hospital Staff for providing Cross-Cultural Health Care • Sub group was established with MTD representation from the main steering committee, Health Promotion Dept in NAHB, community partners BARN & CC Trainer - NAHB • 10 hour Staff training programme • 4 models depts: Cardiac Diagnostics, X-Ray Dept, Cypress & Cherry Ward, Vascular Dept

17. Sub project C: Course Content • Cultural Competence (CC) training for staff is provided in four modules • Training broadly covers three areas: • Awareness • Knowledge • Skills

18. Sub project C: Evaluation • Brief needs assessment in the model depts was carried out to facilitate decision making concerning… • The specific problems of staff the training should address • The scope, design and content of the training and the expertise required from the CC Trainer • Pre & Post Training session evaluation

19. Sub Project C: Commencement • The Cultural Competence Training Programme for staff commenced on Feb 18th to April 8th 2004 • Two programmes were provided to facilitate the participating depts. • 22 staff from the four model depts attended the programme.

20. SP C : Evaluation • Pre Training Evaluation was carried out at the beginning of module one • 22 staff completed questionnaires which were sent to LBI for analysis. • Post questionnaires were disseminated on completion of the 10 hour training programme. The results of which are awaited

21. SP C : Evaluation • Pre-course evaluation analysis revealed • Lack of cultural competence training • Raised awareness of the need for different approaches with different cultures - no “one size fits all” approach

22. Next Steps in MFH in JCMH… • Implementation & evaluation of two sub projects commenced with baseline evaluation in January ‘04 • ‘Implementation Workshop’ held in Feb ‘04 • Interim results from project in June ’04 • Assessment of overall organisation development –Repeat MFQQ • Final results of project in - Dublin Sept ‘04 • Final Conference – Amsterdam Dec ’04