Background
Migrant-friendly hospitals
A case study: Switzerland and MFH
Topic | Summary recommendations |
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Basic structure of organisation | Develop organisational policy to take account of migrant issues, including in mission, strategy, portfolio of services, resources. |
Ensure committed management | |
Migrant-specific data | Collect data specific to migrants and disaggregate migrant data |
Structure, Processes & Outcome Quality | Ensure measures are in place to take into account migrant issues to improve structure, processes, and outcome quality |
Employee skills | Recognise and use staff with various backgrounds as resources |
(considered in recruitment) | |
Medical care procedures | Apply patient-centred approach, respect for patient autonomy |
Provide written processes regarding language assistance | |
Cross language communication | Define and regulate the use of various possible approaches to enable communication: external interpreters, immediate and telephone interpretation. |
On-going employee training | Adapt form/content to needs |
Central Services | Ensure administration, telephone services, enquiries, information, documentation, patient-related services (e.g., visiting rules), accommodation and catering, religious affairs and social services have knowledge and skills to address diverse needs |
Network | Network with institutions |
Hospital care for paediatric migrants – a topic of relevance?
Methods
Interviews with project leaders of paediatric clinics participating in the MFH project
Literature search on non-medical service delivery components
Ethics
Results
Service needs
Paediatric migrants
Basically, all children have similar needs. They don’t want to stay at the hospital alone; they want their parents to stay, enough distraction and to go home healthy as soon as possible. (Social worker 3)
The first need that pops up in my mind is safety: can we be trusted and are they safe where they are? (…)When they come to the hospital they are always afraid so we work hard … that they trust us and that they feel that we do care. This is for the children and the parents. (Clinician)
Children are torn between what they know from their parents and what they know from school/ kindergarten and what we offer here … Should I rather behave like Mummy and Daddy or like the nurses say. (Social worker 2)
Children are children. I do not think they need other toys. Most go to Kindergarten and school here. (Social worker 3)
Parents
Parents need to feel that one wants them well, and this they sense, when one listens and tries to really understand them. (Social worker 2)Needs of parents are: to understand and be understood, to be able to communicate actively with the medical personal and to know more about their child’s disease. (Social worker 1)
The father usually has been here for a while and speaks (…) well but the mother does not … for these people, we use and encourage the use of interpreters so that we can communicate directly with the parent. (Clinician)
It is an issue in some cultures… in the context of hospitalisation not all needs can be met. We try our best… There are situations when it is impossible and parents need to accept this. (Social worker 1)
Health professionals
TIME. They need time. They need much more time than other kids because we have to understand their background; we have to understand not only their acute background but also their general background. It can be very puzzling, these family stories and the impact these stories have on their health and on their general standing. We have to take the time: just meet the child and meet the parents and try to understand what is happening but also to get to a translator and take time with a translator. Doing a personal history with an interpreter doubles the time – there is no doubt – and unfortunately that is what is mostly missing: time. (Clinician)
Staff’s desire and interest to gain more security when treating families with migrant background and to learn how to do better is great, …to know how the family system works, if there are different positions for girls and boys – once I know how the family system works then I know better how to approach them, what to consider, what is important. (Social worker 2)
Interpreters
When interpreting, there are topics where interpreters reach their limits and need training. (Social worker 3)
Hospitals
Overarching challenges
Language
In the beginning we did not have a translator. It was horrible. Ok, it takes time, you always have to talk twice, but afterwards you gain so much. (Clinician)
It was interesting to see that even people who sometimes did not speak French properly although they sort of manage when we talk to them directly, would need an interpreter. (French-speaking participant)
For emergency issues you have to deal with what you have. You won’t wait for two hours to have an interpreter to come in the middle of the night. (Clinician)
Intercultural challenges in paediatric care
Many migrant parents do not understand why they are supposed to participate in the medical decision process: They say: the physician has to decide, he is the expert! The only thing that counts is that the child gets well. (Social worker 3)
In several countries it is not common to directly address the child and speak with her/him in the parent’s presence. Many migrants asked us to speak with the head of the family. (Social worker 3)
It is not evident to many migrant parents, why when a child was treated here, they have to continue treatment at home… we have to work hard on compliance. (Social worker 3)
We had a child who had big psychiatric problems and the parents were completely convinced that it was because the child was bewitched. They came from a small African village and were sure that something had happened there. Obviously, here people are not very aware of this thing and do not ask about it, so they (staff) just thought that parents were against psychiatric care or they just laughed about it – but this is very serious business for the family – it means a lot, it is their whole believe – so the ethno-psychiatric consult helps us to take care of these children taking into account the background of the child and the parents. (Clinician)
Not just small adults – differences to adult MFH care
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Different disease patterns (paediatric diseases)
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Admission often via emergency room, shorter hospitalisations, often immediate decisions required
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More individuals involved in care planning
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Primary decisions & responsibility by family, (usually) not patient
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History often told by parents, not child patient
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Care (at the hospital and after discharge) usually impossible without the family
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Different levels of language-skills and acculturation of minor, mother and father: different resulting needs/views
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Different position/meaning of a sick child vs. an adult in the family
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Hours of consultation not only determined by child but also by the parents’ availability to bring the child to the facility
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Care for siblings may be a concern
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Rooming-in (Room-allocation based on gender of child or parent staying?)
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Child in the middle of development, different vulnerabilities
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Child’s thinking focuses on present
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Legal matters, truth of story not of primary interest
Approaches chosen by hospitals
General approach
We emphasise that the nurses – all in their own way - talk with the mothers about things that are important to her [mother]: the name’s meaning, rituals, and from there you can start. Before, it was the checklist: the bath, the breast, (…) Now, the fact of being attentive is often enough..... It’s for everyone! (Clinician1)During the morning debriefing of all teams, a standard question is: is there a communication problem? If yes, we order an interpreter. (Clinician)
Staff and training
The adult population is much more worried about legal stuff; about Post-Traumatic-Stress-Disorder; about true stories or untrue stories. There are different things that are more important for adults than for children. We don’t really ask them to tell their stories, how they felt it but how they are feeling now. Children are much more in the present than in the past. And the parents, we use the parents much more to tell us what has happened. (Clinician2)
Infrastructural and service adaptations
Migrant involvement
In many countries, it isn’t common to be asked about your opinion as a patient. (Social worker 1)
The Swiss MFH project and MFH criteria
Literature on non-medical Service Delivery Needs and Approaches
Discussion
Paediatric non-medical service delivery needs
Defining P-MFH
The Swiss MFH pilot project and policies
Limitations
Recommendations
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Define a clear P-MFH vision and strategy and minimum standards;
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Identify a reference team composed of different professionals, including senior management and frontline professionals to ensure the implementation of PM care that is congruent with everyday reality.
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Develop a P-MFH care strategy based on an evaluation of:
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Needs of PMs, parents and siblings, human resources, interpreters;○
Key challenges: language/cultural differences, time limitations, acculturation levels of PM/-parents;○
Opportunities (e.g., human resources’ variety and motivation, migrant families and interpreters). -
Revise hospital processes from admission to discharge [1] tailored to the needs of migrant children and their families (e.g., register different language proficiency levels/acculturation levels, possibly matching with language congruent staff, colour coded sign posts)
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Revise structural components [43] related to: infrastructure (privacy for breastfeeding, space for visitors/siblings); services (social services, trans-cultural-mediators, easily available interpreting services, contacts for religious/language congruent support); human resources.
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Address language barriers to avoid potential harm and costs; make immediate translations available for parents and PMs, e.g., phone-interpretation.
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Recognise staffs’ diverse backgrounds and motivation as a resource.
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Provide staff support and skill training in intercultural and paediatric migrant health care (e.g., on PM health, child health beliefs, family structures etc.)
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Recognise staffs’ migrant-friendly efforts, e.g., longer consultations due to the need for translations, even if it increases time requirements.
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Consider innovative approaches to solve problems (e.g., family rooms to allow sibling to stay over).
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Involve partners (migrant groups, other hospitals, etc.)
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Avoid stigmatising
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Conduct regular evaluations of migrant friendliness while continuously raising standards.
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Use migrant-friendly health aspects to reflect on emerging care needs for migrant and non-migrant children and families alike and mainstream solutions