1. Cultural Competence Training: a Sub Project of the Migrant Friendly Hospitals Initiative at University College Hospital, Galway Presented by Fiona Falvey & Catherine Sherlock

2. Migrant Friendly Hospital Initiative The increasing diversity of patient populations poses new challenges to hospitals, which are frequently the first point of access for migrants and ethnic minorities. This European-wide pilot initiative aimed to implement model interventions, enabling hospitals to respond effectively to the diverse needs of our migrant population. 12 countries in Europe participated in this project: Austria, Denmark, Germany, France, Finland, Ireland, Italy, Netherlands, Sweden, UK, Greece and Spain.

3. Migrant Friendly Hospital Initiative Migrant Friendly Hospital Project Aims To identify, develop and evaluate models of good practice for promoting the health & health related knowledge and competence of migrants and ethnic minorities Improving hospital services for these patients groups These models of good practice served as a basis for the Amsterdam Declarion of European recommendations which was launched in December 2004

4. Benefits of MFH Project For Patients: Migrant friendly health care settings through increased availability of culturally adequate services Improved communication Enhanced quality of life during hospital treatment Empowerment through improved health literacy Increased patient satisfaction

5. Benefits of MFH Project: For Hospitals: Quality improvement in aspects of patient orientation and patient-orientated services with special focus for a migrant population Reduction of conflicts in the provision of care for migrants and ethnic minorities

6. Benefits of MFH Project: For Staff: Reduced workload through reduction of conflicts though increased patient satisfaction and adequate help-seeking Reduction of barriers to effective service delivery Improved compliance of migrant patients through better health literacy Improved communication with migrant patients

7. Galway Regional Hospitals Steering committee formed including representatives from:  Senior Management  Social Work  Health Promotion  Psychiatry  Galway Refugee Support Group  Irish Refugee Council  Accreditation Dept  Obstetrics-Gynaecology Division  Accident & Emergency Dept  Medical Records Dept  Human Resources The Health Promotion Officer and Social Worker chaired the meetings

8. Galway Regional Hospitals The Steering Committee picked 2 Areas of intervention:  Improving interpreting (services) for clinical communication.  Improving the cultural sensitivity and cultural competence of hospital staff through training and personnel development and 3 pilots areas of the hospital:  Maternity Outpatients’ Dept  Ward Clerks  Accident & Emergency Dept

9. Cultural Competence Training Aim To increase staffs’ understanding of the impact culture can have on patients’ access and experience of health care. Objectives To improve participants’ knowledge in relation to the health/social/economic status of migrants Participants to identify the ways in which fear and prejudice can affect the way services are delivered Participants to identify the main barriers to accessing the health services experienced by migrants

10. Methodology A subcommittee was formed to develop a training pack. We were provided with best practice guidelines from the European MFHI project. We also used a Traveller Friendly Training Pack which had previously been developed, and successfully evaluated, by the Western Health Board Health Promotion Team. Other resources came from the Social Work Dept, UCHG. The training was edited by the Galway Refugee Support Group The training was 10 hours in length and was delivered over 3 days (approximately 3.5 hours each day) to staff in 2 pilots areas of the hospital:  Maternity Outpatients’ Dept  Ward Clerks

11. Contents of Training The training pack included modules on:  Relevant reading material  What is Culture?  Myths and Beliefs about migrants  Health service providers’ experiences of working with migrants  Barriers to accessing our services  A reflection on privilege  Culturally sensitive work  Audit of good practice

12. Results  2 10-hour training programmes were delivered to ward clerks and staff in Maternity Outpatients’ Dept.  13 participants began the first training session, and 7 participants completed the full 10 hours.  9 participants began the second training session, and all 9 participants completed the full 10 hours.  Of the 22 participants, 4 were midwives in the Maternity Outpatients’ Dept, the remaining 18 being ward clerks throughout the hospital (including A&E and Maternity Outpatients’).

13. Evaluation Overall, evaluations have found the training programme to be informative and useful. The following points give a flavour of the evaluations, both positive and negative: What participants found most helpful in the training programme: The information about other cultures provided, entitlements, etc.  The discussions generated among the groups  More understanding of migrants  Made participants think more about culture  Not being judged by facilitators  Clarified a lot of myths  Realising the challenges that face migrants

14. Evaluation What participants found least helpful in the training programme:  Not enough time to discuss all topics raised  Facilitators making excuses for migrants  Not getting some answers  Would like more handouts  Expected more feedback from facilitators

15. Conclusions There were a number of issues which we felt could be changed 1. Definition of a migrant was not available from the European Initiative and this may have been helpful for the purposes of discussion. 2. Training might be more accessible over two days instead of three days. The current training has been incorporated into the overall Human Resources Training Plan, and is now being run successfully over 2 afternoons. 3. Having a facilitator who is a migrant would have possibly been quite beneficial 4. Some further preparation work by management with each Dept may have been useful so that participants felt that they attended the training voluntarily

16. Culturally Diverse Health Care Information & Resources Arising out of the pilot Migrant Friendly Hospital Initiative, a pack was developed to assist staff with the many issues which may arise when working with people from other cultures, including language barriers, racism, misunderstandings, and contact details for useful organisations.

17. Culturally Diverse Health Care Information & Resources The guide was developed by the MFHI steering committee and includes information on:  Culture and cultural identity  Culturally competent care and its relevance  How to access and work with interpreters  How to work without an interpreter  Rights and entitlements of migrants, including asylum seekers and refugees  Contact details for government and NGO support agencies and churches  Notes on racism, inter-culturalism and equality

18. Conclusion Promoting a migrant friendly culture is an ongoing process. Both areas of this pilot initiative have evaluated positively, and we have continued beyond the pilot phase and expanded the project to the rest of the hospital.

19. Contact Details Fiona Falvey, Health Promotion Services, UCHG 091 542103 Fiona.falvey@mailn.hse.ieFiona.falvey@mailn.hse.ie Catherine Sherlock, Social Work Dept, UCHG 091 544089, socialwork.obsgynae@mailn.hse.iesocialwork.obsgynae@mailn.hse.ie