Health Equity at The Hospital for Sick Children Meeting of The Task Force for Migrant Friendly and Culturally Competent HealthCare Oct 24 & 25, 2013
The Hospital for Sick Children (SickKids) Our Vision Healthier Children. A Better World. Our Mission As innovators in child health, we lead and partner to improve the health of children provincially, nationally and internationally throughthe integration of care, research and education: Providing the best in complex and specialized family-centred care; Creating groundbreaking scientific and clinical advancements; Engaging in knowledge translation and sharing our expertise globally; Enhancing an academic environment that nurtures experts in child health; and Championing an accessible, comprehensive and sustainable child health-care system. Our Values Excellence Integrity Collaboration Innovation 2
The Case for Cultural Competence Canada welcomes more than 200,000 immigrants annually with 31% choosing Toronto as their home (Citizenship and Immigration Canada, 2011) 190 languages spoken in the GTA This diversity is reflected in the children and families at SickKids Quality of care and patient safety can be compromised when healthcare providers do not respond appropriately to language barriers and cultural factors (Gainy et al., 2010; Institute of Medicine, 2002) Research indicates that Canada s newest settlers are subject to health disparities and inequities in health care (Beiser & Stewart, 2005) The demographics of our society have changed but have healthcare organizations kept pace?
Cultural Competence Program In 2009, SickKids was awarded an $8.7M dollar grant from Citizenship and Immigration Canada for two key initiatives: 1. Translation of patient education materials into various languages; this included the translation of our AboutKidsHealth website into French and Simplified Chinese 2. Staff education on cultural competence
Cultural Competence Framework Based on Joseph Betancourt s Practical Framework for Addressing Health Disparities, July, 2003
Cultural Competence Education Over 2000 clinicians attended clinical cultural competence education Evaluation results show: Significant changes in clinical practice Increases in interpretation services Improvements in patient/family satisfaction Accreditation Canada acknowledgement 22 Train-the Trainer workshops delivered across to 257 organizations Local health authority will strongly recommend healthcare organizations to ask its staff to complete cultural competence education
Cultural Competence E-Learning Series http://www.sickkids.ca/culturalcompetence/elearning-modules/elearning-modules.html
Patient/Family Satisfaction with Cultural Sensitivity % Positive Scores 80 78 76 74 72 70 68 66 64 Were hospital staff members sensitive to your (your child's) special cultural needs or concerns? 69.42 69.2 70.1 70.9 70 75.3 74.5 NRC Picker Patient Satisfaction CC Education 73.5 78.9 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 All In-Patient Areas CC Education
Face-to-Face Interpreter Volumes
Over-the-Phone Interpretation Volumes
Patient & Family Centred-Care Equitable Efficient Effective Timely Safe Source: Institute for Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century
Quality Dimensions Patient and Family-Centred Provide care that is respectful of and responsive to individual patient and family preferences, needs, and values Equitable Provide care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographical location, and socioeconomic status Source: Institute for Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century
Next Steps: Key Areas of Focus Measurement and Monitoring Performance Patient/Family satisfaction with cultural sensitivity of staff a key performance indicator on Corporate Scorecard Quality Improvement Plan Must develop improvement plans to ensure targets are achieved
Next Steps: Key Areas of Focus Health Equity Data Collection Project Required by the Local Health Integration Network to collect socio-demographic data along equity lines Tool being developed for paediatric settings Includes questions on: language, Canadian-born, race/ethnicity, gender, sexual orientation, disability, and income
Next Steps: Canadian Health Equity Standards SickKids, in partnership with the Canadian Consortium for Health Equity, CAMH and the Wellesley Institute, organized a Symposium to make advancements Towards Canadian Health Equity Standard in Feb, 2013 Attended by 80 health equity and health systems experts (by invitation only) from across Canada Gained support to move forward with Canadian Health Equity Standards Next steps: plan of action to move forward