We All Come From Somewhere - Our Experience with Cultural Diversity

Dr. K. L. Ong Chairperson NTWC Committee on Service for Diverse Ethnicities Consultant A&E Department Pok Oi Hospital

Background • People of ethnic minority origin made up around 6.4% of Hong Kong

population. Relatively large groups included Indonesian (1.9% of HK population), Filipino (1.9%), Indian (0.4%), Pakistani (0.3%), Nepali (0.2%), and Thai (0.2%).

• There is general trend of increasing number of ethnic minority population residing in Hong Kong.

• Limited proficiency in Chinese or English or even illiteracy together with different cultural beliefs and customs at times affect community integration, health maintenance, as well as use of social and health services.

Population statistics

Thematic Report 2011, p.112 % refers to EM% within district EM in NTWC ~15% of HK population

3.4%

5%

Top 7 Ethnic Minority Patients Out of the 158,993 crude admissions of TMH in 2013,

5.2 % indicated themselves as Non-Chinese

Nationality No. % of all patients

Pakistani 928 0.58%

Nepalese 696 0.44%

Filipino 461 0.29%

Thai 411 0.26%

Indonesian 312 0.20%

Vietnamese 267 0.17%

Indian 216 0.14%

Census 2011 Ethnic minority (EM): 6.4% of the population Total EM: 451,183, 87% born outside HK Non-Chinese by 28% compared to 2006 Nepalese: 37.3% in NT & 28.1% in NTW Pakistani: 49.4% in NT & 20.5% in NTW Indonesian: 48.7% in NT & 12.8% in NTW

Top 7 Ethnic Minority Patients

Pakistani Nepalese Filipino Thai Indonesian Vietnamese Indian2013 928 696 461 411 312 267 2162014 1025 775 556 399 362 431 2912015 1021 787 577 407 454 400 2722016 1071 835 582 325 368 513 259

0

200

400

600

800

1000

1200

NO

. of p

atie

nts

Top 7 ethnic minority patients (IP and DP)

Top 7 Ethnic Minority Patients

• Growing trend of EM Patients from 2013 – 2016 • An 20% increase when 2016 compared with

2013 Year Total no of Top 7 ethnic

minority patients

2013 3291

2014 3839

2015 3918

2016 3953

3291

3839 3918 3953

Top 7 ethnic minority patients

2013 2014 2015 2016

POH • Around 50000 people of EM origin living in the

vicinity of Pok Oi Hospital

• The A&E attendance data showed that approximately 6% of A&E attendance at Pok Oi Hospital in 2016 are clients of Pakistani and Nepali origin (7,300 attendances)

The table shown the AE attendances and headcount in all Race Code between 2014and 2016. The majority of Ethnic minority in HK is highlight in Green.

Paycode (at diacharge, EIS) 2014 Row Total 2014 Row Total in %

2015 Row Total 2015 Row Total in %

2016 Row Total 2016 Row Total in %

Race Code Race Description No. of AE 1st

Attend. No. of AE Pt

Head

Attendences. in % Headcount in % No. of AE 1st

Attend. No. of AE Pt

Head

Attendences. in % Headcount in % No. of AE 1st

Attend. No. of AE Pt

Head

Attendences. in % Headcount in %

CH CHINESE/中國大陸 106180 68119 86.11% 86.65% 103620 67040 84.52% 85.14% 101598 65510 83.60% 83.99%

UN UNKNOWN 5104 4199 4.14% 5.34% 6389 5101 5.21% 6.48% 7688 6091 6.33% 7.81%

NE NEPALESE/尼泊爾 4602 2273 3.73% 2.89% 4422 2262 3.61% 2.87% 4561 2236 3.75% 2.87%

PA PAKISTANI/巴基斯坦 3271 1453 2.65% 1.85% 3488 1581 2.85% 2.01% 3100 1428 2.55% 1.83%

FI FILIPINO/菲律賓 1134 734 0.92% 0.93% 1251 772 1.02% 0.98% 1288 836 1.06% 1.07%

ID INDONESIAN/印尼 806 539 0.65% 0.69% 933 581 0.76% 0.74% 872 552 0.72% 0.71%

IN INDIAN/印度 718 379 0.58% 0.48% 835 398 0.68% 0.51% 830 384 0.68% 0.49%

OT OTHERS 709 405 0.58% 0.52% 782 419 0.64% 0.53% 814 446 0.67% 0.57%

TH THAI/泰國 185 113 0.15% 0.14% 219 141 0.18% 0.18% 210 113 0.17% 0.14%

BR BRITISH/英國 222 160 0.18% 0.20% 216 160 0.18% 0.20% 197 137 0.16% 0.18%

VI VIETNAMESE/越南 81 48 0.07% 0.06% 129 88 0.11% 0.11% 134 92 0.11% 0.12%

JA JAPANESE/日本 35 20 0.03% 0.03% 37 29 0.03% 0.04% 36 22 0.03% 0.03%

CA CANADIAN/加拿大 26 17 0.02% 0.02% 32 18 0.03% 0.02% 35 22 0.03% 0.03%

AF AFRICAN/非洲 77 32 0.06% 0.04% 75 35 0.06% 0.04% 34 25 0.03% 0.03%

AM AMERICAN/美國 35 27 0.03% 0.03% 28 23 0.02% 0.03% 34 27 0.03% 0.03%

KO KOREAN/南韓 25 15 0.02% 0.02% 21 10 0.02% 0.01% 14 9 0.01% 0.01%

AU AUSTRALIAN/澳洲 23 16 0.02% 0.02% 17 12 0.01% 0.02% 13 11 0.01% 0.01%

GE GERMAN/德國 2 2 0.00% 0.00% 6 5 0.00% 0.01% 13 8 0.01% 0.01%

PO PORTUGUESE/葡萄牙 5 5 0.00% 0.01% 11 7 0.01% 0.01% 9 8 0.01% 0.01%

BA BRAZILIAN/巴西 8 8 0.01% 0.01% 6 5 0.00% 0.01% 8 5 0.01% 0.01%

MA MALAYSIAN/馬來西亞 6 6 0.00% 0.01% 11 7 0.01% 0.01% 6 4 0.00% 0.01%

BE BELGIAN/比利時 4 3 0.00% 0.00% 5 4 0.00% 0.01% 5 3 0.00% 0.00%

VE VENEZUELAN/委內瑞拉 1 1 0.00% 0.00% 0 0 0.00% 0.00% 5 4 0.00% 0.01%

IT ITALIAN/意大利 7 4 0.01% 0.01% 10 5 0.01% 0.01% 4 2 0.00% 0.00%

NT NETHERLANDER/荷蘭 6 6 0.00% 0.01% 2 2 0.00% 0.00% 3 2 0.00% 0.00%

RU RUSSIAN/俄羅斯 0 0 0.00% 0.00% 6 5 0.00% 0.01% 3 3 0.00% 0.00%

CZ CZECH/捷克 0 0 0.00% 0.00% 0 0 0.00% 0.00% 2 1 0.00% 0.00%

SI SINGAPOREAN/新加坡 5 4 0.00% 0.01% 4 3 0.00% 0.00% 2 2 0.00% 0.00%

SP SPANISH/西班牙 1 1 0.00% 0.00% 1 1 0.00% 0.00% 2 2 0.00% 0.00%

AS OTHER ASIAN 3 3 0.00% 0.00% 0 0 0.00% 0.00% 1 1 0.00% 0.00%

BU BURMESE/緬甸 0 0 0.00% 0.00% 1 1 0.00% 0.00% 1 1 0.00% 0.00%

DN DANE/丹麥 0 0 0.00% 0.00% 1 1 0.00% 0.00% 1 1 0.00% 0.00%

EU OTHER EUROPEAN 0 0 0.00% 0.00% 2 1 0.00% 0.00% 1 1 0.00% 0.00%

FR FRENCH/法國 3 3 0.00% 0.00% 3 3 0.00% 0.00% 1 1 0.00% 0.00%

GU GUATEMALA/危地馬拉 1 1 0.00% 0.00% 2 1 0.00% 0.00% 1 1 0.00% 0.00%

IR IRISHMAN/愛爾蘭 1 1 0.00% 0.00% 1 1 0.00% 0.00% 1 1 0.00% 0.00%

ME MIDDLE EAST/中東 4 2 0.00% 0.00% 10 5 0.01% 0.01% 1 1 0.00% 0.00%

SW SWISS/瑞士 1 1 0.00% 0.00% 0 0 0.00% 0.00% 1 1 0.00% 0.00%

BO BOLIVIAN/玻利維亞 0 0 0.00% 0.00% 1 1 0.00% 0.00% 0 0 0.00% 0.00%

CO COLOMBIAN/哥倫比亞 0 0 0.00% 0.00% 1 1 0.00% 0.00% 0 0 0.00% 0.00%

CU CUBAN/古巴 0 0 0.00% 0.00% 2 1 0.00% 0.00% 0 0 0.00% 0.00%

EC ECUADORIAN/厄瓜多爾 1 1 0.00% 0.00% 1 1 0.00% 0.00% 0 0 0.00% 0.00%

HO HONDURAN/洪都拉斯 0 0 0.00% 0.00% 1 1 0.00% 0.00% 0 0 0.00% 0.00%

NZ NEW ZEALANDER/新西蘭 6 6 0.00% 0.01% 2 2 0.00% 0.00% 0 0 0.00% 0.00%

PN PANAMANIAN/巴拿馬 1 1 0.00% 0.00% 0 0 0.00% 0.00% 0 0 0.00% 0.00%

RO ROMANIAN/羅馬尼亞 0 0 0.00% 0.00% 3 1 0.00% 0.00% 0 0 0.00% 0.00%

SA SOUTH AMERICAN 1 1 0.00% 0.00% 1 1 0.00% 0.00% 0 0 0.00% 0.00%

SD SWEDE/瑞典 1 1 0.00% 0.00% 0 0 0.00% 0.00% 0 0 0.00% 0.00%

TU TURK/土耳其 1 1 0.00% 0.00% 3 3 0.00% 0.00% 0 0 0.00% 0.00%

Grand Total : 123302 78611 100% 100% 122591 78739 100% 100% 121529 77994 100% 100%

Background

• This group of patients account for only a small fraction of the overall attendance and admission to public hospital service, their special needs are not something we should overlook.

• As a health service provider pledged to provide people-oriented service, examining their service needs and providing support to narrow any service gap

Formation of COME concept

Milestones

1. POH EM Networking Group

2. EM Corner Working Group

NTWC Committee on Service for Diverse

Ethnicities

Governance Structure

NTWC Cluster Quality & Safety Committee

NTWC Committee on Service for Diverse Ethnicity (set up in Dec 2015)

Interpretation Service

TMH, POH, CPH/SLH

Working Groups Linked by

“COME Concept” team

Consumer Participation: Patient focus

groups, Satisfaction

surveys

Staff Education & Training

NTWC Committee on Service for Diverse Ethnicities

• The Committee on Service for Diverse Ethnicities was set up to act as a

cluster-based formal body on matters related to ethnic minority service

• Its committee members consists of – Team leaders in major working groups – Senior managers of various administrative units

• Enable decision making and executive planning

• In the long run, the Committee will have direct involvement of senior

administration and explore how to strengthen our funding and staffing to sustain the support for diverse ethnicities

Communication

Staff Training

• Orientation for new staff (HRU) • Seminar on ethnic minority needs • Tutorials (tools)

Reminder in NewsExpress on ordering Halal food

Halal food production guideline on Intranet

Staff Training – Halal Meals

Staff Training – Support Self Learning

• Handy access reference on diverse needs included in orientation kits

• HA e-Course promoted (ethnic minority, visually impaired)

• Past presentations and handy access reference on ethnic minority support at Intranet of Supporting Service and Ethnic Minority Corner

Staff Training – Cultural Competence

• Promotion of HA e-Course on EM (EM Corner) • TMH library has many books on cultural

competence

http://ntwc.home/em/

Ethnic Minority Corner

E-Learning Program on NTWC Intranet

Notice Boards for communication

24

Display of health related materials

Display of health related materials

Periodic display at public areas

Interpretation information

Interpretation information to external clients

Sharing Session of Interpretation service

• “Communication can raise the tolerance of patient.”

• “Someone who can speak URDU should be employed in hospital to do occasion translation.”

• “In hospital, is always waiting and waiting. I have brought newspaper to kill time.”

• “EM ladies love TV drama and movies. If you can make videos by popular Indian actors, your work will be very popular.”

• “How can service providers comfort the patient if they cannot voice out their needs and feelings?”

• “Without interpreter, they cannot explain themselves fully, and have phobia, and prefer not go to the hospital.”

Communication tools • Issues identified

– Difficulty and timeliness of communication at A&E – No interpreter available immediately

Every time EM patients come to hospital, they need to be accompanied

by friends, family and even their small children as their interpreters However adult family members always dominate the conversation with

health care professionals without actually asking for feedback from the patients. (Isolation)

Cue cards for clinical use in different languages – NTWC intranet linkage to HAHO intranet

Sample Questions • What’s your mobile number? • Which part/parts of your body

is/are feeling painful? • The level of pain • Any closed contact with poultry

or birds? • Any travel history within 2

weeks? • Any long term medical illness

and medication you need to take?

• Take some blood for investigation

• Save urine for investigation • X-ray investigation • Any drug allergy? • Any Anti-tetanus injection

within 10 years? • Help you to measure your

blood pressure • Help you to measure your

blood sugar • Help you to measure your

temperature • Please pay attention to the

screen for your turn

Cue Cards

Translated materials

Urdu

Chinese

English

Nepalese

Simplified Chinese

Patients’ Charter is available in different languages

Health Education

Health talks at TMH

Health Talks at POH • On-going since 2011 • Target groups Nepali & Pakistani with on-site translation • Topics covered

– 2011 First Aid Care – 2013 Minor Injury and Common Illness – 2014 Musculoskeletal Pain – 2015 Abdominal pain and Triage system of A&E Department – 2016 Breast Cancer and screening

Exhibition • Posters for health

promotion – Balanced diet – Hypertension – Useful Information

• Hospital diet for Muslim clients

Evaluation Nepal

• 25 out of 25 evaluation forms were collected (100%)

• 98.9% (score 5 & 4) were satisfied • No participants showed

dissatisfaction

Pakistani • Total 21 out of 25 evaluation forms

were collected (84%) • 98.5% (score 5 & 4) were satisfied • No participants showed

dissatisfaction

Clients’ Opinions

• Focus group & questionnaire survey in collaborating with community partners

• Patient journey in TMH & POH • Nepali, Pakistani (Urdu)

1. Clinical service 2. Patient’s charter 3. Ideas for health talks

Focus group for A&E

• Participants from clients with feedback and from NGOs

• Various improvement measures – Posters in EM languages – Resource centre in

Community Health Centre – Triage categories in EM

language

Focus Group for Hospital Service

To survey 5 domains in patient journey:

1. Accessibility and convenience 2. Environment 3. Clinical Service 4. Attitude 5. Efficiency / overall management

Video on Hospital Services

Target languages:- • Nepalese • Pakistani (Urdu)

Nepalese

Touch Screen Communication Aid (TSCA)

Non-English speaking volunteers

• Basic infection control • Get them ready to deliver support to non-English

speaking ethnic minorities in hospital • 23 volunteers

Community Services Centre TMH Chaplaincy TMH Infection Control Team

Spiritual Support

• Ceiling “ Compass ” • Direction of prayer for Muslims