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Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
1
Enabling hospitals to become empowering organizations –some observations from HPH networks
Jürgen M. Pelikan ([email protected])Christina Dietscher Karl KrajicHermann Schmied
WHO-CC for Health Promotion in Hospitals and Health Care,Ludwig Boltzmann Institute for the Sociology of Health and Medicine,University of Vienna
13th International Conference on Health Promoting Hospitals, Dublin, May 20th 2005
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
2
Overview
• A framework• Results from a last minute survey• Conclusions
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
3
The settings approach of HPH – empowering people by enabling situations for HP behavior & action
Health promoting behavior & action
depends on …
Structuralfactors
Culturalfactors
People(patients, staff,
Inhabitants)
Situation of Hospital
Peoples knowledge, skills & capacities
Peoples preferences, attitudes & values
Hospitals socio-materialinfra-structures & resources
Hospitals cultural values, regulations & incentives
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
4
Internal and environmental preconditions for hospitals to implement
Health Promotion StrategiesImplementation of Health Promotion
in hospitalsdepends on …
Structuralfactors
Culturalfactors
Hospital internal factors
Environmentalexternal factors
(local, regional, national,international)
Hospitalssocio-material infra-structures & resources
Hospitals culture (regulations & incentives)
Environmentssocio-material infra-structures & resources
Environmentsculturalvalues, regulations & incentives
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
5
The last minute survey
• Electronic questionaire• Sample of national/ regional HPH network
coordinators• Response-rate: 19 out of 35, i.e. already more
than 50%!• Selected results
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
6
Question 1
• How many hospitals do you have in your network …– a) …in absolute figures?– b) … in % of the total number of hospitals in your
country/ region?
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
7
Hospitals in HPH-Network in % of the total number in country/region
00-010%
11-020%
21-050%
50-100%
no data
Questionnaire data of19 countries / regions
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
8
Question 2
• In general: According to your estimation, how supportive are the general political frameworks in your country or region for the implementation of HPH for …– Patients– Staff– Community
• Scale:– O, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 – Not at all supportive …… Very supportive
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
9
Supportiveness of political frameworks – estimated supportive/hindering conditions of implementation(19 countries / regions – 0 = not at all supportive, 10 = very supportive)
0
1
2
3
4
5
6
7
8
9
10
TR NIR FI EM AT LT SE EE NL EN LO EL SK NO DE RU BE CH PL
Patient strategies Staff strategies Community strategies
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
10
Question 3
• Specifically: How supportive or hindering for the implementation of HPH in your country / region would you qualify …– … the general political interest in health promotion in health
care?– … the financial frameworks for health promotion in health
care?– … the legal frameworks for hospitals in your country /
region?– … the quality regulations for hospitals?– … the specific health promotion regulations?
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
11
How supportive or hindering for the implementation of HPH in you country / region would you qualify ...
the general political interest in health promotion in health care?
supportive hindering Specific objectives in the planning
act Increasing interest in the
integration of HP in curative medicine
HPH is a strategic choice in the regional health plan
HP is a main goal of health policy HP is included in the hospital
quality policy Positive trend in the society
Finances „short-time thinking“ Political focus on reform of the
funding of the health care system/insurance system
Scare or factitious interest Only on the paper HP is synonym of „extra-hospital“ HP is delegated to health care
system/insurance system
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
12
How supportive or hindering for the implementation of HPH in you country / region would you qualify ...
the financial frameworks in health promotion in health care?
supportive hindering Financial support is fragmented
HP not considered in hospital financing No sufficient founds Still very little money for prevention DRG and acute matters win Economic incentives still only according to productivity, and not to focused outcome Inexistent, except for staff Non-systematic
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
13
How supportive or hindering for the implementation of HPH in you country / region would you qualify ...
the legal frameworks for hospitals in your country?
supportive hindering Emphasis on managing clinical risk / liability National targets including HP as one major strategyGood support in fundamental documentsQuality act and new agreement on hospital financing HP laws have passed during the past few years
Very poor Non-systematic Almost not existing Must be evidenced for effect prior to implementation Do not include HP
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
14
How supportive or hindering for the implementation of HPH in you country / region would you qualify ...
the quality regulations for hospitals?
supportive hindering HP considered in quality act Aims of HPH are consistent with accreditation requirements HPH membership considering in accreditation Standards for HPH (joining with JCR standards) Quality guidelines exist in all strategy plans Quality regulations are under an intensive progress Quality evaluation including HP standards
Shortage of resources Not well developed, except for specific approach (nosocomial infections control) Are not yet linked to HP – hospitals are using different systems
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
15
How supportive or hindering for the implementation of HPH in you country / region would you qualify ...
the specific health promotion regulations?
supportive hindering „Health Plans are projects that each health board is required to carry out together with the local communities Guidelines Assessment against public health standards
Does not exist Still too few Not for hospitals No overt incentive to being a HPH
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
16
Question 4
• How do you assess the feasibility to implement the 6 Core HPH Strategies …
– … for Hospital Patients?– … for Hospital Staff?– … for the Hospital Community?
• Scale: 0 ….10 (hardly ….totally feasible)• What are the most supportive / hindering conditions
for this strategy in your country?• Are there specific examples of “best practice” for this
strategy in your country/ region?
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
17
HP by ...HP for...
HP s
trate
gic
(re-)p
ositi
onin
gHP
qua
lity
deve
lopm
ent 1. Enabling for
HP self manage-ment in living
3. Development of a HP hospital setting
4. Enabling for HP illness management
5. Enabling for HP lifestyle development
2. Enabling forHP co-production of health
6. Development of a HP community setting
18 HPH strategies – estimated feasibility to implement
Patients Staff Community
PAT-1 : 5,63 HP living in the hospital
for patients
PAT-2: 5,74HP Co-production of patients in treatment
PAT-3: 5,74HP hospital setting
for patients
PAT-4: 6,83HP illness management
for patients
PAT-5: 5,63HP lifestyle development
for patients
PAT-6: 5,16HP community setting
for patients
COM-2: 6,00HP Co-production with
services in region
COM-3 : 6,00HP hospital setting
for citizens
COM-4: 6,00HP illness management
for citizens
COM-5: 5,67HP lifestyle development
for citizens
COM-6: 5,28HP community setting
for citizens
STA-2: 5,58HP Co-production of
staff in work processes
STA-3: 6,24HP hospital setting
for staff
STA-4: 5,50HP illness management
for staff
STA-5: 5,63HP lifestyle development
for staff
STA-6: 4,42 HP community setting
for staff
STA-1: 5,32HP work life in the
hospital for staff
COM-1: 6,50HP access to the
hospital for citizens
5,82
5,77
5,99
6,11
5,64
4,95
5,77 5,41 5,90
_x
_x 5,68
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
18
6,836,50
6,246,00 6,00 6,00
5,74 5,74 5,67 5,63 5,63 5,63 5,58 5,50 5,32 5,28 5,16
4,42
0,00
1,00
2,00
3,00
4,00
5,00
6,00
7,00
8,00
9,00
10,00
PAT 4 COM 1 STA 3 COM 2 COM 3 COM 4 PAT 2 PAT 3 COM 5 PAT 1 PAT 5 STA 5 STA 2 STA 4 STA 1 COM 6 PAT 6 STA 6
x = 5,90
Ranking of 18 HPH strategies -estimated feasibility of implementation (average above 19 countries/regions – 0 = hardly feasible, 10 = totally feasible)
x = 5,77 x = 5,41
Patient strategies Staff strategies Community strategies
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
19
• Is there a correlation between estimated supportiveness of conditions & estimated feasibility of implementation?
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
20
0 1 2 3 4 5 6 7 8 9 10
10
9
8
7
6
5
4
3
2
1
0
estim
ated
sup
porti
vene
ss o
f pol
itical
fram
ewor
ks
estimated feasibility of implementation of patient strategies (average for 6)
Correlation: supportiveness of frameworks & feasibility of PATIENT strategies
AT
BE
EN LT
SK
SE
FIEM
NO
EENL
LO
PL
DE
CH
r = 0.63
EL
RU
TR NIR
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
21
0 1 2 3 4 5 6 7 8 9 10
10
9
8
7
6
5
4
3
2
1
0
AT BE LTSK
SE
FI
EM
NO EE
NL
LO
PL
DE
CH
r = 0.33
EN
EL
estim
ated
sup
porti
vene
ss o
f pol
itical
fram
ewor
ks
estimated feasibility of implementation of staff strategies (average for 6)
RU
Correlation: supportiveness of frameworks & feasibility of STAFF strategies
TR NIR
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
22
0 1 2 3 4 5 6 7 8 9 10
10
9
8
7
6
5
4
3
2
1
0
AT
BE
LT
SK
SE
FI
EM
NO EE
NL
LO
PL
DE
r = 0.61
EN
EL
estim
ated
sup
porti
vene
ss o
f pol
itical
fram
ewor
ks
estimated feasibility of implementation of community strategies (average for 6)
RU
Correlation: supportiveness of frameworks & feasibility of COMMUNITY strategies
TR NIR
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
23
Internal and environmental supporting preconditions for implementing Health Promotion in hospitals
Implementation of Health Promotion in
hospitalsdepends on …
Structuralfactors
Culturalfactors
Hospital internal factors
Environmentalfactors
(local, regional, national,international)
HP- & Q-expert infra- structures as part ofintegrated management system and HP- & Q- knowledge, human& financial resources
Explicit HP- & Q- values in mission statement, strategic policies, service protocols, guide lines etc.
Professional HP & Q tools, knowledge centres & infra- structures for exchange & financial resources for HP- & Q- structures & services
Political, legal, profession.& customer expectations for HP & Q structures, processes, outcomes& impacts; with incentives
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
24
What can we do to improve the implementation of HPH in Europe?Further …• analyse the regional / national / European situation• develop the HPH case for relevant stakeholders • develop tools for implementation in everyday
practice• communicate the case and tools effectively to the
relevant publics, build alliances • lobby for supportive legal, institutional, financial
frameworks for quality and HP on local, regional, national & European level
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
25
Questionnaire – 19 countries /regions
AT AustriaBE BelgiumCH SwitzerlandDE GermanyEE EstoniaEL GreeceEM Emilia Romagna (Italy)EN England (UK)FI FinlandLO Lombardia (Italy)LT LithuaniaNIR Nord Irland (UK)NL NetherlandsNO NorwayPL PolandRU RussiaSE SwedenSK SlovakiaTR Trentino (ITALY
Missing from HPH
Belgium Flemish CommunityBulgariaCanadaDenmarkFranceHungaryIrelandIsraelPiemonte (Italy)Veneto (Italy)Liguria (Italy)Toscana (Italy)KazakhstanPortugalWelsh national Network (UK)
Scientifically and technically supported by
WHO Collaborating Centre for Health Promotion in Hospitals and Health Care
atLudwig Boltzmann Institute for the Sociology of Health and Medicine
atUniversity of Vienna
Supported by
Federal Ministry of Health and Women
Coordinated by
World HealthOrganization,European Office for Integrated Health Care Services, Barcelona
HealthPromotingHospitals
26
External actors & stakeholders relevant for implementation of HP in hospitals
HospitalOwners
ManagementStaff
Health Care / Social
Policy
FinancingSystems
UserExpectations
(Media)
ProfessionalEducation &Associations
PublicHealthPolicy
Regional / National
HPH Network