co-ordinated by: world health organization european office for integrated health care services,...

Co-ordinated by:

World HealthOrganizationEuropean Office for Integrated Health Care Services, Barcelona

Technically supported by:

WHO Collaborating Centre for Health Promotion in Hospitals and Health Care

At the Ludwig Boltzmann Institute for the Sociology of Health and Medicine

at the Institute for Sociology, University of Vienna

Sponsored by Federal Ministry for Health and Women

HealthPromotingHospitals

Health Promoting Hospitals:18 HPH Core Strategies and their implementation

Jürgen M. Pelikan ([email protected])

Karl Krajic, Christina Dietscher, Peter Nowak

Ludwig Boltzmann-Institute for the Sociology of Health & Medicine,

WHO-CC for Health Promotion in Hospitals &Health Care, University of Vienna

Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation12th International Conference, Moscow, May 26-28, 2004


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Overview

• Framework of WG• Comprehensive Concept of HPH• 18 Core Strategies • Implementation by (Quality) Management• Relationship Strategies and Standards • Further information


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HealthPromotingHospitalsFramework for and Product of the Working

Group

Basic documents:•Ottawa HP•Budapest HPH•Ljubljana HC•Vienna HPH•Jakarta HP

WHO network experiences:• Pilot and model projects

•National / regional networks• Models of good practice

•Guidelines and recommendations

Developments in Health promotion:•Empowerment•Health literacy•Healthy Alliances•Evidence based HP•Quality assurance of HP

Developments in Health care:

•Cost containment by quality development:

•Quality management systems•Evidence based health care

•Q-Instruments (standards, guidelines, tools)

•HPH

18 HPH core

strategies

+7 HPQM

Strategies for

sustainable implemen-

tation


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HealthPromotingHospitalsThe Comprehensive Concept of HPH ....

• reorients (quality) management of the hospital at the systematic achievement

- and by creating/ developing supportive hospital (& community) settings.

- and for HP co-production of health & for HP illness management

- for HP self-management (i.e. maintenance & development) of their health & for HP lifestyle development

- By developing services empowering persons

- By strategies of HP quality management & HP strategic (re-) positioning of the hospital.

• for patients, staff & citizens of the community.

• of the optimal somatic, psychological & social health gain that can be influenced / reached by the hospital

• (measured as clinical outcome & quality of life, personal satisfaction & health literacy & impact of hospital on health)


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HealthPromotingHospitalsHP initiatives in hospitals follow general

Health Promotion Principles, defined by a WHO-WG on evaluation of HP initiativesHP initiatives have to be …

– Empowering: Enabling individuals and communities to assume more power over the personal, socioeconomic and environmental factors that affect their health

– Participatory: Involving all concerned at all stages of the process– Holistic: Fostering physical, mental, social and spiritual health – Intersectoral: Involving the collaboration of agencies from relevant sectors– Equitable: Guided by a concern for equity and social justice– Sustainable: Bringing about changes that individuals and communities can

maintain once initial funding has ended)– Multistrategy: Using a variety of approaches – including policy development,

organizational change, community development, legislation, advocacy, education and communication – in combination

(Rootman et.al., 2001)


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HealthPromotingHospitals18 HPH Core Strategies

HP for...

The health of which stakeholders should benefit from the HPH Core Strategies ?


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PatientsHP for...


1. The health of hospital patients


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Patients StaffHP for...


1. The health of hospital patients 2. The health of hospital staff


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Patients Staff CommunityHP for...


1. The health of hospital patients 2. The health of hospital staff3. The health of all other people in the

community, possibly in contact with the hospital


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HP by ...

18 HPH Core Strategies


From what types of strategies should the health of the stakeholders benefit?


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HP by ...




(A) From HP quality development strategies, improving the HP characteristics of existing hotel & clinical core services of the hospital.

HP

qual

ity d

evel

opm

ent


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HP by ...



HP

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HP

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(B) From HP strategic (re-)positioning of the hospital by investing more into specific HP services & projects for patients, staff & community:


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HP by ...

1. Enabling for HP self manage-ment in living



HP

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ity d

evel

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HP

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Oriented at communication & interaction processes:

1. Enabling for HP self management


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HP by ...


2. Enabling forHP co-production of health



HP

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ity d

evel

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HP

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1. Enabling for HP self management2. Enabling for HP co-production in health care


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HP by ...



3. Development of a HP hospital setting





1. Enabling for HP self management2. Enabling for HP co-production in health care

Oriented at the material, social & cultural structures of the hospital:


HP

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ity d

evel

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HP

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HP by ...






4. Enabling for HP illness management

HP

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HP

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By offering educative HP services:4. Enabling for HP illness management


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HP by ...




5. Enabling for HP lifestyle development



HP

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ity d

evel

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HP

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By offering educative HP services:4. Enabling for HP illness management 5. Enabling for HP life style development


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HP by ...






6. Development of a HP community setting




By offering educative HP services:4. Enabling for HP illness management 5. Enabling for HP life style development

By participating in HP community development projects for improvement of the material, social & cultural structures of the community:



HP

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ity d

evel

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HP

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Patients Staff Community


HP for...HP by ...

HP

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HP

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PAT-1:HP living in the

hospital for patients

PAT-2:HP Co-production of patients in treatment

PAT-3:HP hospital setting

for patients

PAT-4:HP illness manage-ment for patients

PAT-5:HP lifestyle develop-

ment for patients

PAT-6:HP community

setting for patients

COM-2: HP Co-production with

services in region

COM-3:HP hospital setting

for citizens

COM-4HP illness manage-

ment for citizens

COM-5:HP lifestyle develop-

ment for citizens

COM-6:HP community

setting for citizens

STA-2: HP Co-production of staff in

work processes

STA-3:HP hospital setting

for staff

STA-4HP illness

management for staff

STA-5:HP lifestyle develop-

ment for staff

STA-6:HP community setting for staff

STA-1:HP work life in the hospital for staff

COM-1:HP access to the

hospital for citizens



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Patients Staff Community


HP for...HP by ...



PAT-2:HP Co-production of patients in treatment

PAT-3:HP hospital setting

for patients

PAT-4:HP disease manage-

ment for patients

PAT-5:HP lifestyle develop-

ment for patients

PAT-6:HP community

setting for patients

COM-2: HP Co-production with

services in region

COM-3:HP hospital setting

for citizens

COM-4HP disease manage-

ment for citizens

COM-5:HP lifestyle develop-

ment for citizens

COM-6:HP community

setting for citizens

STA-2: HP Co-production of staff in

work processes

STA-3:HP hospital setting

for staff

STA-4HP disease

management for staff

STA-5:HP lifestyle develop-

ment for staff

STA-6:HP community setting for staff

STA-1:HP work life in the hospital for staff

COM-1:HP access to the

hospital for citizens





HP

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HP

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1. Objectives of strategy

2. Indications for strategy

3. Main topics / routines: selected examples, guidelines and evidence


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HealthPromotingHospitalsWhich subsystems of a hospital have to be

HP-quality assured & improved by HP-Quality Management (HPQM)?

Hotel services• Nutrition• Cleaning• Etc.

Other Support services• Transport• Maintenance• Waste management• Etc.

Management• Human resource management• Finance management• Purchasing management• Safety & occupational health management• Quality Management• Health Promotion Management• Etc.

Clinical services*• Admission > Discharge

• Diagnosis•Therapy• Rehabilitation• Patient education• Prevention• Etc.

*) Medical, nursing, therapeutic, educative


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HealthPromotingHospitalsHow can (Quality) Management assure &

improve comprehensive HP of a Hospital? > 7 HPQM Strategies


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Quality functions/

activities for quality of …

Structures of services (& settings)

Processes of services(& settings)

Outcomes/ impacts of services(& settings)


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Quality functions/





Explination


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Quality functions/





Explination


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Quality functions/





Explination


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Quality functions/





1. Definition S1: Define HP criteria/standardsfor structures


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Quality functions/






P1: Define HP guidelines/ indicatorsfor processes


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Quality functions/







O1: Define HP targets for Outcomes/impacts


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Quality functions/





1. Definition

2. Evaluation/ Monitoring

S1: Define HP criteria/standardsfor structures



S2: Evaluate for HP of structures


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Quality functions/





1. Definition






P2: Evaluate for HP of processes


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Quality functions/





1. Definition







O2: Evaluate for HPof outcomes & impacts


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Quality functions/





1. Definition


3. Development/ Improvement







S3: Develop improved HP structures by OD,PD, TD


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Quality functions/





1. Definition


3. Development/ Improvement







S3: Develop improved HP structures by OD,PD, TD

X X


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How can a comprehensive HP-QualityManagement-System be quality assured?

HPQM-Outcomes

HP quality-

assurance &

-development

1. Definition of …

2. Evaluation/

Monitoring of …

3. Development/

Improve

ment of …

HPQM-Processes

HPQ

M S

trat

egie

s

• HPQM aims: targets,principles, criteria, standards, indicators• HPQM strategic definitions: written policies, (action-) plans, programs, projects • HPQM tools: guidelines, protocols, manuals • HPQM structures: steering committee, team, network of contact persons• HPQM dissemination policy• HPQM budget

HPQM-Structures


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HealthPromotingHospitalsRelationship of the five Standards of the

Standard WG to the Strategies of the Putting into Practice WG

• 1. Management policy– HPQM strategies

• 2. Patient Assessment– PAT 1,2

• 3. Patient Information and Intervention– PAT1, 2, 4, 5

• 4. Promoting a healthy Workplace– STA 3, 1,2

• 5. Continuity and Cooperation– COM 1, 2, (PAT6, STA6, COM6)


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Further information

• WHO-Collaboration Centre for Health Promotion in Hospitals and Health Care– http://www.hph-hc.cc/– Folder Download > Draft of Working Group

“Strategies”• Paper of Working Group “Standards”

– http://www.euro.who.int/document/e82490.pdf

co-ordinated by: world health organization european office for integrated health care services,...

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