Does a WHO HPH Recognition Process Improve Health Service 

Delivery and Outcome? 

PHD Student Jeff Kirk Svane MA (DK)Professor Hanne Tønnesen MD PHD (DK/S)Supervisor Shu-Ti Chiou MD PHD MSc (TW)Advisor Oliver Groene MSc PHD (UK)

Overview • Study aim and hypotheses• Scope & Purpose• Background• Framework

– WHO HPH Standards / Indicators– HPH DATA Model– HPH Doc Act Model– Other evaluated tools

• Project Status

Study aim

The “WHO HPH Recognition Project” aims to:

•Evaluate whether a WHO-HPH recognition / certification process for HP generates

– more health promotion deliveries – better health gain for patients and staff

Main hypotheses

• Hospitals departments allocated to the Recognition Process will after 1 year:

– Improve health gain for patients and staff– Deliver more HP services

compared to the departments allocated to the control group continuing routine clinical practice

Scope & Purpose

Why a recognition project about HP?

•Clinical HP is a patient-centred approach in health care services

•HP Improves the effect of treatment results and contributes to improved patient safety

=> HP is a key dimension of quality in hospitals

Scope & PurposeIt is THE LEADING risk factors that can be influenced by HP•“(…) the three leading risk factors for global disease burden were high blood pressure (…), tobacco smoking including second-hand smoke (…), and alcohol use (…)”•Among leading risk factors are also overweight, malnutrition, physical inactivity

Lim, Vos, Flaxman et al. Lancet. 2012

Scope & Purpose

Duly, HP integration is now recognized as a core issue. E.g.:•Health 2020 (WHO, signed at WHA in Geneva, May 2012)•Strengthening Public Health Capacities and Services (WHO, signed at RC62 in Malta, September 2012)•Strategy for the Prevention and Control of Non-Communicable Diseases 2012–2016 (WHO at RC61 in Baku, September 2011)

Scope & Purpose

So HP is core, also for hospitals and health services

But Implementation in real-life is still a challenge

Scope & Purpose

What about existing processes?•Hospitals and health services implement QM, accreditation, certification and recognition But:•HP is poorly included•… and we dont know if it really generates better health gain?

Background

• Sparse literature on accreditation and quality improvement

– 1 Randomised Clinical Trials (RCT) evaluating impact of hospital accreditation on the quality of care at the national level in South Africa

(Salmon JW, Heavens J, Lombard C, Tavrow P. Operations Research Results 2003;2:17)

What can we conclude?

• Better technical procedures and structure

• No better clinical outcome or health gain

• We need further studies with adequate power (sizeable sample)

Framework (project elements)

1. Management policy of HP 2. Patient Assessment3. Patient Intervention and Info4. Promoting a healthy workplace5. Continuity and cooperation

Hospitals: Useful recommendable

(Groene O, Jorgensen SJ, Fugleholm AM, Garcia Barbero M. Int J Health Care Qual Assur Inc Leadersh Health Serv 2005;18:300-7.

Framework

HPH DATA Model(St. 2)

HPH

Doc. HP

Activities(St. 3)

HPH

Clinicians: Understandable, applicable & sufficient for our patients (high reliability)

(Tonnesen H et al, BMC Health Serv Res 2007 + Clin HP 2012)

Other evaluative tools

Short Form Health Survey (SF36):– Physical, mental and social conditions

+

17 additional indicators– WHO HPH Standards not otherwise

included

(McHorney, Colleen A.; Ware, John E.; Raczek, Anastasia E. Med Care 1993; 31: 247-263)

Design

• An RCT with 2x44 hospital departments allocated to one of the two groups

– Undergo the Recognition Process immediately = Intervention group

– Continue their usual routine = Control group

Evidence degree: Pyramid

In Vitro studies

Animal Studies

Editorial papers and Consensus (’GOBSAT’)

Cases (Obs)

Cohorts, Case-Control studies (Obs)

CCT (intervention)

RCT (intervention)

Meta-analysesSyst reviews

(Eccles M BMJ 1998)

Trial Profile

Clin Dept

n = 2x44

RData collect TAU

1y

2y

Data collect

Data collect

Data collect

Site Visit & Data Val

Site Visit & Data Val

I

I

Inclusion criteria

• All kinds of clinical hospital departments are eligible; from university as well as non-university clinical hospital departments

Exclusion criteria

• Palliative care departments, paediatric departments, nursing homes, non-hospital departments, and primary care facilities

• WHO-HPH standards and tools are not validated for these clinical activities.

   

  mo I II III IV I II III IV I II III IV I

Incl, Agree, Allocate

2                        

Baseline Package

1                          

Int Audit + Q Plan 2                          

Return Package

1                          

Implementation 12                          

Follow-up Package

-                          

Int Audit + Rev Quality Plan +Return package

3                          

Site Visit + certificate

2                          

Tailored timeline for each countryYear 1 Year 2 Year 3

Project status: Almost half way40 out of 88 depts included:•Taiwan: 21•Czech Rep: 8•Thailand: 4•Slovenia: 2•Estonia: 2•Canada: 1•Indonesia: 1•Malaysia: 1•More are coming up! (48 depts to go)

Overview Study aim and hypothesesScope & PurposeBackgroundFramework

WHO HPH Standards / IndicatorsHPH DATA ModelHPH Doc Act ModelOther evaluated tools

Project Status

Welcome!

• We look forward to the fruitful collaboration