Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in...

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





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Overview

• A framework• Results from a last minute survey• Conclusions





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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





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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





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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





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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?





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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





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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





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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





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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?





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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





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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





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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





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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





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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





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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?





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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





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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





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• Is there a correlation between estimated supportiveness of conditions & estimated feasibility of implementation?





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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





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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





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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





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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





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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





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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)





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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

Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in...

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