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The Tuscany HPH Network and Health Promotion in the Conceptual Framework of Complexity

This article explores the integration of health promotion into the culture and daily work of Health Promoting Hospitals, focusing on the patients, staff, and community. It discusses the principles of self-organization, recursion, dialogues, and holograms, and presents the Tuscany HPH conceptual pathway.

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The Tuscany HPH Network and Health Promotion in the Conceptual Framework of Complexity

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  1. The Tuscany HPH Network and Health Promotion in the conceptual framework of the Complexity Fabrizio Simonelli - Head, Health Promotion Program, ‘A.Meyer’ Hospital - Florence Paolo Morello Marchese - Co-ordinator, Tuscany HPH Network ‘A.Meyer’ Hospital - Florence • HPH : a complex project • Complexity & Health Promotion • The Tuscany HPH conceptual pathway

  2. HPH project: aim • A Health Promoting Hospital has to demonstrate to incorporate into its culture and daily work the idea of health promotion of its personnel, the patients and their families as well of the community. PATIENTS Complexity HPH COMMUNITY STAFF

  3. Complexity & Health Promotion Complexity is the property of a real world system that is manifest in the inability of any one formalism being adequate to capture all its properties. (D.C. Mikulecky)

  4. Complexity & Health Promotion 1. The SELF-ORGANISATION principle From Health Care management… … to HEALTH PROMOTION Multiplicy of determinants Policies Investments Infrastructures Health needs Resources Norms Influences Health Health Care Services a system capable to get itself organized

  5. Complexity & Health Promotion 2. The RECURSIVE principle: From linear conception … … ...to circular framework INFRASTRUCTURE ( SERVICES & PROJECTS) INVESTMENTS COMMUNITY (values and capital) POLICIES HEALTH (effects act on causes)

  6. Complexity & Health Promotion 3. The DIALOGIC principle: HEALTH Scenarios Powerfullness Empowerment HEALTH PROMOTION QUALITY ‘SERVUCTION‘ Co-operation with professionals HEALTH CARE Dependence (the phenomena happen between two antagonist and complementar logics)

  7. Complexity & Health Promotion 4. The HOLOGRAM principle: COMMUNITY DEVELOPMENT PROCESSES CULTURE HPH STRUCTURE (the part is a share of the whole system, but also the whole is inscribed in the part: act on a single part means to change the whole system)

  8. Complexity & Health Promotion Synthesis CONCEPTUAL FRAMEWORK Self-organising principle Action in the changing context Health Community Development Recursive principle Dependence Empowerment Dialogic principle Personal and Community Development Hologram principle HPH

  9. The Tuscany HPH conceptual pathway Learn and think does not mean to arrive at any absolutely certain truth, but it is to dialogue with the uncertainty and the error. (E. Morin)

  10. The Tuscany HPH conceptual pathway (1) PARADIGMATIC level (Inspirer principles and values) METHODOLOGICAL level (Sistematic pathways) OPERATIVE level (Practical applications) HPH

  11. The Tuscany HPH conceptual pathway (1) HEALTH PARADIGM A) Health determinants multiciplity B) Semantic context C) Declination of the concept of the person’s centrality

  12. The Tuscany HPH conceptual pathway (1) A) The multiciplity of health determinants ECONOMIC FACTORS ENVIRONMENTAL FACTORS DEMOGRAPHIC FACTORS PEACE HEALTH CARE SERVICES personal HEALTH factors CULTURAL FACTORS SOCIAL-ECONOMIC DEVELOPMENT STAGE JUSTICE EDUCATION LIFESTYLES MASS MEDIA Requirements Determinants

  13. The Tuscany HPH conceptual pathway (1) B) The semantic context OTTAWA CHART (1986) general principles on health promotion BUDAPEST DECLARATION (1991) aims and criteria for Health Promoting Hospitals VIENNA RECOMMENDATIONS (1997) strategies for the implementation of the HPH project and acceptance modalities HEALTH PROMOTION GLOSSARY (1998) definition

  14. The Tuscany HPH conceptual pathway (1) C) Declination of roles, expectations, activities SOCIAL HEALTH ACTOR RESOURCE FOR THE COMMUNITY PROTAGONIST OF HIS OWN HEALTH HEALTH LITERACY AND HEALTHY LIFESTYLES Health promotion Person’s centrality CLIENT OF THE HEALTH CARE SERVICES QUALITY STANDARDS ASSURANCE Continuous Quality Improvement CARRIER OF DISEASES (PATIENT) THERAPEUTIC BENEFITS Diagnostic-Therapeutic Activities

  15. The Tuscany HPH conceptual pathway (2) HEALTH PARADIGM - Health determinants multiciplity - Semantic context - Declination of the concept of the person’s centrality HEALTH METHODOLOGY New health governance: Outlines and Open methods (Integrated Health Plans, Health Societies)

  16. The Tuscany HPH conceptual pathway (2) Outlines GOVERNMENT OF HEALTH SERVICES NEW HEALTH GOVERNANCE The philosophy: BOTTOM LINE The philosophy: BEYOND BOTTOM LINE FOCUS ON FINAL BALANCE FOCUS ON VALUES-GUIDE PERSONS AS PATIENTS AND CLIENTS PERSONS (and ASSOCIATIONS) AS PROTAGONISTS OF HEALTH Activities:DISEASE MANAGEMENT AND QUALITY IMPROVEMENT Activities: HEALTH PROMOTION AND COMMUNITY DEVELOPMENT

  17. The Tuscany HPH conceptual pathway (3) HEALTH PARADIGM A) Health determinants multiciplity B) Semantic context C) Declination of the concept of the person’s centrality HEALTH METHODOLOGY New health governance: Outlines and Open methods (Integrated Health Plans, Health Societies): HPH PLANNING SKILL A) International Guidances B) Net work C) Project work

  18. The Tuscany HPH conceptual pathway (3) Network of Health Promoting Hospitals in Denmark Health Promoting Hospitals Development and ChallengesWORLD HEALTH ORGANIZATION European Office of Barcelona A) GENERAL AND SCIENTIFIC GUIDANCES: Putting Health Promoting Hospital policy into action ‘L. BOLTZMANN‘ INSTITUTE for the Sociology of Health and Medicine of Vienna Standards for Health Promotion in Hospitals

  19. The Tuscany HPH conceptual pathway (3) B) OLONIC NETWORK (- increased knowledge - common orientation) LOCAL HEALTH PLANS Healthy Cities HP Schools (other HP projects) Health PromotingHospitals Health Education Units

  20. The Tuscany HPH conceptual pathway (3) • cultural • communicativeness • organisational C) PROJECT WORK (3 levels) SETTING STANDARDS • re-engineering • innovation HEALTH GAIN HPH PROCESSES RE-DESIGN • between: • patients • relatives • professionals • volunteers • partners RELATIONS TRAINING

  21. The Tuscany HPH conceptual pathway (3) • COMMITTEE • PRIORITY: • (post-operation pain) • PROTOCOLS PROJECT WORK (an example: Pain-free Hospitals) SETTING STANDARDS • DAILY PAIN • MEASUREMENT • AND TREATMENT PAIN REDUCTION HPH PROCESSES RE-DESIGN • COMPETENCES • FOR THE STAFF • ABILITIES • FOR THE PATIENTS • (pain meter) RELATIONS TRAINING

  22. Bibliografia: Dahlgren, G. and Whitehead, M (1992) Policies and Strategies to Promote Social Equity in Health, Stockholm; Institute of Future Studies, 1991 Eglier P.- Langeard E.: “Servuction – Le marketing des services” – McGraw-Hill, 1988 Ewles L., Simnet I.:” Promoting health – A practical guide” – Scutari Press, 1992 Morin E.: ‘La methode 5. L’Humanité de l’Humanité. Tome 1, L’identité humaine’, Editions du Seuil, 2001 Morgan G.: ‘ Images of organizations’, 1986 C. Piccardo: “Empowerment – Strategie di sviluppo centrate sulla persona” – R.Cortina Editore, Milano, 1995 Simonelli F.: ‘Promotori di salute, costruttori di pace’ - Janus – Medicina: cultura, culture - n. 9, Roma, 2003

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