Health Promoting Hospitals: 18 HPH Core Strategies and their implementation

1. Health Promoting Hospitals:18 HPH Core Strategies and their implementation Jürgen M. Pelikan (juergen.pelikan@univie.ac.at) 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 implementation 12th International Conference, Moscow, May 26-28, 2004

2. Overview • Framework of WG • Comprehensive Concept of HPH • 18 Core Strategies • Implementation by (Quality) Management • Relationship Strategies and Standards • Further information Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

3. 18 HPH core strategies +7 HPQMStrategies for sustainable implemen-tation Framework 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 Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

4. The Comprehensive Concept of HPH .... • of the optimal somatic, psychological & social health gain that can be influenced / reached by the hospital • reorients(quality) managementofthe hospital at the systematic achievement • (measured as clinical outcome & quality of life, personal satisfaction & health literacy & impact of hospital on health) • for patients, staff & citizensof the community. • By strategies of HPquality management & HP strategic (re-) positioning of the hospital. • By developing services empowering persons • for HPself-management (i.e. maintenance & development) of their health & forHPlifestyle development • and forHP co-production of health & for HP illness management • and by creating/ developing supportive hospital (& community) settings. Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

5. HP initiatives in hospitals follow general Health Promotion Principles, defined by a WHO-WG on evaluation of HP initiatives HP 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) Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

6. HP for... 18 HPH Core Strategies The health of which stakeholders should benefit from the HPH Core Strategies ? Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

7. HP for... Patients 18 HPH Core Strategies • The health of which stakeholders should • benefit from the HPH Core Strategies ? • The health of hospital patients Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

8. HP for... Patients Staff 18 HPH Core Strategies • The health of which stakeholders should • benefit from the HPH Core Strategies ? • The health of hospital patients • The health of hospital staff Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

9. HP for... Patients Staff Community 18 HPH Core Strategies • The health of which stakeholders should • benefit from the HPH Core Strategies ? • The health of hospital patients • The health of hospital staff • The health of all other people in the community, possibly in contact with the hospital Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

10. HP for... Patients Staff Community HP by ... 18 HPH Core Strategies From what types of strategies should the health of the stakeholders benefit? Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

11. HP for... Patients Staff Community HP by ... HP quality development 18 HPH Core Strategies • From what types of strategies should • the health of the stakeholders benefit? • From HPquality development strategies, improving the HP characteristics of existing hotel & clinical core services of the hospital. Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

12. HP for... Patients Staff Community HP by ... HP quality development HP strategic (re-)positioning 18 HPH Core Strategies • From what types of strategies should • the health of the stakeholders benefit? • From HPquality development strategies, improving the HP characteristics of existing hotel & clinical core services of the hospital. • (B) From HPstrategic (re-)positioning of the hospital by investing more into specific HP services & projects for patients, staff & community: Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

13. HP for... Patients Staff Community HP by ... 1. Enabling for HP self manage-ment in living HP quality development HP strategic (re-)positioning 18 HPH Core Strategies • From what types of strategies should • the health of the stakeholders benefit? • (A) From HPquality development strategies, improving the HP characteristics of existing hotel & clinical core services of the hospital. • Oriented at communication & interaction • processes: • Enabling for HP self management Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

14. HP for... Patients Staff Community HP by ... 1. Enabling for HP self manage-ment in living 2. Enabling for HP co-production of health HP quality development HP strategic (re-)positioning 18 HPH Core Strategies • From what types of strategies should • the health of the stakeholders benefit? • (A) From HPquality development strategies, improving the HP characteristics of existing hotel & clinical core services of the hospital. • Oriented at communication & interaction • processes: • Enabling for HP self management • Enabling for HP co-production in health care Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

15. HP for... Patients Staff Community HP by ... 1. Enabling for HP self manage-ment in living 2. Enabling for HP co-production of health HP quality development 3. Development of a HP hospital setting HP strategic (re-)positioning 18 HPH Core Strategies • From what types of strategies should • the health of the stakeholders benefit? • (A) From HPquality development strategies, improving the HP characteristics of existing hotel & clinical core services of the hospital. • Oriented at communication & interaction • processes: • Enabling for HP self management • Enabling for HP co-production in health care • Oriented at the material, social & cultural • structures of the hospital: • Development of a HP hospitalsetting Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

16. HP for... Patients Staff Community HP by ... 1. Enabling for HP self manage-ment in living 2. Enabling for HP co-production of health HP quality development 3. Development of a HP hospital setting 4. Enabling for HP illness management HP strategic (re-)positioning 18 HPH Core Strategies • From what types of strategies should • the health of the stakeholders benefit? • (B) From HPstrategic (re-)positioning of the hospital by investing more into specific HP services & projects for patients, staff & community: • By offering educative HP services: • Enabling for HP illness management Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

17. HP for... Patients Staff Community HP by ... 1. Enabling for HP self manage-ment in living 2. Enabling for HP co-production of health HP quality development 3. Development of a HP hospital setting 4. Enabling for HP illness management 5. Enabling for HP lifestyle development HP strategic (re-)positioning 18 HPH Core Strategies • From what types of strategies should • the health of the stakeholders benefit? • (B) From HPstrategic (re-)positioning of the hospital by investing more into specific HP services & projects for patients, staff & community: • By offering educative HP services: • Enabling for HP illness management • Enabling for HP life style development Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

18. HP for... Patients Staff Community 1. Enabling for HP self manage-ment in living 2. Enabling for HP co-production of health HP quality development 3. Development of a HP hospital setting 4. Enabling for HP illness management 5. Enabling for HP lifestyle development HP strategic (re-)positioning 6. Development of a HP community setting 18 HPH Core Strategies HP by ... • From what types of strategies should • the health of the stakeholders benefit? • (B) From HPstrategic (re-)positioning of the hospital by investing more into specific HP services & projects for patients, staff & community: • By offering educative HP services: • Enabling for HP illness management • Enabling for HP life style development • By participatingin HP community development projects for improvement of the material, social & cultural structures of the community: • Development of a HP community setting Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

19. HP for... Patients Staff Community HP by ... 1. Enabling for HP self manage-ment in living PAT-1: HP living in the hospital for patients STA-1: HP work life in the hospital for staff COM-1: HP access to the hospital for citizens 2. Enabling for HP co-production of health PAT-2: HP Co-production of patients in treatment STA-2: HP Co-production of staff in work processes COM-2: HP Co-production with services in region HP quality development 3. Development of a HP hospital setting PAT-3: HP hospital setting for patients STA-3: HP hospital setting for staff COM-3: HP hospital setting for citizens 4. Enabling for HP illness management PAT-4: HP illness manage-ment for patients COM-4 HP illness manage-ment for citizens STA-4 HP illness management for staff 5. Enabling for HP lifestyle development PAT-5: HP lifestyle develop-ment for patients STA-5: HP lifestyle develop-ment for staff COM-5: HP lifestyle develop-ment for citizens HP strategic (re-)positioning PAT-6: HP community setting for patients STA-6: HP community setting for staff COM-6: HP community setting for citizens 6. Development of a HP community setting 18 HPH Core Strategies Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

20. HP for... Patients Staff Community HP by ... 1. Enabling for HP self manage-ment in living PAT-1: HP living in the hospital for patients STA-1: HP work life in the hospital for staff COM-1: HP access to the hospital for citizens 2. Enabling for HP co-production of health PAT-2: HP Co-production of patients in treatment STA-2: HP Co-production of staff in work processes COM-2: HP Co-production with services in region HP quality development PAT-1: HP living in the hospital for patients 3. Development of a HP hospital setting PAT-3: HP hospital setting for patients STA-3: HP hospital setting for staff COM-3: HP hospital setting for citizens 4. Enabling for HP illness management PAT-4: HP disease manage-ment for patients COM-4 HP disease manage-ment for citizens STA-4 HP disease management for staff 5. Enabling for HP lifestyle development PAT-5: HP lifestyle develop-ment for patients STA-5: HP lifestyle develop-ment for staff COM-5: HP lifestyle develop-ment for citizens HP strategic (re-)positioning PAT-6: HP community setting for patients STA-6: HP community setting for staff COM-6: HP community setting for citizens 6. Development of a HP community setting 18 HPH Core Strategies 1. Objectives of strategy 2. Indications for strategy 3. Main topics / routines: selected examples, guidelines and evidence Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

21. Clinical services* • Admission > Discharge • Diagnosis • Therapy • Rehabilitation • Patient education • Prevention • Etc. *) Medical, nursing, therapeutic, educative Which subsystems of a hospital have to be HP-quality assured & improved by HP-Quality Management (HPQM)? • Management • Human resource management • Finance management • Purchasing management • Safety & occupational health • management • Quality Management • Health Promotion Management • Etc. • Other Support services • Transport • Maintenance • Waste management • Etc. • Hotel services • Nutrition • Cleaning • Etc. Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

22. How can (Quality) Management assure & improve comprehensive HP of a Hospital? > 7 HPQM Strategies Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

23. How can (Quality) Management assure & improve comprehensive HP of a Hospital? > 7 HPQM Strategies Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

24. Explination How can (Quality) Management assure & improve comprehensive HP of a Hospital? > 7 HPQM Strategies Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

25. How can (Quality) Management assure & improve comprehensive HP of a Hospital? > 7 HPQM Strategies Explination Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

26. How can (Quality) Management assure & improve comprehensive HP of a Hospital? > 7 HPQM Strategies Explination Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

27. How can (Quality) Management assure & improve comprehensive HP of a Hospital? > 7 HPQM Strategies • 1. Definition S1:Define HP criteria/standards for structures Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

28. How can (Quality) Management assure & improve comprehensive HP of a Hospital? > 7 HPQM Strategies • 1. Definition S1:Define HP criteria/standards for structures P1: DefineHP guidelines/ indicators for processes Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

29. How can (Quality) Management assure & improve comprehensive HP of a Hospital? > 7 HPQM Strategies • 1. Definition S1:Define HP criteria/standards for structures P1: DefineHP guidelines/ indicators for processes O1:Define HP targets for Outcomes/impacts Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

30. How can (Quality) Management assure & improve comprehensive HP of a Hospital? > 7 HPQM Strategies • 1. Definition S1:Define HP criteria/standards for structures P1: DefineHP guidelines/ indicators for processes O1:Define HP targets for Outcomes/impacts 2. Evaluation/ Monitoring S2: Evaluate for HP of structures Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

31. How can (Quality) Management assure & improve comprehensive HP of a Hospital? > 7 HPQM Strategies • 1. Definition S1:Define HP criteria/standards for structures P1: DefineHP guidelines/ indicators for processes O1:Define HP targets for Outcomes/impacts 2. Evaluation/ Monitoring S2: Evaluate for HP of structures P2: Evaluate for HP of processes Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

32. How can (Quality) Management assure & improve comprehensive HP of a Hospital? > 7 HPQM Strategies • 1. Definition S1:Define HP criteria/standards for structures P1: DefineHP guidelines/ indicators for processes O1:Define HP targets for Outcomes/impacts 2. Evaluation/ Monitoring S2: Evaluate for HP of structures P2: Evaluate for HP of processes O2: Evaluate for HP of outcomes & impacts Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

33. How can (Quality) Management assure & improve comprehensive HP of a Hospital? > 7 HPQM Strategies • 1. Definition S1:Define HP criteria/standards for structures P1: DefineHP guidelines/ indicators for processes O1:Define HP targets for Outcomes/impacts 2. Evaluation/ Monitoring S2: Evaluate for HP of structures P2: Evaluate for HP of processes O2: Evaluate for HP of outcomes & impacts 3. Development/ Improvement S3:Develop improved HP structures by OD, PD, TD Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

34. How can (Quality) Management assure & improve comprehensive HP of a Hospital? > 7 HPQM Strategies • 1. Definition S1:Define HP criteria/standards for structures P1: DefineHP guidelines/ indicators for processes O1:Define HP targets for Outcomes/impacts 2. Evaluation/ Monitoring S2: Evaluate for HP of structures P2: Evaluate for HP of processes O2: Evaluate for HP of outcomes & impacts 3. Development/ Improvement S3:Develop improved HP structures by OD, PD, TD X X Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

35. HPQM-Structures HPQM-Processes HPQM-Outcomes • HPQM aims: targets,principles, criteria, standards, indicators • HPQM strategicdefinitions: 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 1. Definition of … 2. Evaluation/ Monitoring of … 3. Development/ Improve ment of … HP quality- assurance & -development HPQM Strategies How can a comprehensive HP-QualityManagement-System be quality assured? Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

36. Relationship 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) Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004

37. 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 Investing in Health for the Future: Positioning health promotion in health care provision & supporting effective implementation 12th International Conference, Moscow, May 26-28, 2004