13 th International Conference on Health Promoting Hospitals

13 th International Conference on Health Promoting Hospitals -Session II-4 Dublin, May 19, 2005 The Hospital as HPH-Strategy. Focused Organisation Mag. theol. Elimar Brandt, Berlin Prof. Dr. paed. Dr. sc. phil. Werner Schmidt, Berlin CA Dr. med. Rainer Hübner, Bernau IMMANUEL DIAKONIE GROUP GERMAN HPH NETWORK (DNGf. K) May 19, 2005 13 th International HPH Conference Dublin Session II-4 1

1. What should be implemented? Strategic guidelines for health promotion in hospitals „HPH-Strategy“ 1. 1 18 Core HPH Strategies (Pelikan u. a. 2005) 1. 2 Health Promotion Principles 1. 3 Standards for Health Promotion in Hospitals (Rootmann u. a. 2001) (Gröne u. a. 2005) May 19, 2005 13 th International HPH Conference Dublin Session II-4 2

18 HPH Core Strategies (Pelikan u. a. ) May 19, 2005 13 th International HPH Conference Dublin Session II-4 3

Six Core HPH Strategies for Hospital Patients (Pelikan u. a. 2005) Quality development Strategic positioning Patients as persons PAT-1: Assuring/improving PAT-4: Offering specific services for health promoting living in promoting illness the hospital for patients management for patients Patients in their patient role PAT-2: Assuring/improving PAT-5: Offering specific services for health promoting copromoting lifestyle production of patients in development for patients treatment and care Hospital / community setting PAT-3: Assuring/improving a health promoting hospital setting for patients May 19, 2005 PAT-6: Initiating of/participating in the development of health promoting community settings for patients 13 th International HPH Conference Dublin Session II-4 4

Six Core HPH Strategies for Hospital Staff (Pelikan u. a. 2005) Quality development Strategic positioning STA-1: Assuring/improving health promoting living in the hospital for staff STA-4: Offering specific Staff in their professional roles STA-2: Assuring/improving health promoting co-production of staff in work processes STA-5: Offering specific Hospital / community setting STA-3: Assuring/improving a health promoting hospital setting for staff STA-6: Staff as persons May 19, 2005 services for health promoting illness management for staff services for health promoting lifestyle development for staff Initiating of/participating in the development of health promoting community settings for staff 13 th International HPH Conference Dublin Session II-4 5

Six Core HPH Strategies for the Hospital Community (Pelikan u. a. 2005) HP Quality development Citizens as persons Citizens as patients Hospital / community setting May 19, 2005 HP Strategic positioning COM-1: Assuring/improving COM-4: Offering specific health promoting access to the hospital for citizens COM-2: Assuring/improving health promoting coproduction with services in the region health promoting illness management for citizens COM-3: Assuring/improving a health promoting hospital setting for citizens COM-6: Initiating of COM-5: Offering specific health promoting lifestyle development for citizens /participating in the development of health promoting community settings for citizens 13 th International HPH Conference Dublin Session II-4 6

1. 2 Health Promotion Principles 1. Empowering 2. Participatory 3. Holistic (physical + psychological + social) 4. Intersectoral 5. Equitable 6. Sustainable 7. Multistrategy (Rootman et. al. 2001) May 19, 2005 13 th International HPH Conference Dublin Session II-4 7

1. 3 Standards for Health Promotion in Hospitals Standard 1: Management Policy Standard 2: Patient Assessment Standard 3: Patient Information and Intervention Standard 4: Promoting a Healthy Workplace Standard 5: Continuity and Cooperation May 19, 2005 13 th International HPH Conference Dublin Session II-4 8

2. How can be implemented? Three basical options for strategy implementation 2. 1 Integration of HP-Core Strategies in a TQM system (f. e. EFQM) (Brandt u. a. 2000, Pelikan u. a. 2003) 2. 2 HP-Standard implementation in connection with a self-assessment tool (Gröne u. a. WHO 2004) 2. 3 HPH-Policy implementation with EFQM & Balanced Scorecard (BSC) (Brandt / Schmidt 2004) May 19, 2005 13 th International HPH Conference Dublin Session II-4 9

2. 3 Implementation with BSC in connection with EFQM - Model EFQM Excellence Model HPH Policy Balanced Scorecard (BSC) May 19, 2005 13 th International HPH Conference Dublin Session II-4 Health Promoting Organisationel Structure & Culture of the hospital 10

BSC - Development for the Immanuel Diakonie Group 2. 3. 1 Determination of the strategic destination (Vision) 2. 3. 2 Definition of strategic orientations 2. 3. 3 Development and introduction of values 2. 3. 4 Determination of strategic key themes 2. 3. 5 Commitment to strategic objectives and development of a strategy map incl. formulation of „Story of the strategy“ 2. 3. 6 Balanced Scorecard with measurements, targets, and strategic initiatives May 19, 2005 13 th International HPH Conference Dublin Session II-4 11

2. 3. 1 Strategic destination (Vision) of the IMMANUEL DIAKONIE GROUP „…The WHO HPH concept is inserted in connection with comprehensive quality management in the organizational structure and culture of the hospital and the values of the Hospital Holding are observed in staffs daily work in the hospital. ” (2002) May 19, 2005 13 th International HPH Conference Dublin Session II-4 12

2. 3. 3 Values of the IMMANUEL DIAKONIE GROUP • Development, discussion and validation of 18 values • 12 of 18 values are directly related to the strategy standards and principles of health promotion in hospitals • value 18 obliges explicit to integration of the WHO HPH Policy in the structure and culture of the organization (2003) May 19, 2005 13 th International HPH Conference Dublin Session II-4 13

2. 3. 4 Strategic Key Themes of the IMMANUEL DIAKONIE GROUP • Health Promoting Corporate Culture • Process Optimization and Quality Management • Highest possible health gain through comprehensive patient orientation • Partnership and Health Centers May 19, 2005 13 th International HPH Conference Dublin Session II-4 14

2. 3. 5 Commitment to 20 strategic objectives and development of a strategy map May 19, 2005 13 th International HPH Conference Dublin Session II-4 15

BSC Characteristic Ø Concentration on 20 strategic objectives Ø with max. per objective: 1 -2 Measurements and 1 -2 Strategic initiatives Ø put in order 4 business perspectives » Finance » Customer » Processes » Innovation Ø With cause and effect relationships between strategic objectives. May 19, 2005 13 th International HPH Conference Dublin Session II-4 16

BSC structure (Example) Strategic Theme: Health Gain through Pat. Orient. Diagram of the cause and effect relationships between strategic objectives Make positive operating results Increase customer loyalty Strategic Objectives Measurement Target F 1 Increase patient satisfaction Increase health Gain Pat. co-producer in treatment proc. Pat. needs consider and doc. Patient needs consider & documented % Patient records with doc. spec. pat. needs 10% F 2 F 3 30% 70% Strategic Initiative Task forces Patient needs HPHospital setting Increase staff HP-Competence May 19, 2005 13 th International HPH Conference Dublin Session II-4 17

HPH Policy and the Strategic Key Themes of the IMMANUEL DIAKONIE GROUP • 1. Health Promoting Corporate Culture (Standard 1 and 4) (Core Strategies for Staff) • 2. Process Optimization and Quality Management (Standard 1 and 4) (Core Strategies for Staff) • 3. Highest possible health gain through comprehensive patient orientation (Standard 2 and 3) (Core Strategies for Patients) • 4 Partnership and Health Centers (Standard 5) (Core Strategies for Community) May 19, 2005 13 th International HPH Conference Dublin Session II-4 18

Strategy Map (Immanuel Diakonie Group Berlin) Process optimization and quality management Health promoting corporate culture F Arrange professional public relations (F 4) Highest possible health gain through comprehensive patient orientation Make positive operating results (F 2) Open additional business segments and financial resources (F 3) Plan for case costs (F 1) P Configurate and place a Immanuel Diakonie Group related corporate identity (P 3) Strengthen staffs health competence (I 6) I Increase patient-, occupant- and relatives satisfaction (K 1) Increase staff satisfaction (K 2) C May 19, 2005 Introduce a comprehensive human resource development (P 7) Identify and reduce depreciative processes (P 6) Create transparent structures of responsibility and information (P 2) Lead staff to success (I 4) Partnership and health centers Establish regularly self-assements (I 5) Involve patient as co-producer of his health (P 1) Organize care networks and cooperations (P 4) Consider and document the needs of patients and occupants (P 5) Perceive patients, occupants and relatives holistic (I 2) Promote communicant 13 th International HPH Conference Dublin culture (I 1) Session II-4 Promotin health in the region (K 3) Distinguish performance spectrum (I 3) 19

2. 3. 6 Balanced Scorecard IMMANUEL DIAKONIE GROUP Innovation Processes Customer Finance Strategic Objectives May 19, 2005 F 1 Plan for case cost F 2 Make positive operating F 3 Open additional business segments and financial resources F 4 Arrange professional public relations K 1 Increase patient/occupant/relatives satisfaction K 2 Increase staff satisfaction K 3 Promoting health in region P 1 Involve patient as co-producer of his health P 2 Create transparent reponsibilty- & information structures P 3 Configurate & place a IDG related corporate identity P 4 Organize care networks and cooperations P 5 Consider & document patient- & occupants needs P 6 Identify & reduce depreciative processes P 7 Introduce a comprehensive human resource development I 1 Promote communication culture I 2 Perceive patients, occupants & relativs holistic I 3 Distinguish perfomance spectrum I 4 Lead staff to success I 5 Establish regularly self-assessments I 6 Strengthen staffs health competence 13 th International HPH Conference Dublin Session II-4 20

BSC Immanuel Diakonie Group (Perspective: Finance) Strategic Objectives F 1 Plan for case cost Finance F 2 Make positive operating CS: Core HPH Strategies SHP: Standards HP PRI: HP Principles Measurement HPH Policy CS SHP PRI Strategic Initiative % informed departments Task force Information Transfer % in turnover Quarterly reports F 3 Open additional business segments and financial resources % proceeds P 4 5 P 5 C 4 C 5 7 Analysis add. business 1 Realization rate PR-Conception PR-plan for action 13 th International HPH Conference Dublin Session II-4 21 F 4 Arrange professional public relations May 19, 2005

BSC Immanuel Diakonie Group (Perspective: Customer) Strategic Objectives Customer C 1 Increase patient/occupant/relatives satisfaction C 2 Increase staff satisfaction C 3 Promoting health in region May 19, 2005 CS: Core HPH Strategies SHP: Standards HP PRI: HP Principles Measurement Satisfaction index Rate of Realisation Regional Health plan 13 th International HPH Conference Dublin Session II-4 HPH Policy CS SHP PRI P 1 P 3 2 1 S 2 S 3 4 1 C 2 C 3 C 4 C 5 S 6 P 6 5 Strategic Initiative Patient survey Staff survey 1 2 Project Regional Health 22

BSC Immanuel Diakonie Group (Perspective: Processes) Strategic Objectives P 1 Involve patient as co-producer of his health Processes P 2 Create transparent reponsibilty- & informationstructurs CS: Core HPH Strategies SHP: Standards HP PRI: HP Principles Measurement % included Patients (doc. ) Realization installment HPH Policy CS SHP PRI P 2 P 4 3 2 Patient survey S 2 S 3 4 1 2 Task force Responsib. & Inf. Structure S 3 P 3 1 to 5 1 to 7 P 3 Configurate & place a HPH/ID Group related corporate identity • Realization Action plan • Awareness Pat. & Staff P 4 Organize care networks and cooperation's Number & valuation S 6/P 6 5 C 1/C 2 of cooperation's P 5 Consider & document patient- & occupants needs • Realization Pat. needs dok. • Pat. satisfaction (needs index) C 6 P 6 Identify & reduce depreciative processes % change of processes P 7 Introduce a comprehensive human resource development Realization installment May 19, 2005 13 th International HPH Conference Dublin Session II-4 Strategic Initiative P 1 P 4 S 2 (1+3) S 2 4 7 • Task force Values (implementation) • Pat. /Staff servey Task force optimize coop. 2 1 2 Quality working Group Patient needs 4 2 Improvement management 4 1 2 Personal management 23

BSC Immanuel Diakonie Group (Perspective: Innovation) Strategic Objectives I 1 Promote communication culture Innovation I 2 Perceive patients, occupants & relatives holistic I 3 Distinguish performance spectrum I 4 Lead staff to success I 5 Establish regularly self-assessment I 6 Strengthen staffs health competence May 19, 2005 CS: Core HPH Strategies SHP: Standards HP PRI: HP Principles Measurement HPH Policy CS SHP PRI Strategic Initiative S 1 S 2 S 3 4 1 to 5 P 1 to P 5 C 1 C 2 C 3 2 3 3 Holistic Competence Training (HCT) 1 5 2 4 7 Performance distinguish development concept (PDDC) • Number of EOC (Employee/year) • % aim agreements S 2 4 1 2 • Manager-train. • Employeeoriented Conversation (EOC) • EFQM Self assessment (Score / RADAR) • % EFQM-Train. Employee S 2 % departments with monthly activities Score pro employee for HCT participation Realization of PDDC-Targets Number of supplies /year 13 th International HPH Conference Dublin Session II-4 (S 1) (S 3) 1 Training Feedback culture 1+2 EFQM Training of Self 4 Assessment 6+7 team S 4 S 5 4 1 2 3 Hospitals Healthy Lifestyle Supplies 24

Strategic Management Process with the Balanced Scorecard ( nach Horváth 2000)) Phase I: Development/ revise the Balanced Scorecard Phase IV: Learning and adaptation Phase II: Communication and Specification Phase III: Translate into operational control May 19, 2005 13 th International HPH Conference Dublin Session II-4 25

Implementation of the BSC What does that mean? • 1. BSC: an integral part of the Managementand Control systems • 2. BSC: an integral part of the Planning system • 3. Lead staff with BSC • 4. BSC: Integration in the Report system • 5. BSC and EFQM- Model coordinate use May 19, 2005 13 th International HPH Conference Dublin Session II-4 26

April 11, 2005: Start meeting for BSC Implementation of the Immanuel Diakonie Group (in 3 hospitals) with 100 Participants • Statement CEO • Nomination of „Responsible employees“ for every Strategic Objective and for every Strategic Initiative • Final Training • Next steps May 19, 2005 13 th International HPH Conference Dublin Session II-4 27

Consistency: • The HPH Strategy/Policy is an integral part of the BSC of the Immanuel Diakonie Group • The BSC of the Immanuel Diakonie Group is now the official Management instrument in the institutions of this Holding • We are sure: May 19, 2005 13 th International HPH Conference Dublin Session II-4 28

The Strategic destination (Vision) of the Immanuel Diakonie Group becoming reality: „The WHO HPH concept is inserted in connection with comprehensive quality management in the organizational structure and culture of the hospital and the values of the Hospital Holding are observed in staffs daily work in the hospital. ” May 19, 2005 13 th International HPH Conference Dublin Session II-4 29

e. brandt@immanuel. de werner. schmidt@immanuel. de May 19, 2005 13 th International HPH Conference Dublin Session II-4 30