Putting Health Promoting Hospital policy into action Results

Putting Health Promoting Hospital policy into action: Results of a WHO working group Supported by: Ludwig Boltzmann. Institute for the Sociology of Health and Medicine at the Institute for Sociology, University of Vienna Sponsored by Federal Ministry for Health and Women Jürgen M. Pelikan Co-ordinated by: WHO Collaborating Centre for Health Promotion in Hospitals and Health Care Supported by Christina Dietscher, Karl Krajic, Peter Nowak, Thomas Stidl 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien World Health Organization European Office for Integrated Health Care Services, Barcelona

Members of the WHO Working Group Supported by: Ludwig Boltzmann. Institute for the Sociology of Health and Medicine Elimar Brandt (Berlin), Christina Dietscher (Vienna), Carlo Favaretti (Trento), Pascal Garel (Paris), Oliver Gröne (Barcelona, WHO) Bernhard J. Güntert (Bielefeld), Ann Kerr (Edinburgh), Karl Krajic (Vienna), Elisabeth Marty-Tschumy (Lausanne), Peter Nowak (Vienna), Raymond Mc. Cartney (London. Derry), Jürgen M. Pelikan (Vienna, co-ordinator), Yannis Tountas (Athens) at the Institute for Sociology, University of Vienna Sponsored by Federal Ministry for Health and Women Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 2 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien

Aim of the Working Group Supported by: Ludwig Boltzmann. Institute for the Sociology of Health and Medicine • To develop recommendations for translating health promotion policy into action at hospital level at the Institute for Sociology, University of Vienna Sponsored by Federal Ministry for Health and Women Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 3 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien

Framework and Product of the Working Group Basic documents: • Ottawa • Budapest • Ljubljana • Vienna • Jakarta Health promotion developments: • Empowerment • Health literacy • Healthy Alliances • Quality assurance 18 HPH core strategies + Criteria for sustainable implementation WHO network experiences: • Pilot and model projects • National / regional networks • Models of good practice • Guidelines and recommendations Health care developments: Cost containment by quality development: • Quality management systems • Evidence based health care • Instruments (standards, guidelines, . . . ) • HPH 4 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien Supported by: Ludwig Boltzmann. Institute for the Sociology of Health and Medicine at the Institute for Sociology, University of Vienna Sponsored by Federal Ministry for Health and Women Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona

Health Promotion Principles Supported by: – – – – Ludwig Boltzmann. Institute for the Sociology of Health and Medicine Empowering Participatory Holistic (physical + psychological + social), Intersectoral Equitable Sustainable Multistrategy at the Institute for Sociology, University of Vienna Sponsored by Federal Ministry for Health and Women Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona (Rootman et. al. 2001) 5 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien

Distinctions for Generating HPH Core Strategies • Health gain for 3 relevant target groups Supported by: – patients (relatives) & staff & community Ludwig Boltzmann. Institute for the Sociology of Health and Medicine • Investment in – quality development & strategic re-orientation at the Institute for Sociology, University of Vienna • Through development of Sponsored by Federal Ministry for Health and Women – services & settings • By introducing into core services more empowerment for – re-production of positive health & coproduction in treatment Co-ordinated by: • By offering (more) services empowering for World Health Organization European Office for Integrated Health Care Services, Barcelona – illness management & healthy lifestyles development • By (participation in) development of – Hospital & community setting 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien 6

HPH Core Strategies are. . . • oriented at improving health gain (measured as clinical outcome +, quality of life, health literacy, satisfaction) • realised by treatment + prevention of disease, but also by protection + development of positive health • using expert solutions + enabling by personal empowerment and creating supportive environments 7 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien Supported by: Ludwig Boltzmann. Institute for the Sociology of Health and Medicine at the Institute for Sociology, University of Vienna Sponsored by Federal Ministry for Health and Women Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona

Health Promotion for Patients (I) Supported by: Ludwig Boltzmann. Institute for the Sociology of Health and Medicine • Better health outcomes of services (quality) by empowering patients for … – self care / self maintenance / self reproduction (PAT-1) – active co-production in treatment and care (PAT-2) • BECAUSE: – Self care affects health by reducing hospitalism, improving quality of life and patient satisfaction and thus also clinical outcome. – Co-production directly affects health outcomes by reducing complications and speeding up recovery. 8 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien at the Institute for Sociology, University of Vienna Sponsored by Federal Ministry for Health and Women Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona

Health Promotion for Patients (II) Supported by: Ludwig Boltzmann. Institute for the Sociology of Health and Medicine • More health gain by improving health impact through … at the Institute for Sociology, University of Vienna – developing the hospital into a less dangerous and more supportive setting (PAT-3) Sponsored by Federal Ministry for Health and Women • BECAUSE: The setting affects health by providing risks / resources, by influencing patient satisfaction and quality of life and by that also clinical outcomes in some cases. Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 9 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien

Health Promotion for Patients (III) Supported by: • More mid- and long term health gain by offering specific services for: – Information / education / counselling / training for health promoting illness management (after discharge) (PAT 4) – Information / education / counselling / training for health promoting life style development (PAT-5) • and by participating in health promoting and empowering community development for specific patient needs (PAT-6) • BECAUSE: – Illness and health behaviour of patients affect health – Settings affect illness and health behaviour 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien Ludwig Boltzmann. Institute for the Sociology of Health and Medicine at the Institute for Sociology, University of Vienna Sponsored by Federal Ministry for Health and Women Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 10

Health Promotion for Staff Supported by: Better health for staff by • Empowering for Ludwig Boltzmann. Institute for the Sociology of Health and Medicine – Healthy self-reproduction (STA-1) – Health protecting work performance (STA-2) at the Institute for Sociology, University of Vienna • Creating a – Less dangerous and more supportive work environment (STA -3) Sponsored by Federal Ministry for Health and Women • Offering services for – Managing occupational illness (STA-4) – Developing healthy lifestyles (STA-5) Co-ordinated by: • Participating in – Health promoting Community development for specific needs of staff (STA-6) • BECAUSE: All these factors do affect health of staff 11 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien World Health Organization European Office for Integrated Health Care Services, Barcelona

Health Promotion for the Community Supported by: Ludwig Boltzmann. Institute for the Sociology of Health and Medicine • Better regional health impact of the hospital by empowering … – For equitable and appropriate access to the hospital (COM-1) – Health professionals and lay carers for treatment and care after discharge (COM-2) • Developing the hospital into a less dangerous and more supportive environment for its neighbours and nature (COM -3) • Offering services for …. – Managing (chronic) illness (COM-4) – Developing healthy lifestyles (COM-5) • Participating in general health promoting community development (COM-6) • BECAUSE: All these factors do affect community health 12 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien at the Institute for Sociology, University of Vienna Sponsored by Federal Ministry for Health and Women Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona

Overview: 18 HPH Strategies HP for. . . HP by. . . Patients Staff MIT-1 Community REG-1 Supported by: Self-reproduction Co-production Lifestyledevelopment Regional development STA-1 COM-1 PAT-2 STA-2 COM-2 Quality development Settingsdevelopment Illnessmanagement PAT-1 PAT-3 PAT-4 STA-3 COM-3 STA-4 COM-4 Strategic -orientation PAT-5 STA-5 COM-5 PAT-6 STA-6 COM-6 at the Institute for Sociology, University of Vienna Sponsored by Federal Ministry for Health and Women re 13 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien Ludwig Boltzmann. Institute for the Sociology of Health and Medicine Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona

Recommendations • All 18 strategies are relevant for increasing health gain attributable to a hospital • There is evidence for the effectiveness of each of them, although on different levels, and there are models of good practice • Independent from the specific health care systems, the 9 quality development strategies are relevant for all hospitals • But, it depends of the situation of a hospital and its (health policy) environments in which strategies to invest for strategic reorientation • Implementation in a concrete hospital will need to be based upon an assessment of status quo on deficits and opportunities for implementation 14 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien Supported by: Ludwig Boltzmann. Institute for the Sociology of Health and Medicine at the Institute for Sociology, University of Vienna Sponsored by Federal Ministry for Health and Women Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona

Putting Strategies into Action Implementation by … • Specific measures (following best available evidence, principles of project management, standards, . . . ) • Selected thematic policies on specific topics Supported by: Ludwig Boltzmann. Institute for the Sociology of Health and Medicine at the Institute for Sociology, University of Vienna Sponsored by Federal Ministry for Health and Women – population oriented – Lifestyle oriented – Settings oriented Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona • Introducing a comprehensive HP (quality) Management System 15 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien

List of Criteria for an HP (quality) Management System - Outcome Supported by: • HP outcomes have to be explicitly defined by Ludwig Boltzmann. Institute for the Sociology of Health and Medicine – – goals, criteria, targets standards indicators at the Institute for Sociology, University of Vienna Sponsored by Federal Ministry for Health and Women • So that HP outcomes can be regularly observed, monitored, documented, evaluated, reported and improved • This has to be done as well for HP relevant structures, processes and quality monitoring 16 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona

List of Criteria for a HP (Quality) Management System - Structure • • • HP as explicit aim and value in mission statement of the hospital Strategic HP policy document, specifying aims, goals, targets and strategies and specific policies Annual HP action plan Budget ear-marked for HP HP quality management structure – – – • Supported by: Ludwig Boltzmann. Institute for the Sociology of Health and Medicine at the Institute for Sociology, University of Vienna Sponsored by Federal Ministry for Health and Women Co-ordinated by: steering committee manager/ team network of focal points in all sub-units of hospital World Health Organization European Office for Integrated Health Care Services, Barcelona HP organisational manual 17 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien

List of Criteria for a HP (Quality) Management System - Processes • Inform and involve hospital leadership and staff in HP communication (health circles, employee suggestion system, news-letters, annual presentations, forum on website) • Include/ develop specific HP criteria/ HP sub-guidelines in all guidelines/ protocols of the hospital • Regularly provide HP education and training for staff and leadership • Regularly implement HP measures/ policies (by HP projects) • Regularly monitor, evaluate, report HP relevant outcomes and impacts, structures and processes (by surveys, balanced score card, reporting) • Involve hospital in healthy alliances and partnerships with other partners in local community 18 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien Supported by: Ludwig Boltzmann. Institute for the Sociology of Health and Medicine at the Institute for Sociology, University of Vienna Sponsored by Federal Ministry for Health and Women Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona

Opportunities to get into action. . . Supported by: . . . at the conference: • Panel discussion following these presentations • Specific Workshop „Putting HPH Policy into action“: Monday, May 19, 16. 30 -18. 00. . . in the web: • Working group paper for download at: www. univie. ac. at/hph/florence 2003/htm/ proceedings. htm Feedback welcome to: • hph. soc-gruwi@univie. ac. at Ludwig Boltzmann. Institute for the Sociology of Health and Medicine at the Institute for Sociology, University of Vienna Sponsored by Federal Ministry for Health and Women Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 19 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien

References Supported by: • Bauchemin K. M. , Hays P. (1998): Dying in the dark: Sunshine, gender and outcomes in myocardial infarctions. In: Journal of the Royal Society of Medicine. Vol. 91, No. 7, 352 -354 • Di Blasi Z. ; Harkness E. ; Ernst E. ; Georgiou A. ; Kleijnen J. (1999): Health and patient-practitioner interactions: a systematic review. University of York • Michie / Williams 2002: „Reducing work related psychological ill health and sickness absence: a systematic literature review“ in: Occupational and Environmental Medicine • Rootman I. ; Goodstadt M; Hyndman B. ; Mc. Queen D. ; Potvin L. ; Springett J. ; Ziglio E. (2001): Evaluation in health promotion: principles and perspectives. Copenhagen: WHO 20 11 th International Conference on HPH Florence, Italy, May 18 -20, 2003, Wien Ludwig Boltzmann. Institute for the Sociology of Health and Medicine at the Institute for Sociology, University of Vienna Sponsored by Federal Ministry for Health and Women Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona