Health Promoting Hospitals: Trends and Developments in Europe Shanghai International Forum on Health

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Health Promoting Hospitals Trends and
Developments in EuropeShanghai International
Forum on Healthy Cities20-22 November 2005
Shanghai China

• Jürgen M. Pelikan
• Professor Director,
• WHO-CC for Health Promotion in Hospitals Health
  Care,
• Ludwig Boltzmann Institute for the Sociology of
  Health Medicine,
• University of Vienna
• juergen.pelikan_at_univie.ac.at

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Overview

• A Working Definition of a HPH
• Development of HPH vision/ mission/concept
• Development implementation of HPH by model
  pilot projects
• Networks Media for continuously sharing
  experiences on HPH
• HPH and Quality
• HPH and Healthy Cities
• Possible Futures of HPH

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1. A Working Definition of a Health Promoting
Hospital
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How to define a Health Promoting Hospital?

• A health Promoting Hospital is a hospital that
• reorients its (quality-) management at the
  systematic comprehensive achievement
• of optimal physical mental social health gain
  (i.e. reduction of ill health increase of
  positive health), attributable to the hospital,
• measured as clinical outcome quality of life
  personal satisfaction health literacy impact
  on health,
• for patients staff citizens of the community,
  
• using strategies of HP quality management HP
  strategic (re-) positioning of the hospital
• by developing services to empower persons for
• HP self management of living
• HP co-production in services
• HP illness management
• HP lifestyle development
• by creating more HP supporting hospital
  community settings.

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How physical, mental social health is
reproduced related?
Prevention
Promotion
C U L T U R A L E N V I R O N M E N T
Mental Health
M AT E R I A L E N V I R O N M E N T
S O C I A L E N V I R O N M E N T
Individualbehavior/ action
Physical Health
Social Health
Prevention
Prevention
Promotion
Promotion
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Four Strategies for influencing health
Strategy oriented at
Specific diseases
Positive health
Improving health
Treatment of disease
Health development
Preserving health
Disease prevention
Health protection
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What does it mean to integrate HC HP? Adding
Three HP Strategies to Health Care
Strategy oriented at
Specific diseases
Positive health
Improving health
Treatment of disease
Health development
Preserving health
Disease prevention
Health protection
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What does it mean to integrate HC HP?Reentry
of the Four in Treatment of Disease
Strategy oriented at
Specific diseases
Positive health
Improving health
Treatment of disease
Health development
Preserving health
Disease prevention
Health protection
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Why integrating Health Promotion Health Care?

• Why HP into hospitals?
• EU countries spend nearly 10 of their GNP for HC
• Hospitals consume between 40-70 of national HC
  expenditure
• 1-3 of working population is occupied by
  hospitals, which are hazardous workplaces
• Up to 20 of population come into contact with
  hospitals as patients every year, in a situation
  of a health crisis
• Hospitals have relevant knowledge about
  population health its determinants
• Hospitals are important buyers of products
  services on the market
• Hospitals ecologically are high energy material
  consumers high waste producers

• Why hospitals for HP?
• Hospitals have to deal with an aging patient
  population with chronic diseases
  multi-morbidity
• Hospital staff is aging, too
• Some hospitals are competing for staff (magnet
  hospitals)
• Hospitals are under pressure for better quality
  cost containment
• Clinical staff wants better outcomes, but by
  evidence based interventions
• Some hospitals are competing for patients
  (patient-centered hospitals)
• Hospital management wants to improve prestige of
  hospitals
• Some hospitals are expected to provide better
  contributions to population health

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2. Development of a Mission/ Vision/ Concept for
HPH
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1986 Ottawa Charter for Health Promotion
5. REORIENT HEALTH SERVICES The role of the
health sector must move increasingly in a health
promotion direction, beyond its responsibility
for providing clinical and curative services.
This must lead to a change of attitude and
organization of health services, which refocuses
on the total needs of the individual as a whole
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1991 Budapest Declaration on Health Promoting
Hospitals
This Declaration has been issued at the1st
Business Meeting of the International Network of
HPH in Budapest. It adopts a comprehensive
vision of the health promoting hospital. The
document consists of two parts Part 1 Content
and Aims for hospitals participating in HPH Part
2 17 criteria to be fulfilled by hospitals
participating in HPH.
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1996 Ljubljana Charter on Reforming Health Care
The Ljubljana Charter was issued in June1996 with
the approval of the health ministers, or their
representatives, of the Member States of the WHO
European Region. The Charter addresses health
care reforms in the specific context of Europe
and is centered on the principle that health care
should first and foremost lead to better health
and quality of life for people.
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1997 Vienna Recommendations on Health Promoting
Hospitals
Based on the Ottawa Charter, the Budapest
Declaration the Ljubljana Charter as well as
the experiences of the European Pilot Hospital
HPH project a new mission statement was
launched. It defined six fundamental principles
four general strategies for implementation
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2004 18 HPH Core Strategies www.hph-hc.cc/
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2005 Standards for Health Promoting
Hospitalshttp//www.euro.who.int/document/e82490.
pdf
An international working group Standards for
Health Promotion in Hospitals developed from
2001-2005five standards 1 Management Policy 2
Patient Assessment 3 Patient Information and
Intervention 4 Promoting a Healthy
Workplace 5 Continuity and Cooperation with 24
sub-standards indicator sets.
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3. Development Implementation of HPH by Model
Pilot Projects
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The Vienna WHO-Model Project "Health and
Hospital" (1989-1996)

• Partners WHO-EURO, City of Vienna,
  Rudolfstiftung Hospital a scientific institute
  LBISHM
• Organizational development project with 12
  subprojects dealing with specific issues
• AimKnowledge production by documentation,
  evaluation, handbooks
• Initiated supported start of international HPH
  network, EPHP of HPH, Austrian HPH network,
  Vienna information network on HPH

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European WHO-Pilot Hospital Project on Health
Promoting Hospitals (1993-1997)

• Partners WHO-EURO, 20 hospitals from 12 European
  countries scientific institute
• These hospitals together invested in a
  benchmarking project to develop into more HP
  organizations, by doing patient, staff
  community oriented HP initiatives
• By documenting, evaluating publishing their
  cases they provided experience, knowledge and
  evidence as models of good practice of HPH.
• Based on the evaluation of the project the
  Budapest declaration on HPH was revised
  developed into the Vienna Declaration on HPH
• Pilot Hospitals were and are actively involved in
  setting up and supporting regional/national
  networks of HPH hosting conferences

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Publications on results of the project

• Pelikan,Jürgen M. Garcia-Barbero,Mila
  Lobnig,Hubert Krajic,Karl (Edt.) 1998 Pathways
  to a health promoting hospital. Experiences from
  the European Pilot Hospital Project 1993-1997. G.
  Conrad Health Promotion Publications
  Werbach-Gamburg
• http//www.euro.who.int/Document/IHB/hphseriesvol2
  .pdf
• Pelikan,Jürgen M. Krajic,Karl Lobnig,Hubert
  (Edt.) 1998 Feasibility, Effectiveness, Quality
  and Sustainability of Health Promoting Hospital
  Projects. Proceedings of the 5th International
  Conference on Health Promoting Hospitals. G.
  Conrad Health Promotion Publications
  Werbach-Gamburg
• http//www.euro.who.int/Document/IHB/hphvienna1997
  .pdf

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4. Networks Media for continuously sharing
experiences
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An international WHO Network of HPH

• 1988 WHO Copenhagen Consultation
• 1990 Network as Multi action plan of Healthy
  Cities, supported by WHO with LBISHM as
  coordinating center secretariat
• 1998 coordinated by WHO Barcelona Center
  supported by LBISHM as WHO-CC
• 2004 Copenhagen WHO-CC for evidence based HP in
  hospitals
• 2005 New steering committee of HPH-NW

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Annual International HPH Conferences 1993-1999

• Warsaw, Poland, April 30-May02, 1993
  "Establishing New Structure of the Network The
  European Pilot Hospital Project Tobacco-Free
  Hospitals
• Padova, Italy, April 15-16, 1994 "Developing
  Health Promoting Organizations by Strenghtening
  Intersectoral and Community Action. Healthy
  Nutrition Policies for Hospitals"
• Linkoping, Sweden, June 1-June 2, 1995 "Health
  gain Measurements as a Tool for Hospital
  Management and Health Policy"
• Londonderry, UK - Northern Ireland, April
  18-April 19, 1996 "Health Promoting Hospitals A
  Vision for Develpment in Times of Change"
• Vienna, Austria, April 16-April 19, 1997 "From
  Projects to Networks Effectiveness, Quality
  Assurance and Sustainability of Health Promoting
  Hospitals Projects"
• Darmstadt, Germany, April 29-May 2, 1998 "Health
  Promoting Hospitals Healthy Workplace, Clinical
  Centre of Excellence, Partner for Comprehensive
  Care, Ally for Public Health Health Promoting
  Psychiatric Hospitals"
• Swansea, Wales, April 21-23, 1999 "Health
  Promotion and Quality Challenges and
  Opportunities for Health Promoting Hospitals"

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Annual International HPH Conferences 2000-2005

• Athens, Greece, June 14 - 16, 2000 "The Health
  Promoting Hospital in the 21st Century -
  Challenges and Opportunities, Strategies and
  Scenarios for Patients, Staff, Communities and
  the Hospital as an Organisation"
• Copenhagen, Denmark, May 16 -18, 2001 "Health
  Promoting Hospitals in a National Health Policy
  Perspective Evidence in Health Promotion"
• Bratislava, Slovakia, May 15-17, 2002 "The
  contribution of HPH to reorient health
  servicesImproving health gain by developing
  partnerships and quality"
• Florence, Italy, May 18-20, 2003 "Reorienting
  hospitals for better health in Europe New
  governance, patient orientation and cultural
  diversity in hospitals"
• Moscow, Russian Federation,May 26-28, 2004
  "Investing in health for the future Positioning
  health promotion in care provision supporting
  effective implementation"
• Dublin, Ireland, May 18-20, 2005 "Empowering for
  health Practising the principles
• Palanga, Lithuania, May 24-26, 2006 Integrating
  health promotion, prevention, treatment and care
  for chronic diseases across the health system
  www.univie.ac.at/hph/palanga2006.

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Newsletter of the HPH network twice a year since
1993

• The WHO Collaboration Centre scientifically edits
  the "Health Promoting Hospital Newsletter
• It is published semi-annually on the web.
• The Newsletter aims at providing information
  about HPH concept developments, models of good /
  innovative HPH practice, developments in the
  national / regional networks of HPH and network
  events .

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Foundation of Regional/National Networks of HPH

• Since 1995 a policy of establishing national and
  regional Networks in the context of the
  international HPH network
• 1996 EU sponsored workshop supporting this policy
• Presently 38 national/regional networks in 25
  European countries
• Somewhat different policies concerning
  accreditation, but member hospitals, national
  conferences, NL etc. is a common feature
• Annual international workshop of coordinators

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HPH outside Europe

• Australia
• Canada
• Thailand
• South Africa
• Etc.

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International Task Forces Working Groups

• 1994- TF Smoke-free Hospitals
• 1998- TF Health Promoting psychiatric services
• 2001- WG Putting HPH policy into action
• 2001- WG Standards for Health Promotion in
  Hospitals
• 2003- TF Health Promotion for children and
  adolescents
• 2004- TF Migrant-Friendly hospitals
• 2005- Mental Health Promotion in Hospitals

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Website of HPH WHO Europehttp//www.euro.who.int/
healthpromohosp
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Online project databasehttp//data.euro.who.int/h
ph/
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5. Development of HPH by Quality Management
Projects
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7 HPQM Strategies for Implementing the
Comprehensive Concept of HPH, Following
Donabedians Approach
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European Foundation for Quality Management (EFQM)
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The Integration of the HPH Concept into the EFQM,
by WHO Pilot Project Berlin (2001-)
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Balanced Scorecard
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Balanced Scorecard Example for a HPH Strategy
Map, WHO Pilot Project Berlin
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EFQM and BSC Two complementary models, (Brandt
et al. 2005)
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6. HPH and Healthy Cities
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Healthy Cities HPH HPH Healthy Cites

• From the Beginning many Healthy Cities were
  supportive to HPH
• The WHO model project started in a healthy city
  -Vienna
• Healthy Cities Project of WHO-Euro hosted the HPH
  network as a Multi City Action Plan
• Many of the European Pilot Hospital Project
  Partner hospitals came from healthy cities
• Several International HPH conferences were hosted
  by healthy cities
• In the future every Healthy City should include a
  Health Promoting Hospital health care program
  to really be a comprehensive Healthy City!

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7. Possible Futures of HPH
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Lessons to be learned

• There is no comprehensive model of a Healthy City
  without integrating systematic HPH programs
• But, HPH has to be developed further into the
  direction of HP Health Care Services
• HPH to be sustainable, has to become an integral
  part of hospital management of quality
  management
• Management of Healthy Cities as a meta-setting
  can learn from the specific experiences of
  managing HPH by using specific instruments of
  standardisation integrated management

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Further information

• WHO-Collaboration Centre for Health Promotion in
  Hospitals and Health Care
• http//www.hph-hc.cc/
• Groene, Oliver Garcia-Barbero, Mila (eds.)
  Health Promotion in Hospitals Evidence and
  Quality Management, WHO Regional Office for
  Europe, May 2005
• juergen.pelikan_at_univie.ac.at