1 Health Promoting Hospitals Development and Challenges Oliver Gröne, Technical Officer Health Services WORLD HEALTH ORGANIZATION European Office for Integrated Health Care Services Barcelona, Spain

2  What is a health promoting hospital?  Why is/was it necessary to have a programme like this?  What are the principles and strategies of HPH?  What have been the main developments in the last ten years?  What are the future challenges for HPH? Outline of the presentation

3 What is a HPH? The aim of a health promoting hospital is: to provide high quality comprehensive medical and nursing services, to develop a corporate identity that embraces the aims of health promotion, to develop a health promoting organizational structure and culture and to develop itself into a health promoting physical environment that actively cooperates with its community. (WHO HPH Infopackage 2001)

4 Why hospitals?  Prevalence of chronic disease and quality-of- life enhancing treatments  Enhance health literacy  Hazardous working conditions in hospitals  Reduce risks and improve working conditions  Production of waste and hazardous substances  Ecological approach towards waste, energy management  Hospitals as knowledge-organizations  Intersectoral development of HP activities for community orientation

5 What is a HPH?

6  Shared responsibility [...] to work together towards a health care system which contributes to the pursuit of health;  A move of the health sector in a health promotion direction, beyond clinical and curative services;  A need of health services to embrace an expanded mandate which is sensitive and respects cultural needs;  A stronger attention to health research and professional education and training conducive to changes in the organization of health services... Ottawa Charter: Reorienting Health Services

7 Settings for health Health Promotion “is the process of enabling people to increase control over, and improve, their health.” “Health is created and lived by people within the settings of everyday life; where they learn, work, play, and love.” (WHO Ottawa Charter 1986)  Health Promotion not only has to address individual behavior, but underlying norms, rules and cultures.

8 “The Ottawa Charter for Health Promotion [...] included as one of the five components of health promotion action, the notion of reorienting health services. Since then... Little progress has been attained in defining an explicit, detailed and commonly agreed upon framework for implementing changes in a systematic fashion.” López-Acuña et al. 2000: Reorienting health systems and services. Fifth Global Conference on Health Promotion Progress since Ottawa?

9 Evolution of the HPH Network 1988:1 st International consultation on the possibility of Health promotion in and by hospitals 1989: WHO model project “Health and Hospital” with Rudolpfstiftung in Vienna, Austria 1990: Initiation of the International Network of Health Promoting Hospitals by WHO EURO 1993: Initiation of the European Pilot Hospital Project by WHO EURO ( , involving 20 hospitals in 11 countries) 1997: Subsequent development of national/regional networks

10 Distribution of HPH in Europe

“Establishing New Structures of the Network: The European Pilot Hospital Project & Tobacco-Free Hospitals” in Warsaw, Poland 1994“Developing HP Organizations by Strengthening Intersectoral and Community Action of Hospitals & Healthy Nutrition Policies for the Hospital”, Padova, Italy 1995“Health Gain Measurements as a Tool for Hospital Management and Health Policy”, Linköping, Sweden 1996“Health Promoting Hospitals: A Vision for Development in Times of Change”, Londonderry, Northern Ireland 1997“From Projects to Networks: Effectiveness, Quality Assurance and Sustainability of Health Promoting Hospital Projects”, Vienna, Austria 1998“Health Promoting Hospitals: Healthy Workplace, Clinical Centre of Excellence, Partner for Comprehensive Care & Ally for Public Health + Health Promoting Psychiatric Hospitals” Darmstadt, Germany International Conferences on HPH

“Health Promotion and Quality Challenges and Opportunities for Health Promoting Hospitals”, Swansea, Wales 2000“The Health Promoting Hospital in the 21st Century”, Athens, Greece 2001“Health Promoting Hospitals in a National Health Policy Perspective – Evidence in Health Promotion”, Copenhagen, Denmark, May “The contribution of HPH to reorient health services: Improving health gain by developing partnerships and quality”, May 15-17, Bratislava, Slovakia 2003“Re-orienting hospitals for better health in Europe: New governance, patient orientation and cultural diversity in hospitals” Florence, Italy International Conferences on HPH

13 Do we know if we are doing well?

14 Already in the 19th century, Florence Nightingale was concerned about the shortcomings of hospital information systems: “In attempting to arrive at the truth, I have applied everywhere for information, but in scarcely an instance have I been able to obtain hospital records fit for any purpose of comparison. If they could be obtained, they would enable us to decide many other questions besides the one alluded to.They would show subscribers how their money was being spent, what amount of good was really being done with it, or whether the money was not doing mischief rather than good.” (Nightingale 1863) Do we know if we are doing well?

15 Stage of HPH development (1/2) “... The settings approach to health promotion is about much more than introducing a variety of opportunities for individuals using the hospital to change their behavior.”* 1. Doing a health promotion project? 2. Delegating it to the role of a specific division, department or staff? 3. Being a health promoting setting? 4. Being a health promoting setting and improving the health of the community? * Johnson, A. & Baum, F. Health Promoting Hospitals: A Typology of different organizational approaches to health promotion. Health Promotion International 2001, 16, 3, motion International 2001, 16, 3,

16 Stage of HPH development (2/2) 1. Ad hoc projects: No re-orientation of whole organization or staff roles; Starting point when no support from senior management is available? 2. Specified department deals with HP, but it is not integrated into overall organization: Developmental phase or dead-end? 3. HP is cross-sectional issue in hospital: Hospital is HP setting, but rare community intervention. 4. Hospital takes overall responsibility for and improves community health: Vision or reality?

17  Systematic implementation of health promotion in hospitals?

18 Systematic implementation  Evidence-base for health promotion in hospitals  Comprehensive framework for HPH development  Standards for health promotion in hospitals  Health promotion and EFQM  Task force on Health Promoting Psychiatric hospitals  Task force on Health Promotion for Children and Adolescents  Reimbursement of health promotion activities

19

20

21