Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 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 Putting Health Promoting Hospital policy into action: Results of a WHO working group Jürgen M. Pelikan WHO Collaborating Centre for Health Promotion in Hospitals and Health Care Supported by Christina Dietscher, Karl Krajic, Peter Nowak, Thomas Stidl

Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 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 11th International Conference on HPH Florence, Italy, May 18-20, 2003, Wien 2 Members of the WHO Working Group 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 McCartney (LondonDerry), Jürgen M. Pelikan (Vienna, co-ordinator), Yannis Tountas (Athens)

Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 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 11th International Conference on HPH Florence, Italy, May 18-20, 2003, Wien 3 Aim of the Working Group To develop recommendations for translating health promotion policy into action at hospital level

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

Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 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 11th International Conference on HPH Florence, Italy, May 18-20, 2003, Wien 5 Health Promotion Principles –Empowering –Participatory –Holistic (physical + psychological + social), –Intersectoral –Equitable –Sustainable –Multistrategy (Rootman et.al. 2001)

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

Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 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 11th International Conference on HPH Florence, Italy, May 18-20, 2003, Wien 7 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

Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 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 11th International Conference on HPH Florence, Italy, May 18-20, 2003, Wien 8 Health Promotion for Patients (I) 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.

Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 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 11th International Conference on HPH Florence, Italy, May 18-20, 2003, Wien 9 Health Promotion for Patients (II) More health gain by improving health impact through … –developing the hospital into a less dangerous and more supportive setting (PAT-3) 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 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 11th International Conference on HPH Florence, Italy, May 18-20, 2003, Wien 10 Health Promotion for Patients (III) 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

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

Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 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 11th International Conference on HPH Florence, Italy, May 18-20, 2003, Wien 12 Health Promotion for the Community 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

Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 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 11th International Conference on HPH Florence, Italy, May 18-20, 2003, Wien 13 Quality development Self-repro- duction Co-production Settings- development Strategic re-orientation Illness- management Lifestyle- development Regional development PAT-1 PAT-2 PAT-3 PAT-4 PAT-5 PAT-6 MIT-1REG-1 COM-2 COM-3 COM-4 COM-5 COM-6 STA-2 STA-3 STA-4 STA-5 STA-6 PatientsStaff Community HP for... HP by... Overview: 18 HPH Strategies STA-1COM-1

Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 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 11th International Conference on HPH Florence, Italy, May 18-20, 2003, Wien 14 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

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

Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 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 11th International Conference on HPH Florence, Italy, May 18-20, 2003, Wien 16 List of Criteria for an HP (quality) Management System - Outcome HP outcomes have to be explicitly defined by –goals, –criteria, targets –standards –indicators 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

Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 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 11th International Conference on HPH Florence, Italy, May 18-20, 2003, Wien 17 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 –steering committee –manager/ team –network of focal points in all sub-units of hospital HP organisational manual

Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 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 11th International Conference on HPH Florence, Italy, May 18-20, 2003, Wien 18 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

Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 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 11th International Conference on HPH Florence, Italy, May 18-20, 2003, Wien 19 Opportunities to get into action at the conference: Panel discussion following these presentations Specific Workshop „Putting HPH Policy into action“: Monday, May 19, in the web: Working group paper for download at: proceedings.htm Feedback welcome to:

Co-ordinated by: World Health Organization European Office for Integrated Health Care Services, Barcelona 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 11th International Conference on HPH Florence, Italy, May 18-20, 2003, Wien 20 References 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, 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.; McQueen D.; Potvin L.; Springett J.; Ziglio E. (2001): Evaluation in health promotion: principles and perspectives. Copenhagen: WHO