1. The Tuscany HPH Network and Health Promotion in the conceptual framework of the Complexity Fabrizio Simonelli - Head, Health Promotion Program, ‘A.Meyer’ Hospital - Florence Paolo Morello Marchese - Co-ordinator, Tuscany HPH Network ‘A.Meyer’ Hospital - Florence The Tuscany HPH conceptual pathway HPH : a complex project Complexity & Health Promotion

2. COMMUNITY STAFF PATIENTS HPH A Health Promoting Hospital has to demonstrate to incorporate into its culture and daily work the idea of health promotion of its personnel, the patients and their families as well of the community. HPH project: aim Complexity

3. Complexity is the property of a real world system that is manifest in the inability of any one formalism being adequate to capture all its properties. (D.C. Mikulecky) Complexity & Health Promotion

4. Multiplicy of determinants Policies Investments Infrastructures 1. The SELF-ORGANISATION principle … to HEALTH PROMOTION Health needs Resources Norms Influences Health Care Services Health a system capable to get itself organized Complexity & Health Promotion From Health Care management…

5. POLICIES INVESTMENTS HEALTH COMMUNITY (values and capital) (effects act on causes) From linear conception … 2. The RECURSIVE principle : …...to circular framework INFRASTRUCTURE ( SERVICES & PROJECTS) Complexity & Health Promotion

6. HEALTH Scenarios Empowerment Co-operation with professionals Powerfullness HEALTH PROMOTION QUALITY ‘SERVUCTION‘ HEALTH CARE Dependence 3. The DIALOGIC principle: (the phenomena happen between two antagonist and complementar logics) Complexity & Health Promotion

7. CULTURE PROCESSES STRUCTURE 4. The HOLOGRAM principle: (the part is a share of the whole system, but also the whole is inscribed in the part: act on a single part means to change the whole system) HPH COMMUNITY DEVELOPMENT Complexity & Health Promotion

8. Self-organising principle Recursive principle Dialogic principle Hologram principle Action in the changing context Community Development Health EmpowermentDependence HPH Personal and Community Development Synthesis CONCEPTUAL FRAMEWORK

9. Learn and think does not mean to arrive at any absolutely certain truth, but it is to dialogue with the uncertainty and the error. ( E. Morin) The Tuscany HPH conceptual pathway

10. OPERATIVE level (Practical applications) METHODOLOGICAL level (Sistematic pathways) HPH PARADIGMATIC level (Inspirer principles and values) The Tuscany HPH conceptual pathway (1)

11. HEALTH PARADIGM The Tuscany HPH conceptual pathway (1) A) Health determinants multiciplity B) Semantic context C) Declination of the concept of the person’s centrality

12. HEALTH CARE SERVICES ENVIRONMENTAL FACTORS LIFESTYLES SOCIAL-ECONOMIC DEVELOPMENT STAGE DEMOGRAPHIC FACTORS EDUCATION CULTURAL FACTORS Determinants MASS MEDIA personal HEALTH factors PEACE Requirements A) The multiciplity of health determinants ECONOMIC FACTORS JUSTICE The Tuscany HPH conceptual pathway (1)

13. OTTAWA CHART (1986) general principles on health promotion BUDAPEST DECLARATION (1991) aims and criteria for Health Promoting Hospitals VIENNA RECOMMENDATIONS (1997) strategies for the implementation of the HPH project and acceptance modalities HEALTH PROMOTION GLOSSARY (1998) definition The Tuscany HPH conceptual pathway (1) B) The semantic context

14. Person’s centrality CARRIER OF DISEASES (PATIENT) CLIENT OF THE HEALTH CARE SERVICES PROTAGONIST OF HIS OWN HEALTH SOCIAL HEALTH ACTOR THERAPEUTIC BENEFITS QUALITY STANDARDS ASSURANCE HEALTH LITERACY AND HEALTHY LIFESTYLES RESOURCE FOR THE COMMUNITY Diagnostic- Therapeutic Activities Continuous Quality Improvement Health promotion C) Declination of roles, expectations, activities The Tuscany HPH conceptual pathway (1)

15. HEALTH PARADIGM The Tuscany HPH conceptual pathway (2) - Health determinants multiciplity - Semantic context - Declination of the concept of the person’s centrality New health governance: Outlines and Open methods (Integrated Health Plans, Health Societies) HEALTH METHODOLOGY

16. GOVERNMENT OF HEALTH SERVICES PERSONS AS PATIENTS AND CLIENTS NEW HEALTH GOVERNANCE Activities:DISEASE MANAGEMENT AND QUALITY IMPROVEMENT The philosophy: BOTTOM LINE PERSONS (and ASSOCIATIONS) AS PROTAGONISTS OF HEALTH Activities: HEALTH PROMOTION AND COMMUNITY DEVELOPMENT The philosophy: BEYOND BOTTOM LINE The Tuscany HPH conceptual pathway (2) FOCUS ON FINAL BALANCE FOCUS ON VALUES-GUIDE Outlines

17. HPH PLANNING SKILL HEALTH PARADIGM A) International Guidances B) Net work C) Project work New health governance: Outlines and Open methods (Integrated Health Plans, Health Societies): The Tuscany HPH conceptual pathway (3) A) Health determinants multiciplity B) Semantic context C) Declination of the concept of the person’s centrality HEALTH METHODOLOGY

18. Health Promoting Hospitals Development and Challenges WORLD HEALTH ORGANIZATION European Office of Barcelona Putting Health Promoting Hospital policy into action ‘L. BOLTZMANN‘ INSTITUTE for the Sociology of Health and Medicine of Vienna Network of Health Promoting Hospitals in Denmark Standards for Health Promotion in Hospitals The Tuscany HPH conceptual pathway (3) A) GENERAL AND SCIENTIFIC GUIDANCES:

19. Health Promoting Hospitals HP Schools Healthy Cities (other HP projects) LOCAL HEALTH PLANS B) OLONIC NETWORK (- increased knowledge - common orientation) Health Education Units The Tuscany HPH conceptual pathway (3)

20. SETTING cultural communicativeness organisational PROCESSES re-engineering innovation between: patients relatives professionals volunteers partners RELATIONS HEALTH GAIN HPH C) PROJECT WORK (3 levels) TRAINING RE-DESIGN STANDARDS The Tuscany HPH conceptual pathway (3)

21. SETTING COMMITTEE PRIORITY: (post-operation pain) PROTOCOLS PROCESSES DAILY PAIN MEASUREMENT AND TREATMENT COMPETENCES FOR THE STAFF ABILITIES FOR THE PATIENTS (pain meter) RELATIONS PAIN REDUCTION HPH PROJECT WORK (an example: Pain-free Hospitals) TRAINING RE-DESIGN STANDARDS The Tuscany HPH conceptual pathway (3)

22. Bibliografia: Dahlgren, G. and Whitehead, M (1992) Policies and Strategies to Promote Social Equity in Health, Stockholm; Institute of Future Studies, 1991 Eglier P.- Langeard E.: “Servuction – Le marketing des services” – McGraw-Hill, 1988 Ewles L., Simnet I.:” Promoting health – A practical guide” – Scutari Press, 1992 Morin E.: ‘La methode 5. L’Humanité de l’Humanité. Tome 1, L’identité humaine’, Editions du Seuil, 2001 Morgan G.: ‘ Images of organizations’, 1986 C. Piccardo: “Empowerment – Strategie di sviluppo centrate sulla persona” – R.Cortina Editore, Milano, 1995 Simonelli F.: ‘Promotori di salute, costruttori di pace’ - Janus – Medicina: cultura, culture - n. 9, Roma, 2003