1. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 1 Enabling hospitals to become empowering organizations – some observations from HPH networks Jürgen M. Pelikan (juergen.pelikan@univie.ac.at) Christina Dietscher Karl Krajic Hermann Schmied WHO-CC for Health Promotion in Hospitals and Health Care, Ludwig Boltzmann Institute for the Sociology of Health and Medicine, University of Vienna 13th International Conference on Health Promoting Hospitals, Dublin, May 20th 2005

2. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 2 Overview A framework Results from a last minute survey Conclusions

3. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 3 The settings approach of HPH – empowering people by enabling situations for HP behavior & action Health promoting behavior & action depends on … Structural factors Cultural factors People (patients, staff, Inhabitants) Situation of Hospital Peoples knowledge, skills & capacities Peoples preferences, attitudes & values Hospitals socio-material infra-structures & resources Hospitals cultural values, regulations & incentives

4. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 4 Internal and environmental preconditions for hospitals to implement Health Promotion Strategies Implementation of Health Promotion in hospitals depends on … Structural factors Cultural factors Hospital internal factors Environmental external factors (local, regional, national, international) Hospitals socio-material infra-structures & resources Hospitals culture (regulations & incentives) Environments socio-material infra-structures & resources Environments cultural values, regulations & incentives

5. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 5 The last minute survey Electronic questionaire Sample of national/ regional HPH network coordinators Response-rate: 19 out of 35, i.e. already more than 50%! Selected results

6. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 6 Question 1 How many hospitals do you have in your network … –a) …in absolute figures? –b) … in % of the total number of hospitals in your country/ region?

7. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 7 Hospitals in HPH-Network in % of the total number in country/region 00-010% 11-020% 21-050% 50-100% no data Questionnaire data of 19 countries / regions

8. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 8 Question 2 In general: According to your estimation, how supportive are the general political frameworks in your country or region for the implementation of HPH for … –Patients –Staff –Community Scale: –O, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 –Not at all supportive …… Very supportive

9. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 9 Supportiveness of political frameworks – estimated supportive/hindering conditions of implementation (19 countries / regions – 0 = not at all supportive, 10 = very supportive) Patient strategies Staff strategies Community strategies

10. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 10 Question 3 Specifically: How supportive or hindering for the implementation of HPH in your country / region would you qualify … –… the general political interest in health promotion in health care? –… the financial frameworks for health promotion in health care? –… the legal frameworks for hospitals in your country / region? –… the quality regulations for hospitals? –… the specific health promotion regulations?

11. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 11 How supportive or hindering for the implementation of HPH in you country / region would you qualify... the general political interest in health promotion in health care? supportive hindering  Specific objectives in the planning act  Increasing interest in the integration of HP in curative medicine  HPH is a strategic choice in the regional health plan  HP is a main goal of health policy  HP is included in the hospital quality policy  Positive trend in the society  Finances „short-time thinking“  Political focus on reform of the funding of the health care system/insurance system  Scare or factitious interest  Only on the paper  HP is synonym of „extra-hospital“  HP is delegated to health care system/insurance system

12. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 12 How supportive or hindering for the implementation of HPH in you country / region would you qualify... the financial frameworks in health promotion in health care? supportive hindering   Financial support is fragmented  HP not considered in hospital financing  No sufficient founds  Still very little money for prevention  DRG and acute matters win  Economic incentives still only according to productivity, and not to focused outcome  Inexistent, except for staff  Non-systematic

13. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 13 How supportive or hindering for the implementation of HPH in you country / region would you qualify... the legal frameworks for hospitals in your country? supportive hindering  Emphasis on managing clinical risk / liability  National targets including HP as one major strategy  Good support in fundamental documents  Quality act and new agreement on hospital financing  HP laws have passed during the past few years  Very poor  Non-systematic  Almost not existing  Must be evidenced for effect prior to implementation  Do not include HP

14. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 14 How supportive or hindering for the implementation of HPH in you country / region would you qualify... the quality regulations for hospitals? supportive hindering  HP considered in quality act  Aims of HPH are consistent with accreditation requirements  HPH membership considering in accreditation  Standards for HPH (joining with JCR standards)  Quality guidelines exist in all strategy plans  Quality regulations are under an intensive progress  Quality evaluation including HP standards  Shortage of resources  Not well developed, except for specific approach (nosocomial infections control)  Are not yet linked to HP – hospitals are using different systems

15. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 15 How supportive or hindering for the implementation of HPH in you country / region would you qualify... the specific health promotion regulations? supportive hindering  „Health Plans are projects that each health board is required to carry out together with the local communities  Guidelines  Assessment against public health standards  Does not exist  Still too few  Not for hospitals  No overt incentive to being a HPH

16. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 16 Question 4 How do you assess the feasibility to implement the 6 Core HPH Strategies … –… for Hospital Patients? –… for Hospital Staff? –… for the Hospital Community? Scale: 0 ….10 (hardly ….totally feasible) What are the most supportive / hindering conditions for this strategy in your country? Are there specific examples of “best practice” for this strategy in your country/ region?

17. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 17 HP by... HP for... HP strategic (re-)positioning HP quality development 1. Enabling for HP self manage- ment in living 3. Development of a HP hospital setting 4. Enabling for HP illness management 5. Enabling for HP lifestyle development 2. Enabling for HP co-production of health 6. Development of a HP community setting 18 HPH strategies – estimated feasibility to implement Patients StaffCommunity PAT-1 : 5,63 HP living in the hospital for patients PAT-2: 5,74 HP Co-production of patients in treatment PAT-3: 5,74 HP hospital setting for patients PAT-4: 6,83 HP illness management for patients PAT-5: 5,63 HP lifestyle development for patients PAT-6: 5,16 HP community setting for patients COM-2: 6,00 HP Co-production with services in region COM-3 : 6,00 HP hospital setting for citizens COM-4: 6,00 HP illness management for citizens COM-5: 5,67 HP lifestyle development for citizens COM-6: 5,28 HP community setting for citizens STA-2: 5,58 HP Co-production of staff in work processes STA-3: 6,24 HP hospital setting for staff STA-4: 5,50 HP illness management for staff STA-5: 5,63 HP lifestyle development for staff STA-6: 4,42 HP community setting for staff STA-1: 5,32 HP work life in the hospital for staff COM-1: 6,50 HP access to the hospital for citizens 5,82 5,77 5,99 6,11 5,64 4,95 5,775,415,90 _x_x _x_x 5,68

18. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 18 x = 5,90 Ranking of 18 HPH strategies - estimated feasibility of implementation (average above 19 countries/regions – 0 = hardly feasible, 10 = totally feasible) x = 5,77 x = 5,41 Patient strategies Staff strategies Community strategies

19. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 19 Is there a correlation between estimated supportiveness of conditions & estimated feasibility of implementation?

20. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 20 0 1 2 3 4 5 6 7 8 9 10 10 9 8 7 6 5 4 3 2 1 0 estimated supportiveness of political frameworks estimated feasibility of implementation of patient strategies (average for 6) Correlation: supportiveness of frameworks & feasibility of PATIENT strategies AT BE ENLT SK SE FIEM NO EENL LO PL DE CH r = 0.63 EL RU TRNIR

21. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 21 0 1 2 3 4 5 6 7 8 9 10 10 9 8 7 6 5 4 3 2 1 0 ATBELTSK SE FI EM NOEE NL LO PL DE CH r = 0.33 EN EL estimated supportiveness of political frameworks estimated feasibility of implementation of staff strategies (average for 6) RU Correlation: supportiveness of frameworks & feasibility of STAFF strategies TRNIR

22. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 22 0 1 2 3 4 5 6 7 8 9 10 10 9 8 7 6 5 4 3 2 1 0 AT BE LT SK SE FI EM NOEE NL LO PL DE r = 0.61 EN EL estimated supportiveness of political frameworks estimated feasibility of implementation of community strategies (average for 6) RU Correlation: supportiveness of frameworks & feasibility of COMMUNITY strategies TRNIR

23. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 23 Internal and environmental supporting preconditions for implementing Health Promotion in hospitals Implementation of Health Promotion in hospitals depends on … Structural factors Cultural factors Hospital internal factors Environmental factors (local, regional, national, international) HP- & Q-expert infra- structures as part of integrated management system and HP- & Q- knowledge, human & financial resources Explicit HP- & Q- values in mission statement, strategic policies, service protocols, guide lines etc. Professional HP & Q tools, knowledge centres & infra- structures for exchange & financial resources for HP- & Q- structures & services Political, legal, profession. & customer expectations for HP & Q structures, processes, outcomes & impacts; with incentives

24. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 24 What can we do to improve the implementation of HPH in Europe? Further … analyse the regional / national / European situation develop the HPH case for relevant stakeholders develop tools for implementation in everyday practice communicate the case and tools effectively to the relevant publics, build alliances lobby for supportive legal, institutional, financial frameworks for quality and HP on local, regional, national & European level

25. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 25 Questionnaire – 19 countries /regions ATAustria BEBelgium CHSwitzerland DEGermany EEEstonia ELGreece EMEmilia Romagna (Italy) ENEngland (UK) FIFinland LOLombardia (Italy) LTLithuania NIRNord Irland (UK) NLNetherlands NONorway PLPoland RURussia SESweden SKSlovakia TRTrentino (ITALY Missing from HPH Belgium Flemish Community Bulgaria Canada Denmark France Hungary Ireland Israel Piemonte (Italy) Veneto (Italy) Liguria (Italy) Toscana (Italy) Kazakhstan Portugal Welsh national Network (UK)

26. Scientifically and technically supported by WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at Ludwig Boltzmann Institute for the Sociology of Health and Medicine at University of Vienna Supported by Federal Ministry of Health and Women Coordinated by World Health Organization, European Office for Integrated Health Care Services, Barcelona Health Promoting Hospitals 26 External actors & stakeholders relevant for implementation of HP in hospitals Hospital Owners Management Staff Health Care / Social Policy Financing Systems User Expectations (Media) Professional Education & Associations Public Health Policy Regional / National HPH Network