24 World Health • SOth Year, No. 3, Moy-June 1997
Health-promoting hospitals
Juergen Pelikan, Hubert Lobnig & Karl Kraiic
Started in 1988, the Heolth- Promoting Hospitals initiative hos now proved to be not only a vision but a concrete development strategy for hospitals of all types and sizes, in widely varying health core systems, mainly in
Europe.
hat role can the health care services play in supporting people to adopt healthy lifestyles and make their living environments more health-promot- ing? Medical services are usually busy providing curative care, and many health professionals are al- ready overworked. A growing population of elderly people, new diseases and epidemics, as well as technological innovation in diagno- sis and treatment, already face health workers with more than enough challenges and opportunities for taking appropriate and useful profes- sional action. The idea of health promotion is not to add to this bur- den but to ease it, and to improve the chances of effectiveness.
The Ottawa Charter for Health Promotion, issued in November 1986, focuses on political and inter- sectoral action for health but also asks for a reorientation of the health care sector itself towards health promotion. Actually putting this proposition into effect took some time to get started.
In 1988, a working group in the WHO Regional Office for Europe recommended focusing on the hospi- tal as the hub of the modern medical and health care system - a centre providing education, training and professional standards.
Staff, patients and members of the community con all contribute to making hospitals health- promoting Photo WHO/PAHO/A Waak
Later that year, WHO initiated a first demonstration project called
"Health and Hospital" at the Rudolfstiftung Hospital in Vienna, Austria.
During the next eight years, 12 sub-projects, mainly using existing know-how from health promotion and organizational development, were planned and carried out with the aim of improving the health of patients, hospital staff and the popu- lation in the community. The project also aimed at improving the overall organization of the hospital by focusing on effectiveness, quality, flexibility, staff commitment and becoming "a learning organization".
Evaluation showed that most of the measures taken were successful.
For example, the health of patients was promoted by reducing hospital infections through establishing a professional hygiene team. An educational programme became part of the standard treatment for diabet- ics. The quality of nursing services was improved by changing to team nursing on many wards. Staff satis- faction increased as a result of per- sonnel development projects, and this was reflected in a reduction of
staff turnover. The cooperative culture of the hospital changed significantly: all levels of staff actively participated in project groups composed of members from different units, professions and levels of the hierarchy. Opening the hospital towards the local commu- nity, on the other hand, proved more difficult for a big inner-city hospital without a defined catchment area.
The Budapest Declaration
The "Budapest Declaration on Health-Promoting Hospitals", worked out at a WHO meeting in 1991 by a multi-professional European group, presented a model for health-promoting hospitals.
Since then, many hospitals and other partners in Europe, as well as Australia, Canada and some other countries, have got involved. In 1993, the model was extended to 20 hospitals in 11 European countries, and pilot projects were started. All but one of the 20 hospitals have been successful in initiating health- promoting processes and maintain- ing them for four years.
World Health • SOth Year, No. 3, Moy-June 1997
By early 1997, 150 sub-projects, planned according to local needs and available resources, had been docu- mented. The majority were aimed at improving the health of patients, but almost half included activities aimed at improving the health of staff and of the population in the community, and at helping the hospital as a whole to develop into a "healthy organization". Most of these sub- projects were carried out within the normal hospital budget, relying to a large extent on voluntary work contributed by staff. Only 13 of them have had to be cancelled, and most of the others are now part of normal hospital routine. Detailed reports on these activities were presented at the fifth International Conference on Health-Promoting Hospitals, which was held in Vienna, from 16 to 19 April, 1997. The conference was organized by WHO in cooperation with the European Union and other partners, and was attended by 315 participants from 33 countries.
In 1995, a European Project of National and Regional Networks of Health-Promoting Hospitals (HPH) was initiated, and since then HPH networks have been set up in 15 European countries, as well as in Australia and Canada, with an in- creasing number of hospitals partici- pating. The HPH network is being coordinated by WHO and the Ludwig Boltzmann Institute for the Sociology of Health and Medicine, Vienna (sponsored by the Austrian Federal Ministry of Health).
What is a Health-Promoting Hospital?
When people first hear about
"health-promoting hospitals", there are usually two types of reaction.
The first is: "Of course every hospi- tal fights illness and is thus health- promoting in itself - what else should it do?" The second is almost the opposite: "Hospitals are full of sick and dying people. What a strange place to choose for health promotion!" The following points try to clear up these misconceptions by mentioning some of the more
important characteristics of such a hospital.
• A health-promoting hospital does not have to change its main functions, which in industrialized countries consist of combining
"high tech" with "high touch" in caring for patients, coordinating different professions and special- ties, managing crises and emo- tional stress, and performing reliably for 24 hours a day and 365 days a year. But such a hospital expands the scope of these activities and tries to keep them in a constructive longer- term perspective.
• A health-promoting hospital promotes patients' health by continuously improving and developing services, thus reduc- ing the risks involved in hospital stays and interventions. It im- proves patients' well-being by providing services in a humane, caring way in a health-promoting physical environment. Such a hospital also uses episodes of acute illness or injury as win- dows of opportunity to promote health, for instance by providing or organizing rehabilitation, and empowering patients to protect themselves against disease, cope with chronic illness, or make better use of primary health care services. Resources are allocated according to the potential health gain to be derived from the service in question.
The Vienna Model Hospital Rudolfstiftung.
Photo WHO/Ludwig Bolzmann Institute, Vienna
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• A health-promoting hospital pays attention to the health of its staff.
Awareness of biological, chemi- cal, psychosocial and other risks involved in hospital work leads to policies and measures aimed at reducing these risks and helping staff to fulfil their own health potential.
• A health-promoting hospital modifies its services to reduce risks for the community stem- ming from hazardous wastes such as radioactive, pharmaceuti- cal and biological materials. It networks with the relevant local services and associations to build alliances for continuous care and health promotion, thus becoming an agent for health development in the community.
• A health-promoting hospital is a
"healthy organization", which means it has effective manage- ment, active staff participation and an overall organizational culture which is "people- oriented". It uses effective organizational development techniques such as project man- agement, mission statements, quality management, expert support for change processes, and re-engineering of wards and functional units.
Health-promoting hospitals have already proved to be not only a vision but a concrete development strategy. The concept is being ap- plied in hospitals of all types and sizes and in widely varying health care systems. By taking a health promotion approach many hospitals have been discovering new opportu- nities for effective action and new ways to solve difficult problems.
Rather than facing them with a new challenge, health promotion is pro- viding them with fresh ways to tackle existing challenges. •
Professor juergen M. Pelikan is Director, Dr Hubert Lobnig and Dr Kori Kraiic are both Senior Scientists at the Ludwig Boltzmann Institute for the Sociology of Health and Medicine, WHO Collaborating Centre for Hospitals and Health Promotion,
Universitatsstrasse 7 /2, IOI O Vienna, Austria.
E-mail: hph.soc-gruwi@univie.ac.at
