Health Promotion International Advance Access originally published online on April 6, 2005
Health Promotion International 2005 20(2):205-207; doi:10.1093/heapro/dah613
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COMMENTARY |
Evaluating the progress of the Health Promoting Hospitals Initiative? A WHO perspective
Commentary on: Whitehead, D. (2004) The European Health Promoting Hospitals (HPH) project: how far on? Health Promotion International, 19, 259–267.
World Health Organization, European Office for Integrated Health Care Services, Barcelona, Spain
Address for correspondence: Mr Oliver Grone, MA, MPH, Technical Officer Health Services, WHO European Office for Integrated Health Care Services, Marc Aureli 22–36, E-08006 Barcelona, Spain E-mail: ogr{at}es.euro.who.int
Key words: health promotion; hospitals; programme evaluation; standards
We have read with interest the contribution of Dean Whitehead on ‘The European Health Promoting Hospitals (HPH) project: how far on?’ in a recent issue of Health Promotion International (Whitehead, 2004
). He points out some of the issues the HPH movement has faced over the years that are linked to the inherent difficulties in changing the behaviour of organizations. However, we would like to clarify a number of points.
Dean Whitehead's article aims ‘to investigate the nature and progress of the European HPH movement’ and he concludes that ‘the majority of the available literature demonstrates a more limited impact than perhaps the World Health Organization (WHO) might have anticipated for its efforts over the last 15 years or so’. In his assessment of the progress of the HPH network, Whitehead states that there is a general lack of literature on HPH activities. Indeed, a lot of the information on HPH is not retrievable through a MEDLINE search, but extensive information is available through literature published in national journals or as internal reports, databases and progress reports presented at annual coordinator workshops.
The WHO-coordinated HPH network is a ‘network of networks’ that sets the agenda for strategic development, plans annual international conferences, technical working groups and thematic networks, and facilitates contacts between members of the network. Most of the activities of the network are at regional or national network level, or indeed at hospital level, and evaluations of these activities are frequently published in the vernacular language. The author refers to a selection of European HPH member-states' website addresses (from England, the Russian Federation, Sweden, Germany, Denmark, Estonia, Lithuania, Poland and Slovakia) but does not comment on the information contained in these pages. For example, in 2004:
- the HPH network in the Russian Federation organized the 12th International Conference on HPH in Moscow (12th International Conference on Health Promoting Hospitals);
- the German HPH network presented the results of a pilot project to introduce health promotion values into hospital culture and structure through the quality management model of the European Foundation for Quality Management (EFQM). Furthermore, it cooperated in the development of an MBA degree in health management (German Network of Health Promoting Hospitals: http://www.dngfk.de/);
- a new WHO Collaborating Centre on ‘Evidence- based Health Promotion in HOSPITALS’ was established in Denmark and is preparing to offer the first summer school in clinical health promotion (WHO Collaborating Centre on Evidence-based Health Promotion in Hospitals: http://clinicalhealthpromotion.dk/);
- the Italian HPH network expanded its activities and established regional networks in the region of Venice and Vall D'Aosta (Italian Network of Health Promoting Hospitals: http://www.retehphitalia.it/); and
- the Czech, Swedish, Lithuanian and Slovak networks of HPHs participated in the pilot implementation of standards and indicators for health promotion in hospitals.
The developmental phase of the HPH initiative has been documented in three volumes, edited by the WHO Collaborating Centre for Health Promotion in Hospitals and Health Care (http://www.hph-hc.cc/), WHO and network coordinators (Pelikan et al., 1998a; Pelikan et al., 1998b; Berger et al., 1999). In 2001, WHO started to assess systematically the progress of national and regional HPH networks, and projects and activities at the level of hospitals. A standardized template was developed to gather information on the state of development of the network, on activities, and on strategic factors for further development (Grone, 2001), some of which are publicly available (Annual Health Promoting Hospitals Networks Progress Reports). Information on activities and projects at hospital level are registered in the WHO Health Promoting Hospitals Database, full access to which is restricted to HPH members (http://data.euro.who.int/hph/).
In addition to networking and conferences, the WHO coordinates a number of technical activities through working groups, as detailed below (this information was not available on the Internet at the time D. Whitehead accessed our webpages).
- Working group on standards and indicators for health promotion in hospitals: information on the developmental process and the final set of standards has been published (Grone, 2003; Grone and Jorgensen, 2003; WHO, 2003). Quality agencies have begun to incorporate the WHO standards in national accreditation systems, affecting all hospitals seeking accreditation by the relevant agency.
- Working group to develop a policy framework for the evaluation of health promotion in hospitals: the working group has published a discussion paper on strategies to implement health promotion activities in hospitals [Putting HPH Policy into Action (working paper: http://www.hph-hc.cc/Downloads/HPH-Publications/Working-Paper-HPH-core-strategiesdraft040518.doc)].
- Working group on developing a coding scheme for the reimbursement of health promotion activities in hospitals: preliminary work has been carried out and the working group is currently preparing an international pilot test (Grone et al., 2004).
- Working group on health promotion for children and adolescents in hospitals: this working group aims to identify best health promotion strategies for hospitalized children (Health Promotion for Children and Adolescents in Hospital).
Moreover, two WHO Collaborating Centres were established to technically support the HPH Network: the WHO Collaborating Centre for Health Promotion in Hospitals and Health Care at the Ludwig-Boltzmann Institute for the Sociology of Health and Medicine, Vienna, Austria and the WHO Collaborating Centre on Evidence-based Health Promotion in Hospitals at the Clinical Unit for Health Promotion, Bispebjerg Hospital, Copenhagen, Denmark. WHO Collaborating Centres contribute to the scientific literature in peer-reviewed journals, but may not do so under the keywords of Health Promoting Hospitals (Tonnesen et al., 1999; Pelikan et al., 2001; Moller, 2002; Bauer et al., 2003; Fugleholm et al., 2003; Tonnesen, 2003).
We concur with the author in encouraging a further evaluation of HPH activities. What has been the impact of WHO in reorienting health care services towards health promotion? To evaluate the impact of any initiative in health care delivery is a difficult task and even more so to evaluate the impact of WHO's advocacy work. However, in this latter domain the HPH may have had a strong impact and at present brings together more than 700 hospitals in 25 countries of the WHO European Region.
In conclusion, we very much welcome the interest in the HPH network and we agree that there is disparity between member hospitals regarding their commitment to putting health promotion into practice. We also agree there is a need to make the activities and outcomes more visible by improving access to publications; however, we would have appreciated it if more efforts had been made to seek further information and to base assessment of the impact of HPH not only upon the number of (English) publications.
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REFERENCES |
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 TOP REFERENCES |
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12th International Conference on Health Promoting Hospitals. Proceedings, Moscow, 26–28 May 2004 (http://www.univie.ac.at/hph/moscow2004/).
Annual Health Promoting Hospitals Networks Progress Reports, 2001/2002. WHO (http://www.euro.who.int/healthpromohosp/About/20020620_1).
Bauer, G., Davies, J. K., Pelikan, J., Noack, H., Broesskamp, U. and Hill, C. (EUHPID Consortium) (2003) Advancing a theoretical model for public health and health promotion indicator development: proposal from the EUHPID consortium. European Journal of Public Health, 13 (Suppl. 3), 107–113 (http://www3.oup.co.uk/eurpub/hdb/Volume_13/Supplement_01/).
Berger, H., Krajic, K. and Paul, R. (1999) Health Promoting Hospitals in Practice: Developing Projects and Networks. Gamburg: G. Conrad Health Promotion Publications, (http://www.euro.who.int/healthpromohosp/Publications/20020227_1).
Fugleholm, A. M. and Tonnesen, H. (2003) Life style and prevention in hospitals. The power of experts or patient rights (in Danish). Ugeskr Laeger, 165, 1121–1123.[Medline]
Grone, O. (2001) The Health Promoting Hospitals Progress Report Template: Purpose, Development and Overview on Selected Results. Working paper prepared for the Seventh Workshop of National/Regional Health Promoting Hospitals Network Coordinators, 5016675(1)/5, Copenhagen.
Grone, O. (2003) Developing Standards for Health Promotion in Hospitals. Results of a Pilot Test in Nine European Countries. Report on a WHO Workshop, Barcelona, Spain. WHO EURO, Barcelona, EUR/03/5038045 (http://www.euro.who.int/Document/IHB/hphstandardsfinrpt.pdf).
Grone, O. and Jorgensen, S. J. (2003) Quality improvement of health promotion activities in hospitals. Hospital, 5, 50–53.
Grone, O., Tonnesen, H. and Fröhlich, A. (2004) Background Paper for the First Workshop on Health Promoting Hospitals Quality-based Purchasing. WHO Barcelona, 5045761/5.
Health Promotion for Children and Adolescents in Hospital. University Children's Hospital, Florence, Italy (http://www.meyer.it/hph/hph-ca).
Moller, A. M., Villebro, N., Pedersen, T. and Tonnesen, H. (2002) Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. The Lancet, 359, 114–117.[CrossRef][Web of Science][Medline]
Pelikan, J. M., Garcia-Barbero, M., Lobnig, H. and Krajic, K. (1998a) Pathways to a health promoting hospital. Gamburg: G. Conrad Health Promotion Publications (http://www.euro.who.int/Document/IHB/hphseriesvol2.pdf).
Pelikan, J. M., Krajic, K. and Lobnig, H. (1998b) Feasibility, effectiveness, quality and sustainability of health promoting hospital projects. Gamburg: G. Conrad Health Promotion Publications (http://www.euro.who.int/Document/IHB/hphvienna1997.pdf).
Pelikan, J. M., Krajic, K. and Dietscher, C. (2001) The health promoting hospital (HPH): concept and development [Review]. Patient Education and Counselling, 45, 239–243.[CrossRef][Web of Science][Medline]
Tonnesen, H. (2003) Alcohol abuse and postoperative morbidity [Review]. Danish Medical Bulletin, 50, 139–160.[Medline]
Tonnesen, H., Rosenberg, J., Nielsen, H. J. et al. (1999) Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers: randomised controlled trial. British Medical Journal, 318, 1311–1316.
Whitehead, D. (2004) The European Health Promoting Hospitals (HPH) project: how far on? Health Promotion International, 19, 259–267 (http://heapro.oupjournals.org/content/vol19/issue2/).
WHO (2003) Standards for Health Promotion in Hospitals. WHO, Copenhagen (http://www.euro.who.int/document/e82490.pdf).
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