Health promoting hospitals

1

Health promoting hospitals

Christina Dietscher, Jürgen Pelikan, Hermann Schmied

Published online at

http://www.oxfordbibliographies.com/view/document/obo-

9780199756797/obo-9780199756797-

0131.xml?rskey=czAWVb&result=1&q=health+promoting

+hospitals#firstMatch

LAST MODIFIED: 07/30/2014

DOI: 10.1093/OBO/9780199756797-0131

1 Introduction

“Health Promoting Hospitals” (and health services) (HPH) is a hospital reform concept

developed in Europe that has also roots in early initiatives of the 1970s and 1980s in the

United States under the label of “hospital health promotion.” HPH, which is based on the

Ottawa Charter (1986) of the World Health Organization (WHO) and is promoted by WHO,

was developed and started to be implemented in the late 1980s. The current definition of HPH

is that it aims at improving the health outcomes of hospital patients, staff, and community,

and at enhancing its health impact on the hospital´s environment. HPH can be understood as a

policy concept with a strong research tradition. It builds on two strands of discourse: criticism

of medicine for being paternalistic and expertocratic rather than being patient oriented and

empowering, and criticism of health-care systems for being too exclusively focused on

treatment of disease rather than including prevention and health promotion as well. While

WHO’s Ottawa Charter called for wider public health–oriented reforms of health-care

systems, concepts and implementation approaches of HPH have primarily focused on

reforming hospitals as the core settings of modern health-care systems. As such, HPH

strongly relates to the settings approach in health promotion. HPH has also been described as

an umbrella approach, embracing many other (hospital) reform movements such as patients’

rights, the quality movements, green hospitals, and, most recently, health-literate

organizations. In the early 1990s, WHO-Euro initiated the international HPH network, which

now has around forty national and regional subnetworks in all continents except Africa.

Today, HPH has more than nine hundred member organizations, around the globe. The

international network also has a number of task forces that link HPH to specific topics, target

groups, and types of health services. Early research on HPH strongly focused on concept

development. This was followed by a phase of evaluation studies on model and pilot

implementation, with a strong focus on organizational development. Toward the end of the

1990s, when the HPH concept was further refined by orientation at quality movements, the

ongoing organizational research was increasingly accompanied by studies on the role of

health professions in health promotion (HP), especially that of nurses, and on clinical health

promotion including randomized controlled trials (RCTs) on patient-oriented interventions.

http://www.oxfordbibliographies.com/view/document/obo-9780199756797/obo-9780199756797-0131.xml?rskey=czAWVb&result=1&q=health+promoting+hospitals#firstMatch




2

This article will focus on general overviews of HPH development, on HPH history, on the

development of HPH concepts, and on implementation approaches that can be differentiated

into organization-wide approaches, quality management, HP as a professional role, and HP as

applied to different target groups.

2 General Overviews

Several publications providing general overviews of HPH developments are available.

Typically, they include descriptions of HPH background and history, descriptions of the HPH

concept, with a focus on target groups and rationales for addressing them in light of

considerations of the settings approach in health promotion, and implementation aspects and

descriptions of the structure of the international HPH network and its national and regional

subnetworks. Overviews in journals include Pelikan, et al. 2001; Pelikan 2007; Dietscher and

Pelikan 2013; and Pelikan, et al. 2014 offer a textbook contribution; Dietscher 2012 is an

academic thesis. Overviews are available mostly in English, including Pelikan, et al. 2001;

Groene 2005; Pelikan 2007; and Dietscher 2012. The contribution in Pelikan, et al. 2014 is in

German, and Dietscher and Pelikan 2013 is a French paper. While earlier work and textbook

articles have a stronger focus on describing HPH concepts, later publications, such as Pelikan

2007 or Dietscher 2012, describe HPH along specified phases of development, including

linking HPH to quality movements and the globalization of HPH. The available overviews,

which have been prepared mostly by the same research group, basically build on one another,

and there is high consistency between the different contributions. Contributions listed below

were selected so as to consistently mirror the development of HPH.

Dietscher, Christina. 2012. Interorganizational networks in the settings approach of

health promotion—the case of the International Network of Health Promoting

Hospitals and Health Services (HPH). PhD diss., Univ. of Vienna.

Save Citation »Export Citation »E-mail Citation »

The dissertation contains a chapter on the history of HPH that builds on Pelikan, et al.

2001; Pelikan 2007; and Pelikan, et al. 2014.

Find this resource:

Dietscher, Christina, and Jürgen M. Pelikan. 2013. Hôpitaux et services de santé

promoteurs de santé (HPS): Évolutions du réseau international. La Santé en Action

424:18–19.


A summary article in French that briefly describes the development of HPH in Europe

until 2013.

Find this resource:

Groene, Oliver. 2005. Health promotion in hospitals—from principles to

implementation. In Health promotion in hospitals: Evidence and quality management.

Edited by Oliver Groene and Mila Garcia-Barbero, 3–20. Copenhagen: World Health

Organization Regional Office for Europe.

http://www.oxfordbibliographies.com/view/document/obo-9780199756797/obo-9780199756797-0131.xml#obo-9780199756797-0131-bibItem-0005















http://www.oxfordbibliographies.com/view/document/obo-9780199756797/obo-9780199756797-0131.xml?rskey=czAWVb&result=1&q=health+promoting+hospitals#obo-9780199756797-0131-bibItemGroup-0001


http://www.oxfordbibliographies.com/view/document/obo-9780199756797/obo-9780199756797-0131.xml?rskey=czAWVb&result=1&q=health+promoting+hospitals








3


The chapter makes the case for health promotion in hospitals, provides examples of

interventions, and describes the history of the WHO-initiated HPH network.

Find this resource:

Pelikan, Jürgen M. 2007. Health promoting hospitals—assessing developments in the

network. Italian Journal of Public Health 4.4: 261–270.


A summary article structuring the development of the European HPH network in

phases; builds on Pelikan, et al. 2001.

Find this resource:

Pelikan, Jürgen M., Karl Krajic, and Christina Dietscher. 2001. The health promoting

hospital (HPH): Concept and development. Patient Education and Counseling 45.4:

239–243.

DOI: 10.1016/S0738-3991(01)00187-2Save Citation »Export Citation »E-mail

Citation »

A summary article providing an overview on the development of HPH, with a focus

on Europe.

Find this resource:

Pelikan, Jürgen M., Hermann Schmied, and Christina Dietscher. 2014. Prävention und

Gesundheitsförderung im Krankenhaus. In Lehrbuch Prävention und

Gesundheitsförderung. Edited by Klaus Hurrelmann, Theodor Klotz, and Jochen

Haisch, 297–310. Verlag Hans Huber: Programmbereich Gesundheit. Bern,

Switzerland: Hans Huber.


The chapter describes the HPH concept, with a focus on disease prevention for three

target groups—patients, staff, and the community population. It provides an overview

on implementation approaches and on the international HPH network and is designed

for undergraduate use.

Find this resource:

3 Anthologies

An early anthology on the European Pilot Hospital Project of Health Promoting Hospitals,

which summarizes case studies from twenty hospitals, was published by Pelikan, et al. 1998a.

A WHO-Euro publication, Groene and Garcia-Barbero 2005, relates HPH to two increasingly

important trends for the hospital sector (i.e., evidence and quality management). Anthologies








http://dx.doi.org/10.1016/S0738-3991%2801%2900187-2

http://dx.doi.org/10.1016/S0738-3991%2801%2900187-2








4

have also been prepared in relation to the international HPH conferences that have been

organized annually since 1993. Publications include proceedings such as in Pelikan, et al.

1998b and Berger, et al. 1999, as well as abstracts published in Jorgensen, et al. 2001 and

Pelikan and Dietscher 2011. Abstracts and proceedings typically cover a wide range of HPH-

related issues, from theory and conceptual considerations to descriptions and evaluation

studies of organization-wide implementation approaches, as well as specific interventions for

patients, staff, and the community population, and for developing hospitals and health

services into physically supportive settings. Since 2003, conference proceedings are available

as online sources, and WHO Collaborating Centre for Health Promotion in Hospitals and

Health Services 2013 is one example. Since 2011, conference abstract books such as in

Pelikan and Dietscher 2011 have been published annually as a supplement to the official HPH

journal Clinical Health Promotion (see Journals). Proceedings and abstract books are

especially useful for finding specific examples of interventions from the broad field of HPH.

Because of the international character of the conferences, they are all in English.

Berger, Hartmut, Karl Krajic, and Rainer Paul, eds. 1999. Health promoting hospitals

in practice: Developing projects and networks; Proceedings of the 6th International

Conference on Health Promoting Hospitals, Darmstadt April 29th–May 2nd, 1998.

Health Promoting Hospital Series 3. Gamburg, Germany: G. Conrad.


The publication summarizes presentations given at the 6th International Conference on

Health Promoting Hospitals in 1998, including evaluation studies and practice

examples of interventions for patients, staff, and community members, as well as

organization-wide approaches.

Find this resource:

Groene, Oliver, and Mila Garcia-Barbero, eds. 2005. Health promotion in hospitals:

Evidence and quality management. Copenhagen: World Health Organization Regional

Office for Europe.


The anthology gives an overview on the HPH network and is especially relevant for

those interested in linking health promotion to the quality movements and looking for

evidence for the approach.

Find this resource:

Jorgensen, Svend Juul, Lillian Moller, and Hanne Tonnesen, eds. 2001. Supplement:

9th International Conference on Health Promoting Hospitals, Copenhagen, May 16–

18, 2001; Health promoting hospitals in a national health policy perspective—

evidence in health promoting; Book of abstracts. International Journal of Integrated

Care 1.S1.


This is the first HPH abstract book to be published as a supplement to a scientific

journal. Contributions refer to evaluation studies and practice examples of









http://www.oxfordbibliographies.com/view/document/obo-9780199756797/obo-9780199756797-0131.xml?rskey=czAWVb&result=1&q=health+promoting+hospitals#obo-9780199756797-0131-div1-0004










5

interventions for patients, staff, and community members, as well as whole-

organization approaches.

Find this resource:

Pelikan, Jürgen M., and Christina Dietscher, eds. 2011. The 19th International

Conference on Health Promoting Hospitals & Health Services: Improving health gain

orientation in all services; Better cooperation for continuity in care; Abstract book.

Clinical Health Promotion 1.S.


This is the first conference abstract book that was published as a supplement to the

official HPH journal Clinical Health Promotion. Since then, there have been annual

abstract book supplements to Clinical Health Promotion.

Find this resource:

Pelikan, Jürgen M., Mila Garcia-Barbero, Hubert Lobnig, and Karl Krajic, eds. 1998a.

Pathways to a health promoting hospital: Experiences from the European Pilot

Hospital Project, 1993–1997. Health Promoting Hospital Series 2. Gamburg,

Germany: G. Conrad.


The book provides a summary description of the European Pilot Hospital Project on

Health Promoting Hospitals and case studies of the twenty participating organizations.

Find this resource:

Pelikan, Jürgen M., Karl Krajic, and Hubert Lobnig, eds. 1998b. Feasibility,

effectiveness, quality, and sustainability of health promoting hospital projects:

Proceedings of the 5th International Conference on Health Promoting Hospitals,

Vienna, Austria, April 16–19, 1997. Gamburg, Germany: G. Conrad.


This publication contains reports on early HPH projects, especially implementation

experiences from the European Pilot Hospital Project of HPH (1993–1997), and first

experiences with national/regional networks of HPH. It is especially useful to get an

idea of HPH implementation practice.

Find this resource:

WHO Collaborating Centre for Health Promotion in Hospitals and Health Services, ed.

2013. Virtual Proceedings of the 21st International Conference on Health Promoting

Hospitals and Health Services. International Network of Health Promoting Hospitals

& Health Services.











http://www.hphconferences.org/gothenburg2013/proceedings.html

http://www.hphconferences.org/gothenburg2013/proceedings.html




6

Conference proceedings have been provided online annually since 2003. More

proceedings and conference material are available online.

Find this resource:

4 Journals

Since 2011, the International Network of Health Promoting Hospitals and Health Services

(HPH) has its own scientific journal, Clinical Health Promotion: Research & Best Practice

for Patients, Staff & Community, with a strong focus on clinical interventions. Research on

HPH has, however, been published in several international journals, including Patient

Education and Counseling (especially in relation to links between health promotion and

patient education), Health Promotion International, and Global Health Promotion (formerly

Promotion & Education). Publications on HPH have also appeared in organizational and

managerial journals as well as in journals referring to specific clinical disciplines, including

nursing journals. Examples of national journals with referral to HPH include the French La

Santé en Action, which had a special issue on HPH in 2013. In addition, there is a bimonthly

international HPH Newsletter.

Clinical Health Promotion: Research & Best Practice for Patients, Staff &

Community.


The official journal of the International Network of Health Promoting Hospitals and

Health Services. Appears twice annually and provides articles mostly on clinical

studies in the wider context of health promotion in hospitals, and information about

activities in the HPH network.

Find this resource:

Global Health Promotion.


The official publication of the International Union for Health Promotion and

Education (IUHPE), covering a broad range of health promotion studies, including

HPH-related topics.

Find this resource:

Health Promotion International.


An exciting journal for all those working in the broader field of health promotion; has

published numerous articles on HPH.

Find this resource:

http://www.hphconferences.org/past-conferences.html










http://www.clinhp.org/

http://www.clinhp.org/




http://ped.sagepub.com/




http://heapro.oxfordjournals.org/




7

HPH Newsletter.


The newsletter is published every two months. It offers news from HPH networks,

task forces, and member organizations, as well as referrals to international studies and

literature.

Find this resource:

La Santé en Action.


The official journal of the French Institut national de prévention et d‘éducation pour la

santé, which hosts the coordination of the French HPH network. The journal had a

special issue on HPH in 2013 (La Santé en Action 424, Promouvoir la santé à

l’hôpital).

Find this resource:

Patient Education and Counseling.


The journal relates to HPH content especially with regard to patient education and

intervention activities. It had a special issue on HPH in 2001 (Patient Education and

Counseling 45.4).

Find this resource:

5 Textbooks, Manuals, Guidelines

Lobnig, et al. 1996 is a textbook, and Groene 2006 is a manual on health promotion in

hospitals as an overall implementation approach (also see the HPH Core Concept). Lagarde

2009, building on Groene 2006, provides a specific guideline for developing a health-

promoting hospital policy as a first step of implementation. Brandt 2001 offers a German-

language guideline on linking HPH to the European Foundation for Quality Management

(EFQM) approach (see Linking HPH to Evidence-Based Medicine and to the Quality

Movements). Johnson and Paton 2007 is a valuable source on health promotion as a hospital

management approach. The authors of McBride 1995 and Raingruber 2014 have worked on

health promotion as a professional role specifically in relation to nursing.

Brandt, Elimar, ed. 2001. Qualitätsmanagement und Gesundheitsförderung im

Krankenhaus: Handbuch zur EFQM-Einführung. Munich: Luchterhand.


http://www.hph-hc.cc/hph-newsletter/english.html




http://www.inpes.sante.fr/SLH/




http://www.journals.elsevier.com/patient-education-and-counseling/



















8

The book, in German, suggests criteria for assessing the quality of health-promoting

hospitals on the basis of the quality model of the EFQM. It is especially valuable for

quality managers, or to inform studies relating to hospital quality.

Find this resource:

Groene, Oliver, ed. 2006. Implementing health promotion in hospitals: Manual and

self-assessment forms. Copenhagen: WHO Regional Office for Europe.


This is a manual for hospital managers and clinical staff, providing guidance on

organizational self-assessment. In a research context, it can inform the development of

tools for organizational diagnosis.

Find this resource:

Johnson, Anne, and Kevin Paton. 2007. Health promotion and health services:

Management for change. Oxford: Oxford Univ. Press.


Provides a framework for reorienting health services to become more health

promoting, integrating health promotion and change management theory. The book is

especially relevant for internal or external organizational-change agents.

Find this resource:

Lagarde, François. 2009. Guide to develop a health promotion policy and compendium

of policies. Edited by François Alarie, Marie-Dominique Charier, and Louis Côté.

Publications Gouvernementales du Québec en Ligne: Monographies Électroniques.

Montreal: Agence de la santé et des services sociaux de Montréal.


This handbook relates to standard 1 of the five World Health Organization (WHO)

Standards for Health Promotion in Hospitals. It provides step-by-step guidance on

how to develop a health promotion policy in clinical settings and is especially valuable

for hospital managers.

Find this resource:

Lobnig, Hubert, Peter Nowak, and Jürgen M. Pelikan. 1996. Wie ein

“Gesundheitsförderndes Krankenhaus” entwickelt werden kann.

Gesundheitsförderung, Organisationsentwicklung und Projektmanagement im

Krankenhaus. Wiener WHO-Modellprojekt, Modelldokument 1. Vienna: Ludwig

Boltzmann-Institut für Medizin- und Gesundheitssoziologie.














9

The guideline, in German, summarizes the experiences of the first WHO model

hospital project, “Health and Hospital,” and provides step-by-step guidance on

implementation.

Find this resource:

McBride, Anita S. 1995. Health promotion in hospital: A practical handbook for

nurses. London: Scutari.


This handbook covers both the development of a specific organizational health

promotion strategy and the implementation of specific interventions. It especially

addresses nurses in clinical practice and nursing students.

Find this resource:

Raingruber, Bonnie. 2014. Contemporary health promotion in nursing practice.

Burlington, MA: Jones & Bartlett.


The book claims that nurses are more effective health promoters if they become role

models for their patients. It also includes referrals to current topics such as health

literacy. The main target groups are nurses in clinical practice and nursing students.

Find this resource:

6 The History of Health Promotion as Applied to

Hospitals

While the most systematic uptake of health-promoting hospitals was in Europe (see Health

Promoting Hospitals in Europe), there have been early developments also in Australia (see

Developments in Australia), Canada (see Developments in Canada), and the United States

(see Developments in the United States). After the establishment of the HPH network in

Europe, initiatives also started to develop in other continents, especially in Asia and partly in

South Africa (see Globalization of HPH).

7 Developments in the United States

In the United States, health promotion as a responsibility of hospitals and health services goes

back to the US Healthy People program, which was launched for the first time in 1979 and

has, since then, been evaluated and revised annually. As described in Institute of Medicine,

National Academy of Sciences 1979 and Hilgerson and Prohaska 2003, hospitals have been

expected to expand their services toward health promotion activities such as nutrition

counseling or community initiatives. As outlined in American Hospital Association 1979, the

idea was also taken up by the American Hospital Association. Longe and Wolf 1984 provides

an orientation on the US approach toward hospital health promotion that seems more

pragmatic than theory driven, being described as usually combining preventive and early-

detection services, health education, and an orientation toward supporting the health of


















10

community members before they get ill, especially by means of lifestyle development.

Hilgerson and Prohaska 2003 and Olden and Clement 2000 are examples of publications that

focus, in relation to the decennial reviews of the achievements of the goals set by Healthy

People, on measuring policy impact on the level of implementation in US hospitals in general.

Hendryx 1993 focuses on the specific impact on rural hospitals. In addition, much of the US

literature on hospital health promotion has a focus on hospitals’ motives for health promotion.

Longe and Wolf 1984 identifies attempts to improve the hospitals’ reputation in the

community as one driver toward health promotion, while market and economic considerations

are described in Sol and Wilson 1989, and legal regulations are detailed in Ginn and Moseley

2006.

American Hospital Association. 1979. The hospital’s responsibility for health

promotion. Policy and Statement (American Hospital Association). Chicago:

American Hospital Publishing.


This first specific policy paper on the role of hospitals in health promotion, which

relates to the US Healthy People program of 1979 (Institute of Medicine, National

Academy of Sciences 1979), is especially useful for understanding the policy context

of hospital health promotion in the United States.

Find this resource:

Ginn, Gregory O., and Charles B. Moseley. 2006. The impact of state community

benefit laws on the community health orientation and health promotion services of

hospitals. Journal of Health Politics, Policy and Law 31.2: 321–344.

DOI: 10.1215/03616878-31-2-321Save Citation »Export Citation »E-mail Citation »

This empirical study focuses on the impact of legal regulations on the implementation

of hospital health promotion and concludes that coercive measures such as community

benefit laws can motivate not-for-profit hospitals to increase community-oriented

activities. It may be especially useful when studying the impact of policy incentives on

the organizational uptake of health promotion.

Find this resource:

Hendryx, Michael S. 1993. Rural hospital health promotion: Programs, methods,

resource limitations. Journal of Community Health 18.4: 241–250.

DOI: 10.1007/BF01324434Save Citation »Export Citation »E-mail Citation »

This article is an example of a study on the organizational uptake of health promotion

in rural hospitals, drawing on empirical data from Iowa and suggesting that available

resources, and the range of health promotion programs offered, may be more limited

in rural hospitals than in urban ones.

Find this resource:













http://dx.doi.org/10.1215/03616878-31-2-321

http://dx.doi.org/10.1215/03616878-31-2-321



http://dx.doi.org/10.1007/BF01324434

http://dx.doi.org/10.1007/BF01324434



11

Hilgerson, Lori L., and Thomas R. Prohaska. 2003. Hospital health promotion:

Swimming or sinking in an upstream business? Health Promotion Practice 4.1: 56–63.

DOI: 10.1177/1524839902238292Save Citation »Export Citation »E-mail Citation »

Against the background of the US Healthy People 2000 program, this article provides

a case study analysis of how national policy translates into the health promotion

programs that one urban Midwest hospital offered to its community during a year. It

can inform case study approaches in the hospital context and is of interest when

studying policy impact on organizational practice.

Find this resource:

Institute of Medicine, National Academy of Sciences. 1979. Healthy people: The

surgeon general’s report on health promotion and disease prevention. DHEW

Publication 79-55071A. Washington, DC: US Department of Health, Education, and

Welfare.


This document is the first national health program that mentions health promotion as a

dedicated task of health service organizations. It is of historical interest and still

influences US hospital health promotion.

Find this resource:

Longe, Mary E., and Anne Wolf. 1984. Promoting community health through

innovative hospital-based programs. Chicago: American Hospital Publications.


In line with US health policy, the publication describes the development of hospital-

based programs that have a positive impact on community health.

Find this resource:

Olden, Peter C., and Dolores G. Clement. 2000. The prevalence of hospital health

promotion and disease prevention services: Good news, bad news, and policy

implications. Milbank Quarterly 78.1: 115–146.

DOI: 10.1111/1468-0009.00163Save Citation »Export Citation »E-mail Citation »

Drawing on national data from the American Hospital Association Annual Survey of

Hospitals, the authors focus on the prevalence of twenty-six services provided by

general hospitals that could contribute to health promotion and disease prevention

(HPDP). The paper is especially relevant for studying policy impact on the

organizational implementation of hospital health promotion.

Find this resource:

http://dx.doi.org/10.1177/1524839902238292

http://dx.doi.org/10.1177/1524839902238292









http://dx.doi.org/10.1111/1468-0009.00163

http://dx.doi.org/10.1111/1468-0009.00163



12

Sol, Neil, and Philip K. Wilson, eds. 1989. Hospital health promotion. Champaign, IL:

Human Kinetics.


This is the first book on comprehensive approaches toward hospital health promotion

as a business perspective for hospitals. It presents strategies of hospital-based health

promotion and primarily addresses hospital managers and health-care professionals.

Find this resource:

8 Developments in Australia

As in the United States (see Developments in the United States), early considerations of

hospital health promotion in Australia were raised by national health policy, with a strong

focus on community health. A conceptual outline is offered in Tyler and James 1988.

However, concepts of health-promoting hospitals in Australia are in principle very similar to

those in Europe, both in strongly focusing on comprehensive whole-organization approaches

(see Health Promoting Hospitals in Europe) and building on WHO’s Ottawa Charter. An

overview on developments is provided in Dwyer 1998, and Radoslovich and Barnett 1998

suggests steps toward implementation. Johnson and Baum 2001 offers a typology of different

implementation types, while Stanton, et al. 1996 focuses on organizational barriers to

implementing health promotion in public hospitals in Australia.

Dwyer, Judith. 1998. Health promoting hospitals in Australia. In Feasibility,



Vienna, Austria, April 16–19, 1997. Edited by Jürgen M. Pelikan, Karl Krajic, and

Hubert Lobnig, 47–51. Gamburg, Germany: G. Conrad.


This is a short overview article providing a concise outline on HPH developments in

Australia and presenting examples of practice.

Find this resource:

Johnson, Anne, and Fran Baum. 2001. Health promoting hospitals: A typology of

different organizational approaches to health promotion. Health Promotion

International 16.3: 281–287.

DOI: 10.1093/heapro/16.3.281Save Citation »Export Citation »E-mail Citation »

The authors present a typology of four approaches of organizational arrangements to

health promotion that are of interest for studying levels of health promotion

implementation.

Find this resource:














http://dx.doi.org/10.1093/heapro/16.3.281




13

Radoslovich, Helen, and Kate Barnett. 1998. Making the move! Towards health

promoting hospitals, health services and regions. Adelaide, Australia: South

Australian Health Commission.


Building on WHO’s Ottawa Charter (World Health Organization 1986, cited under

Developments in Canada), the document provides an introduction to health promotion

and to reorienting health services toward health promotion. The publication contains

numerous case studies and has a focus on overall organizational development and

change management.

Find this resource:

Stanton, Warren R., Kevin P. Balanda, Amaya M. Gillespie, and John B. Lowe. 1996.

Barriers to health promotion activities in public hospitals. Australian and New

Zealand Journal of Public Health 20.5: 500–504.

DOI: 10.1111/j.1467-842X.1996.tb01629.xSave Citation »Export Citation »E-mail

Citation »

In light of the limited uptake of health promotion by Australian hospitals, the article

investigates barriers to hospital health promotion and provides useful perspectives on

understanding organizational preparedness for health promotion.

Find this resource:

Tyler, Colin, and Ray James. 1988. What should hospitals be doing in health

promotion services? Australian Health Review: A Publication of the Australian

Hospital Association 11.3: 182–185.


The article discusses the level of health promotion services that each hospital or area

health service should offer the community, drawing on recommendations by the

Australian Health Targets and Implementation Committee. It is primarily targeted at

senior administrators.

Find this resource:

9 Developments in Canada

As in the United States (see Developments in the United States) and Australia (see

Developments in Australia), Canada too had early health policy initiatives to promote the role

of health-care facilities in health promotion, which can be traced back to the 1970s. Pineault,

et al. 1990 provides an overview for the Quebec area. According to Health and Welfare

Canada 1990, the concept has been more systematically taken up since the 1990s, and, as

Baskerville and Letouzé 1990 describes, these developments were supported by an

involvement of the Canadian Hospital Association. As in Europe (see Health Promoting

Hospitals in Europe), developments in Canada can be traced back to WHO’s Ottawa Charter






http://dx.doi.org/10.1111/j.1467-842X.1996.tb01629.x

http://dx.doi.org/10.1111/j.1467-842X.1996.tb01629.x















14

(World Health Organization 1986). An introductory overview of developments was prepared

in Korn 1998.

Baskerville, Bruce, and Daniel Letouzé. 1990. Facilitating the involvement of

Canadian health care facilities in health promotion. Patient Education and Counseling

15.2: 113–125.

DOI: 10.1016/0738-3991(90)90055-PSave Citation »Export Citation »E-mail Citation

»

Following a brief background on Canadian efforts in health promotion policy and the

Canadian health-care system, and a discussion of the reasons for increased interest in

the area, the article describes practice examples from two initiatives on health

promotion and health-care facilities undertaken by the Canadian Hospital Association.

Find this resource:

Health and Welfare Canada. 1990. A guide for health promotion by health care

facilities. Ottawa, ON: Health Services and Promotion Branch, Health and Welfare

Canada, Ministry for Supply and Services.


A health policy document offering guidance to health-care facilities in the process of

implementing health promotion.

Find this resource:

Korn, David A. 1998. Health promoting hospitals in Canada. In Feasibility,



Vienna, Austria, April 16–19, 1997. Edited by Jürgen M. Pelikan, Karl Krajic, and

Hubert Lobnig, 52–53. Gamburg, Germany: G. Conrad.


This is a short overview article providing a concise overview on HPH developments in

Canada, including references to examples of practice.

Find this resource:

Pineault, Reynald, Bruce Baskerville, and Daniel Letouzé. 1990. Health promotion

activities in Quebec hospitals: A comparison of DSC and non-DSC hospitals.

Canadian Journal of Public Health / Revue canadienne de santé publique 81.3: 199–

203.


The article examines health promotion activities in relation to specific organizational

capacities. It concludes that organizations with a mandate for community health have



http://dx.doi.org/10.1016/0738-3991%2890%2990055-P

http://dx.doi.org/10.1016/0738-3991%2890%2990055-P












15

more health promotion activities in this field. The article is of interest when studying

the preconditions for a comprehensive health promotion approach.

Find this resource:

World Health Organization. 1986. Ottawa Charter for Health Promotion: An

international conference on health promotion; The move towards a new public health,

November 17–21, 1986, Ottawa, Ontario, Canada. Geneva, Switzerland: World

Health Organization.


The intervention principles for health promotion and action areas lined out in the

charter were influential for developing initiatives around health-promoting hospitals in

Canada.

Find this resource:

10 Health Promoting Hospitals in Europe

The Health Promoting Hospitals initiative (which was, in 2009, renamed Health Promoting

Hospitals and Health Services), abbreviated as HPH, was inspired by WHO’s Ottawa Charter

(World Health Organization 1986) and was started in Europe. The charter document lists a

specific action area on the health sector that demands its reorientation toward health

promotion “beyond its responsibility for providing clinical and curative services.” The Ottawa

Charter informed the development of numerous, especially setting-oriented, health promotion

activities, interventions, and networks in a number of areas, including hospitals. The first

conceptual considerations focusing on hospitals were commissioned by WHO and published

in Milz and Vang 1988, outlining, for the first time, the three major HPH target groups

(patients, staff, and the hospital community), and interventions to address them. While a

community approach is predominant in Milz and Vang 1988, the publication also lists specific

responsibilities of the hospital toward its inpatients (patient education, patient safety) and its

staff. On the basis of these contents, the very first European model project on health-

promoting hospitals was set up in Vienna, Austria, from 1989 to 1997 (World Health

Organization Regional Office for Europe 1997). Nowak, et al. 1998 describes the evaluation

of this project. In 1990, WHO-Euro started the International Network of Health Promoting

Hospitals in collaboration with the WHO Healthy Cities project, in the form of a multicity

action plan, as is described in Krajic, et al. 1992. Target groups of the HPH concept and ways

to address them were further refined in the first policy document of the HPH network, the

Budapest Declaration on Health Promoting Hospitals, launched by WHO-Euro in 1991

(World Health Organization Regional Office for Europe 1991). The document specifically

added the need to establish sufficient organizational capacities to implement the HPH

approach. The collaboration with Healthy Cities proved to be helpful for the recruitment and

implementation of the European Pilot Hospital Project on Health Promoting Hospitals, which

had twenty participating hospitals from eleven European countries and tested and evaluated

the applicability of the HPH approach in different types of hospitals and in different national

health policy contexts. Pelikan, et al. 1998 contains the case study experiences of the

participating hospitals. Toward the end of the pilot hospital project, the Vienna

Recommendations, a new policy document of the network, were launched by WHO-Euro in

1997 to mirror international developments in HPH, especially the WHO-Euro policy to

disseminate HPH via the establishment of national and regional HPH networks, starting in













16

1995. A next phase of the European HPH network was characterized by a stronger orientation

toward hospital quality management (see also Concepts of Health Promoting Hospitals and

Implementing Health Promotion in Specific Hospital Types and Units). In addition to contents,

the international HPH network also further developed its structure and became an

international association in 2008, with a constitution specifying its mission and defining its

bodies and their responsibilities. An overview of the history of the international HPH network

is in Pelikan, et al. 2011.

Krajic, Karl, Heather McDonald, and Jürgen M. Pelikan. 1992. Health promoting

hospitals: An international network initiated by WHO-EURO; A multi-city action plan

of the Healthy Cities Project. Copenhagen: World Health Organization Regional

Office for Europe.


This policy document describes WHO-Euro’s first approach to disseminate health-

promoting hospitals by using the WHO Healthy Cities as dissemination agents. Its

value is mainly historical.

Find this resource:

Milz, Helmut, and Johannes O. Vang. 1988. Consultation on the role of health

promotion in hospitals. Health Promotion International 3.4: 425–427.


This article represents the perspectives of a team of researchers commissioned by

WHO-Euro on health promotion in hospitals. It is of specific value when studying the

development of the HPH approach over time.

Find this resource:

Nowak, Peter, Hubert Lobnig, Karl Krajic, and Jürgen M. Pelikan. 1998. Case Study

Rudolfstiftung Hospital, Vienna, Austria—WHO model project “Health and Hospital.”

In Pathways to a health promoting hospital: Experiences from the European Pilot

Hospital Project, 1993–1997. Edited by Jürgen M. Pelikan, Mila Garcia-Barbero,

Hubert Lobnig, and Karl Krajic, 47–66. Health Promoting Hospital Series 2. Gamburg,

Germany: G. Conrad.


The article describes the evaluation of the first systematic HPH approach in Europe,

highlighting an organizational development approach and building on Milz and Vang

1988 and the Budapest Declaration (World Health Organization Regional Office for

Europe 1991).

Find this resource:

Pelikan, Jürgen M., Mila Garcia-Barbero, Hubert Lobnig, and Karl Krajic, eds. 1998.



















17


Germany: G. Conrad.


This book is a summary of case studies from the twenty hospitals that participated in

the European pilot hospital project on health-promoting hospitals from 1993 to 1997.

It describes the subprojects performed by these hospitals, as well as their evaluation.

The book provides a good orientation on this first systematic international

dissemination approach to HPH.

Find this resource:

Pelikan, Jürgen M., Oliver Groene, and Jeff Kirk Svane. 2011. The international HPH

network—a short history of two decades of development. Clinical Health Promotion

1.1: 32–36.


This is the most recent and comprehensive journal article on the history of the HPH

network.

Find this resource:

World Health Organization. 1986. Ottawa Charter for Health Promotion: An

international conference on health promotion; The move towards a new public health,

November 17–21, 1986, Ottawa, Ontario, Canada. Geneva, Switzerland: World



Many health promotion initiatives including HPH refer to WHO’s Ottawa Charter as a

major policy background document. Action area 5 of the charter, reorienting health

services, is especially relevant for understanding the HPH context.

Find this resource:

World Health Organization Regional Office for Europe. 1997. The Vienna

recommendations on health promoting hospitals. Copenhagen: World Health

Organization Regional Office for Europe.


This document confirms the contents of the Budapest Declaration (World Health

Organization Regional Office for Europe 1991) and specifies the approach for the new

phase of dissemination by networks that started in 1995.

Find this resource:















18

World Health Organization Regional Office for Europe, ed. 1991. The Budapest

Declaration on Health Promoting Hospitals. Copenhagen: World Health Organization

Regional Office for Europe.


The Budapest Declaration was the first policy document of the European network of

HPH. It has two parts, which specify the content of the HPH concept and the

conditions for participation in the European Pilot Hospital Project of Health Promoting

Hospitals (Pelikan, et al. 1998).

Find this resource:

11 Globalization of HPH

While early developments in hospital health promotion and health-promoting hospitals all

occurred in developed regions of the world (see Developments in Australia, Developments in

the United States, Developments in Canada, and Health Promoting Hospitals in Europe) and

go as far back as the 1970s and 1980s, the dissemination to less developed regions and other

continents took more time. There are only a few examples from the first decade of the 21st

century, with an increasing number of publications being available since around 2010.

Mangoud 2000 describes experiences from Albania; Guo, et al. 2007 focuses on

implementation in Beijing, China; Kar, et al. 2012 elaborates on the applicability of HPH in

India; Yaghoubi and Javadi 2013 discusses HPH in Iran; Khowaja, et al. 2011 refers to the

adaptation of the HPH concept in Pakistan; Kumpalanon, et al. 2012 describes

implementation in district hospitals in Thailand; Lin and Lin 2011 focuses on experiences in

Taiwan; and Delobelle, et al. 2011 describes implementation in South Africa. Articles that are

in English typically focus on the national receptivity and interpretation of the HPH concept

and on preconditions for and the scope of national implementation; some publications,

including Delobelle, et al. 2011; Guo, et al. 2007; and Mangoud 2000 describe case study

experiences. With the exception of Kumpalanon, et al. 2012, which follows a public health

approach, articles typically follow the understanding of the WHO-initiated network of HPH

(see Health Promoting Hospitals in Europe and Concepts of Health Promoting Hospitals.

Delobelle, Peter, Hans Onya, Cynthia Langa, Joyce Mashamba, and Anne-Marie

Depoorter. 2011. Pilot health promoting hospital in rural South Africa: Evidence-

based approach to systematic hospital transformation. Global Health Promotion 18.1:

47–50.


The article describes the case of one South African hospital that aimed at

implementing the WHO standards for health promotion in hospitals. The authors

conclude that the project indicated applicability of the model in a resource-limited

setting, on the basis of staff empowerment, local leadership, and stakeholder

engagement.

Find this resource:
























http://dx.doi.org/10.1177/1757975910393171

http://dx.doi.org/10.1177/1757975910393171



19

Guo, Xiu-Hua, Xiang-Yang Tian, Yue-Song Pan, et al. 2007. Managerial attitudes on

the development of health promoting hospitals in Beijing. Health Promotion


DOI: 10.1093/heapro/dam010Save Citation »Export Citation »E-mail Citation »

This study followed the approach of the European Pilot Hospital Project of Health

Promoting Hospitals (see European Pilot and Model Hospital Projects), selecting

hospitals and supporting them in organizational change toward HPH. It provides

interesting insights into the applicability of HPH in China.

Find this resource:

Kar, Sitanshu Sekar, Gautam Roy, and Subitha Lakshminarayanan. 2012. Health

promoting hospital: A noble concept. National Journal of Community Medicine 3.3:

558–562.


The authors state that the HPH concept is rather new in India, currently implemented

only in a handful of hospitals. However, they would recommend it for broader uptake.

Find this resource:

Khowaja, Asif Raza, Rozina Karmaliani, Rozina Mistry, and Ajmal Agha. 2011.

Transition towards health promoting hospitals: Adapting a global framework to

Pakistan. Eastern Mediterranean Health Journal 17.10: 738–743.


The article presents the perceptions of a number of national stakeholders on the HPH

approach, outlining that stakeholders see more-pressing urgency in providing basic

needs such as hygiene, safety, security, and emotional support. The paper is of specific

interest when studying the specific conditions for HPH in Pakistan.

Find this resource:

Kumpalanon, Jutarat, Dusadeee Ayuwat, and Pattara Sanchaisuriya. 2012. Developing

of health promotion of district hospitals in Thailand. American Journal of Health

Sciences 3.1: 43–52.


The article describes programs of community health promotion that are delivered by

district hospitals in Thailand, mirroring a public health approach taken in the region.

Find this resource:

Lin, Yea-Wen, and Yueh-Ysen Lin. 2011. Health-promoting organization and

organizational effectiveness of health promotion in hospitals: A national cross-

sectional survey in Taiwan. Health Promotion International 26.3: 362–375.

http://dx.doi.org/10.1093/heapro/dam010














20

DOI: 10.1093/heapro/daq068Save Citation »Export Citation »E-mail Citation »

The article describes a countrywide study on the organizational health promotion

status of Taiwanese hospitals, relating health promotion to organizational

effectiveness.

Find this resource:

Mangoud, Abdallah M. 2000. Establishing a health promoting setting: An experience

in an Albanian polyclinic. International Journal of Public Administration 23.1: 1–20.


Following the settings approach in health promotion, the article describes the

experiences of one Albanian hospital in undergoing a process of organizational change

toward health promotion, supported by an external change agent. It provides

interesting insights into the capacities needed for a successful reorientation of

hospitals toward HPH.

Find this resource:

Yaghoubi, Maryam, and Marzieh Javadi. 2013. Health promoting hospitals in Iran:

How it is. Journal of Education and Health Promotion 2:41.

DOI: 10.4103/2277-9531.115840Save Citation »Export Citation »E-mail Citation »

The article describes a study using the WHO standards for health promotion in

hospitals to evaluate public and private hospitals in Iran, concluding that more

capacity building is needed to motivate Iranian hospitals to implement HPH.

Find this resource:

12 Concepts of Health Promoting Hospitals

With regard to conceptual considerations around HPH, two strands of research can be

distinguished. One strand focuses on the core concept of HPH, relating to the concept of

health that is pursued, to the target groups addressed, and to concepts of organizational

development and change needed to make hospitals and health services more health promoting

(see the HPH Core Concept). The second strand is about relating HPH to other reform

concepts and movements (see Linking HPH to Other Reform Concepts).

13 The HPH Core Concept

Following WHO’s Ottawa Charter (World Health Organization 1986, cited under Health

Promoting Hospitals in Europe), HPH has been developed as a broad and comprehensive

approach to organizational development. Introductions are offered in Pelikan and Wolff 1999

and Pelikan, et al. 2010. The specific health orientation of the concept, which is focused on

positive health—differentiating health promotion from, and relating it to, preventive and

clinical work in and by hospitals and health services and combining risk reduction and

resource-strengthening approaches, empowering patients, staff, and community populations to

http://dx.doi.org/10.1093/heapro/daq068




http://dx.doi.org/10.1080/01900690008525450

http://dx.doi.org/10.1080/01900690008525450



http://dx.doi.org/10.4103/2277-9531.115840

http://dx.doi.org/10.4103/2277-9531.115840










21

become better coproducers of health, as well as developing the hospital setting physically and

socially to support the hospital’s health promotion endeavors—is well described in Pelikan

and Halbmayer 1999 (in German) and is also taken up in Pelikan, et al. 2005 and Pelikan, et al.

2010 (in English). The three target groups of the HPH core concept—patients, staff, and the

hospital community—were first described in Milz and Vang 1988 and were confirmed and

refined in later works, including Pelikan and Halbmayer 1999; Pelikan, et al. 2001; Pelikan, et

al. 2005; Pelikan, et al. 2010; and World Health Organization 1998. With regard to the

organizational implementation of the concept, early work such as Pelikan and Wolff 1999

focuses on open developmental approaches, informed by an understanding of systemic and

systematic organizational development. More recently, under the influence of the rising

importance of the quality movements, a trend toward formalization and standardization of the

HPH concept can be observed (e.g., by defining eighteen HPH core strategies, as included in

Pelikan, et al. 2005, and by developing HPH standards, as described in Groene 2006). See

also Linking HPH to Other Reform Concepts.

Groene, Oliver, ed. 2006. Implementing health promotion in hospitals: Manual and

self-assessment forms. Copenhagen: WHO Regional Office for Europe.


Building on HPH core concepts, this manual for hospital managers and clinical staff

links the implementation of HPH to quality management. It introduces five standards

with thirteen substandards and forty measurable elements for organizational self-

assessment.

Find this resource:

Milz, Helmut, and Johannes O. Vang. 1988. Consultation on the role of health

promotion in hospitals. Health Promotion International 3.4: 425–427.


This article is the first conceptual publication on health promotion in hospitals.

Building on WHO’s Ottawa Charter, it reflects the perspectives of a research team

commissioned by WHO-Euro.

Find this resource:

Pelikan, Jürgen M., Christina Dietscher, Karl Krajic, and Peter Nowak. 2005. Eighteen

core strategies for health promoting hospitals. In Health promotion in hospitals:

Evidence and quality management. Edited by Oliver Groene and Mila Garcia-Barbero,

46–63. Copenhagen: World Health Organization Regional Office for Europe.


The article marks a shift from the rather open organizational development approach of

HPH from earlier work to a more structured approach, condensing HPH into eighteen

theoretically deducted core strategies (six each for patients, staff, and the hospital

community).

Find this resource:



























22

Pelikan, Jürgen M., Christina Dietscher, Florian Röthlin, and Hermann Schmied. 2010.

Hospitals as organizational settings for health and health promotion. Working Paper

5. Vienna: Ludwig Boltzmann Institute for Health Promotion Research.


The publication relates the HPH approach to a perspective of sociological systems

theory on the settings approach of health promotion. It is especially interesting for

those interested in health promotion theory.

Find this resource:

Pelikan, Jürgen M., and Ernst Halbmayer. 1999. Gesundheitswissenschaftliche

Grundlagen zur Strategie des Gesundheitsfördernden Krankenhauses. In Das

gesundheitsfördernde Krankenhaus: Konzepte und Beispiele zur Entwicklung einer

lernenden Organisation. Edited by Jürgen M. Pelikan and Stephan Wolff, 13–36.

Gesundheitsforschung. Weinheim, Germany, and Munich: Juventa-Verlag.


The chapter provides valuable theoretical concepts for understanding health and health

promotion interventions in relation to the settings approach of health promotion.

Find this resource:

Pelikan, Jürgen M., Karl Krajic, and Christina Dietscher. 2001. The health promoting

hospital (HPH): Concept and development. Patient Education and Counseling 45.4:

239–243.


Citation »

This is an overview article on the HPH concept and history. It provides good

orientation on developments until 2001.

Find this resource:

Pelikan, Jürgen M., and Stephan Wolff, eds. 1999. Das gesundheitsfördernde

Krankenhaus: Konzepte und Beispiele zur Entwicklung einer lernenden Organisation.



The book has a focus on organizational development as a core health promotion

strategy. It provides important insights into health promotion theory but also contains

examples of implementation practice.

Find this resource:







http://dx.doi.org/10.1016/S0738-3991%2801%2900187-2

http://dx.doi.org/10.1016/S0738-3991%2801%2900187-2






23

World Health Organization. 1998. Health promoting hospitals. In Health promotion

glossary. Rev. ed. By World Health Organization, 11. Geneva, Switzerland: World



This entry of HPH into WHO’s Health Promotion glossary provides a concise

definition of and an ideal first introduction to HPH, its target groups, and its

intervention approach.

Find this resource:

14 Linking HPH to Evidence-Based Medicine and to the Quality Movements

Under the influence of the increasing role of evidence-based medicine and quality

management in health care, the international HPH network developed five standards for

health promotion in health care. Several publications, such as Fugleholm, et al. 2005 and

Groene, et al. 2010, focus on the development and testing of this tool. Zhou 2009 offers a

translation of the standards into Chinese. But there are also other examples of interlinks with

the quality movements, such as a manual (Brandt 2001) that suggests criteria for assessing the

quality of HPH on the basis of the quality model of the European Foundation for Quality

Management (EFQM). Another strand of interlinks with hospital quality management relates

to reimbursement systems and diagnosis-related groups (DRGs). A suggestion for registering

clinical health-promotion interventions in DRG systems is provided in Tønnesen, et al. 2007.

In relation to a more evidence-oriented approach in hospital health promotion, Groene and

Garcia-Barbero 2005 contains an explicit chapter (Tønnesen, et al. 2005) on the evidence for

HPH, with the main focus on evidence for specific clinical interventions. In contrast, McHugh,

et al. 2010, which looks for evidence for the overall HPH approach, finds a lack of high-level

studies in the field.

Brandt, Elimar, ed. 2001. Qualitätsmanagement und Gesundheitsförderung im

Krankenhaus: Handbuch zur EFQM-Einführung. Munich: Luchterhand.


This book is the first publication that describes interlinks between HPH and a specific

quality approach, in this case the quality model of the EFQM. It provides important

contents for assessing and further developing the health promotion quality of a

hospital.

Find this resource:

Fugleholm, Anne Mette, Svend Juul Jørgensen, Lillian Møller, and Oliver Groene.

2005. Development of standards for disease prevention and health promotion. In

Health promotion in hospitals: Evidence and quality management. Edited by Oliver

Groene and Mila Garcia-Barbero, 64–79. Copenhagen: World Health Organization

Regional Office for Europe.





















24

The chapter introduces the development of the WHO standards for health promotion

in hospitals as a consensus process of an international working group and as following

the International Society for Quality in Healthcare (ISQUA) process for standard

development.

Find this resource:

Groene, Oliver, Jordi Alonso, and Niek Klazinga. 2010. Development and validation

of the WHO self-assessment tool for health promotion in hospitals: Results of a study

in 38 hospitals in eight countries. Health Promotion International 25.2: 221–229.


The article outlines the development of a self-assessment tool for health promotion in

hospitals and describes the testing of its validity.

Find this resource:

Groene, Oliver, and Mila Garcia-Barbero, eds. 2005. Health promotion in hospitals:

Evidence and quality management. Copenhagen: World Health Organization Regional

Office for Europe.


The booklet offers a collection of articles on interlinks between health promotion in

hospitals and quality management, as well as a summary of available evidence for the

HPH approach.

Find this resource:

McHugh, Claire, Anske Robinson, and Janice Chesters. 2010. Health promoting health

services: A review of the evidence. Health Promotion International 25.2: 230–237.


The authors aimed at collecting the evidence for the overall organizational HPH

approach and claim there is a lack of high-level studies on the topic.

Find this resource:

Tønnesen, Hanne, Mette E. Christensen, Oliver Groene, et al. 2007. An evaluation of a

model for the systematic documentation of hospital based health promotion activities:

Results from a multicentre study. BMC Health Services Research 7.1: 145.


The study suggests specific codes for registering clinical health-promotion

interventions that are connective to DRG systems. It can inform health planning and

the development of reimbursement models for clinical health promotion.

Find this resource:












http://dx.doi.org/10.1186/1472-6963-7-145

http://dx.doi.org/10.1186/1472-6963-7-145



25

Tønnesen, Hanne, Anne Mette Fugleholm, and Svend Juul Jørgensen. 2005. Evidence

for health promotion in hospitals. In Health promotion in hospitals: Evidence and

quality management. Edited by Oliver Groene and Mila Garcia-Barbero, 21–45.

Copenhagen: World Health Organization Regional Office for Europe.


Focusing on clinical interventions, the authors summarize the available evidence for

general lifestyle-related and disease-specific health promotion interventions for

hospital patients.

Find this resource:

Zhou, Fengqiong. 2009. Development of a Chinese version WHO self-assessment tool

for evaluating health promotion in hospital. MA thesis, Université de Montréal.


This is an interesting thesis that not only provides a Chinese version of the WHO

standards for health promotion in hospitals but also discusses their applicability under

conditions of the Chinese health-care system.

Find this resource:

15 Linking HPH to Other Reform Concepts

HPH can be described as an umbrella concept with many options for interlinking with other

concepts. For example, linkages between HPH and the ecology and sustainability movements,

as outlined in Hancock 1999, go back to the late 1990s but have been described more

systematically in Weisz, et al. 2011. Collaboration between HPH and the self-help movements

is suggested in a German-language article (Forster, et al. 2013). And, most recently, the HPH

concept has been discussed in relation to the capacity approach in health promotion (Röthlin

2013) and the discourse on salutogenic organizations (Pelikan, et al. 2013).

Forster, Rudolf, Daniela Rojatz, Hermann Schmied, and Jürgen M. Pelikan. 2013.

Selbsthilfegruppen und Gesundheitsförderung im Krankenhaus—eine

entwicklungsfähige Allianz für Gesundheit. Prävention und Gesundheitsförderung 8.1:

9–14.

DOI: 10.1007/s11553-012-0364-zSave Citation »Export Citation »E-mail Citation »

The article links the HPH concept to hospital-based support for self-help groups,

suggesting specific strategies for cooperation. It is interesting in the context of patient

empowerment and cooperation with the self-help movements.

Find this resource:

Hancock, Trevor. 1999. Creating health and health promoting hospitals: A worthy

challenge for the twenty-first century. Leadership in Health Services 12.2: 8–19.














http://dx.doi.org/10.1007/s11553-012-0364-z

http://dx.doi.org/10.1007/s11553-012-0364-z



http://dx.doi.org/10.1108/13660759910266784

http://dx.doi.org/10.1108/13660759910266784



26

This is the first article not only relating HPH to health gains for people but also giving

attention to the impact of health care on the environment.

Find this resource:

Pelikan, Jürgen M., Christina Dietscher, and Hermann Schmied. 2013. In how far is

the health promoting hospital a salutogenic hospital, and how can it be developed? In

Salutogenic organizations and change: The concepts behind organizational health

intervention research. Edited by Georg F. Bauer and Gregor J. Jenny, 149–165.

Dordrecht, The Netherlands, and New York: Springer.

DOI: 10.1007/978-94-007-6470-5Save Citation »Export Citation »E-mail Citation »

Building on the HPH core concept (see the HPH Core Concept), the chapter discusses

similarities and differences between concepts of health promotion and salutogenesis

and implications for the HPH concept. It is mainly of theoretical value.

Find this resource:

Röthlin, Florian. 2013. Managerial strategies to reorient hospitals towards health

promotion: Lessons from organisational theory. Journal of Health Organization and

Management 27.6: 747–761.

DOI: 10.1108/JHOM-07-2011-0070Save Citation »Export Citation »E-mail Citation »

Drawing on an organizational-theory background, the article identifies a number of

capacities that facilitate the implementation of health promotion in hospitals. It is of

theoretical value but is also interesting for hospital managers.

Find this resource:

Weisz, Ulli, Willi Haas, Jürgen M. Pelikan, and Hermann Schmied. 2011. Sustainable

hospitals: A socio-ecological approach. Gaia 20.3: 191–198.


Drawing on Hancock 1999, the article provides a systematic outline of conceptual

interlinks between sustainability and the HPH approach. It is of specific value for

those interested in theory.

Find this resource:

16 Studies on Implementing the Overall HPH Approach

The overall HPH approach (see the HPH Core Concept) was first implemented in pilot and

model projects in Europe during the 1990s (see European Pilot and Model Hospital Projects).

In the years since 2000, implementation has been continuously supported by specific quality

approaches (see Using Quality Concepts for Implementing and Evaluating HPH). In the early

21st century, studies are increasingly focusing on barriers, facilitators, and capacities needed

for HPH (see Studying Capacities Needed, Furthering and Hindering Factors for HPH). A

http://dx.doi.org/10.1007/978-94-007-6470-5

http://dx.doi.org/10.1007/978-94-007-6470-5




http://dx.doi.org/10.1108/JHOM-07-2011-0070

http://dx.doi.org/10.1108/JHOM-07-2011-0070











27

smaller part of the literature is on linking HPH to broader health systems reforms (see

Relating HPH to Health Systems Reform).

17 European Pilot and Model Hospital Projects

The first WHO European model project, “Health and Hospital,” which took place in Vienna,

Austria, between 1989 and 1997, with accompanying evaluation, is described in Nowak, et al.

1998; Pelikan, et al. 1993; and Pelikan, et al. 1996. With the exception of Nowak, et al. 1998,

the cited publications on the Vienna model hospital project are in German. They all describe

an organizational development approach toward HPH, focusing on the selection and

specification of interventions as well as on their outcomes. Coordinated by the same research

team that evaluated the model project, a WHO-initiated European pilot hospital project, with

twenty participating hospitals from eleven countries, was launched in 1993 and successfully

terminated in 1997. A collection of case studies containing implementation experiences and

evaluation results of the twenty participating hospitals is in Pelikan, et al. 1998, and the

German-language Pelikan and Wolff 1999 contains case studies on the German pilot hospitals.

In addition, a couple of journal articles are available on single hospitals that participated in the

project: Trojan, et al. 1997 describes experiences of one pilot hospital in Hamburg, Germany,

and Tountas, et al. 2004 describes the evaluation of the Greek hospital that participated in the

project.

Nowak, Peter, Hubert Lobnig, Karl Krajic, and Jürgen M. Pelikan. 1998. Case Study

Rudolfstiftung Hospital, Vienna, Austria—WHO model project “Health and Hospital.”

In Pathways to a health promoting hospital: Experiences from the European Pilot

Hospital Project, 1993–1997. Edited by Jürgen M. Pelikan, Mila Garcia-Barbero,

Hubert Lobnig, and Karl Krajic, 47–66. Health Promoting Hospital Series 2. Gamburg,

Germany: G. Conrad.


The chapter is a good English-language summary description of interventions and

evaluation outcomes of the first WHO European model project, “Health and Hospital,”

in Vienna, Austria.

Find this resource:

Pelikan, Jürgen M., Mila Garcia-Barbero, Hubert Lobnig, and Karl Krajic, eds. 1998.



Germany: G. Conrad.


The book collects twenty case studies of hospital health promotion from eleven

different European countries and provides valuable insight on the applicability of the

HPH approach to different types of hospitals and health-care systems.

Find this resource:

Pelikan, Jürgen M., Hubert Lobnig, and Peter Nowak. 1993. Das Wiener WHO-

Modellprojekt “Gesundheit und Krankenhaus.” In Gesundheitsförderung durch

















28

Organisationsentwicklung: Konzepte, Strategien und Projekte für Betriebe,

Krankenhäuser und Schulen. Edited by Jürgen M. Pelikan, Hildegard Demmer, and

Klaus Hurrelmann, 204–222. Gesundheitsforschung. Weinheim, Germany, and

Munich: Juventa-Verlag.


The chapter describes the Vienna WHO model project as one example of an

organizational development approach toward health promotion. It is interesting from

an intervention perspective but also with regard to the concept and history of HPH.

Find this resource:

Pelikan, Jürgen M., Peter Nowak, and Hubert Lobnig. 1996. Das Krankenhaus auf

dem Weg zu einer gesundheitsfördernden Organisation: Das WHO-Modellprojekt

Gesundheit und Krankenhaus. In Gesundheitsförderung und Public Health:

Öffentliche Gesundheit durch Organisation entwickeln. Edited by Ralph Grossmann,

148–170. Vienna: Facultas-Universitätsverlag.


The chapter builds on Pelikan, et al. 1993, also including experiences of the model

hospital during the subsequent European pilot hospital project (see also Pelikan, et al.

1998).

Find this resource:

Pelikan, Jürgen M., and Stephan Wolff, eds. 1999. Das gesundheitsfördernde

Krankenhaus: Konzepte und Beispiele zur Entwicklung einer lernenden Organisation.



The book contains case studies from the German-speaking HPH pilot hospitals.

Find this resource:

Tountas, Yannis, Elpida Pavi, Kyriaki Tsamandouraki, Nikolaos Arkadopoulos, and

Dimitra Triantafyllou. 2004. Evaluation of the participation of Aretaieion Hospital,

Greece in the WHO Pilot Project of Health Promoting Hospitals. Health Promotion


DOI: 10.1093/heapro/dah407Save Citation »Export Citation »E-mail Citation »

The article outlines the evaluation concept and outcomes of Aretaieion University

Hospital, Greece, during the European pilot hospital project of HPH. It can inform the

development of evaluation designs but also refers to points to be considered when

implementing health promotion in the hospital context.

Find this resource:













http://dx.doi.org/10.1093/heapro/dah407




29

Trojan, Alf, Stefan Nickel, and Petra Schneiders-Kastning. 1997. Quality evaluation

from the patient viewpoint—exemplary results from the European WHO project

“Health-Promoting Hospitals.” Gesundheitswesen 59.12: 720–725.


This article, in German, provides an outline of the European WHO project “Health

Promoting Hospitals” and presents patient-reported hospital quality as one important

outcome dimension of HPH.

Find this resource:

18 Using Quality Concepts for Implementing and Evaluating HPH

There are two strands of implementation-oriented research around quality and HPH. One aims

at generating experiences and guidelines on implementing health promotion in hospitals, by

means of specific quality tools and management approaches. Examples include Brandt, et al.

2005 and Groene, et al. 2009 on using the Balanced Scorecard to implement HPH. The other

strand of research focuses on evaluating the health promotion quality of hospitals, using the

WHO standards for health promotion in hospitals (see Linking HPH to Evidence-Based

Medicine and to the Quality Movements) as a tool. Examples include Goel, et al. 2011 and

Põlluste, et al. 2007, which compare the degree of standard fulfillment in HPH member

hospitals against fulfillment in non-members. Miseviciene and Zalnieraitiene 2013 uses the

standards to measure the preparedness of health professionals to implement health promotion

in hospitals.

Brandt, Elimar, Werner Schmidt, Ralf Dziewas, and Oliver Groene. 2005.

Implementing the health promoting hospitals strategy through a combined application

of the EFQM Excellence Model and the Balanced Scorecard. In Health promotion in

hospitals: Evidence and quality management. Edited by Oliver Groene and Mila

Garcia-Barbero, 80–99. Copenhagen: World Health Organization Regional Office for

Europe.


On the basis of a national initiative in the German HPH network, the chapter describes

how quality tools can be used to strategically support the comprehensive

implementation of health promotion in hospital organizations.

Find this resource:

Goel, Sonu, A. K. Gupta, Parampreet Ahuja, et al. 2011. Comparison of the health-

promoting orientation of three tertiary care hospitals of India. National Medical

Journal of India 24.2: 83–85.


The study compares the health promotion quality of two members of the international

HPH network with the quality of a non-HPH hospital and concludes that the HPH

member organizations have better health promotion quality.


















30

Find this resource:

Groene, Oliver, Elimar Brandt, Werner Schmidt, and Johannes Moeller. 2009. The

Balanced Scorecard of acute settings: Development process, definition of 20 strategic

objectives and implementation. International Journal for Quality in Healthcare 21.4:

259–271.

DOI: 10.1093/intqhc/mzp024Save Citation »Export Citation »E-mail Citation »

The chapter describes how a combination of specific quality tools can be used to

support the implementation of health promotion in hospitals.

Find this resource:

Miseviciene, Irena, and Kristina Zalnieraitiene. 2013. Health promoting hospitals in

Lithuania: Health professional support for standards. Health Promotion International

28.4: 512–521.

DOI: 10.1093/heapro/das035Save Citation »Export Citation »E-mail Citation »

The authors assess the degree of awareness of the WHO health promotion standards in

doctors and nurses of the Lithuanian HPH network, concluding that nurses and doctors

assess the feasibility of standards in different ways. The study can be useful for

understanding the perspectives of health professionals on HPH.

Find this resource:

Põlluste, Kaja, Jane Alop, Oliver Groene, Tiiu Härm, Eda Merisalu, and Lagle

Suurorg. 2007. Health-promoting hospitals in Estonia: What are they doing differently?

Health Promotion International 22.4: 327–336.

DOI: 10.1093/heapro/dam032Save Citation »Export Citation »E-mail Citation »

Using the WHO HPH standards, the study compares the health promotion quality of

members and non-members of the Estonian HPH network. It is especially valuable for

developing comparative research designs.

Find this resource:

19 Studying Capacities Needed, Furthering and Hindering Factors for HPH

Research has identified hospital-internal as well as hospital-external capacities, furthering and

hindering factors for HPH. With regard to hospital-internal factors, Lin and Lin 2011 (cited

under Globalization of HPH) identifies the level of institutionalization of health promotion,

while Lee, et al. 2012a and Röthlin, et al. 2013 focus on the relevance of organizational

capacity and infrastructure, including the support from in-house HPH coordinators. Johansson,

et al. 2010a and Johansson, et al. 2010b focus on the role of objectives and guidelines and

professional power play (i.e., the fact that professional groups with comparatively low

decision power—such as psychologists, occupational therapists, and physiotherapists—are

more interested in health promotion than are more-dominant groups in health care). Relating

to the role of professionals, Deccache, et al. 1999 finds the recognition of health promotion

http://dx.doi.org/10.1093/intqhc/mzp024

http://dx.doi.org/10.1093/intqhc/mzp024



http://dx.doi.org/10.1093/heapro/das035
















31

(HP) as a professional domain as an important furthering factor. Among the hospital-external

factors, Deccache, et al. 1999 points to the level of political support, public awareness, and

demand, while Lee, et al. 2012b highlights options for reimbursement of health promotion

services, and Aujoulat, et al. 2001 sees a need for implementation support in the form of the

availability of implementation guidelines. With the exception of Deccache, et al. 1999, which

is a French publication, these articles are in English.

Aujoulat, Isabelle, Anne-Laurence Le Faou, Brigitte Sandrin-Berthon, François Martin,

and Alain Deccache. 2001. Implementing health promotion in health care settings:

Conceptual coherence and policy support. Patient Education and Counseling 45.4:

245–254.


Citation »

The authors claim a lack of guidelines to support the implementation of health

promotion in hospitals, and they call for professional skill building to support the

approach.

Find this resource:

Deccache, Alain, France Libion, Caroline van Cangh, Jacques Dumont, Jean-Luc

Collignon, and M. Borgs. 1999. Promouvoir la santé dans les milieux de soins et les

hôpitaux? Une enquête en communauté française de Belgique. Promotion &

Education 6.1: 31–35.

DOI: 10.1177/102538239900600112Save Citation »Export Citation »E-mail Citation

»

The authors outline the development of HPH in Belgium, drawing on a survey among

hospitals in the French part of Belgium. It is interesting in the context of country

comparisons.

Find this resource:

Johansson, Helene, Hans Stenlund, Lena Lundström, and Lars Weinehall. 2010a.

Reorientation to more health promotion in health services: A study of barriers and

possibilities from the perspective of health professionals. Journal of Multidisciplinary

Healthcare 3:213–224.

DOI: 10.2147/JMDH.S14900Save Citation »Export Citation »E-mail Citation »

The authors argue that hospital reorientation toward health promotion could be

strengthened by better involving a more diverse range of clinical professions that are

often left out.

Find this resource:

Johansson, Helene, Lars Weinehall, and Maria Emmelin. 2010b. “If only we got a

chance”: Barriers to and possibilities for a more health-promoting health service.

Journal of Multidisciplinary Healthcare 3:1–9.





http://dx.doi.org/10.1016/S0738-3991%2801%2900188-4

http://dx.doi.org/10.1016/S0738-3991%2801%2900188-4



http://dx.doi.org/10.1177/102538239900600112

http://dx.doi.org/10.1177/102538239900600112



http://dx.doi.org/10.2147/JMDH.S14900

http://dx.doi.org/10.2147/JMDH.S14900



32


Authors identify (a lack of) leadership as one of the key hindering or facilitating

factors to health promotion in hospitals.

Find this resource:

Lee, Chiachi Bonnie, Michael S. Chen, Michael John Powell, and Cordia Ming-Yeuk

Chu. 2012a. Achieving organizational change: Findings from a case study of health

promoting hospitals in Taiwan. Health Promotion International.

DOI: 10.1093/heapro/das056Save Citation »Export Citation »E-mail Citation »

Drawing on an evaluation of HPH member hospitals in Taiwan, the authors conclude

that HPH membership contributed to organizational capacity building of hospitals for

health promotion.

Find this resource:

Lee, Chiachi Bonnie, Michael S. Chen, Michael John Powell, and Cordia Ming-Yeuk

Chu. 2013. Organisational change to health promoting hospitals: A review of the

literature. Springer Science Reviews 1.1–2: 13–23.


The authors argue that insufficient organizational support is one of the major barriers

for hospitals’ engagement in health promotion, and therefore they demand an

organizational capacity-building approach as a relevant precondition for hospitals to

adopt the HPH initiative.

Find this resource:

Lee, Chiachi Bonnie, Michael S. Chen, and Ying Wei Wang. 2012b. Barriers to and

facilitators of the implementation of health promoting hospitals in Taiwan: a top-down

movement in need of ground support. International Journal of Health Planning and

Management

DOI: 10.1002/hpm.2156Save Citation »Export Citation »E-mail Citation »

The authors investigate barriers to and facilitators of HPH in Taiwan. On the basis of

these findings, the authors strongly promote an organizational capacity-building

approach to foster HPH in Taiwanese hospitals.

Find this resource:

Röthlin, Florian, Hermann Schmied, and Christina Dietscher. 2013. Organizational

capacities for health promotion implementation: Results from an international hospital

study. Health Promotion International.

DOI: 10.1093/heapro/dat048Save Citation »Export Citation »E-mail Citation »











http://dx.doi.org/10.1002/hpm.2156

http://dx.doi.org/10.1002/hpm.2156



http://dx.doi.org/10.1093/heapro/dat048




33

Drawing on data from an international evaluation study of the international HPH

network, the authors argue that specific organizational structures or capacities can

significantly contribute to implementing more-elaborated and more-comprehensive

health promotion approaches. They conclude that health promotion needs to be

supported by organizational capacity building.

Find this resource:

20 Relating HPH to Health Systems Reform

While HPH was predominantly developed as an organizational concept, the Ottawa Charter’s

demand to reorient health services referred to the health sector at large. Some countries and

regions have used health promotion approaches to guide health system reform. Whitelaw, et al.

2006 and Whitelaw, et al. 2012 describe the example of Scotland, and Swedish National

Institute of Public Health 2006 focuses on reforms in Sweden.

Swedish National Institute of Public Health. 2006. Towards a more health-promoting

health service: Summary of study material, government bills, parliamentary decisions,

draft indicators and examples of application. Stockholm: Swedish National Institute

of Public Health.


The booklet describes the preparation of the Swedish public health policy domain “A

More ‘Health-Promoting’ Health Service” of 2003, and draft indicators for a more

health-promoting health service.

Find this resource:

Whitelaw, Sandy, Nicola Graham, David Black, Jonathan Coburn, and Lorna Renwick.

2012. Developing capacity and achieving sustainable implementation in healthy

“settings”: Insights from NHS Health Scotland’s Health Promoting Health Service

project. Health Promotion International 27.1: 127–137.

DOI: 10.1093/heapro/dar038Save Citation »Export Citation »E-mail Citation »

Building on Whitelaw, et al. 2006, the article presents outcomes of the Health

Promoting Health Service Framework (HPHS) in NHS Scotland, raising optimism for

the feasibility of effective implementation of the settings approach in health service

settings.

Find this resource:

Whitelaw, Sandy, Claudia Martin, Ann Kerr, and Erica Wimbush. 2006. An

evaluation of the Health Promoting Health Service Framework: The implementation

of a settings based approach within the NHS in Scotland. Health Promotion


DOI: 10.1093/heapro/dal009Save Citation »Export Citation »E-mail Citation »









http://dx.doi.org/10.1093/heapro/dar038

http://dx.doi.org/10.1093/heapro/dar038




http://dx.doi.org/10.1093/heapro/dal009

http://dx.doi.org/10.1093/heapro/dal009



34

Drawing on an evaluation of the development of HPHS in NHS Scotland, which

started in 1996, the article discusses a range of supportive and hindering factors and

mechanisms for the effective implementation of health promotion practice.

Find this resource:

21 Health Promotion as a Professional Concept for

Different Health Professions, Types, and Units of Hospitals

Some authors have broken down the overall approach of health promotion as a reform

concept for hospitals to different clinical disciplines, types of hospitals, and hospital units.

22 Health Promotion and Hospital Nurses

Most of the literature on health promotion as a professional concept refers to nurses as the

largest professional group in health care. For example, handbooks on health promotion in

nursing practice have been prepared in McBride 1995 and Raingruber 2014. While McBride

1995 also focuses on the role of nurses in developing organizational health promotion

strategies, Raingruber 2014 refers mostly to nurses’ role in specific health promotion and

disease prevention interventions for patients. Publications also reflect on the barriers and

facilitators for implementing health promotion as part of the nurse role. Caraher 1994 and

Whitehead 2007 identify the standing of health promotion in nursing education, as well as the

relevance of health promotion on the professional agenda and the impact of organizational

environments as important factors. A bigger part of the literature links health promotion to the

professionalization of nurses. In this context, Shoqirat and Cameron 2002 criticizes that

Jordanian nurses have too-narrow concepts of health promotion, and Whitehead 2005 stresses

the need for reform. Similar conclusions are given by authors from different continents,

including in Mazza Nunes, et al. 2009 (from Brazil), Whitehead, et al. 2008 (in relation to the

situation in China), and Shoqirat and Cameron 2002 (on developments in Jordan).

Caraher, Martin. 1994. A sociological approach to health promotion for nurses in an

institutional setting. Journal of Advanced Nursing 20.3: 544–551.

DOI: 10.1111/j.1365-2648.1994.tb02394.xSave Citation »Export Citation »E-mail

Citation »

The article proposes a model that takes account of the institutional and professional

agendas in which nurses work and the need to balance these with the needs and rights

of the patient.

Find this resource:

Mazza Nunes, Joyce, Álissan Karine Lima Martins, Maria de Fátima Bastos Nóbrega,

Ângela Maria Alves e Souza, Ana Fátima Carvalho Fernandes, and Neiva Francenely

Cunha Vieira. 2009. Promoting health in the hospital from the viewpoint of the nurse:

Descriptive-exploratory study. Online Brazilian Journal of Nursing 8.3.














http://dx.doi.org/10.1111/j.1365-2648.1994.tb02394.x

http://dx.doi.org/10.1111/j.1365-2648.1994.tb02394.x






35

Drawing on a study from one public hospital, the authors conclude that hospital nurses

are more focused on prevention than on promotion and that reforms are needed to

change their professional behavior.

Find this resource:

McBride, Anita S. 1995. Health promotion in hospital: A practical handbook for

nurses. London: Scutari.


The handbook refers both to nurses’ role in developing specific organizational health-

promotion strategies and to implementing specific clinical interventions, addressing

nurses in clinical practice and nursing students.

Find this resource:

Raingruber, Bonnie. 2014. Contemporary health promotion in nursing practice.

Burlington, MA: Jones & Bartlett.


The book offers a comprehensive introduction to health promotion in nursing practice,

referring to a wide range of topics, including health literacy. The main target groups

are nurses in clinical practice and nursing students.

Find this resource:

Shoqirat, Noordeen, and Shona Cameron. 2002. Promoting hospital patients’ health in

Jordan: Rhetoric and reality of nurses’ roles. International Journal of Nursing 1.1: 27–

36.


The authors point out that Jordanian nurses understand and practice health promotion

mainly as giving information to individuals and addressing behavior change, which

they find is inconsistent with health promotion concepts such as empowerment. In

response, they suggest a radical reform of the Jordanian health-care system.

Find this resource:

Whitehead, Dean. 2005. Health promoting hospitals: The role and function of nursing.

Journal of Clinical Nursing 14.1: 20–27.

DOI: 10.1111/j.1365-2702.2004.01012.xSave Citation »Export Citation »E-mail

Citation »

The author introduces the European HPH movement as a vehicle for substantial

change in hospitals, and he encourages nurses to steer these developments as radical

change agents.










http://dx.doi.org/10.1111/j.1365-2702.2004.01012.x

http://dx.doi.org/10.1111/j.1365-2702.2004.01012.x



36

Find this resource:

Whitehead, Dean. 2007. Reviewing health promotion in nursing education. Nurse

Education Today 27.3: 225–237.

DOI: 10.1016/j.nedt.2006.05.003Save Citation »Export Citation »E-mail Citation »

The article refers to the WHO European Strategy for Nursing and Midwifery

Education (2000), which calls for the explicit inclusion of health promotion in nursing

curricula. The author concludes that this call has broadly remained without

consequence, and he presents considerations for wider reform.

Find this resource:

Whitehead, Dean, Yonghuan Wang, Jianhong Wang, Jing Zhang, Zhen Sun, and Chen

Xie. 2008. Health promotion and health education practice: Nurses’ perceptions.

Journal of Advanced Nursing 61.2: 181–187.


Citation »

Drawing on data from one Chinese provincial hospital, the authors conclude that the

understanding of health promotion in Chinese nurses is similar to the understanding in

European or North American nurses and that constraints such as lack of time are also

similar.

Find this resource:

23 Health Promotion in Hospitals and Medical Doctors

Compared to the literature on the role of nurses in health promotion, there are few

publications on health promotion as part of the role profile of hospital doctors (there is a

wealth of literature on the role of primary-care physicians in health promotion, which is,

however, out of the scope of this article). There is broad consensus in the cited articles on

medical doctors being important partners for hospital health promotion in principle. For

example, Orr and Hauck 1984 sees the support by medical doctors as an important

prerequisite for the success of organizational health-promotion programs. Roemer 1984,

however, argues that medical care is health promoting per se. Most contributions, including

Jones and Hsu-Hage 1999; Perkins 1999; Naidoo and Orme 2000; and Rondeau, et al. 2006,

see a need for better training of clinicians as a prerequisite for improving their role in health

promotion. Wylie and Holt 2010 is a handbook on health promotion in medical education.

Jones, Kenneth V., and Bridget H. H. Hsu-Hage. 1999. Health promotion projects:

Skill and attitude learning for medical students. Medical Education 33.8: 585–591.


Citation »

The article offers an example for integrating health promotion into medical education.

It describes a project-learning approach in which medical students design and deliver

community health promotion projects as part of their professional formation.

http://dx.doi.org/10.1016/j.nedt.2006.05.003

http://dx.doi.org/10.1016/j.nedt.2006.05.003



http://dx.doi.org/10.1111/j.1365-2648.2007.04479.x

http://dx.doi.org/10.1111/j.1365-2648.2007.04479.x










http://dx.doi.org/10.1046/j.1365-2923.1999.00438.x

http://dx.doi.org/10.1046/j.1365-2923.1999.00438.x



37

Find this resource:

Naidoo, Jennie, and Judy Orme. 2000. Health promotion in the medical curriculum:

Enhancing its potential. Medical Teacher 22.3: 282–287.


The article discusses the potential content of health promotion in medical education

and presents a series of vignettes for teachers to use to enhance the effective delivery

of health promotion for medical students.

Find this resource:

Orr, G. A., III, and R. Hauck. 1984. Physicians and hospital-based health promotion:

Formalizing the relationship. Hospital Medical Staff 13.12: 16–22.


Hospitals and health-care organizations are faced with a multitude of new pressures

that threaten their very survival. Redirecting a threat into an opportunity requires close

cooperation between a health-care institution and its medical staff. One opportunity

that has emerged is the development of health promotion programs, whose success

depends on medical staff support.

Find this resource:

Perkins, Elizabeth R. 1999. Hospital doctors and health promotion: Support for

teaching behaviour change. Medical Teacher 21.2: 180–183.


The article introduces an educational pack for junior doctors, on the basis of James

Prochaska and Carlo DiClemente’s “Cycle of Change” model.

Find this resource:

Roemer, Milton I. 1984. The value of medical care for health promotion. American

Journal of Public Health 74.3: 243–248.

DOI: 10.2105/AJPH.74.3.243Save Citation »Export Citation »E-mail Citation »

The paper argues that medical care should not be counterposed to health promotion or

prevention. Rather, the author propagates an integrated approach for the benefit of

both strategies.

Find this resource:

Rondeau, Kent V., Louis H. Francescutti, and Garnet E. Cummings. 2006. Health

promoting attitudes and behaviors of emergency physicians: Exploring gender

differences. Journal of Health Organization and Management 20.4: 269–284.

http://dx.doi.org/10.1080/01421590050006269

http://dx.doi.org/10.1080/01421590050006269






http://dx.doi.org/10.1080/01421599979833

http://dx.doi.org/10.1080/01421599979833



http://dx.doi.org/10.2105/AJPH.74.3.243

http://dx.doi.org/10.2105/AJPH.74.3.243



38


On the basis of a comparison of male and female emergency physicians, the paper

argues that in the future, educating emergency physicians in the practice of health

promotion will make emergency departments more-effective resources for their

community.

Find this resource:

Wylie, Ann, and Tangerine Holt, eds. 2010. Health promotion in medical education:

From rhetoric to action. Oxford: Radcliffe.


The publication makes a plea for the inclusion of health promotion into medical

education, outlining learning needs of medical students and core competencies.

Find this resource:

24 Implementing Health Promotion in Specific Hospital Types and Units

Some authors have adapted general health-promotion approaches to the demands of specific

hospital types or types of hospital units. Coakley 1998 discusses the application of health

promotion on the ward level, Bensberg, et al. 2003 describes a framework for health-

promoting emergency departments, Barnett 2007 focuses on the application in maternity

wards, and Berger, et al. 2006 concentrates on mental health promotion in general hospitals.

Barnett, Carol. 2007. WHO health promoting hospitals: Maternity services in Scotland.

British Journal of Midwifery 15.10: 647–649.


The article describes one maternity service that was declared a hub unit for HPH in

Scotland, arguing that the quality of services delivered depends on the knowledge and

skills of the midwives.

Find this resource:

Bensberg, Monica, Marcus Kennedy, and Scott Bennetts. 2003. Identifying the

opportunities for health promoting emergency departments. Accident and Emergency

Nursing 11.3: 173–181.

DOI: 10.1016/S0965-2302(03)00002-XSave Citation »Export Citation »E-mail

Citation »

The authors argue that emergency departments could specifically contribute to health

promotion since emergencies are often caused by the living circumstances of the

patients. They demand better training for emergency staff.

Find this resource:

http://dx.doi.org/10.1108/14777260610680087

http://dx.doi.org/10.1108/14777260610680087













http://dx.doi.org/10.1016/S0965-2302%2803%2900002-X

http://dx.doi.org/10.1016/S0965-2302%2803%2900002-X



39

Berg, Geir V., Birgitta Hedelin, and Anneli Sarvimäki. 2005. A holistic approach to

the promotion of older hospital patients’ health. International Nursing Review 52.1:

73–80.


Citation »

The article relates to the discourse on preconditions for health promotion in hospitals,

arguing that hospital nurses in typical hospital environments need to constantly

balance between a biomedical and a holistic approach toward their patients.

Find this resource:

Berger, Hartmut, Rainer Paul, and Eva Heimsath. 2006. Health promoting hospitals

and consultation liaison-psychiatry. Psychosomatik und Konsiliarpsychiatrie 1.1: 52–

55.


Drawing on the WHO model of HPH, the authors suggest that consultation-liaison

psychiatrists could be an important link for mental health promotion in general acute

hospitals.

Find this resource:

Coakley, Ann-Louise. 1998. Health promotion in a hospital ward; Reality or asking

the impossible? Journal of the Royal Society for the Promotion of Health 118.4: 217–

220.

DOI: 10.1177/146642409811800406Save Citation »Export Citation »E-mail Citation

»

The article addresses preconditions for the implementation of health promotion on the

ward level, including increased multiprofessional collaboration.

Find this resource:

25 Health Promotion for Different Target Groups

The HPH approach traditionally differentiates between interventions addressing patients, staff,

and the hospital community, and interventions targeting persons and situations or settings and

the environment (see the HPH Core Concept). This approach is only partly mirrored in the

literature, since interventions for the different target groups can be very specific and are not

always explicitly labeled as being in relation to a HPH or hospital health promotion approach.

This is due to the broad conceptual approach of HPH, which has also been described as an

umbrella concept and covers, for example, aspects of patient participation and empowerment,

workplace health promotion, and community outreach. Given the broadness of the field, only

literature with an explicit link to HPH was included in this section of the article.

26 Patient-Oriented Health Promotion

http://dx.doi.org/10.1111/j.1466-7657.2004.00264.x

http://dx.doi.org/10.1111/j.1466-7657.2004.00264.x






http://dx.doi.org/10.1177/146642409811800406

http://dx.doi.org/10.1177/146642409811800406




40

Following the HPH concept suggested in Pelikan, et al. 2005 (cited under the HPH Core

Concept), patient-oriented hospital health promotion can be focused on empowering patients

for self-care and for the coproduction of health, for disease management and lifestyle

development, and on developing the hospital into a physically and socially supportive setting

for patients, as well as on informing or supporting community development for the needs of

hospital patients. While literature on each of these aspects could fill a bibliographic article of

its own, this section contains only literature with explicit referrals to hospital health

promotion. Earlier literature, as in Caraher 1998, is concerned with differentiating health

promotion for patients from health education. However, Härm 2001 understands health

education as part of health promotion for patients and, consequently, sees the rise of the HPH

movement as an enhancer of patient education. Overall, there seem to be two poles of

research on patient-oriented health promotion. One of these, as represented for example by

Shoqirat and Cameron 2013, focuses on patient-driven concepts of health promotion. The

other pole is characterized by expert- and risk-oriented concepts of health promotion for

patients, with screening for lifestyle risks and lifestyle counseling being reported as the main

types of interventions. Representatives of this pole include Haynes and Cook 2008; McBride

2003; Oppedal, et al. 2011; Sinclair, et al. 2010; and Tønnesen, et al. 2007 (the last of which

is cited under Linking HPH to Evidence-Based Medicine and to the Quality Movements). Yet

another strand of the literature follows a quality understanding of patient-oriented hospital

health promotion, measuring its impact on the outcomes of patient satisfaction surveys; Guo,

et al. 2008 and Misevičienė and Milašauskienė 2003 are two examples.

Caraher, Martin. 1998. Patient education and health promotion: Clinical health

promotion—the conceptual link. Patient Education and Counseling 33.1: 49–58.


Citation »

The article presents a model linking health promotion, health education, and patient

education, providing guidance on conceptual and theoretical approaches around these

topics.

Find this resource:

Guo, Xiu-Hua, Xiang-Yang Tian, Yue-Song Pan, et al. 2008. Investigation of the

current status of health promotion hospitals in Beijing: A clinical analysis of 805

inpatients. Chinese General Practice 1.


The study provides an evaluation of patient satisfaction in pilot HPHs in Beijing,

identifying some needs for improvement.

Find this resource:

Härm, Tiiu. 2001. Patient education in Estonia. In Special issue: Patient education in

Europe. Patient Education and Counseling 44.1: 75–78.


Citation »

















http://dx.doi.org/10.1016/S0738-3991%2897%2900055-4

http://dx.doi.org/10.1016/S0738-3991%2897%2900055-4






http://dx.doi.org/10.1016/S0738-3991%2801%2900107-0

http://dx.doi.org/10.1016/S0738-3991%2801%2900107-0



41

The article outlines how the national HPH network in Estonia enhanced patient

education in the country, by that understanding health education as one type of health

promotion service.

Find this resource:

Haynes, Charlotte L., and Gary A. Cook. 2008. Audit of health promotion practice

within a UK hospital: Results of a pilot study. Journal of Evaluation in Clinical

Practice 14.1: 103–109.


Citation »

The article follows a risk-oriented approach toward health promotion in hospitals,

providing a study on screening and intervening inpatients for lifestyle-related risk

factors and identifying needs for improvement in both dimensions.

Find this resource:

McBride, Anita. 2003. Health promotion in the acute hospital setting: The receptivity

of adult in-patients. Patient Education and Counseling 54.1: 73–78.


Citation »

The article presents a study on patients’ supportiveness of interventions in clinical

health education if these meet their specific needs.

Find this resource:

Misevičienė, Irena, and Žemyna Milašauskienė. 2003. Changes of patients’

satisfaction with the health care services in Lithuanian Health Promoting Hospitals

network. Medicina 39.6: 604–609.


The article describes observed improvements in patient satisfaction in hospitals of the

Lithuanian HPH network, thus implying patient satisfaction as one outcome dimension

of health promotion in hospitals.

Find this resource:

Oppedal, Kristian, Sverre Nesvåg, Bolette Pedersen, et al. 2011. Health and the need

for health promotion in hospital patients. European Journal of Public Health 21.6:

744–749.

DOI: 10.1093/eurpub/ckq148Save Citation »Export Citation »E-mail Citation »

The study describes international experiences with a suggested model for screening

patients for lifestyle-related health risks.

http://dx.doi.org/10.1111/j.1365-2753.2007.00810.x

http://dx.doi.org/10.1111/j.1365-2753.2007.00810.x



http://dx.doi.org/10.1016/S0738-3991%2803%2900198-8

http://dx.doi.org/10.1016/S0738-3991%2803%2900198-8






http://dx.doi.org/10.1093/eurpub/ckq148

http://dx.doi.org/10.1093/eurpub/ckq148



42

Find this resource:

Shoqirat, Noordeen, and Shona Cameron. 2013. A qualitative study of hospital

patients’ understanding of health promotion. Journal of Clinical Nursing 22.19–20:

2714–2722.

DOI: 10.1111/jocn.12212Save Citation »Export Citation »E-mail Citation »

The authors support the development of health promotion concepts that incorporate

patient perspectives and needs, rather than understanding health promotion solely as

an expert-driven concept.

Find this resource:

Sinclair, Janet, Charlotte Haynes, and Deborah Lee. 2010. Development of a health

promotion care pathway for adult hospital-based patients. International Journal of

Care Pathways 14.4: 155–160.

DOI: 10.1258/jicp.2010.010m15Save Citation »Export Citation »E-mail Citation »

The study is in line with other risk-oriented approaches toward screening hospital

patients for lifestyle-related risk factors, suggesting a care pathway to support lifestyle

change, including follow-up after discharge.

Find this resource:

27 Health Promotion for Vulnerable Groups of Patients

Specific emphasis has been given to addressing the needs of vulnerable groups of patients in

the context of health promotion in hospitals. Aujoulat, et al. 2006 is a review on health

promotion for children and adolescents; Berg, et al. 2010 and Chiou and Chen 2009 focus on

the health promotion needs of older patients; Björklund, et al. 2008 discusses health

promotion for patients with cancer; Svedberg, et al. 2009 focuses on patient and staff attitudes

toward health promotion for psychiatric patients; Krajic, et al. 2005 describes a European

project on health promotion for migrants and ethnic minorities, held in cooperation with the

HPH network; and migrant health promotion as a public health strategy is described in

MacLaren and Kekeubata 2007. Most articles in this field share a patient-oriented perspective

and relate to a psychological dimension of health, highlighting the needs of specific patient

populations from their own perspective, rather than solely following expert-driven approaches.

Aujoulat, Isabelle, Fabrizio Simonelli, and Alain Deccache. 2006. Health promotion

needs of children and adolescents in hospitals: A review. Patient Education and

Counseling 61.1: 23–32.

DOI: 10.1016/j.pec.2005.01.015Save Citation »Export Citation »E-mail Citation »

On the basis of a literature review, the article provides a valuable introduction to the

health promotion needs of children and adolescents in hospitals, both for health-care

practitioners and researchers.

http://dx.doi.org/10.1111/jocn.12212

http://dx.doi.org/10.1111/jocn.12212



http://dx.doi.org/10.1258/jicp.2010.010m15

http://dx.doi.org/10.1258/jicp.2010.010m15










http://dx.doi.org/10.1016/j.pec.2005.01.015

http://dx.doi.org/10.1016/j.pec.2005.01.015



43

Find this resource:

Berg, Geir V., Anneli Sarvimäki, and Birgitta Hedelin. 2010. The diversity and

complexity in health promotion and empowerment related to older hospital patients—

exploring nurses’ reflections. Nordic Journal of Nursing Research & Clinical Studies

30.1: 9–13.


On the basis of focus group interviews, the article outlines nurses’ perceptions of

health promotion and empowerment for older patients, suggesting a need for better

clarifying concepts and more-professional reflections.

Find this resource:

Björklund, Margereth, Anneli Sarvimäki, and Agneta Berg. 2008. Health promotion

and empowerment from the perspective of individuals living with head and neck

cancer. European Journal of Oncology Nursing 12.1: 26–34.

DOI: 10.1016/j.ejon.2007.09.003Save Citation »Export Citation »E-mail Citation »

In contrast to professional perspectives on health promotion in health care, which are

often risk oriented, this study explored the positive health-oriented needs of cancer

patients from their own perspective, with a focus on enhancing their well-being on the

psychological dimension of health promotion.

Find this resource:

Chiou, Shu-Ti, and Liang-Kung Chen. 2009. Towards age-friendly hospitals and

health services. In Supplement: Developing geriatric services and research in Taiwan.

Archives of Gerontology and Geriatrics 49.S2: S3–S6.


The article provides a framework for age-friendly care that is being disseminated in

Taiwan, focusing both on implementation and evaluation.

Find this resource:

Krajic, Karl, Christa Straßmayr, Ursula Karl-Trummer, Sonja Novak-Zezula, and

Jürgen M. Pelikan. 2005. Improving ethnocultural competence of hospital staff by

training: Experiences from the European “Migrant-Friendly Hospitals” project.

Diversity in Health and Social Care 2.4: 279–290.


The paper gives insight into cultural-competence training for hospital staff in the

framework of the European “Migrant-Friendly Hospitals” project.

Find this resource:




http://dx.doi.org/10.1016/j.ejon.2007.09.003

http://dx.doi.org/10.1016/j.ejon.2007.09.003









44

MacLaren, David, and Esau Kekeubata. 2007. Reorienting health services through

community health promotion in Kwaio, Solomon Islands. Promotion & Education

14.2: 78–79.

DOI: 10.1177/10253823070140021701Save Citation »Export Citation »E-mail

Citation »

The article provides an example of how community-oriented health promotion

interventions can be developed to meet the needs of ethnic minorities.

Find this resource:

Svedberg, Petra, Lars Hansson, and Bengt Svensson. 2009. The attitudes of patients

and staff towards aspects of health promotion interventions in mental health services

in Sweden. Health Promotion International 24.3: 269–276.

DOI: 10.1093/heapro/dap019Save Citation »Export Citation »E-mail Citation »

The study shows considerable differences in the attitudes of patients and staff toward

health promotion, thus suggesting the need not only for using expert-driven health

promotion concepts but to better meet patients’ self-perceived health promotion needs.

Find this resource:

28 Health Promotion for Hospital Staff

Following the HPH concept suggested in Pelikan, et al. 2005 (see the HPH Core Concept),

health promotion for hospital staff would involve the support of staff in health-promoting self-

care, their involvement in the coproduction of working conditions, and specific interventions

to support staff in managing (occupational) illness and in developing healthy lifestyles, to

develop the hospital toward a physically and socially health-promoting setting for staff and to

inform or support community developments to meet the health needs of hospital staff.

Concepts and interventions for this target group are very similar to those that can be found in

occupational health management or workplace health promotion. Thus, while there is a lot of

literature on specific interventions to enhance the health of hospital staff or the hospital as a

work environment, publications are rarely labeled as explicitly linking to a health promotion

or HPH approach. In light of the broadness of the field, this section contains only articles with

an explicit referral to health promotion in hospitals. Contributions in the literature include a

comprehensive outline of health promotion for hospital staff (Pelikan, et al. 2013), a survey of

the health status of hospital staff and of their participation in health promotion programs

(Tountas, et al. 2003), considerations on the role of program managers in program

implementation (Whitehead 2006), and considerations and findings on the participation in the

HPH network as one facilitator for staff-oriented health promotion (Lee, et al. 2013). A

comprehensive guide on hospital-based workplace health promotion is in Coté and Alarie

2011, on the basis of work of an international HPH task force.

Coté, Louis, and Françoise Alarie. 2011. Guide to promoting healthy workplaces in

healthcare institutions: Winning strategies for health gain. Montreal: Agence de la

santé et des services sociaux de Montréal.


http://dx.doi.org/10.1177/10253823070140021701

http://dx.doi.org/10.1177/10253823070140021701



http://dx.doi.org/10.1093/heapro/dap019















45

This comprehensive guide is based on experiences from the International Network of

Health Promoting Hospitals and Health Services. It addresses health promotion

practitioners but also researchers interested in different approaches to staff-oriented

hospital health promotion.

Find this resource:

Lee, Chiachi Bonnie, Michael S. Chen, and Cordia Ming-Yeuk Chu. 2013. The health

promoting hospital movement in Taiwan: Recent development and gaps in workplace.

International Journal of Public Health 58.2: 313–317.

DOI: 10.1007/s00038-012-0391-8Save Citation »Export Citation »E-mail Citation »

The study focuses on how participation of Taiwanese hospitals in the national HPH

network increased the level of workplace health promotion provided in these

organizations. Thus, it is specifically relevant for understanding participation in a

network as a determinant for organizational change.

Find this resource:

Pelikan, Jürgen M., Hermann Schmied, and Christina Dietscher. 2013. Improving

organizational health: The case of health promoting hospitals. In Bridging

occupational, organizational and public health: A transdisciplinary approach. Edited

by Georg F. Bauer and Oliver Hämmig, 133–153. Dordrecht, The Netherlands, and

New York: Springer.


The chapter describes the six staff-related strategies of the eighteen HPH core

strategies (Pelikan, et al. 2005, cited under the HPH Core Concept) and data of their

implementation in hospitals of the international HPH network. The authors conclude

that specific organizational capacities facilitate staff-oriented health promotion.

Find this resource:

Tountas, Yannis, Panayotes T. H. Demakakos, Yannis Yfantopoulos, Jenny Aga,

Lambrini Houliara, and Elpida Pavi. 2003. The health related quality of life of the

employees in the Greek hospitals: Assessing how healthy are the health workers.

Health and Quality of Life Outcomes 1.1: 61.


The study focuses on the health status of health-care professionals in Greek HPHs,

outlining inequalities between different professional groups. Results indicate that

different approaches toward staff health promotion are needed for the different groups.

Find this resource:

Whitehead, Dean. 2006. Workplace health promotion: The role and responsibility of

health care managers. Journal of Nursing Management 14.1: 59–68.

http://dx.doi.org/10.1007/s00038-012-0391-8

http://dx.doi.org/10.1007/s00038-012-0391-8








http://dx.doi.org/10.1186/1477-7525-1-61

http://dx.doi.org/10.1186/1477-7525-1-61



46


Citation »

The author argues that best results from workplace health promotion can be expected

from overall organizational approaches.

Find this resource:

29 Health Promotion for Community Populations

In relation to the history of hospital health promotion in the United States (see Developments

in the United States) and the HPH movement in Europe (see Health Promoting Hospitals in

Europe), an orientation toward the community has been part of the concept from the

beginning. The HPH concept suggested in Pelikan, et al. 2005 (see the HPH Core Concept)

describes the provision of adequate access and cooperation with other providers, interventions

to support disease management and lifestyle development in the community (as well as

improvements of the hospital as an ecological setting in the community), and its contributions

to health-promoting community development at large as potential elements of community-

oriented hospital health promotion. While literature on all these aspects is available, it is

scarcely labeled as HPH. Thus, this section contains only references with an explicit link to

health promotion in hospitals. Johnson and Nolan 2004 and Olden and Hoffman 2011 are

examples of papers on supportive and hindering factors for community collaboration and

service provision. Mavor 2001 describes an example for a hospital-led community outreach

approach.

Johnson, Anne, and Jo Nolan. 2004. Health promoting hospitals: Gaining an

understanding about collaboration. Australian Journal of Primary Health 10.2: 51–60.

DOI: 10.1071/PY04026Save Citation »Export Citation »E-mail Citation »

The article focuses on furthering and hindering factors for collaboration between

hospitals and other organizations as one important precondition for better addressing

community needs.

Find this resource:

Mavor, Ted. 2001. Like parent, like child: A health promoting hospital project. Patient

Education and Counseling 45.4: 261–264.


Citation »

The article provides an example of hospital-community collaboration in the form of

the joint development of a parental modeling awareness program as one type of

activity that hospitals and communities can jointly perform.

Find this resource:

Olden, Peter C., and Keith E. Hoffman. 2011. Hospitals’ health promotion services in

their communities: Findings from a literature review. Health Care Management

Review 36.2: 104–113.

http://dx.doi.org/10.1111/j.1365-2934.2005.00599.x

http://dx.doi.org/10.1111/j.1365-2934.2005.00599.x












http://dx.doi.org/10.1071/PY04026

http://dx.doi.org/10.1071/PY04026



http://dx.doi.org/10.1016/S0738-3991%2801%2900190-2

http://dx.doi.org/10.1016/S0738-3991%2801%2900190-2



47

DOI: 10.1097/HMR.0b013e3181fb0f2bSave Citation »Export Citation »E-mail

Citation »

Drawing on a systematic review, the authors outline furthering and hindering factors

for the provision of community health promotion interventions by hospitals, and they

describe managerial strategies to implement these. The article is of interest to health-

care managers as well as researchers.

Find this resource:

30 Issue- and Topic-Specific Implementation

While HPH overall relates to the settings approach of health promotion and thus favors a

comprehensive, organization-wide implementation approach, there are of course also

applications of health promotion to specific health topics or issues. In light of the umbrella

concept character of HPH, there is a myriad of topics and publications that would in principle

relate to the concept. However, only a few of these have an explicit link to health promotion

or HPH. One example of contributions referring to health promotion as a means to improve

lifestyles in general is Haynes 2008. Haddock and Burrows 1997; Carlfjord, et al. 2011; and

Quinn, et al. 2001 focus specifically on tobacco control and cessation, and the concepts in

Boldy, et al. 2010 have been applied to the prevention of alcohol abuse. Pelikan, et al. 2013

relates the HPH approach to tackling noncommunicable diseases.

Boldy, Duncan P., Caroline Yates, and Teresa A. Ong. 2010. The role of health

professionals in health promotion: A case study of medical imaging technologists and

alcohol. Australian Health Review 34.1: 36–40.

DOI: 10.1071/AH09658Save Citation »Export Citation »E-mail Citation »

The paper argues that professional disciplines such as medical-imaging technologists

could offer considerable support to health promotion in the health-care setting if they

were better trained; for example, in relation to the impact of alcohol on the symptoms

presented. The article is of relevance in relation to the professionalization of clinical

health promotion.

Find this resource:

Carlfjord, Siw, Margareta Kristenson, and Malou Lindberg. 2011. Experiences of

working with the tobacco issue in the context of health promoting hospitals and health

services: A qualitative study. International Journal of Environmental Research and

Public Health 8.2: 498–513.

DOI: 10.3390/ijerph8020498Save Citation »Export Citation »E-mail Citation »

The article focuses on furthering and hindering factors for tobacco-related health

promotion in health care, drawing on experiences from the Swedish HPH network. It

provides interesting contextual information for studying hospital-based health

promotion interventions.

Find this resource:

http://dx.doi.org/10.1097/HMR.0b013e3181fb0f2b

http://dx.doi.org/10.1097/HMR.0b013e3181fb0f2b









http://dx.doi.org/10.1071/AH09658

http://dx.doi.org/10.1071/AH09658



http://dx.doi.org/10.3390/ijerph8020498

http://dx.doi.org/10.3390/ijerph8020498



48

Haddock, Jane, and Caroline Burrows. 1997. The role of the nurse in health promotion:

An evaluation of a smoking cessation programme in surgical pre-admission clinics.

Journal of Advanced Nursing 26.6: 1098–1110.


Citation »

The empirical study evaluates the impact of a nurse-led cessation program, identifying

a theory-guided approach as one factor for program success.

Find this resource:

Haynes, Charlotte L. 2008. Health promotion services for lifestyle development within

a UK hospital—patients’ experiences and views. BMC Public Health 8.1: 284.


Drawing on data from a patient survey, and using a lifestyle risk factor approach,

Haynes emphasizes the interest of hospital patients in health education on lifestyle risk

factors.

Find this resource:

Pelikan, Jürgen M., Christina Dietscher, and Hermann Schmied. 2013. Health

promotion for NCDs in and by hospitals: A health promoting hospital perspective. In

Global handbook on noncommunicable diseases and health promotion. Edited by

David V. McQueen, 441–460. New York: Springer.

DOI: 10.1007/978-1-4614-7594-1Save Citation »Export Citation »E-mail Citation »

The article provides a comprehensive outline of how the overall HPH approach can

support the prevention of noncommunicable diseases (NCDs). Data from the

international network of HPH on related activities are provided.

Find this resource:

Quinn, Jacqueline, Soumen Sengupta, and Helen Cleary. 2001. The challenge of

effectively addressing tobacco control within a health promoting NHS Trust. Patient

Education and Counseling 45.4: 255–259.


Citation »

This article describes the activities of one UK hospital trust in the area of tobacco

control, against the background of an organization-wide HPH approach. It provides a

good example of how specific interventions can be integrated into the wider HPH

concept.

Find this resource:

http://dx.doi.org/10.1046/j.1365-2648.1997.00452.x

http://dx.doi.org/10.1046/j.1365-2648.1997.00452.x



http://dx.doi.org/10.1186/1471-2458-8-284

http://dx.doi.org/10.1186/1471-2458-8-284



http://dx.doi.org/10.1007/978-1-4614-7594-1

http://dx.doi.org/10.1007/978-1-4614-7594-1



http://dx.doi.org/10.1016/S0738-3991%2801%2900189-6

http://dx.doi.org/10.1016/S0738-3991%2801%2900189-6



49

31 HPH Networks and Task Forces

The International Network of Health Promoting Hospitals and Health Services (HPH) has

always emphasized implementation and dissemination support, in the beginning via biannual

business meetings and international conferences that have been organized annually since 1993.

As described in Dietscher 2012, the network has had a strategy to launch national and

regional HPH networks as a means to support further dissemination and implementation on

country and region levels since 1995. Research on these networks includes case studies and

descriptions of country implementation (such as in Berger, et al. 1999 and Härm 2004),

internationally comparative descriptions of HPH network structures and activities (as offered

in Dietscher, et al. 2011; Dietscher 2012; and Pelikan, et al. 2011), and the development of a

network functioning and effectiveness model (as proposed in Dietscher 2013). Another line of

research refers to task forces of the international HPH network that have focused on health

promotion in different areas (e.g., psychiatric care, children and adolescents, migrants and

cultural competence, older patients, alcohol, tobacco, physical activity, and the environment).

An overview is given in Dietscher 2012. In part, the task forces have published tools to

support practical implementation of health promotion; for example, standards for equity in

health care for migrants and other vulnerable groups, which were launched in Health

Promoting Hospitals Network of Emilia-Romagna 2013.

Berger, Hartmut, Karl Krajic, and Rainer Paul, eds. 1999. Health promoting hospitals

in practice: Developing projects and networks; Proceedings of the 6th International

Conference on Health Promoting Hospitals, Darmstadt April 29th–May 2nd, 1998.

Health Promoting Hospitals Series 3. Gamburg, Germany: G. Conrad.


The book summarizes presentations delivered during the 6th International Conference

on Health Promoting Hospitals, with a specific focus on disseminating HPH by

projects and networks.

Find this resource:

Dietscher, Christina. 2012. Interorganizational networks in the settings approach of

health promotion—the case of the International Network of Health Promoting

Hospitals and Health Services (HPH). PhD diss., Univ. of Vienna.


The dissertation describes a research framework and comparative empirical analyses

of twenty-eight national and regional HPH networks and concludes with

recommendations for network management.

Find this resource:

Dietscher, Christina. 2013. How can the functioning and effectiveness of networks in

the settings approach of health promotion be understood, achieved and researched?

Health Promotion International.

DOI: 10.1093/heapro/dat067Save Citation »Export Citation »E-mail Citation »





















50

Building on Dietscher 2012, the article presents a functioning and effectiveness

framework for networks in the settings approach of health promotion. It may inform

evaluation designs for such networks.

Find this resource:

Dietscher, Christina, Hermann Schmied, Florian Röthlin, and Jürgen M. Pelikan. 2011.

Project on a Retrospective, Internationally Comparative Evaluation Study of HPH

(PRICES-HPH). LBIHPR Working Paper 11. Vienna: Ludwig Boltzmann Institute for

Health Promotion Research.


The working paper describes similarities and differences between twenty-eight

national and regional HPH networks. It provides a good overview on how HPH

networks are structured, and how they support their member organizations in

implementing HPH.

Find this resource:

Härm, Tiiu, ed. 2004. Five years of Health Promoting Hospitals Network in Estonia /

Viis aastat tervist edendavate haiglate võrgustikku Eestis. Tallinn, Estonia: National

Institute for Health Development.


This is a case study on the development of the Estonian HPH network. It contains

interesting lessons for network managers but is also of value to researchers of HPH

networks.

Find this resource:

Health Promoting Hospitals Network of Emilia-Romagna, eds. 2013. Standards for

equity in health care for migrants and other vulnerable groups. Reggio Emilia, Italy:

Health Promoting Hospitals Network of Emilia-Romagna.


The document offers a specification of the WHO standards for health promotion in

hospitals for meeting the needs of migrants and ethnic minorities. It can be used for

evaluation purposes but also for hospital self-assessment in the field.

Find this resource:

Pelikan, Jürgen M., Christina Dietscher, Hermann Schmied, and Florian Röthlin. 2011.

A model and selected results from an evaluation study on the International HPH

Network (PRICES-HPH). Clinical Health Promotion 1.1: 9–15.















51

The article describes an evaluation study of the International Network of Health

Promoting Hospitals, outlining the evaluation model and data from a survey of HPH

member hospitals and networks, concluding that membership in a HPH network is a

relevant determinant for implementing health promotion in the hospital context.

Find this resource:

32 Debate

There has been some critical reflection on the applicability of health promotion to the clinical

setting, especially in relation to the medical approach of most clinicians, which would make

them, according to Goel and McIsaac 2000, better allies for prevention rather than promotion,

and the unwillingness of health-care institutions to engage in wider community work, which

is criticized in Johnson 2000. Especially in relation to the Ottawa Charter’s wider demand for

the reform of health-care systems, some studies, including Whitehead 2004; Wise and

Nutbeam 2007; de Leeuw 2009; and Ziglio, et al. 2011, have questioned the degree to which

reorientation has been accomplished so far. Authors overall conclude that there is still a long

way to go with regard to implementing health promotion into the reform of health-care

systems, while generally referring to the HPH network as one example of good and promising

practice. For example, achievements of the HPH network are described in Groene 2005 in

relation to the criticism in Whitehead 2004.

de Leeuw, Evelyne. 2009. Have the health services reoriented at all? Health

Promotion International 24.2: 105–107.

DOI: 10.1093/heapro/dap015Save Citation »Export Citation »E-mail Citation »

This editorial reflects discourse on HPH in the wider community of health promotion

research.

Find this resource:

Goel, Vivek, and Warren McIsaac. 2000. Health promotion in clinical practice. In

Settings for health promotion: Linking theory and practice. Edited by Blake Poland,

Lawrence W. Green, and Irving Rootman, 217–233. Thousand Oaks, CA: SAGE.


The chapter offers critical reflection of, but also opportunities for, health promotion in

the clinical setting. It is therefore relevant both for developing implementation

strategies and for a critical reflection of the HPH approach.

Find this resource:

Groene, Oliver. 2005. 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. Health Promotion International 20.2: 205–207.






















52

This commentary refers to Whitehead 2004, rejecting some of the critical arguments

raised there and providing evidence for progress in HPH. The paper is interesting for

those interested in the effectiveness of the HPH approach.

Find this resource:

Johnson, Joy L. 2000. The health care institution as a setting for health promotion. In

Settings for health promotion: Linking theory and practice. Edited by Blake Poland,

Lawrence W. Green, and Irving Rootman, 175–199. Thousand Oaks, CA: SAGE.


The chapter describes approaches toward health promotion in health-care institutions

and critically reflects the potential of health promotion in these settings. It provides

interesting pros and cons on health promotion in hospitals.

Find this resource:

Whitehead, Dean. 2004. The European Health Promoting Hospitals (HPH) project:

How far on? Health Promotion International 19.2: 259–267.


The article criticizes the European HPH network for being underresearched and calls

for more evaluation on the effectiveness of the approach.

Find this resource:

Wise, Marilyn, and Don Nutbeam. 2007. Enabling health systems transformation:

What progress has been made in re-orienting health services? Promotion & Education

14.2S: 23–27.


The authors argue that, while HPH has concentrated on the hospital sector, broader

health system reform toward health promotion needs yet to be achieved.

Find this resource:

Ziglio, Erio, Sarah Simpson, and Agis Tsouros. 2011. Health promotion and health

systems: Some unfinished business. Health Promotion International 26.2S: ii216–

ii225.


In line with Wise and Nutbeam 2007, the publication argues that a broader

reorientation of health services toward health promotion needs yet to be developed.

The article is interesting for those interested in health policy and system reform.
















Documents

Health promoting hospitals