There has been a shift in recent years away from an emphasis on the compliant patient to one which is more patient-centred that acknowledges patients’ concerns and their own expertise (see Chapter 9 for an outline of the Expert Patient programme). Considerable evidence exists to show that patient outcomes are much improved when patients are involved in their own care and have adequate explanations and time to discuss their concerns (Coulter 2002; Coulter & Ellins 2007 and see www.pickereurope.org). Researchers from Denmark, for example, showed in various randomized controlled trials that complications and length of stay after surgery were reduced when smokers or heavy drinkers underwent cessation programmes before surgery (Moller et al 2002). A major proportion of hospital admissions are related to patients suffering from one or more chronic diseases. These patients require support to cope with their disease and to achieve some changes in lifestyle, adherence to possibly complicated drug and nutrition regimes and management of their condition. There is evidence that patients are more receptive to information and advice in situations of acute ill health. Although hospitals may appear to be ‘downstream’, the hospital thus provides a ‘window of opportunity’ for patients to understand the potential benefits of behaviour change.

BOX 16.2

Emergency care

The role of an Emergency Department (ED) or Accident and Emergency (A&E) unit is to provide treatment and care for the acutely ill and injured promptly at any time. This downstream focus paradoxically enables the ED to be a suitable setting for health promotion because it is an established entry point to the health system and because it tends to have good links into the community. Bensburg & Kennedy (2002) offer numerous examples of health promotion strategies from risk assessment (young people and alcohol) to health information (triage nurses providing information to carers who are high users of emergency paediatric services, including a follow-up appointment after discharge), to health education (asthma management training and follow-up telephone calls and using the waiting room to promote reading and literacy to children).

An HPH will also have benefits for its staff and community. Staff sickness/absence rates are likely to be lower, and staff retention is likely to be better. Local communities will benefit from having a large, responsible and responsive employer in their area. HPHs will bring income into local communities (through workforce wages), demonstrate how large organizations can be environmentally aware (through, for example, recycling and local sourcing of food) and provide an accessible and local source of expertise regarding health matters.

BOX 16.3

Existing performance management measures for hospitals relate to productivity such as number of emergency admissions, unnecessary procedures and inpatient bed stays. What might be indicators of an HPH?

An HPH would be evident in the following core principles, outlined in the Vienna Recommendations (WHO 1997):

• Acknowledges differences in the needs, values and cultures of different population groups

• Promotes dignity and empowerment

• Forms as close links as possible with other levels of the health care system and the community.

Although hospitals will always be places of treatment and the pressure to reduce length of stay may limit health education opportunities, they are still numerous ways in which the setting can be more conducive to health.

The WHO HPH movement focuses on four areas (Pelikan et al 2001):

1. Promoting the health of patients

2. Promoting the health of staff

3. Changing the organization to a health-promoting setting

4. Promoting the health of the community in the catchment area of the hospital.

Promoting the health of patients

The main focus of most health promotion in hospitals is disease management and prevention for patients (Johnson 2000). But even in case of severe diseases, patients are always partly healthy (whether emotionally, socially, spiritually) when they enter the hospital and these aspects (e.g. of self-care, psychological well-being or social contact) can be maintained.

In many health care settings, including hospitals, health promotion strategies are often referred to as opportunistic when a chance has arisen to offer health education or other preventive action during a clinical visit. There are, however, opportunities for more coordinated intervention strategies such as risk assessment for alcohol-related problems or the offer of Chlamydia screening.

Professionals play a minor role in promoting the health of their patients however; the major contributors to patients’ health are themselves, their relatives and friends. Empowering patients to get involved as partners and (co)producers of their health in decision-making and diagnostic and therapeutic processes, through the provision of information and education, is therefore an important health promotion strategy.