Health promotion in primary care and hospitals

Chapter 16 Health promotion in primary care and hospitals




Key points



• The concept of a health-promoting hospital

• Promoting the health of patients

• Promoting the health of staff

• Hospitals and their community

• Hospitals as a health-promoting organization

• Health-Promoting Hospital movement.


Overview


To change a large and complex organization such as a hospital from being a place of treatment to one where health gain is valued and seen as part of its purpose is a challenging process. Health-promoting hospitals (HPHs) incorporate a variety of different projects, but with the same overall aims:


• To make the hospital a healthier working and living environment for its large workforce and for patients

• To expand self-management, recuperation and rehabilitation programmes

• To encourage participation by staff and patients

• To provide information and advice on health issues

• To act as a community resource and agent of social cohesion

• To act in a socially responsible manner especially in relation to environmental impact.

A hospital, like a school or a workplace, is a social system with its own procedures, culture and values. The process of developing an HPH will thus involve the adaptation of management structures, top-level political commitment and the facilitation of greater participation by staff and patients.



Defining a health promoting hospital


Settings can normally be identified as having physical boundaries (including geographical), a range of people with defined roles and an organizational structure. As we have seen earlier in this part, a settings approach is not about doing a health promotion project such as a display for No Smoking Day nor is it about delegating health promotion to specific departmental or staff ‘champions’ (Johnson & Baum 2001), although both activities may be used as part of wider development. The settings approach to health promotion focuses on bringing about holistic organizational and practice changes to create a more health-promoting environment. The challenge lies in convincing hospital authorities that health promotion does not constitute an additional burden but is very much part of the core business and approach.


The World Health Organization (WHO) definition (Nutbeam 1998) provides a useful starting point for understanding what is required:



A health-promoting hospital does not only provide high quality comprehensive medical and nursing services, but also develops a corporate identity that embraces the aims of health promotion, develops a health-promoting organizational structure and culture, including active, participatory roles for patients and all members of staff, develops itself into a health-promoting physical environment, and actively cooperates with its community.


The hospital as a setting for health was validated by the launch of the Health Promoting Hospitals (HPH) initiative in 1990 by the WHO Regional Office for Europe. This network now includes 669 institutions in 39 countries. In this chapter, the potential of the hospital setting to promote health is examined and examples of good practice are given to illustrate what can be achieved.



Why hospitals are a key setting for health promotion


Many health practitioners assume that health promotion has always been a core task of medicine in general and hospitals in particular. Yet health promotion can be at odds with the hospital context which is based on a medical model of care with an orientation towards cure and treatment. The expectation of the patient role has been one of ‘passivity, trust and a willingness to wait for medical help’ (Latter 2001, p. 78):


• Staff competence, job remit, and time are mainly dedicated to clinical work and care.

• Patient contact with the hospital staff is generally based on brief ‘consultations’ related to their particular disease.

• Patients in hospital are at a late stage in their disease and highlighting prevention may make them feel responsible and blameworthy.

• Hospitals are not in themselves healthy environments.

Yet hospitals are also a natural focus for health promotion:


• 20% of the population will visit a local hospital as a patient within a single year, and a further percentage will visit the hospital as family and friends.

• Hospitals are often the biggest employer in their community. In Europe, at least 3% of the entire workforce is employed at one of the 30000 hospitals.

• Contact is with patients at a time of heightened awareness about health and illness, when they may be motivated to make major lifestyle changes.

• Staff are respected and credible.


imageBOX 16.1


What might be the benefits of being an HPH?


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.



imageBOX 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.



imageBOX 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.



imageBOX 16.4


Describe how the following activities might be implemented in hospital:


• Risk assessment

• Health information

• Health education and counselling

• Maximizing choice

• Promoting involvement and participation

Related posts:

  1. Developing healthy public policy
  2. Models and approaches to health promotion
  3. Measuring health
  4. Influences on health

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Mar 21, 2017 | Posted by in MEDICAL ASSISSTANT | Comments Off on Health promotion in primary care and hospitals

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