Health Promoting Hospitals

by

Christina Dietscher, Jürgen Pelikan, Hermann Schmied

• LAST REVIEWED: 30 July 2014
• LAST MODIFIED: 30 July 2014
• DOI: 10.1093/obo/9780199756797-0131

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. 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.

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.

  The dissertation contains a chapter on the history of HPH that builds on Pelikan, et al. 2001; Pelikan 2007; and Pelikan, et al. 2014.

• 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.

• 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.

  The chapter makes the case for health promotion in hospitals, provides examples of interventions, and describes the history of the WHO-initiated HPH network.

• 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.

• 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)00187-2

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

• 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.