1. Does a WHO HPH Recognition Process Improve Health Service Delivery and Outcome? PHD Student Jeff Kirk Svane MA (DK) Professor Hanne Tønnesen MD PHD (DK/S) Supervisor Shu-Ti Chiou MD PHD MSc (TW) Advisor Oliver Groene MSc PHD (UK)

2. Overview Study aim Scope and purpose –Background Framework –WHO HPH Standards / Indicators –HPH DATA Model –HPH Doc Act Model –Other evaluated tools Joining the project

3. Study aim To evaluate whether a WHO-HPH recognition / certification process for HP generates –more health deliveries –better health gain for patients and staff.

4. Main hypotheses Hospitals departments allocated to the Recognition Process will after 1 year: –Improve health gain for patients and staff –Deliver more health promotion services compared to the departments allocated to the control group continuing routine clinical practice

5. Clinical Health Promotion Clinical Health Promotion is a patient-centred approach in health care services. Improves the effect of treatment results and contributes to improved patient safety

6. Clinical Health Promotion HP is a key dimension of quality in hospitals, along with clinical effectiveness and patient safety Hosp & HS implement QM, accreditation, certification and recognition – but does it generate better health gain?

7. Background Sparse literature on accreditation and quality improvement –1 Randomised Clinical Trials (RCT) evaluating impact of hospital accreditation on the quality of care at the national level in South Africa (Salmon JW, Heavens J, Lombard C, Tavrow P. Operations Research Results 2003;2:17)

8. South African Study Material: –2 x 10 hospitals in South Africa (underpowered) Methods: –Structural, process and clinical variables –Periodic measurement –Feedback to each hospital –Technical assistance Results re. technical structure and process variables: –Control 37% to 38% –Intervention 38% to 76% (looking good, but...) (Salmon JW, Heavens J, Lombard C, Tavrow P. Operations Research Results 2003;2:17)

9. Clinical variables Effect variables: Nurse perception p=0.03 Patient satisfaction p=0.48 Structure and process variables: Medical evaluation p=0.40 MR accessibility p=0.50 MR completeness p=0.14 MR operation completeness p=0.49 Hospital sanitation p=0.64 (Salmon JW, Heavens J, Lombard C, Tavrow P. Operations Research Results 2003;2:17)

10. What can we conclude? Better technical procedures and structure No better clinical outcome or health gain We need further studies with adequate power (sizeable sample)

11. Recap: our study aim To evaluate whether a WHO-HPH recognition / certification process for HP generates –more health deliveries –better health gain for patients and staff.

12. Framework (project elements) 1.Management policy of HP 2.Patient Assessment 3.Patient Intervention and Info 4.Promoting a healthy workplace 5.Continuity and cooperation Hospitals: Useful recommendable (Groene O, Jorgensen SJ, Fugleholm AM, Garcia Barbero M. Int J Health Care Qual Assur Inc Leadersh Health Serv 2005;18:300-7.

13. Framework HPH DATA Model (St. 2) HPH Doc. HP Activities (St. 3) HPH Clinicians: Understandable, applicable & sufficient for our patients (high reliability) (Tonnesen H et al, BMC Health Serv Res 2007 + Clin HP 2012)

14. Other evaluative tools Short Form Health Survey (SF36): –Physical, mental and social conditions + 17 additional indicators –WHO HPH Standards not otherwise included (McHorney, Colleen A.; Ware, John E.; Raczek, Anastasia E. Med Care 1993; 31: 247-263)

15. Design An RCT with 2x44 hospital departments allocated to one of the two groups –Undergo the Recognition Process immediately = Intervention group –Continue their usual routine = Control group

16. Evidence degree: Pyramid In Vitro studies Animal Studies Editorial papers and Consensus (’GOBSAT’) Cases (Obs) Cohorts, Case-Control studies (Obs) CCT (intervention) RCT (intervention) Meta-analyses Syst reviews (Eccles M BMJ 1998)

17. Trial Profile Clin Dept n = 2x44 R Data collect TAU 1y 2y Data collect Site Visit & Data Val I I

18. Inclusion criteria All kinds of clinical hospital departments are eligible; from university as well as non-university clinical hospital departments

19. Exclusion criteria Palliative care departments, paediatric departments, nursing homes, non-hospital departments, and primary care facilities WHO-HPH standards and tools are not validated for these clinical activities.

20. Tailored timeline for each country Year 1 Year 2Year 3

21. So far: 39 of 88 depts Taiwan: 21 Czech Rep: 8 Thailand: 4 Slovenia: 2 Canada: 1 Indonesia: 1 Estonia: 2 More are coming up! 49 depts to go

22. Overview Study aim Scope and purpose Background Framework WHO HPH Standards / Indicators HPH DATA Model HPH Doc Act Model Other evaluated tools Joining the project

23. Welcome! We look forward to the fruitful collaboration