The Hospital as HPH-Strategy-Focused Organisation 13th International Conference on Health Promoting Hospitals -Session II-4- Dublin, May 19, 2005 The Hospital as HPH-Strategy-Focused Organisation Mag. theol. Elimar Brandt, Berlin Prof. Dr.paed. Dr.sc.phil. Werner Schmidt, Berlin CA Dr.med. Rainer Hübner, Bernau IMMANUEL DIAKONIE GROUP GERMAN HPH NETWORK (DNGfK) May 19, 2005 13th International HPH Conference Dublin Session II-4

1. What should be implemented? Strategic guidelines for health promotion in hospitals „HPH-Strategy“ 1.1 18 Core HPH Strategies (Pelikan u.a. 2005) 1.2 Health Promotion Principles (Rootmann u.a.2001) 1.3 Standards for Health Promotion in Hospitals (Gröne u.a.2005) May 19, 2005 13th International HPH Conference Dublin Session II-4

18 HPH Core Strategies (Pelikan u.a.) All 18 strategies have in common that they improve the health gain that is attributable to hospitals. They focus on different opportunities for improving health gain. It depends upon the situation of the hospital and its environments, in which of the strategies to invest. May 19, 2005 13th International HPH Conference Dublin Session II-4

Six Core HPH Strategies for Hospital Patients (Pelikan u.a. 2005) Quality development Strategic positioning Patients as persons PAT-1: Assuring/improving health promoting living in the hospital for patients PAT-4: Offering specific services for health promoting illness management for patients Patients in their patient role PAT-2: Assuring/improving health promoting co-production of patients in treatment and care PAT-5: Offering specific services for health promoting lifestyle development for patients Hospital / community setting PAT-3:Assuring/improving a health promoting hospital setting for patients PAT-6: Initiating of/participating in the development of health promoting community settings for patients May 19, 2005 13th International HPH Conference Dublin Session II-4

Six Core HPH Strategies for Hospital Staff (Pelikan u.a. 2005) Quality development Strategic positioning Staff as persons STA-1: Assuring/improving health promoting living in the hospital for staff STA-4: Offering specific services for health promoting illness management for staff Staff in their professional roles STA-2: Assuring/improving health promoting co-production of staff in work processes STA-5: Offering specific services for health promoting lifestyle development for staff Hospital / community setting STA-3: Assuring/improving a health promoting hospital setting for staff STA-6: Initiating of/participating in the development of health promoting community settings for staff May 19, 2005 13th International HPH Conference Dublin Session II-4

Six Core HPH Strategies for the Hospital Community (Pelikan u.a. 2005) HP Quality development HP Strategic positioning Citizens as persons COM-1: Assuring/improving health promoting access to the hospital for citizens COM-4: Offering specific health promoting illness management for citizens Citizens as patients COM-2: Assuring/improving health promoting co-production with services in the region COM-5: Offering specific health promoting lifestyle development for citizens Hospital / community setting COM-3: Assuring/improving a health promoting hospital setting for citizens COM-6:Initiating of /participating in the development of health promoting community settings for citizens May 19, 2005 13th International HPH Conference Dublin Session II-4

1.2 Health Promotion Principles 1. Empowering 2. Participatory 3. Holistic (physical + psychological + social) 4. Intersectoral 5. Equitable 6. Sustainable 7. Multistrategy (Rootman et.al. 2001) TEXT: Health promotion reacts to changed life expectation, increase of chronic diseases, changes in society like increasing number of singles, increasing interest for participation Basis - Health promotion concepts: WHO Founding document 1948 („Health is not only the absence of disease or infirmity, but a state of comprehensive physical, mental and social well-being“) Ottawa 1986 („Health promotion is the process of enabling people to increase control over, and to improve their health“) Budapest 1991 (first strategic formulation of HPH concept) Vienna 1997 (further development of HPH concept) Jakarta 1997 (introduction of healthy alliances) OD and QD concepts (e.g. EFQM) May 19, 2005 13th International HPH Conference Dublin Session II-4

1.3 Standards for Health Promotion in Hospitals Standard 1: Management Policy Standard 2: Patient Assessment Standard 3: Patient Information and Intervention Standard 4: Promoting a Healthy Workplace Standard 5: Continuity and Cooperation May 19, 2005 13th International HPH Conference Dublin Session II-4

13th International HPH Conference Dublin 2. How can be implemented? Three basical options for strategy implementation 2.1 Integration of HP-Core Strategies in a TQM system (f.e. EFQM) (Brandt u.a. 2000, Pelikan u.a. 2003) 2.2 HP-Standard implementation in connection with a self-assessment tool (Gröne u.a. WHO 2004) 2.3 HPH-Policy implementation with EFQM & Balanced Scorecard (BSC) (Brandt / Schmidt 2004) May 19, 2005 13th International HPH Conference Dublin Session II-4

2.3 Implementation with BSC in connection with EFQM - Model Health Promoting Organi- sationel Structure & Culture of the hospital EFQM Excellence Model HPH Policy Balanced Scorecard (BSC) May 19, 2005 13th International HPH Conference Dublin Session II-4

BSC - Development for the Immanuel Diakonie Group 2.3.1 Determination of the strategic destination (Vision) 2.3.2 Definition of strategic orientations 2.3.3 Development and introduction of values 2.3.4 Determination of strategic key themes 2.3.5 Commitment to strategic objectives and development of a strategy map incl. formulation of „Story of the strategy“ 2.3.6 Balanced Scorecard with measurements, targets, and strategic initiatives May 19, 2005 13th International HPH Conference Dublin Session II-4

2.3.1 Strategic destination (Vision) of the IMMANUEL DIAKONIE GROUP „…The WHO HPH concept is inserted in connection with comprehensive quality management in the organizational structure and culture of the hospital and the values of the Hospital Holding are observed in staffs daily work in the hospital.” (2002) May 19, 2005 13th International HPH Conference Dublin Session II-4

IMMANUEL DIAKONIE GROUP 2.3.3 Values of the IMMANUEL DIAKONIE GROUP Development, discussion and validation of 18 values 12 of 18 values are directly related to the strategy standards and principles of health promotion in hospitals value 18 obliges explicit to integration of the WHO HPH Policy in the structure and culture of the organization (2003) May 19, 2005 13th International HPH Conference Dublin Session II-4

2.3.4 Strategic Key Themes of the IMMANUEL DIAKONIE GROUP Health Promoting Corporate Culture Process Optimization and Quality Management Highest possible health gain through comprehensive patient orientation Partnership and Health Centers May 19, 2005 13th International HPH Conference Dublin Session II-4

13th International HPH Conference Dublin 2.3.5 Commitment to 20 strategic objectives and development of a strategy map May 19, 2005 13th International HPH Conference Dublin Session II-4

13th International HPH Conference Dublin BSC Characteristic Concentration on 20 strategic objectives with max. per objective: 1-2 Measurements and 1-2 Strategic initiatives put in order 4 business perspectives Finance Customer Processes Innovation With cause and effect relationships between strategic objectives. May 19, 2005 13th International HPH Conference Dublin Session II-4

BSC structure (Example) Strategic Theme: Health Gain through Pat. Orient. Diagram of the cause and effect relationships between strategic objectives Make positive operating results Increase customer loyalty Strategic Objectives Measurement Target Initiative Patient needs consider & documented % Patient records with doc. spec. pat.needs F1 F2 F3 10% 30% 70% Task forces Patient needs Increase patient satisfaction Increase health Gain Pat. co-producer in treatment proc. Pat. needs consider and doc. HP-Hospital setting Increase staff HP-Competence May 19, 2005 13th International HPH Conference Dublin Session II-4

the Strategic Key Themes of the IMMANUEL DIAKONIE GROUP HPH Policy and the Strategic Key Themes of the IMMANUEL DIAKONIE GROUP 1. Health Promoting Corporate Culture (Standard 1 and 4) (Core Strategies for Staff) 2.Process Optimization and Quality Management 3. Highest possible health gain through comprehensive patient orientation (Standard 2 and 3) (Core Strategies for Patients) 4 Partnership and Health Centers (Standard 5) (Core Strategies for Community) May 19, 2005 13th International HPH Conference Dublin Session II-4

Strategy Map (Immanuel Diakonie Group Berlin) Health promoting corporate culture Process optimization and quality management Highest possible health gain through comprehensive patient orientation Partnership and health centers Make positive operating results (F2) Arrange professional public relations (F4) Open additional business segments and financial resources (F3) F Plan for case costs (F1) Increase staff satisfaction (K2) Increase patient-, occupant- and relatives satisfaction (K1) Promotin health in the region (K3) C Involve patient as co-producer of his health (P1) Introduce a comprehensive human resource development (P7) Identify and reduce depreciative processes (P6) Organize care networks and cooperations (P4) Configurate and place a Immanuel Diakonie Group related corporate identity (P3) P Consider and document the needs of patients and occupants (P5) Create transparent structures of responsibility and information (P2) Strengthen staffs health competence (I6) Lead staff to success (I4) Establish regularly self-assements (I5) Perceive patients, occupants and relatives holistic (I2) Distinguish performance spectrum (I3) I Promote communicant culture (I1)

IMMANUEL DIAKONIE GROUP 2.3.6 Balanced Scorecard IMMANUEL DIAKONIE GROUP Strategic Objectives F1 Plan for case cost F2 Make positive operating F3 Open additional business segments and financial resources F4 Arrange professional public relations K1 Increase patient/occupant/relatives satisfaction K2 Increase staff satisfaction K3 Promoting health in region P1 Involve patient as co-producer of his health P2 Create transparent reponsibilty- & information structures P3 Configurate & place a IDG related corporate identity P4 Organize care networks and cooperations P5 Consider & document patient- & occupants needs P6 Identify & reduce depreciative processes P7 Introduce a comprehensive human resource development I1 Promote communication culture I2 Perceive patients, occupants & relativs holistic I3 Distinguish perfomance spectrum I4 Lead staff to success I5 Establish regularly self-assessments I6 Strengthen staffs health competence Finance Customer Processes Innovation May 19, 2005 13th International HPH Conference Dublin Session II-4

BSC Immanuel Diakonie Group (Perspective: Finance) CS:Core HPH Strategies SHP: Standards HP PRI: HP Principles Strategic Initiative Strategic Objectives HPH Policy Measurement CS SHP PRI F1 Plan for case cost F2 Make positive operating F3 Open additional business segments and financial resources F4 Arrange professional public relations Task force Information Transfer % informed departments % in turnover % proceeds Realization rate PR-Conception Quarterly reports Finance P4 P5 C4 C5 5 7 Analysis add. business 1 PR-plan for action May 19, 2005 13th International HPH Conference Dublin Session II-4

BSC Immanuel Diakonie Group (Perspective: Customer) CS:Core HPH Strategies SHP: Standards HP PRI: HP Principles Strategic Initiative Strategic Objectives HPH Policy Measurement CS SHP PRI C1 Increase patient/occupant/relatives satisfaction C2 Increase staff satisfaction C3 Promoting health in region Satisfaction index P1 P3 2 1 Patient survey S1 S2S3 4 1 Satisfaction index Staff survey Customer C1 C2 C3 C4 C5 S6 P6 5 1 2 Rate of Realisation Regional Health plan Project Regional Health May 19, 2005 13th International HPH Conference Dublin Session II-4

BSC Immanuel Diakonie Group (Perspective: Processes) CS:Core HPH Strategies SHP: Standards HP PRI: HP Principles Strategic Initiative Strategic Objectives HPH Policy Measurement CS SHP PRI P1 Involve patient as co-producer of his health P2 Create transparent reponsibilty- & informationstructurs P3 Configurate & place a HPH/ID Group related corporate identity P4 Organize care networks and cooperation's P5 Consider & document patient- & occupants needs P6 Identify & reduce depreciative processes P7 Introduce a comprehensive human resource development % included Patients (doc.) P2 P4 3 2 Patient survey S2 S3 Task force Responsib. & Inf. Structure Realization installment 4 1 2 Realization Action plan Awareness Pat. & Staff S3 P3 1 to5 1 to 7 Task force Values (implementation) Pat./Staff servey Processes Number & valuation of cooperation's S6/P6 C1/C2 C6 Task force optimize coop. 5 4 7 Realization Pat.needs dok. Pat. satisfaction (needs index) P1 P4 2 1 2 Quality working Group Patient needs % change of processes S2 (1+3) Improvement management 4 2 Realization installment S2 4 1 2 Personal management May 19, 2005 13th International HPH Conference Dublin Session II-4

BSC Immanuel Diakonie Group Innovation (Perspective: Innovation) CS:Core HPH Strategies SHP: Standards HP PRI: HP Principles HPH Policy Strategic Initiative Strategic Objectives Measurement I1 Promote communication culture I2 Perceive patients, occupants & relatives holistic I3 Distinguish performance spectrum I4 Lead staff to success I5 Establish regularly self-assessment I6 Strengthen staffs health competence CS SHP PRI S1 S2 S3 Training Feedback culture % departments with monthly activities 4 1 to 5 P1to P5 2 3 3 Holistic Competence Training (HCT) Score pro employee for HCT participation C1 C2 C3 1 5 2 4 7 Performance distinguish development concept (PDDC) Realization of PDDC-Targets Number of EOC (Employee/year) % aim agreements S2 (S1) (S3) 4 1 2 Manager-train. Employee- oriented Conversation (EOC) Innovation S2 EFQM Self assessment (Score / RADAR) % EFQM-Train. Employee 1 1+2 4 6+7 EFQM Training of Self Assessment- team S4 S5 Hospitals Healthy Lifestyle Supplies 4 1 2 3 Number of supplies /year May 19, 2005 13th International HPH Conference Dublin Session II-4

Strategic Management Process with the Balanced Scorecard ( nach Horváth 2000)) Phase I: Development/ revise the Balanced Scorecard Phase IV: Learning and adaptation Phase II: Communication and Specification Phase III: Translate into operational control May 19, 2005 13th International HPH Conference Dublin Session II-4

Implementation of the BSC What does that mean? 1. BSC: an integral part of the Management- and Control systems 2. BSC: an integral part of the Planning system 3. Lead staff with BSC 4. BSC: Integration in the Report system 5. BSC and EFQM- Model coordinate use May 19, 2005 13th International HPH Conference Dublin Session II-4

13th International HPH Conference Dublin April 11, 2005: Start meeting for BSC Implementation of the Immanuel Diakonie Group (in 3 hospitals) with 100 Participants Statement CEO Nomination of „Responsible employees“ for every Strategic Objective and for every Strategic Initiative Final Training Next steps May 19, 2005 13th International HPH Conference Dublin Session II-4

13th International HPH Conference Dublin Consistency: The HPH Strategy/Policy is an integral part of the BSC of the Immanuel Diakonie Group The BSC of the Immanuel Diakonie Group is now the official Management instrument in the institutions of this Holding We are sure: May 19, 2005 13th International HPH Conference Dublin Session II-4

The Strategic destination (Vision) of the Immanuel Diakonie Group becoming reality: „The WHO HPH concept is inserted in connection with comprehensive quality management in the organizational structure and culture of the hospital and the values of the Hospital Holding are observed in staffs daily work in the hospital.” May 19, 2005 13th International HPH Conference Dublin Session II-4

e.brandt@immanuel.de werner.schmidt@immanuel.de May 19, 2005 13th International HPH Conference Dublin Session II-4