1. 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

2. 1. What should be implemented?
Strategic guidelines for health
promotion in hospitals
„HPH-Strategy“
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

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 13th International HPH Conference Dublin
Commitment to 20 strategic objectives and development of a strategy map
May 19, 2005
13th International HPH Conference Dublin
Session II-4

16. 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

17. 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

18. 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

19. 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)

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

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