Health promoting hospitals

1
Health promoting hospitals
Christina Dietscher, Jürgen Pelikan, Hermann Schmied
Published online at
http://www.oxfordbibliographies.com/view/document/obo-
9780199756797/obo-9780199756797-
0131.xml?rskey=czAWVb&result=1&q=health+promoting
+hospitals#firstMatch
LAST MODIFIED: 07/30/2014
DOI: 10.1093/OBO/9780199756797-0131
1 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.

2
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.
2 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.
Save Citation »Export Citation »E-mail Citation »
The dissertation contains a chapter on the history of HPH that builds on Pelikan, et al.
2001; Pelikan 2007; and Pelikan, et al. 2014.
Find this resource:
 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.
Find this resource:
 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.

3
The chapter makes the case for health promotion in hospitals, provides examples of
interventions, and describes the history of the WHO-initiated HPH network.
Find this resource:
 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.
Find this resource:
 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)00187-2Save Citation »Export Citation »E-mail
Citation »
A summary article providing an overview on the development of HPH, with a focus
on Europe.
Find this resource:
 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.
Find this resource:
3 Anthologies
An early anthology on the European Pilot Hospital Project of Health Promoting Hospitals,
which summarizes case studies from twenty hospitals, was published by Pelikan, et al. 1998a.
A WHO-Euro publication, Groene and Garcia-Barbero 2005, relates HPH to two increasingly
important trends for the hospital sector (i.e., evidence and quality management). Anthologies

4
have also been prepared in relation to the international HPH conferences that have been
organized annually since 1993. Publications include proceedings such as in Pelikan, et al.
1998b and Berger, et al. 1999, as well as abstracts published in Jorgensen, et al. 2001 and
Pelikan and Dietscher 2011. Abstracts and proceedings typically cover a wide range of HPH-
related issues, from theory and conceptual considerations to descriptions and evaluation
studies of organization-wide implementation approaches, as well as specific interventions for
patients, staff, and the community population, and for developing hospitals and health
services into physically supportive settings. Since 2003, conference proceedings are available
as online sources, and WHO Collaborating Centre for Health Promotion in Hospitals and
Health Services 2013 is one example. Since 2011, conference abstract books such as in
Pelikan and Dietscher 2011 have been published annually as a supplement to the official HPH
journal Clinical Health Promotion (see Journals). Proceedings and abstract books are
especially useful for finding specific examples of interventions from the broad field of HPH.
Because of the international character of the conferences, they are all in English.
 Berger, Hartmut, Karl Krajic, and Rainer Paul, eds. 1999. Health promoting hospitals
in practice: Developing projects and networks; Proceedings of the 6th International
Conference on Health Promoting Hospitals, Darmstadt April 29th–May 2nd, 1998.
Health Promoting Hospital Series 3. Gamburg, Germany: G. Conrad.
The publication summarizes presentations given at the 6th International Conference on
Health Promoting Hospitals in 1998, including evaluation studies and practice
examples of interventions for patients, staff, and community members, as well as
organization-wide approaches.
Find this resource:
 Groene, Oliver, and Mila Garcia-Barbero, eds. 2005. Health promotion in hospitals:
Evidence and quality management. Copenhagen: World Health Organization Regional
Office for Europe.
The anthology gives an overview on the HPH network and is especially relevant for
those interested in linking health promotion to the quality movements and looking for
evidence for the approach.
Find this resource:
 Jorgensen, Svend Juul, Lillian Moller, and Hanne Tonnesen, eds. 2001. Supplement:
9th International Conference on Health Promoting Hospitals, Copenhagen, May 16–
18, 2001; Health promoting hospitals in a national health policy perspective—
evidence in health promoting; Book of abstracts. International Journal of Integrated
Care 1.S1.
This is the first HPH abstract book to be published as a supplement to a scientific
journal. Contributions refer to evaluation studies and practice examples of

5
interventions for patients, staff, and community members, as well as whole-
organization approaches.
Find this resource:
 Pelikan, Jürgen M., and Christina Dietscher, eds. 2011. The 19th International
Conference on Health Promoting Hospitals & Health Services: Improving health gain
orientation in all services; Better cooperation for continuity in care; Abstract book.
Clinical Health Promotion 1.S.
This is the first conference abstract book that was published as a supplement to the
official HPH journal Clinical Health Promotion. Since then, there have been annual
abstract book supplements to Clinical Health Promotion.
Find this resource:
 Pelikan, Jürgen M., Mila Garcia-Barbero, Hubert Lobnig, and Karl Krajic, eds. 1998a.
Pathways to a health promoting hospital: Experiences from the European Pilot
Hospital Project, 1993–1997. Health Promoting Hospital Series 2. Gamburg,
Germany: G. Conrad.
The book provides a summary description of the European Pilot Hospital Project on
Health Promoting Hospitals and case studies of the twenty participating organizations.
Find this resource:
 Pelikan, Jürgen M., Karl Krajic, and Hubert Lobnig, eds. 1998b. Feasibility,
effectiveness, quality, and sustainability of health promoting hospital projects:
Proceedings of the 5th International Conference on Health Promoting Hospitals,
Vienna, Austria, April 16–19, 1997. Gamburg, Germany: G. Conrad.
This publication contains reports on early HPH projects, especially implementation
experiences from the European Pilot Hospital Project of HPH (1993–1997), and first
experiences with national/regional networks of HPH. It is especially useful to get an
idea of HPH implementation practice.
Find this resource:
 WHO Collaborating Centre for Health Promotion in Hospitals and Health Services, ed.
2013. Virtual Proceedings of the 21st International Conference on Health Promoting
Hospitals and Health Services. International Network of Health Promoting Hospitals
& Health Services.

6
Conference proceedings have been provided online annually since 2003. More
proceedings and conference material are available online.
Find this resource:
4 Journals
Since 2011, the International Network of Health Promoting Hospitals and Health Services
(HPH) has its own scientific journal, Clinical Health Promotion: Research & Best Practice
for Patients, Staff & Community, with a strong focus on clinical interventions. Research on
HPH has, however, been published in several international journals, including Patient
Education and Counseling (especially in relation to links between health promotion and
patient education), Health Promotion International, and Global Health Promotion (formerly
Promotion & Education). Publications on HPH have also appeared in organizational and
managerial journals as well as in journals referring to specific clinical disciplines, including
nursing journals. Examples of national journals with referral to HPH include the French La
Santé en Action, which had a special issue on HPH in 2013. In addition, there is a bimonthly
international HPH Newsletter.
 Clinical Health Promotion: Research & Best Practice for Patients, Staff &
Community.
The official journal of the International Network of Health Promoting Hospitals and
Health Services. Appears twice annually and provides articles mostly on clinical
studies in the wider context of health promotion in hospitals, and information about
activities in the HPH network.
Find this resource:
 Global Health Promotion.
The official publication of the International Union for Health Promotion and
Education (IUHPE), covering a broad range of health promotion studies, including
HPH-related topics.
Find this resource:
 Health Promotion International.
An exciting journal for all those working in the broader field of health promotion; has
published numerous articles on HPH.
Find this resource:

7
 HPH Newsletter.
The newsletter is published every two months. It offers news from HPH networks,
task forces, and member organizations, as well as referrals to international studies and
literature.
Find this resource:
 La Santé en Action.
The official journal of the French Institut national de prévention et d‘éducation pour la
santé, which hosts the coordination of the French HPH network. The journal had a
special issue on HPH in 2013 (La Santé en Action 424, Promouvoir la santé à
l’hôpital).
Find this resource:
 Patient Education and Counseling.
The journal relates to HPH content especially with regard to patient education and
intervention activities. It had a special issue on HPH in 2001 (Patient Education and
Counseling 45.4).
Find this resource:
5 Textbooks, Manuals, Guidelines
Lobnig, et al. 1996 is a textbook, and Groene 2006 is a manual on health promotion in
hospitals as an overall implementation approach (also see the HPH Core Concept). Lagarde
2009, building on Groene 2006, provides a specific guideline for developing a health-
promoting hospital policy as a first step of implementation. Brandt 2001 offers a German-
language guideline on linking HPH to the European Foundation for Quality Management
(EFQM) approach (see Linking HPH to Evidence-Based Medicine and to the Quality
Movements). Johnson and Paton 2007 is a valuable source on health promotion as a hospital
management approach. The authors of McBride 1995 and Raingruber 2014 have worked on
health promotion as a professional role specifically in relation to nursing.
 Brandt, Elimar, ed. 2001. Qualitätsmanagement und Gesundheitsförderung im
Krankenhaus: Handbuch zur EFQM-Einführung. Munich: Luchterhand.

8
The book, in German, suggests criteria for assessing the quality of health-promoting
hospitals on the basis of the quality model of the EFQM. It is especially valuable for
quality managers, or to inform studies relating to hospital quality.
Find this resource:
 Groene, Oliver, ed. 2006. Implementing health promotion in hospitals: Manual and
self-assessment forms. Copenhagen: WHO Regional Office for Europe.
This is a manual for hospital managers and clinical staff, providing guidance on
organizational self-assessment. In a research context, it can inform the development of
tools for organizational diagnosis.
Find this resource:
 Johnson, Anne, and Kevin Paton. 2007. Health promotion and health services:
Management for change. Oxford: Oxford Univ. Press.
Provides a framework for reorienting health services to become more health
promoting, integrating health promotion and change management theory. The book is
especially relevant for internal or external organizational-change agents.
Find this resource:
 Lagarde, François. 2009. Guide to develop a health promotion policy and compendium
of policies. Edited by François Alarie, Marie-Dominique Charier, and Louis Côté.
Publications Gouvernementales du Québec en Ligne: Monographies Électroniques.
Montreal: Agence de la santé et des services sociaux de Montréal.
This handbook relates to standard 1 of the five World Health Organization (WHO)
Standards for Health Promotion in Hospitals. It provides step-by-step guidance on
how to develop a health promotion policy in clinical settings and is especially valuable
for hospital managers.
Find this resource:
 Lobnig, Hubert, Peter Nowak, and Jürgen M. Pelikan. 1996. Wie ein
“Gesundheitsförderndes Krankenhaus” entwickelt werden kann.
Gesundheitsförderung, Organisationsentwicklung und Projektmanagement im
Krankenhaus. Wiener WHO-Modellprojekt, Modelldokument 1. Vienna: Ludwig
Boltzmann-Institut für Medizin- und Gesundheitssoziologie.

9
The guideline, in German, summarizes the experiences of the first WHO model
hospital project, “Health and Hospital,” and provides step-by-step guidance on
implementation.
Find this resource:
 McBride, Anita S. 1995. Health promotion in hospital: A practical handbook for
nurses. London: Scutari.
This handbook covers both the development of a specific organizational health
promotion strategy and the implementation of specific interventions. It especially
addresses nurses in clinical practice and nursing students.
Find this resource:
 Raingruber, Bonnie. 2014. Contemporary health promotion in nursing practice.
Burlington, MA: Jones & Bartlett.
The book claims that nurses are more effective health promoters if they become role
models for their patients. It also includes referrals to current topics such as health
literacy. The main target groups are nurses in clinical practice and nursing students.
Find this resource:
6 The History of Health Promotion as Applied to
Hospitals
While the most systematic uptake of health-promoting hospitals was in Europe (see Health
Promoting Hospitals in Europe), there have been early developments also in Australia (see
Developments in Australia), Canada (see Developments in Canada), and the United States
(see Developments in the United States). After the establishment of the HPH network in
Europe, initiatives also started to develop in other continents, especially in Asia and partly in
South Africa (see Globalization of HPH).
7 Developments in the United States
In the United States, health promotion as a responsibility of hospitals and health services goes
back to the US Healthy People program, which was launched for the first time in 1979 and
has, since then, been evaluated and revised annually. As described in Institute of Medicine,
National Academy of Sciences 1979 and Hilgerson and Prohaska 2003, hospitals have been
expected to expand their services toward health promotion activities such as nutrition
counseling or community initiatives. As outlined in American Hospital Association 1979, the
idea was also taken up by the American Hospital Association. Longe and Wolf 1984 provides
an orientation on the US approach toward hospital health promotion that seems more
pragmatic than theory driven, being described as usually combining preventive and early-
detection services, health education, and an orientation toward supporting the health of

10
community members before they get ill, especially by means of lifestyle development.
Hilgerson and Prohaska 2003 and Olden and Clement 2000 are examples of publications that
focus, in relation to the decennial reviews of the achievements of the goals set by Healthy
People, on measuring policy impact on the level of implementation in US hospitals in general.
Hendryx 1993 focuses on the specific impact on rural hospitals. In addition, much of the US
literature on hospital health promotion has a focus on hospitals’ motives for health promotion.
Longe and Wolf 1984 identifies attempts to improve the hospitals’ reputation in the
community as one driver toward health promotion, while market and economic considerations
are described in Sol and Wilson 1989, and legal regulations are detailed in Ginn and Moseley
2006.
 American Hospital Association. 1979. The hospital’s responsibility for health
promotion. Policy and Statement (American Hospital Association). Chicago:
American Hospital Publishing.
This first specific policy paper on the role of hospitals in health promotion, which
relates to the US Healthy People program of 1979 (Institute of Medicine, National
Academy of Sciences 1979), is especially useful for understanding the policy context
of hospital health promotion in the United States.
Find this resource:
 Ginn, Gregory O., and Charles B. Moseley. 2006. The impact of state community
benefit laws on the community health orientation and health promotion services of
hospitals. Journal of Health Politics, Policy and Law 31.2: 321–344.
DOI: 10.1215/03616878-31-2-321Save Citation »Export Citation »E-mail Citation »
This empirical study focuses on the impact of legal regulations on the implementation
of hospital health promotion and concludes that coercive measures such as community
benefit laws can motivate not-for-profit hospitals to increase community-oriented
activities. It may be especially useful when studying the impact of policy incentives on
the organizational uptake of health promotion.
Find this resource:
 Hendryx, Michael S. 1993. Rural hospital health promotion: Programs, methods,
resource limitations. Journal of Community Health 18.4: 241–250.
DOI: 10.1007/BF01324434Save Citation »Export Citation »E-mail Citation »
This article is an example of a study on the organizational uptake of health promotion
in rural hospitals, drawing on empirical data from Iowa and suggesting that available
resources, and the range of health promotion programs offered, may be more limited
in rural hospitals than in urban ones.
Find this resource:

11
 Hilgerson, Lori L., and Thomas R. Prohaska. 2003. Hospital health promotion:
Swimming or sinking in an upstream business? Health Promotion Practice 4.1: 56–63.
DOI: 10.1177/1524839902238292Save Citation »Export Citation »E-mail Citation »
Against the background of the US Healthy People 2000 program, this article provides
a case study analysis of how national policy translates into the health promotion
programs that one urban Midwest hospital offered to its community during a year. It
can inform case study approaches in the hospital context and is of interest when
studying policy impact on organizational practice.
Find this resource:
 Institute of Medicine, National Academy of Sciences. 1979. Healthy people: The
surgeon general’s report on health promotion and disease prevention. DHEW
Publication 79-55071A. Washington, DC: US Department of Health, Education, and
Welfare.
This document is the first national health program that mentions health promotion as a
dedicated task of health service organizations. It is of historical interest and still
influences US hospital health promotion.
Find this resource:
 Longe, Mary E., and Anne Wolf. 1984. Promoting community health through
innovative hospital-based programs. Chicago: American Hospital Publications.
In line with US health policy, the publication describes the development of hospital-
based programs that have a positive impact on community health.
Find this resource:
 Olden, Peter C., and Dolores G. Clement. 2000. The prevalence of hospital health
promotion and disease prevention services: Good news, bad news, and policy
implications. Milbank Quarterly 78.1: 115–146.
DOI: 10.1111/1468-0009.00163Save Citation »Export Citation »E-mail Citation »
Drawing on national data from the American Hospital Association Annual Survey of
Hospitals, the authors focus on the prevalence of twenty-six services provided by
general hospitals that could contribute to health promotion and disease prevention
(HPDP). The paper is especially relevant for studying policy impact on the
organizational implementation of hospital health promotion.
Find this resource:

12
 Sol, Neil, and Philip K. Wilson, eds. 1989. Hospital health promotion. Champaign, IL:
Human Kinetics.
This is the first book on comprehensive approaches toward hospital health promotion
as a business perspective for hospitals. It presents strategies of hospital-based health
promotion and primarily addresses hospital managers and health-care professionals.
Find this resource:
8 Developments in Australia
As in the United States (see Developments in the United States), early considerations of
hospital health promotion in Australia were raised by national health policy, with a strong
focus on community health. A conceptual outline is offered in Tyler and James 1988.
However, concepts of health-promoting hospitals in Australia are in principle very similar to
those in Europe, both in strongly focusing on comprehensive whole-organization approaches
(see Health Promoting Hospitals in Europe) and building on WHO’s Ottawa Charter. An
overview on developments is provided in Dwyer 1998, and Radoslovich and Barnett 1998
suggests steps toward implementation. Johnson and Baum 2001 offers a typology of different
implementation types, while Stanton, et al. 1996 focuses on organizational barriers to
implementing health promotion in public hospitals in Australia.
 Dwyer, Judith. 1998. Health promoting hospitals in Australia. In Feasibility,
Vienna, Austria, April 16–19, 1997. Edited by Jürgen M. Pelikan, Karl Krajic, and
Hubert Lobnig, 47–51. Gamburg, Germany: G. Conrad.
This is a short overview article providing a concise outline on HPH developments in
Australia and presenting examples of practice.
Find this resource:
 Johnson, Anne, and Fran Baum. 2001. Health promoting hospitals: A typology of
different organizational approaches to health promotion. Health Promotion
International 16.3: 281–287.
DOI: 10.1093/heapro/16.3.281Save Citation »Export Citation »E-mail Citation »
The authors present a typology of four approaches of organizational arrangements to
health promotion that are of interest for studying levels of health promotion
implementation.
Find this resource:

13
 Radoslovich, Helen, and Kate Barnett. 1998. Making the move! Towards health
promoting hospitals, health services and regions. Adelaide, Australia: South
Australian Health Commission.
Building on WHO’s Ottawa Charter (World Health Organization 1986, cited under
Developments in Canada), the document provides an introduction to health promotion
and to reorienting health services toward health promotion. The publication contains
numerous case studies and has a focus on overall organizational development and
change management.
Find this resource:
 Stanton, Warren R., Kevin P. Balanda, Amaya M. Gillespie, and John B. Lowe. 1996.
Barriers to health promotion activities in public hospitals. Australian and New
Zealand Journal of Public Health 20.5: 500–504.
DOI: 10.1111/j.1467-842X.1996.tb01629.xSave Citation »Export Citation »E-mail
Citation »
In light of the limited uptake of health promotion by Australian hospitals, the article
investigates barriers to hospital health promotion and provides useful perspectives on
understanding organizational preparedness for health promotion.
Find this resource:
 Tyler, Colin, and Ray James. 1988. What should hospitals be doing in health
promotion services? Australian Health Review: A Publication of the Australian
Hospital Association 11.3: 182–185.
The article discusses the level of health promotion services that each hospital or area
health service should offer the community, drawing on recommendations by the
Australian Health Targets and Implementation Committee. It is primarily targeted at
senior administrators.
Find this resource:
9 Developments in Canada
As in the United States (see Developments in the United States) and Australia (see
Developments in Australia), Canada too had early health policy initiatives to promote the role
of health-care facilities in health promotion, which can be traced back to the 1970s. Pineault,
et al. 1990 provides an overview for the Quebec area. According to Health and Welfare
Canada 1990, the concept has been more systematically taken up since the 1990s, and, as
Baskerville and Letouzé 1990 describes, these developments were supported by an
involvement of the Canadian Hospital Association. As in Europe (see Health Promoting
Hospitals in Europe), developments in Canada can be traced back to WHO’s Ottawa Charter

14
(World Health Organization 1986). An introductory overview of developments was prepared
in Korn 1998.
 Baskerville, Bruce, and Daniel Letouzé. 1990. Facilitating the involvement of
Canadian health care facilities in health promotion. Patient Education and Counseling
15.2: 113–125.
DOI: 10.1016/0738-3991(90)90055-PSave Citation »Export Citation »E-mail Citation
»
Following a brief background on Canadian efforts in health promotion policy and the
Canadian health-care system, and a discussion of the reasons for increased interest in
the area, the article describes practice examples from two initiatives on health
promotion and health-care facilities undertaken by the Canadian Hospital Association.
Find this resource:
 Health and Welfare Canada. 1990. A guide for health promotion by health care
facilities. Ottawa, ON: Health Services and Promotion Branch, Health and Welfare
Canada, Ministry for Supply and Services.
A health policy document offering guidance to health-care facilities in the process of
implementing health promotion.
Find this resource:
 Korn, David A. 1998. Health promoting hospitals in Canada. In Feasibility,
Vienna, Austria, April 16–19, 1997. Edited by Jürgen M. Pelikan, Karl Krajic, and
Hubert Lobnig, 52–53. Gamburg, Germany: G. Conrad.
This is a short overview article providing a concise overview on HPH developments in
Canada, including references to examples of practice.
Find this resource:
 Pineault, Reynald, Bruce Baskerville, and Daniel Letouzé. 1990. Health promotion
activities in Quebec hospitals: A comparison of DSC and non-DSC hospitals.
Canadian Journal of Public Health / Revue canadienne de santé publique 81.3: 199–
203.
The article examines health promotion activities in relation to specific organizational
capacities. It concludes that organizations with a mandate for community health have

15
more health promotion activities in this field. The article is of interest when studying
the preconditions for a comprehensive health promotion approach.
Find this resource:
 World Health Organization. 1986. Ottawa Charter for Health Promotion: An
international conference on health promotion; The move towards a new public health,
November 17–21, 1986, Ottawa, Ontario, Canada. Geneva, Switzerland: World
Health Organization.
The intervention principles for health promotion and action areas lined out in the
charter were influential for developing initiatives around health-promoting hospitals in
Canada.
Find this resource:
10 Health Promoting Hospitals in Europe
The Health Promoting Hospitals initiative (which was, in 2009, renamed Health Promoting
Hospitals and Health Services), abbreviated as HPH, was inspired by WHO’s Ottawa Charter
(World Health Organization 1986) and was started in Europe. The charter document lists a
specific action area on the health sector that demands its reorientation toward health
promotion “beyond its responsibility for providing clinical and curative services.” The Ottawa
Charter informed the development of numerous, especially setting-oriented, health promotion
activities, interventions, and networks in a number of areas, including hospitals. The first
conceptual considerations focusing on hospitals were commissioned by WHO and published
in Milz and Vang 1988, outlining, for the first time, the three major HPH target groups
(patients, staff, and the hospital community), and interventions to address them. While a
community approach is predominant in Milz and Vang 1988, the publication also lists specific
responsibilities of the hospital toward its inpatients (patient education, patient safety) and its
staff. On the basis of these contents, the very first European model project on health-
promoting hospitals was set up in Vienna, Austria, from 1989 to 1997 (World Health
Organization Regional Office for Europe 1997). Nowak, et al. 1998 describes the evaluation
of this project. In 1990, WHO-Euro started the International Network of Health Promoting
Hospitals in collaboration with the WHO Healthy Cities project, in the form of a multicity
action plan, as is described in Krajic, et al. 1992. Target groups of the HPH concept and ways
to address them were further refined in the first policy document of the HPH network, the
Budapest Declaration on Health Promoting Hospitals, launched by WHO-Euro in 1991
(World Health Organization Regional Office for Europe 1991). The document specifically
added the need to establish sufficient organizational capacities to implement the HPH
approach. The collaboration with Healthy Cities proved to be helpful for the recruitment and
implementation of the European Pilot Hospital Project on Health Promoting Hospitals, which
had twenty participating hospitals from eleven European countries and tested and evaluated
the applicability of the HPH approach in different types of hospitals and in different national
health policy contexts. Pelikan, et al. 1998 contains the case study experiences of the
participating hospitals. Toward the end of the pilot hospital project, the Vienna
Recommendations, a new policy document of the network, were launched by WHO-Euro in
1997 to mirror international developments in HPH, especially the WHO-Euro policy to
disseminate HPH via the establishment of national and regional HPH networks, starting in

16
1995. A next phase of the European HPH network was characterized by a stronger orientation
toward hospital quality management (see also Concepts of Health Promoting Hospitals and
Implementing Health Promotion in Specific Hospital Types and Units). In addition to contents,
the international HPH network also further developed its structure and became an
international association in 2008, with a constitution specifying its mission and defining its
bodies and their responsibilities. An overview of the history of the international HPH network
is in Pelikan, et al. 2011.
 Krajic, Karl, Heather McDonald, and Jürgen M. Pelikan. 1992. Health promoting
hospitals: An international network initiated by WHO-EURO; A multi-city action plan
of the Healthy Cities Project. Copenhagen: World Health Organization Regional
Office for Europe.
This policy document describes WHO-Euro’s first approach to disseminate health-
promoting hospitals by using the WHO Healthy Cities as dissemination agents. Its
value is mainly historical.
Find this resource:
 Milz, Helmut, and Johannes O. Vang. 1988. Consultation on the role of health
promotion in hospitals. Health Promotion International 3.4: 425–427.
This article represents the perspectives of a team of researchers commissioned by
WHO-Euro on health promotion in hospitals. It is of specific value when studying the
development of the HPH approach over time.
Find this resource:
 Nowak, Peter, Hubert Lobnig, Karl Krajic, and Jürgen M. Pelikan. 1998. Case Study
Rudolfstiftung Hospital, Vienna, Austria—WHO model project “Health and Hospital.”
In Pathways to a health promoting hospital: Experiences from the European Pilot
Hospital Project, 1993–1997. Edited by Jürgen M. Pelikan, Mila Garcia-Barbero,
Hubert Lobnig, and Karl Krajic, 47–66. Health Promoting Hospital Series 2. Gamburg,
Germany: G. Conrad.
The article describes the evaluation of the first systematic HPH approach in Europe,
highlighting an organizational development approach and building on Milz and Vang
1988 and the Budapest Declaration (World Health Organization Regional Office for
Europe 1991).
Find this resource:
 Pelikan, Jürgen M., Mila Garcia-Barbero, Hubert Lobnig, and Karl Krajic, eds. 1998.

17
Germany: G. Conrad.
This book is a summary of case studies from the twenty hospitals that participated in
the European pilot hospital project on health-promoting hospitals from 1993 to 1997.
It describes the subprojects performed by these hospitals, as well as their evaluation.
The book provides a good orientation on this first systematic international
dissemination approach to HPH.
Find this resource:
 Pelikan, Jürgen M., Oliver Groene, and Jeff Kirk Svane. 2011. The international HPH
network—a short history of two decades of development. Clinical Health Promotion
1.1: 32–36.
This is the most recent and comprehensive journal article on the history of the HPH
network.
Find this resource:
 World Health Organization. 1986. Ottawa Charter for Health Promotion: An
international conference on health promotion; The move towards a new public health,
November 17–21, 1986, Ottawa, Ontario, Canada. Geneva, Switzerland: World
Many health promotion initiatives including HPH refer to WHO’s Ottawa Charter as a
major policy background document. Action area 5 of the charter, reorienting health
services, is especially relevant for understanding the HPH context.
Find this resource:
 World Health Organization Regional Office for Europe. 1997. The Vienna
recommendations on health promoting hospitals. Copenhagen: World Health
Organization Regional Office for Europe.
This document confirms the contents of the Budapest Declaration (World Health
Organization Regional Office for Europe 1991) and specifies the approach for the new
phase of dissemination by networks that started in 1995.
Find this resource:

18
 World Health Organization Regional Office for Europe, ed. 1991. The Budapest
Declaration on Health Promoting Hospitals. Copenhagen: World Health Organization
Regional Office for Europe.
The Budapest Declaration was the first policy document of the European network of
HPH. It has two parts, which specify the content of the HPH concept and the
conditions for participation in the European Pilot Hospital Project of Health Promoting
Hospitals (Pelikan, et al. 1998).
Find this resource:
11 Globalization of HPH
While early developments in hospital health promotion and health-promoting hospitals all
occurred in developed regions of the world (see Developments in Australia, Developments in
the United States, Developments in Canada, and Health Promoting Hospitals in Europe) and
go as far back as the 1970s and 1980s, the dissemination to less developed regions and other
continents took more time. There are only a few examples from the first decade of the 21st
century, with an increasing number of publications being available since around 2010.
Mangoud 2000 describes experiences from Albania; Guo, et al. 2007 focuses on
implementation in Beijing, China; Kar, et al. 2012 elaborates on the applicability of HPH in
India; Yaghoubi and Javadi 2013 discusses HPH in Iran; Khowaja, et al. 2011 refers to the
adaptation of the HPH concept in Pakistan; Kumpalanon, et al. 2012 describes
implementation in district hospitals in Thailand; Lin and Lin 2011 focuses on experiences in
Taiwan; and Delobelle, et al. 2011 describes implementation in South Africa. Articles that are
in English typically focus on the national receptivity and interpretation of the HPH concept
and on preconditions for and the scope of national implementation; some publications,
including Delobelle, et al. 2011; Guo, et al. 2007; and Mangoud 2000 describe case study
experiences. With the exception of Kumpalanon, et al. 2012, which follows a public health
approach, articles typically follow the understanding of the WHO-initiated network of HPH
(see Health Promoting Hospitals in Europe and Concepts of Health Promoting Hospitals.
 Delobelle, Peter, Hans Onya, Cynthia Langa, Joyce Mashamba, and Anne-Marie
Depoorter. 2011. Pilot health promoting hospital in rural South Africa: Evidence-
based approach to systematic hospital transformation. Global Health Promotion 18.1:
47–50.
The article describes the case of one South African hospital that aimed at
implementing the WHO standards for health promotion in hospitals. The authors
conclude that the project indicated applicability of the model in a resource-limited
setting, on the basis of staff empowerment, local leadership, and stakeholder
engagement.
Find this resource:

19
 Guo, Xiu-Hua, Xiang-Yang Tian, Yue-Song Pan, et al. 2007. Managerial attitudes on
the development of health promoting hospitals in Beijing. Health Promotion
DOI: 10.1093/heapro/dam010Save Citation »Export Citation »E-mail Citation »
This study followed the approach of the European Pilot Hospital Project of Health
Promoting Hospitals (see European Pilot and Model Hospital Projects), selecting
hospitals and supporting them in organizational change toward HPH. It provides
interesting insights into the applicability of HPH in China.
Find this resource:
 Kar, Sitanshu Sekar, Gautam Roy, and Subitha Lakshminarayanan. 2012. Health
promoting hospital: A noble concept. National Journal of Community Medicine 3.3:
558–562.
The authors state that the HPH concept is rather new in India, currently implemented
only in a handful of hospitals. However, they would recommend it for broader uptake.
Find this resource:
 Khowaja, Asif Raza, Rozina Karmaliani, Rozina Mistry, and Ajmal Agha. 2011.
Transition towards health promoting hospitals: Adapting a global framework to
Pakistan. Eastern Mediterranean Health Journal 17.10: 738–743.
The article presents the perceptions of a number of national stakeholders on the HPH
approach, outlining that stakeholders see more-pressing urgency in providing basic
needs such as hygiene, safety, security, and emotional support. The paper is of specific
interest when studying the specific conditions for HPH in Pakistan.
Find this resource:
 Kumpalanon, Jutarat, Dusadeee Ayuwat, and Pattara Sanchaisuriya. 2012. Developing
of health promotion of district hospitals in Thailand. American Journal of Health
Sciences 3.1: 43–52.
The article describes programs of community health promotion that are delivered by
district hospitals in Thailand, mirroring a public health approach taken in the region.
Find this resource:
 Lin, Yea-Wen, and Yueh-Ysen Lin. 2011. Health-promoting organization and
organizational effectiveness of health promotion in hospitals: A national cross-
sectional survey in Taiwan. Health Promotion International 26.3: 362–375.

20
DOI: 10.1093/heapro/daq068Save Citation »Export Citation »E-mail Citation »
The article describes a countrywide study on the organizational health promotion
status of Taiwanese hospitals, relating health promotion to organizational
effectiveness.
Find this resource:
 Mangoud, Abdallah M. 2000. Establishing a health promoting setting: An experience
in an Albanian polyclinic. International Journal of Public Administration 23.1: 1–20.
Following the settings approach in health promotion, the article describes the
experiences of one Albanian hospital in undergoing a process of organizational change
toward health promotion, supported by an external change agent. It provides
interesting insights into the capacities needed for a successful reorientation of
hospitals toward HPH.
Find this resource:
 Yaghoubi, Maryam, and Marzieh Javadi. 2013. Health promoting hospitals in Iran:
How it is. Journal of Education and Health Promotion 2:41.
DOI: 10.4103/2277-9531.115840Save Citation »Export Citation »E-mail Citation »
The article describes a study using the WHO standards for health promotion in
hospitals to evaluate public and private hospitals in Iran, concluding that more
capacity building is needed to motivate Iranian hospitals to implement HPH.
Find this resource:
12 Concepts of Health Promoting Hospitals
With regard to conceptual considerations around HPH, two strands of research can be
distinguished. One strand focuses on the core concept of HPH, relating to the concept of
health that is pursued, to the target groups addressed, and to concepts of organizational
development and change needed to make hospitals and health services more health promoting
(see the HPH Core Concept). The second strand is about relating HPH to other reform
concepts and movements (see Linking HPH to Other Reform Concepts).
13 The HPH Core Concept
Following WHO’s Ottawa Charter (World Health Organization 1986, cited under Health
Promoting Hospitals in Europe), HPH has been developed as a broad and comprehensive
approach to organizational development. Introductions are offered in Pelikan and Wolff 1999
and Pelikan, et al. 2010. The specific health orientation of the concept, which is focused on
positive health—differentiating health promotion from, and relating it to, preventive and
clinical work in and by hospitals and health services and combining risk reduction and
resource-strengthening approaches, empowering patients, staff, and community populations to

21
become better coproducers of health, as well as developing the hospital setting physically and
socially to support the hospital’s health promotion endeavors—is well described in Pelikan
and Halbmayer 1999 (in German) and is also taken up in Pelikan, et al. 2005 and Pelikan, et al.
2010 (in English). The three target groups of the HPH core concept—patients, staff, and the
hospital community—were first described in Milz and Vang 1988 and were confirmed and
refined in later works, including Pelikan and Halbmayer 1999; Pelikan, et al. 2001; Pelikan, et
al. 2005; Pelikan, et al. 2010; and World Health Organization 1998. With regard to the
organizational implementation of the concept, early work such as Pelikan and Wolff 1999
focuses on open developmental approaches, informed by an understanding of systemic and
systematic organizational development. More recently, under the influence of the rising
importance of the quality movements, a trend toward formalization and standardization of the
HPH concept can be observed (e.g., by defining eighteen HPH core strategies, as included in
Pelikan, et al. 2005, and by developing HPH standards, as described in Groene 2006). See
also Linking HPH to Other Reform Concepts.
 Groene, Oliver, ed. 2006. Implementing health promotion in hospitals: Manual and
self-assessment forms. Copenhagen: WHO Regional Office for Europe.
Building on HPH core concepts, this manual for hospital managers and clinical staff
links the implementation of HPH to quality management. It introduces five standards
with thirteen substandards and forty measurable elements for organizational self-
assessment.
Find this resource:
 Milz, Helmut, and Johannes O. Vang. 1988. Consultation on the role of health
promotion in hospitals. Health Promotion International 3.4: 425–427.
This article is the first conceptual publication on health promotion in hospitals.
Building on WHO’s Ottawa Charter, it reflects the perspectives of a research team
commissioned by WHO-Euro.
Find this resource:
 Pelikan, Jürgen M., Christina Dietscher, Karl Krajic, and Peter Nowak. 2005. Eighteen
core strategies for health promoting hospitals. In Health promotion in hospitals:
Evidence and quality management. Edited by Oliver Groene and Mila Garcia-Barbero,
46–63. Copenhagen: World Health Organization Regional Office for Europe.
The article marks a shift from the rather open organizational development approach of
HPH from earlier work to a more structured approach, condensing HPH into eighteen
theoretically deducted core strategies (six each for patients, staff, and the hospital
community).
Find this resource:

22
 Pelikan, Jürgen M., Christina Dietscher, Florian Röthlin, and Hermann Schmied. 2010.
Hospitals as organizational settings for health and health promotion. Working Paper
5. Vienna: Ludwig Boltzmann Institute for Health Promotion Research.
The publication relates the HPH approach to a perspective of sociological systems
theory on the settings approach of health promotion. It is especially interesting for
those interested in health promotion theory.
Find this resource:
 Pelikan, Jürgen M., and Ernst Halbmayer. 1999. Gesundheitswissenschaftliche
Grundlagen zur Strategie des Gesundheitsfördernden Krankenhauses. In Das
gesundheitsfördernde Krankenhaus: Konzepte und Beispiele zur Entwicklung einer
lernenden Organisation. Edited by Jürgen M. Pelikan and Stephan Wolff, 13–36.
Gesundheitsforschung. Weinheim, Germany, and Munich: Juventa-Verlag.
The chapter provides valuable theoretical concepts for understanding health and health
promotion interventions in relation to the settings approach of health promotion.
Find this resource:
 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.
Citation »
This is an overview article on the HPH concept and history. It provides good
orientation on developments until 2001.
Find this resource:
 Pelikan, Jürgen M., and Stephan Wolff, eds. 1999. Das gesundheitsfördernde
Krankenhaus: Konzepte und Beispiele zur Entwicklung einer lernenden Organisation.
The book has a focus on organizational development as a core health promotion
strategy. It provides important insights into health promotion theory but also contains
examples of implementation practice.
Find this resource:

23
 World Health Organization. 1998. Health promoting hospitals. In Health promotion
glossary. Rev. ed. By World Health Organization, 11. Geneva, Switzerland: World
This entry of HPH into WHO’s Health Promotion glossary provides a concise
definition of and an ideal first introduction to HPH, its target groups, and its
intervention approach.
Find this resource:
14 Linking HPH to Evidence-Based Medicine and to the Quality Movements
Under the influence of the increasing role of evidence-based medicine and quality
management in health care, the international HPH network developed five standards for
health promotion in health care. Several publications, such as Fugleholm, et al. 2005 and
Groene, et al. 2010, focus on the development and testing of this tool. Zhou 2009 offers a
translation of the standards into Chinese. But there are also other examples of interlinks with
the quality movements, such as a manual (Brandt 2001) that suggests criteria for assessing the
quality of HPH on the basis of the quality model of the European Foundation for Quality
Management (EFQM). Another strand of interlinks with hospital quality management relates
to reimbursement systems and diagnosis-related groups (DRGs). A suggestion for registering
clinical health-promotion interventions in DRG systems is provided in Tønnesen, et al. 2007.
In relation to a more evidence-oriented approach in hospital health promotion, Groene and
Garcia-Barbero 2005 contains an explicit chapter (Tønnesen, et al. 2005) on the evidence for
HPH, with the main focus on evidence for specific clinical interventions. In contrast, McHugh,
et al. 2010, which looks for evidence for the overall HPH approach, finds a lack of high-level
studies in the field.
 Brandt, Elimar, ed. 2001. Qualitätsmanagement und Gesundheitsförderung im
Krankenhaus: Handbuch zur EFQM-Einführung. Munich: Luchterhand.
This book is the first publication that describes interlinks between HPH and a specific
quality approach, in this case the quality model of the EFQM. It provides important
contents for assessing and further developing the health promotion quality of a
hospital.
Find this resource:
 Fugleholm, Anne Mette, Svend Juul Jørgensen, Lillian Møller, and Oliver Groene.
2005. Development of standards for disease prevention and health promotion. In
Health promotion in hospitals: Evidence and quality management. Edited by Oliver
Groene and Mila Garcia-Barbero, 64–79. Copenhagen: World Health Organization
Regional Office for Europe.

24
The chapter introduces the development of the WHO standards for health promotion
in hospitals as a consensus process of an international working group and as following
the International Society for Quality in Healthcare (ISQUA) process for standard
development.
Find this resource:
 Groene, Oliver, Jordi Alonso, and Niek Klazinga. 2010. Development and validation
of the WHO self-assessment tool for health promotion in hospitals: Results of a study
in 38 hospitals in eight countries. Health Promotion International 25.2: 221–229.
The article outlines the development of a self-assessment tool for health promotion in
hospitals and describes the testing of its validity.
Find this resource:
 Groene, Oliver, and Mila Garcia-Barbero, eds. 2005. Health promotion in hospitals:
Evidence and quality management. Copenhagen: World Health Organization Regional
Office for Europe.
The booklet offers a collection of articles on interlinks between health promotion in
hospitals and quality management, as well as a summary of available evidence for the
HPH approach.
Find this resource:
 McHugh, Claire, Anske Robinson, and Janice Chesters. 2010. Health promoting health
services: A review of the evidence. Health Promotion International 25.2: 230–237.
The authors aimed at collecting the evidence for the overall organizational HPH
approach and claim there is a lack of high-level studies on the topic.
Find this resource:
 Tønnesen, Hanne, Mette E. Christensen, Oliver Groene, et al. 2007. An evaluation of a
model for the systematic documentation of hospital based health promotion activities:
Results from a multicentre study. BMC Health Services Research 7.1: 145.
DOI: 10.1186/1472-6963-7-145Save Citation »Export Citation »E-mail Citation »
The study suggests specific codes for registering clinical health-promotion
interventions that are connective to DRG systems. It can inform health planning and
the development of reimbursement models for clinical health promotion.
Find this resource:

25
 Tønnesen, Hanne, Anne Mette Fugleholm, and Svend Juul Jørgensen. 2005. Evidence
for health promotion in hospitals. In Health promotion in hospitals: Evidence and
quality management. Edited by Oliver Groene and Mila Garcia-Barbero, 21–45.
Copenhagen: World Health Organization Regional Office for Europe.
Focusing on clinical interventions, the authors summarize the available evidence for
general lifestyle-related and disease-specific health promotion interventions for
hospital patients.
Find this resource:
 Zhou, Fengqiong. 2009. Development of a Chinese version WHO self-assessment tool
for evaluating health promotion in hospital. MA thesis, Université de Montréal.
This is an interesting thesis that not only provides a Chinese version of the WHO
standards for health promotion in hospitals but also discusses their applicability under
conditions of the Chinese health-care system.
Find this resource:
15 Linking HPH to Other Reform Concepts
HPH can be described as an umbrella concept with many options for interlinking with other
concepts. For example, linkages between HPH and the ecology and sustainability movements,
as outlined in Hancock 1999, go back to the late 1990s but have been described more
systematically in Weisz, et al. 2011. Collaboration between HPH and the self-help movements
is suggested in a German-language article (Forster, et al. 2013). And, most recently, the HPH
concept has been discussed in relation to the capacity approach in health promotion (Röthlin
2013) and the discourse on salutogenic organizations (Pelikan, et al. 2013).
 Forster, Rudolf, Daniela Rojatz, Hermann Schmied, and Jürgen M. Pelikan. 2013.
Selbsthilfegruppen und Gesundheitsförderung im Krankenhaus—eine
entwicklungsfähige Allianz für Gesundheit. Prävention und Gesundheitsförderung 8.1:
9–14.
DOI: 10.1007/s11553-012-0364-zSave Citation »Export Citation »E-mail Citation »
The article links the HPH concept to hospital-based support for self-help groups,
suggesting specific strategies for cooperation. It is interesting in the context of patient
empowerment and cooperation with the self-help movements.
Find this resource:
 Hancock, Trevor. 1999. Creating health and health promoting hospitals: A worthy
challenge for the twenty-first century. Leadership in Health Services 12.2: 8–19.

26
This is the first article not only relating HPH to health gains for people but also giving
attention to the impact of health care on the environment.
Find this resource:
 Pelikan, Jürgen M., Christina Dietscher, and Hermann Schmied. 2013. In how far is
the health promoting hospital a salutogenic hospital, and how can it be developed? In
Salutogenic organizations and change: The concepts behind organizational health
intervention research. Edited by Georg F. Bauer and Gregor J. Jenny, 149–165.
Dordrecht, The Netherlands, and New York: Springer.
DOI: 10.1007/978-94-007-6470-5Save Citation »Export Citation »E-mail Citation »
Building on the HPH core concept (see the HPH Core Concept), the chapter discusses
similarities and differences between concepts of health promotion and salutogenesis
and implications for the HPH concept. It is mainly of theoretical value.
Find this resource:
 Röthlin, Florian. 2013. Managerial strategies to reorient hospitals towards health
promotion: Lessons from organisational theory. Journal of Health Organization and
Management 27.6: 747–761.
DOI: 10.1108/JHOM-07-2011-0070Save Citation »Export Citation »E-mail Citation »
Drawing on an organizational-theory background, the article identifies a number of
capacities that facilitate the implementation of health promotion in hospitals. It is of
theoretical value but is also interesting for hospital managers.
Find this resource:
 Weisz, Ulli, Willi Haas, Jürgen M. Pelikan, and Hermann Schmied. 2011. Sustainable
hospitals: A socio-ecological approach. Gaia 20.3: 191–198.
Drawing on Hancock 1999, the article provides a systematic outline of conceptual
interlinks between sustainability and the HPH approach. It is of specific value for
those interested in theory.
Find this resource:
16 Studies on Implementing the Overall HPH Approach
The overall HPH approach (see the HPH Core Concept) was first implemented in pilot and
model projects in Europe during the 1990s (see European Pilot and Model Hospital Projects).
In the years since 2000, implementation has been continuously supported by specific quality
approaches (see Using Quality Concepts for Implementing and Evaluating HPH). In the early
21st century, studies are increasingly focusing on barriers, facilitators, and capacities needed
for HPH (see Studying Capacities Needed, Furthering and Hindering Factors for HPH). A

27
smaller part of the literature is on linking HPH to broader health systems reforms (see
Relating HPH to Health Systems Reform).
17 European Pilot and Model Hospital Projects
The first WHO European model project, “Health and Hospital,” which took place in Vienna,
Austria, between 1989 and 1997, with accompanying evaluation, is described in Nowak, et al.
1998; Pelikan, et al. 1993; and Pelikan, et al. 1996. With the exception of Nowak, et al. 1998,
the cited publications on the Vienna model hospital project are in German. They all describe
an organizational development approach toward HPH, focusing on the selection and
specification of interventions as well as on their outcomes. Coordinated by the same research
team that evaluated the model project, a WHO-initiated European pilot hospital project, with
twenty participating hospitals from eleven countries, was launched in 1993 and successfully
terminated in 1997. A collection of case studies containing implementation experiences and
evaluation results of the twenty participating hospitals is in Pelikan, et al. 1998, and the
German-language Pelikan and Wolff 1999 contains case studies on the German pilot hospitals.
In addition, a couple of journal articles are available on single hospitals that participated in the
project: Trojan, et al. 1997 describes experiences of one pilot hospital in Hamburg, Germany,
and Tountas, et al. 2004 describes the evaluation of the Greek hospital that participated in the
project.
 Nowak, Peter, Hubert Lobnig, Karl Krajic, and Jürgen M. Pelikan. 1998. Case Study
Rudolfstiftung Hospital, Vienna, Austria—WHO model project “Health and Hospital.”
In Pathways to a health promoting hospital: Experiences from the European Pilot
Hospital Project, 1993–1997. Edited by Jürgen M. Pelikan, Mila Garcia-Barbero,
Hubert Lobnig, and Karl Krajic, 47–66. Health Promoting Hospital Series 2. Gamburg,
Germany: G. Conrad.
The chapter is a good English-language summary description of interventions and
evaluation outcomes of the first WHO European model project, “Health and Hospital,”
in Vienna, Austria.
Find this resource:
 Pelikan, Jürgen M., Mila Garcia-Barbero, Hubert Lobnig, and Karl Krajic, eds. 1998.
Germany: G. Conrad.
The book collects twenty case studies of hospital health promotion from eleven
different European countries and provides valuable insight on the applicability of the
HPH approach to different types of hospitals and health-care systems.
Find this resource:
 Pelikan, Jürgen M., Hubert Lobnig, and Peter Nowak. 1993. Das Wiener WHO-
Modellprojekt “Gesundheit und Krankenhaus.” In Gesundheitsförderung durch

28
Organisationsentwicklung: Konzepte, Strategien und Projekte für Betriebe,
Krankenhäuser und Schulen. Edited by Jürgen M. Pelikan, Hildegard Demmer, and
Klaus Hurrelmann, 204–222. Gesundheitsforschung. Weinheim, Germany, and
Munich: Juventa-Verlag.
The chapter describes the Vienna WHO model project as one example of an
organizational development approach toward health promotion. It is interesting from
an intervention perspective but also with regard to the concept and history of HPH.
Find this resource:
 Pelikan, Jürgen M., Peter Nowak, and Hubert Lobnig. 1996. Das Krankenhaus auf
dem Weg zu einer gesundheitsfördernden Organisation: Das WHO-Modellprojekt
Gesundheit und Krankenhaus. In Gesundheitsförderung und Public Health:
Öffentliche Gesundheit durch Organisation entwickeln. Edited by Ralph Grossmann,
148–170. Vienna: Facultas-Universitätsverlag.
The chapter builds on Pelikan, et al. 1993, also including experiences of the model
hospital during the subsequent European pilot hospital project (see also Pelikan, et al.
1998).
Find this resource:
 Pelikan, Jürgen M., and Stephan Wolff, eds. 1999. Das gesundheitsfördernde
Krankenhaus: Konzepte und Beispiele zur Entwicklung einer lernenden Organisation.
The book contains case studies from the German-speaking HPH pilot hospitals.
Find this resource:
 Tountas, Yannis, Elpida Pavi, Kyriaki Tsamandouraki, Nikolaos Arkadopoulos, and
Dimitra Triantafyllou. 2004. Evaluation of the participation of Aretaieion Hospital,
Greece in the WHO Pilot Project of Health Promoting Hospitals. Health Promotion
DOI: 10.1093/heapro/dah407Save Citation »Export Citation »E-mail Citation »
The article outlines the evaluation concept and outcomes of Aretaieion University
Hospital, Greece, during the European pilot hospital project of HPH. It can inform the
development of evaluation designs but also refers to points to be considered when
implementing health promotion in the hospital context.
Find this resource:

29
 Trojan, Alf, Stefan Nickel, and Petra Schneiders-Kastning. 1997. Quality evaluation
from the patient viewpoint—exemplary results from the European WHO project
“Health-Promoting Hospitals.” Gesundheitswesen 59.12: 720–725.
This article, in German, provides an outline of the European WHO project “Health
Promoting Hospitals” and presents patient-reported hospital quality as one important
outcome dimension of HPH.
Find this resource:
18 Using Quality Concepts for Implementing and Evaluating HPH
There are two strands of implementation-oriented research around quality and HPH. One aims
at generating experiences and guidelines on implementing health promotion in hospitals, by
means of specific quality tools and management approaches. Examples include Brandt, et al.
2005 and Groene, et al. 2009 on using the Balanced Scorecard to implement HPH. The other
strand of research focuses on evaluating the health promotion quality of hospitals, using the
WHO standards for health promotion in hospitals (see Linking HPH to Evidence-Based
Medicine and to the Quality Movements) as a tool. Examples include Goel, et al. 2011 and
Põlluste, et al. 2007, which compare the degree of standard fulfillment in HPH member
hospitals against fulfillment in non-members. Miseviciene and Zalnieraitiene 2013 uses the
standards to measure the preparedness of health professionals to implement health promotion
in hospitals.
 Brandt, Elimar, Werner Schmidt, Ralf Dziewas, and Oliver Groene. 2005.
Implementing the health promoting hospitals strategy through a combined application
of the EFQM Excellence Model and the Balanced Scorecard. In Health promotion in
hospitals: Evidence and quality management. Edited by Oliver Groene and Mila
Garcia-Barbero, 80–99. Copenhagen: World Health Organization Regional Office for
Europe.
On the basis of a national initiative in the German HPH network, the chapter describes
how quality tools can be used to strategically support the comprehensive
implementation of health promotion in hospital organizations.
Find this resource:
 Goel, Sonu, A. K. Gupta, Parampreet Ahuja, et al. 2011. Comparison of the health-
promoting orientation of three tertiary care hospitals of India. National Medical
Journal of India 24.2: 83–85.
The study compares the health promotion quality of two members of the international
HPH network with the quality of a non-HPH hospital and concludes that the HPH
member organizations have better health promotion quality.

30
Find this resource:
 Groene, Oliver, Elimar Brandt, Werner Schmidt, and Johannes Moeller. 2009. The
Balanced Scorecard of acute settings: Development process, definition of 20 strategic
objectives and implementation. International Journal for Quality in Healthcare 21.4:
259–271.
DOI: 10.1093/intqhc/mzp024Save Citation »Export Citation »E-mail Citation »
The chapter describes how a combination of specific quality tools can be used to
support the implementation of health promotion in hospitals.
Find this resource:
 Miseviciene, Irena, and Kristina Zalnieraitiene. 2013. Health promoting hospitals in
Lithuania: Health professional support for standards. Health Promotion International
28.4: 512–521.
DOI: 10.1093/heapro/das035Save Citation »Export Citation »E-mail Citation »
The authors assess the degree of awareness of the WHO health promotion standards in
doctors and nurses of the Lithuanian HPH network, concluding that nurses and doctors
assess the feasibility of standards in different ways. The study can be useful for
understanding the perspectives of health professionals on HPH.
Find this resource:
 Põlluste, Kaja, Jane Alop, Oliver Groene, Tiiu Härm, Eda Merisalu, and Lagle
Suurorg. 2007. Health-promoting hospitals in Estonia: What are they doing differently?
Health Promotion International 22.4: 327–336.
DOI: 10.1093/heapro/dam032Save Citation »Export Citation »E-mail Citation »
Using the WHO HPH standards, the study compares the health promotion quality of
members and non-members of the Estonian HPH network. It is especially valuable for
developing comparative research designs.
Find this resource:
19 Studying Capacities Needed, Furthering and Hindering Factors for HPH
Research has identified hospital-internal as well as hospital-external capacities, furthering and
hindering factors for HPH. With regard to hospital-internal factors, Lin and Lin 2011 (cited
under Globalization of HPH) identifies the level of institutionalization of health promotion,
while Lee, et al. 2012a and Röthlin, et al. 2013 focus on the relevance of organizational
capacity and infrastructure, including the support from in-house HPH coordinators. Johansson,
et al. 2010a and Johansson, et al. 2010b focus on the role of objectives and guidelines and
professional power play (i.e., the fact that professional groups with comparatively low
decision power—such as psychologists, occupational therapists, and physiotherapists—are
more interested in health promotion than are more-dominant groups in health care). Relating
to the role of professionals, Deccache, et al. 1999 finds the recognition of health promotion

31
(HP) as a professional domain as an important furthering factor. Among the hospital-external
factors, Deccache, et al. 1999 points to the level of political support, public awareness, and
demand, while Lee, et al. 2012b highlights options for reimbursement of health promotion
services, and Aujoulat, et al. 2001 sees a need for implementation support in the form of the
availability of implementation guidelines. With the exception of Deccache, et al. 1999, which
is a French publication, these articles are in English.
 Aujoulat, Isabelle, Anne-Laurence Le Faou, Brigitte Sandrin-Berthon, François Martin,
and Alain Deccache. 2001. Implementing health promotion in health care settings:
Conceptual coherence and policy support. Patient Education and Counseling 45.4:
245–254.
Citation »
The authors claim a lack of guidelines to support the implementation of health
promotion in hospitals, and they call for professional skill building to support the
approach.
Find this resource:
 Deccache, Alain, France Libion, Caroline van Cangh, Jacques Dumont, Jean-Luc
Collignon, and M. Borgs. 1999. Promouvoir la santé dans les milieux de soins et les
hôpitaux? Une enquête en communauté française de Belgique. Promotion &
Education 6.1: 31–35.
DOI: 10.1177/102538239900600112Save Citation »Export Citation »E-mail Citation
»
The authors outline the development of HPH in Belgium, drawing on a survey among
hospitals in the French part of Belgium. It is interesting in the context of country
comparisons.
Find this resource:
 Johansson, Helene, Hans Stenlund, Lena Lundström, and Lars Weinehall. 2010a.
Reorientation to more health promotion in health services: A study of barriers and
possibilities from the perspective of health professionals. Journal of Multidisciplinary
Healthcare 3:213–224.
DOI: 10.2147/JMDH.S14900Save Citation »Export Citation »E-mail Citation »
The authors argue that hospital reorientation toward health promotion could be
strengthened by better involving a more diverse range of clinical professions that are
often left out.
Find this resource:
 Johansson, Helene, Lars Weinehall, and Maria Emmelin. 2010b. “If only we got a
chance”: Barriers to and possibilities for a more health-promoting health service.
Journal of Multidisciplinary Healthcare 3:1–9.

32
Authors identify (a lack of) leadership as one of the key hindering or facilitating
factors to health promotion in hospitals.
Find this resource:
 Lee, Chiachi Bonnie, Michael S. Chen, Michael John Powell, and Cordia Ming-Yeuk
Chu. 2012a. Achieving organizational change: Findings from a case study of health
promoting hospitals in Taiwan. Health Promotion International.
DOI: 10.1093/heapro/das056Save Citation »Export Citation »E-mail Citation »
Drawing on an evaluation of HPH member hospitals in Taiwan, the authors conclude
that HPH membership contributed to organizational capacity building of hospitals for
health promotion.
Find this resource:
 Lee, Chiachi Bonnie, Michael S. Chen, Michael John Powell, and Cordia Ming-Yeuk
Chu. 2013. Organisational change to health promoting hospitals: A review of the
literature. Springer Science Reviews 1.1–2: 13–23.
The authors argue that insufficient organizational support is one of the major barriers
for hospitals’ engagement in health promotion, and therefore they demand an
organizational capacity-building approach as a relevant precondition for hospitals to
adopt the HPH initiative.
Find this resource:
 Lee, Chiachi Bonnie, Michael S. Chen, and Ying Wei Wang. 2012b. Barriers to and
facilitators of the implementation of health promoting hospitals in Taiwan: a top-down
movement in need of ground support. International Journal of Health Planning and
Management
DOI: 10.1002/hpm.2156Save Citation »Export Citation »E-mail Citation »
The authors investigate barriers to and facilitators of HPH in Taiwan. On the basis of
these findings, the authors strongly promote an organizational capacity-building
approach to foster HPH in Taiwanese hospitals.
Find this resource:
 Röthlin, Florian, Hermann Schmied, and Christina Dietscher. 2013. Organizational
capacities for health promotion implementation: Results from an international hospital
study. Health Promotion International.
DOI: 10.1093/heapro/dat048Save Citation »Export Citation »E-mail Citation »

33
Drawing on data from an international evaluation study of the international HPH
network, the authors argue that specific organizational structures or capacities can
significantly contribute to implementing more-elaborated and more-comprehensive
health promotion approaches. They conclude that health promotion needs to be
supported by organizational capacity building.
Find this resource:
20 Relating HPH to Health Systems Reform
While HPH was predominantly developed as an organizational concept, the Ottawa Charter’s
demand to reorient health services referred to the health sector at large. Some countries and
regions have used health promotion approaches to guide health system reform. Whitelaw, et al.
2006 and Whitelaw, et al. 2012 describe the example of Scotland, and Swedish National
Institute of Public Health 2006 focuses on reforms in Sweden.
 Swedish National Institute of Public Health. 2006. Towards a more health-promoting
health service: Summary of study material, government bills, parliamentary decisions,
draft indicators and examples of application. Stockholm: Swedish National Institute
of Public Health.
The booklet describes the preparation of the Swedish public health policy domain “A
More ‘Health-Promoting’ Health Service” of 2003, and draft indicators for a more
health-promoting health service.
Find this resource:
 Whitelaw, Sandy, Nicola Graham, David Black, Jonathan Coburn, and Lorna Renwick.
2012. Developing capacity and achieving sustainable implementation in healthy
“settings”: Insights from NHS Health Scotland’s Health Promoting Health Service
project. Health Promotion International 27.1: 127–137.
DOI: 10.1093/heapro/dar038Save Citation »Export Citation »E-mail Citation »
Building on Whitelaw, et al. 2006, the article presents outcomes of the Health
Promoting Health Service Framework (HPHS) in NHS Scotland, raising optimism for
the feasibility of effective implementation of the settings approach in health service
settings.
Find this resource:
 Whitelaw, Sandy, Claudia Martin, Ann Kerr, and Erica Wimbush. 2006. An
evaluation of the Health Promoting Health Service Framework: The implementation
of a settings based approach within the NHS in Scotland. Health Promotion
DOI: 10.1093/heapro/dal009Save Citation »Export Citation »E-mail Citation »

34
Drawing on an evaluation of the development of HPHS in NHS Scotland, which
started in 1996, the article discusses a range of supportive and hindering factors and
mechanisms for the effective implementation of health promotion practice.
Find this resource:
21 Health Promotion as a Professional Concept for
Different Health Professions, Types, and Units of Hospitals
Some authors have broken down the overall approach of health promotion as a reform
concept for hospitals to different clinical disciplines, types of hospitals, and hospital units.
22 Health Promotion and Hospital Nurses
Most of the literature on health promotion as a professional concept refers to nurses as the
largest professional group in health care. For example, handbooks on health promotion in
nursing practice have been prepared in McBride 1995 and Raingruber 2014. While McBride
1995 also focuses on the role of nurses in developing organizational health promotion
strategies, Raingruber 2014 refers mostly to nurses’ role in specific health promotion and
disease prevention interventions for patients. Publications also reflect on the barriers and
facilitators for implementing health promotion as part of the nurse role. Caraher 1994 and
Whitehead 2007 identify the standing of health promotion in nursing education, as well as the
relevance of health promotion on the professional agenda and the impact of organizational
environments as important factors. A bigger part of the literature links health promotion to the
professionalization of nurses. In this context, Shoqirat and Cameron 2002 criticizes that
Jordanian nurses have too-narrow concepts of health promotion, and Whitehead 2005 stresses
the need for reform. Similar conclusions are given by authors from different continents,
including in Mazza Nunes, et al. 2009 (from Brazil), Whitehead, et al. 2008 (in relation to the
situation in China), and Shoqirat and Cameron 2002 (on developments in Jordan).
 Caraher, Martin. 1994. A sociological approach to health promotion for nurses in an
institutional setting. Journal of Advanced Nursing 20.3: 544–551.
DOI: 10.1111/j.1365-2648.1994.tb02394.xSave Citation »Export Citation »E-mail
Citation »
The article proposes a model that takes account of the institutional and professional
agendas in which nurses work and the need to balance these with the needs and rights
of the patient.
Find this resource:
 Mazza Nunes, Joyce, Álissan Karine Lima Martins, Maria de Fátima Bastos Nóbrega,
Ângela Maria Alves e Souza, Ana Fátima Carvalho Fernandes, and Neiva Francenely
Cunha Vieira. 2009. Promoting health in the hospital from the viewpoint of the nurse:
Descriptive-exploratory study. Online Brazilian Journal of Nursing 8.3.

35
Drawing on a study from one public hospital, the authors conclude that hospital nurses
are more focused on prevention than on promotion and that reforms are needed to
change their professional behavior.
Find this resource:
 McBride, Anita S. 1995. Health promotion in hospital: A practical handbook for
nurses. London: Scutari.
The handbook refers both to nurses’ role in developing specific organizational health-
promotion strategies and to implementing specific clinical interventions, addressing
nurses in clinical practice and nursing students.
Find this resource:
 Raingruber, Bonnie. 2014. Contemporary health promotion in nursing practice.
Burlington, MA: Jones & Bartlett.
The book offers a comprehensive introduction to health promotion in nursing practice,
referring to a wide range of topics, including health literacy. The main target groups
are nurses in clinical practice and nursing students.
Find this resource:
 Shoqirat, Noordeen, and Shona Cameron. 2002. Promoting hospital patients’ health in
Jordan: Rhetoric and reality of nurses’ roles. International Journal of Nursing 1.1: 27–
36.
The authors point out that Jordanian nurses understand and practice health promotion
mainly as giving information to individuals and addressing behavior change, which
they find is inconsistent with health promotion concepts such as empowerment. In
response, they suggest a radical reform of the Jordanian health-care system.
Find this resource:
 Whitehead, Dean. 2005. Health promoting hospitals: The role and function of nursing.
Journal of Clinical Nursing 14.1: 20–27.
DOI: 10.1111/j.1365-2702.2004.01012.xSave Citation »Export Citation »E-mail
Citation »
The author introduces the European HPH movement as a vehicle for substantial
change in hospitals, and he encourages nurses to steer these developments as radical
change agents.

36
Find this resource:
 Whitehead, Dean. 2007. Reviewing health promotion in nursing education. Nurse
Education Today 27.3: 225–237.
DOI: 10.1016/j.nedt.2006.05.003Save Citation »Export Citation »E-mail Citation »
The article refers to the WHO European Strategy for Nursing and Midwifery
Education (2000), which calls for the explicit inclusion of health promotion in nursing
curricula. The author concludes that this call has broadly remained without
consequence, and he presents considerations for wider reform.
Find this resource:
 Whitehead, Dean, Yonghuan Wang, Jianhong Wang, Jing Zhang, Zhen Sun, and Chen
Xie. 2008. Health promotion and health education practice: Nurses’ perceptions.
Journal of Advanced Nursing 61.2: 181–187.
Citation »
Drawing on data from one Chinese provincial hospital, the authors conclude that the
understanding of health promotion in Chinese nurses is similar to the understanding in
European or North American nurses and that constraints such as lack of time are also
similar.
Find this resource:
23 Health Promotion in Hospitals and Medical Doctors
Compared to the literature on the role of nurses in health promotion, there are few
publications on health promotion as part of the role profile of hospital doctors (there is a
wealth of literature on the role of primary-care physicians in health promotion, which is,
however, out of the scope of this article). There is broad consensus in the cited articles on
medical doctors being important partners for hospital health promotion in principle. For
example, Orr and Hauck 1984 sees the support by medical doctors as an important
prerequisite for the success of organizational health-promotion programs. Roemer 1984,
however, argues that medical care is health promoting per se. Most contributions, including
Jones and Hsu-Hage 1999; Perkins 1999; Naidoo and Orme 2000; and Rondeau, et al. 2006,
see a need for better training of clinicians as a prerequisite for improving their role in health
promotion. Wylie and Holt 2010 is a handbook on health promotion in medical education.
 Jones, Kenneth V., and Bridget H. H. Hsu-Hage. 1999. Health promotion projects:
Skill and attitude learning for medical students. Medical Education 33.8: 585–591.
Citation »
The article offers an example for integrating health promotion into medical education.
It describes a project-learning approach in which medical students design and deliver
community health promotion projects as part of their professional formation.

37
Find this resource:
 Naidoo, Jennie, and Judy Orme. 2000. Health promotion in the medical curriculum:
Enhancing its potential. Medical Teacher 22.3: 282–287.
The article discusses the potential content of health promotion in medical education
and presents a series of vignettes for teachers to use to enhance the effective delivery
of health promotion for medical students.
Find this resource:
 Orr, G. A., III, and R. Hauck. 1984. Physicians and hospital-based health promotion:
Formalizing the relationship. Hospital Medical Staff 13.12: 16–22.
Hospitals and health-care organizations are faced with a multitude of new pressures
that threaten their very survival. Redirecting a threat into an opportunity requires close
cooperation between a health-care institution and its medical staff. One opportunity
that has emerged is the development of health promotion programs, whose success
depends on medical staff support.
Find this resource:
 Perkins, Elizabeth R. 1999. Hospital doctors and health promotion: Support for
teaching behaviour change. Medical Teacher 21.2: 180–183.
The article introduces an educational pack for junior doctors, on the basis of James
Prochaska and Carlo DiClemente’s “Cycle of Change” model.
Find this resource:
 Roemer, Milton I. 1984. The value of medical care for health promotion. American
Journal of Public Health 74.3: 243–248.
DOI: 10.2105/AJPH.74.3.243Save Citation »Export Citation »E-mail Citation »
The paper argues that medical care should not be counterposed to health promotion or
prevention. Rather, the author propagates an integrated approach for the benefit of
both strategies.
Find this resource:
 Rondeau, Kent V., Louis H. Francescutti, and Garnet E. Cummings. 2006. Health
promoting attitudes and behaviors of emergency physicians: Exploring gender
differences. Journal of Health Organization and Management 20.4: 269–284.

38
On the basis of a comparison of male and female emergency physicians, the paper
argues that in the future, educating emergency physicians in the practice of health
promotion will make emergency departments more-effective resources for their
community.
Find this resource:
 Wylie, Ann, and Tangerine Holt, eds. 2010. Health promotion in medical education:
From rhetoric to action. Oxford: Radcliffe.
The publication makes a plea for the inclusion of health promotion into medical
education, outlining learning needs of medical students and core competencies.
Find this resource:
24 Implementing Health Promotion in Specific Hospital Types and Units
Some authors have adapted general health-promotion approaches to the demands of specific
hospital types or types of hospital units. Coakley 1998 discusses the application of health
promotion on the ward level, Bensberg, et al. 2003 describes a framework for health-
promoting emergency departments, Barnett 2007 focuses on the application in maternity
wards, and Berger, et al. 2006 concentrates on mental health promotion in general hospitals.
 Barnett, Carol. 2007. WHO health promoting hospitals: Maternity services in Scotland.
British Journal of Midwifery 15.10: 647–649.
The article describes one maternity service that was declared a hub unit for HPH in
Scotland, arguing that the quality of services delivered depends on the knowledge and
skills of the midwives.
Find this resource:
 Bensberg, Monica, Marcus Kennedy, and Scott Bennetts. 2003. Identifying the
opportunities for health promoting emergency departments. Accident and Emergency
Nursing 11.3: 173–181.
DOI: 10.1016/S0965-2302(03)00002-XSave Citation »Export Citation »E-mail
Citation »
The authors argue that emergency departments could specifically contribute to health
promotion since emergencies are often caused by the living circumstances of the
patients. They demand better training for emergency staff.
Find this resource:

39
 Berg, Geir V., Birgitta Hedelin, and Anneli Sarvimäki. 2005. A holistic approach to
the promotion of older hospital patients’ health. International Nursing Review 52.1:
73–80.
Citation »
The article relates to the discourse on preconditions for health promotion in hospitals,
arguing that hospital nurses in typical hospital environments need to constantly
balance between a biomedical and a holistic approach toward their patients.
Find this resource:
 Berger, Hartmut, Rainer Paul, and Eva Heimsath. 2006. Health promoting hospitals
and consultation liaison-psychiatry. Psychosomatik und Konsiliarpsychiatrie 1.1: 52–
55.
Drawing on the WHO model of HPH, the authors suggest that consultation-liaison
psychiatrists could be an important link for mental health promotion in general acute
hospitals.
Find this resource:
 Coakley, Ann-Louise. 1998. Health promotion in a hospital ward; Reality or asking
the impossible? Journal of the Royal Society for the Promotion of Health 118.4: 217–
220.
DOI: 10.1177/146642409811800406Save Citation »Export Citation »E-mail Citation
»
The article addresses preconditions for the implementation of health promotion on the
ward level, including increased multiprofessional collaboration.
Find this resource:
25 Health Promotion for Different Target Groups
The HPH approach traditionally differentiates between interventions addressing patients, staff,
and the hospital community, and interventions targeting persons and situations or settings and
the environment (see the HPH Core Concept). This approach is only partly mirrored in the
literature, since interventions for the different target groups can be very specific and are not
always explicitly labeled as being in relation to a HPH or hospital health promotion approach.
This is due to the broad conceptual approach of HPH, which has also been described as an
umbrella concept and covers, for example, aspects of patient participation and empowerment,
workplace health promotion, and community outreach. Given the broadness of the field, only
literature with an explicit link to HPH was included in this section of the article.
26 Patient-Oriented Health Promotion

40
Following the HPH concept suggested in Pelikan, et al. 2005 (cited under the HPH Core
Concept), patient-oriented hospital health promotion can be focused on empowering patients
for self-care and for the coproduction of health, for disease management and lifestyle
development, and on developing the hospital into a physically and socially supportive setting
for patients, as well as on informing or supporting community development for the needs of
hospital patients. While literature on each of these aspects could fill a bibliographic article of
its own, this section contains only literature with explicit referrals to hospital health
promotion. Earlier literature, as in Caraher 1998, is concerned with differentiating health
promotion for patients from health education. However, Härm 2001 understands health
education as part of health promotion for patients and, consequently, sees the rise of the HPH
movement as an enhancer of patient education. Overall, there seem to be two poles of
research on patient-oriented health promotion. One of these, as represented for example by
Shoqirat and Cameron 2013, focuses on patient-driven concepts of health promotion. The
other pole is characterized by expert- and risk-oriented concepts of health promotion for
patients, with screening for lifestyle risks and lifestyle counseling being reported as the main
types of interventions. Representatives of this pole include Haynes and Cook 2008; McBride
2003; Oppedal, et al. 2011; Sinclair, et al. 2010; and Tønnesen, et al. 2007 (the last of which
is cited under Linking HPH to Evidence-Based Medicine and to the Quality Movements). Yet
another strand of the literature follows a quality understanding of patient-oriented hospital
health promotion, measuring its impact on the outcomes of patient satisfaction surveys; Guo,
et al. 2008 and Misevičienė and Milašauskienė 2003 are two examples.
 Caraher, Martin. 1998. Patient education and health promotion: Clinical health
promotion—the conceptual link. Patient Education and Counseling 33.1: 49–58.
Citation »
The article presents a model linking health promotion, health education, and patient
education, providing guidance on conceptual and theoretical approaches around these
topics.
Find this resource:
 Guo, Xiu-Hua, Xiang-Yang Tian, Yue-Song Pan, et al. 2008. Investigation of the
current status of health promotion hospitals in Beijing: A clinical analysis of 805
inpatients. Chinese General Practice 1.
The study provides an evaluation of patient satisfaction in pilot HPHs in Beijing,
identifying some needs for improvement.
Find this resource:
 Härm, Tiiu. 2001. Patient education in Estonia. In Special issue: Patient education in
Europe. Patient Education and Counseling 44.1: 75–78.
Citation »

41
The article outlines how the national HPH network in Estonia enhanced patient
education in the country, by that understanding health education as one type of health
promotion service.
Find this resource:
 Haynes, Charlotte L., and Gary A. Cook. 2008. Audit of health promotion practice
within a UK hospital: Results of a pilot study. Journal of Evaluation in Clinical
Practice 14.1: 103–109.
Citation »
The article follows a risk-oriented approach toward health promotion in hospitals,
providing a study on screening and intervening inpatients for lifestyle-related risk
factors and identifying needs for improvement in both dimensions.
Find this resource:
 McBride, Anita. 2003. Health promotion in the acute hospital setting: The receptivity
of adult in-patients. Patient Education and Counseling 54.1: 73–78.
Citation »
The article presents a study on patients’ supportiveness of interventions in clinical
health education if these meet their specific needs.
Find this resource:
 Misevičienė, Irena, and Žemyna Milašauskienė. 2003. Changes of patients’
satisfaction with the health care services in Lithuanian Health Promoting Hospitals
network. Medicina 39.6: 604–609.
The article describes observed improvements in patient satisfaction in hospitals of the
Lithuanian HPH network, thus implying patient satisfaction as one outcome dimension
of health promotion in hospitals.
Find this resource:
 Oppedal, Kristian, Sverre Nesvåg, Bolette Pedersen, et al. 2011. Health and the need
for health promotion in hospital patients. European Journal of Public Health 21.6:
744–749.
DOI: 10.1093/eurpub/ckq148Save Citation »Export Citation »E-mail Citation »
The study describes international experiences with a suggested model for screening
patients for lifestyle-related health risks.

Health promoting hospitals

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Ähnlich wie Health promoting hospitals

Ähnlich wie Health promoting hospitals (20)

Mehr von Carlo Favaretti

Mehr von Carlo Favaretti (20)

Health promoting hospitals