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Fast-tracking implementation of HPH in Estonia
Workshop on the WHO HPH Recognition Project (an international multi-centre RCT)
Jeff Kirk Svane, PhD.studWHO CC, Bispebjerg University Hospital, Denmark
Overview of today 1. HPH Research and Implementation - An
introduction /Jeff
2. Group work
3. HPH QM: The WHO HPH Recognition Project /Jeff
4. Group work
5. Estonian HPH Network's activities of 2013 and plans for 2014 /Tiiu
6. LUNCH
7. Presentations of projects /HP Coordinators
8. Visits to clinical departments /all
HPH Quality ManagementWHO HPH Recognition Project
- An international multi-centre RCT
This presentation
• HPH QM: WHO HPH RP Study – a way to measure quality of clinical health promotion– Study aim and hypotheses– Scope and purpose– Background– Framework
• WHO HPH Standards / Indicators• HPH DATA Model• HPH Doc Act Model• Other evaluated tools
– Project Status
• Workshop 2• Conclusion
WHO-HPH RP: just follow the recipe
In detail: Clin HP Quality
Quality = a combination of a) overall effect (what really happens)
• Outcomes or results (the effect overall, having first graded all available evidence)
• Consensus of clinical experts (when no or weak evidence)
b) Performance – a predefined quality measure (what is agreed to be “good quality”) setting the bar• Quality indicators (measures that indicate output quality, to
what degree a quality goal is achieved)
• Standards (ideal/acceptable goal for quality, based on the evidence, within specific situation or timeframe)
(Quality measures should be based on evidence too)
Kjærgaard, Mainz, Jørgensen, Willaing 2006
Measuring Quality of Clinical HP by QMExample from WHO HPH Recognition Process
• Studies / Projects = efficacy
– measures how well something works in clinical trials and studies
• RL Implementation Research = effectiveness
– effectiveness relates to how well something works in practice
– RP is an RCT
Study aim
The “WHO HPH Recognition Project” aims to:
• Evaluate whether a WHO-HPH recognition / certification process for HP generates
– more health promotion deliveries
– better health gain for patients and staffOUTCOMES
Main hypotheses
• Hospitals departments allocated to the Recognition Process will after 1 year:
– Improve health gain for patients and staff
– Deliver more HP services
compared to the departments allocated to the control group continuing routine clinical practice
Scope & Purpose
Why a recognition project about HP?
• Clinical HP is a patient-centred approach in health care services
• HP Improves the effect of treatment results and contributes to improved patient safety
=> HP is a key dimension of quality in hospitals
Scope & PurposeIt is THE LEADING risk factors that can be influenced by HP
• “(…) the three leading risk factors for global disease burden were high blood pressure (…), tobacco smoking including second-hand smoke (…), and alcohol use (…)”
• Among leading risk factors are also overweight, malnutrition, physical inactivity
Lim, Vos, Flaxman et al. Lancet. 2012
Scope & Purpose
Duly, HP integration is now recognized as a coreissue. E.g.:
• Health 2020 (WHO, signed at WHA in Geneva, May 2012)
• Strengthening Public Health Capacities and Services (WHO, signed at RC62 in Malta, September 2012)
• Strategy for the Prevention and Control of Non-Communicable Diseases 2012–2016 (WHO at RC61 in Baku, September 2011)
Scope & Purpose
So HP is core, also for hospitals and health services
But Implementation in real-lifeis still a challenge
Scope & Purpose
What about existing processes?
• Hospitals and health services implement QM, accreditation, certification and recognition
But:
• HP is poorly included
• … and we dont know if it really generates better health gain?
Background
• Sparse high quality literature on accreditation and quality improvement
– 1 Randomised Clinical Trial (RCT) evaluating impact of hospital accreditation on the quality of care at the national level in South Africa
(Salmon JW, Heavens J, Lombard C, Tavrow P. Op Res Results 2003;2:17)
South African Study
• Material:
– 2 x 10 hospitals in South Africa (underpowered)
• Methods:
– Structural, process and result variables
– Periodic measurement
– Feedback to each hospital
– Technical assistance
• Results re. technical structure and process variables:
– Control 37% to 38%
– Intervention 38% to 76% (looking good, but...)
(Salmon JW, Heavens J, Lombard C, Tavrow P. Operations Research Results 2003;2:17)
SA: Variables
• Result variables:Nurse perception p=0.03
Patient satisfaction p=0.48
• Structure and process variables:Medical evaluation p=0.40
MR accessibility p=0.50
MR completeness p=0.14
MR operation completeness p=0.49
Hospital sanitation p=0.64
(Salmon JW, Heavens J, Lombard C, Tavrow P. Operations Research Results 2003;2:17)
SA: Conclusion ?
• Better technical procedures and structure
• No better clinical outcome or health gain
• We need further studies with adequate power (sizeable sample)
I: Project elements
5 standards + 17 indicators
1. Management policy of HP
2. Patient Assessment
3. Patient Intervention and Info
4. Promoting a healthy workplace
5. Continuity and cooperation
Hospitals: Useful
recommendable
(Groene O, Jorgensen SJ, Fugleholm AM, Garcia Barbero M. Int J Health
Care Qual Assur Inc Leadersh Health Serv 2005;18:300-7.
II: Project elements:
Two HPH models
Clinicians: Understandable, applicable & sufficient for our patients (high reliability)
(Tonnesen H et al, BMC Health Serv Res 2007 + Clin HP 2012)
III. Project elements
Short Form Health Survey (SF36):
–Physical, mental and social conditions
Distributed to staff and patients
(McHorney, Colleen A.; Ware, John E.; Raczek, Anastasia E. Med Care
1993; 31: 247-263)
Design
• An RCT with 2x44 hospital departments allocated to one of the two groups
–Undergo the Recognition Process immediately = Intervention group
–Continue their usual routine = Control group
Trial Profile
2. Team Up
10. Reassessment 3. Baseline assessment;
4. Identification of weaknesses and resources
Organization: standards Patients: M.R. + Survey Staff: survey
5. Quality plan and role assignment
6. Kick-off quality plan with
announcement of targets of
improvement; training;
promotion
7. implementation8. Monitoring, feedback, reward, communication
9. Improvement, revision, diffusion
1. High level support
11. Recognition
12. Best practice,
maintenance, sharing
Loop of the quality initiative
P
D
C
A
In a nutshell…
HP Research EB HP practice Quality M
(Status: 40 of 88 dept included from 8 countries)
An invitation…
The WHO HPH is still open for participation for European countries (48 depts to go).
-Norway: signing up w 8 departments-Finland: process initiated-Sweden: process initiated-Denmark: process initiated-And more...
More departments from Estonia are welcome.
Overview of today 1. HPH Research and Implementation - An
introduction /Jeff
2. Group work
3. HPH QM: The WHO HPH Recognition Project /Jeff
4. Group work
5. Estonian HPH Network's activities of 2013 and plans for 2014 /Tiiu
6. LUNCH
7. Presentations of projects /HP Coordinators
8. Visits to clinical departments /all
Q1: What challenges would your department have related to participating in the WHO HPH RP?Q2: What benefits would your department get from participating in the WHO HPH RP?
1) 10 minutes discussion in groups2) 10 minutes present discussions in
plenum
WORKSHOP 2
Conclusion • Why is HP in hospitals important?
– Key factor for pathway, underdeveloped, not there yet
• Why EB HP?– Helps to plan, be serious, recommend, expand, get money etc.
• Measure Effect and Performance = Measure Quality – Effect that matters: e.g. on short term in surgery– Important to select right way to measure
• Relevant and validated
– Performance: use WHO Standards & Indicators for Clin HP – You can use Clin HP QM continuous improvement– Ex from WHO HPH RP Study:
• Goal: evaluate a process more HP activities? Better health?• Measured by EB tools: WHO Standards + indicators + models + SF36 • RCT design • More clinical departments from Estonia are welcome!
– Good luck with your Clinical Health Promotion!
