The Tuscany HPH Network and Health Promotion in the conceptual framework of the Complexity Fabrizio Simonelli - Head, Health Promotion Program, ‘A.Meyer’

The Tuscany HPH Network and Health Promotion

in the conceptual framework of the Complexity

Fabrizio Simonelli - Head, Health Promotion Program, ‘A.Meyer’ Hospital - Florence

Paolo Morello Marchese - Co-ordinator, Tuscany HPH Network ‘A.Meyer’ Hospital - Florence

•The Tuscany HPH conceptual pathway

•HPH : a complex project

•Complexity & Health Promotion

COMMUNITY STAFF

PATIENTS

HPH

A Health Promoting Hospital has to demonstrate to incorporate into its culture and daily work the idea of health promotion of its personnel, the patients and their families as well of the community.

HPH project: aim

Complexity

Complexity is the property of a real world system

that is manifest in the inability of any one formalism

being adequate to capture all its properties.

(D.C. Mikulecky)

Complexity & Health Promotion

Multiplicy ofdeterminants

Policies

Investments

Infrastructures

1. The SELF-ORGANISATION principle

… to HEALTH PROMOTION

Health needs

Resources

Norms

Influences

Health Care

ServicesHealth

a system capable to get itself organized


From Health Care management…

PO

LICIE

S

INV

ES

TM

EN

TS

HEALTH

CO

MM

UN

ITY

(valu

es a

nd

ca

pita

l)

(effects act on causes)

From linear conception …

2. The RECURSIVE principle :

… ...to circular framework

INFR

AS

TR

UC

TU

RE

( SE

RV

ICE

S &

PR

OJE

CTS

)


HEALTH Scenarios

Empowerment

Co-operation with professionals

Po

we

rfu

llne

ssHEALT

H

PROMOTION

QUALITY

‘SERVUCTION‘

HEALTH

CARE

Dependence

3. The DIALOGIC principle:

(the phenomena happen between two antagonist and complementar logics)


CULTURE

PROCESSES

STRUCTURE

4. The HOLOGRAM principle:

(the part is a share of the whole system, but also the whole is inscribed in the part: act on a single part means to change the whole

system)

HPH

COMMUNITYDEVELOPMENT



Self-organising principle

Recursive principle

Dialogic principle

Hologram principle

Action in the changing context

Community Development

Health

EmpowermentDependence

HPHPersonal andCommunity Development

Synthesis

CONCEPTUAL FRAMEWORK

Learn and think does not mean to arrive at any absolutely certain truth,

but it is to dialogue with the uncertainty and the error.

(E. Morin)

The Tuscany HPH conceptual pathway

OPERATIVE level(Practical

applications)

METHODOLOGICAL level(Sistematic pathways)

HPH

PARADIGMATIC level(Inspirer principles and values)

The Tuscany HPH conceptual pathway (1)

HEALTH PARADIGM


A) Health determinants multiciplityB) Semantic context C) Declination of the concept of the person’s centrality

HEALTH CARE

SERVICES

ENVIRONMENTALFACTORS

LIFESTYLES

SOCIAL-ECONOMICDEVELOPMENT

STAGE

DEMOGRAPHIC FACTORS

EDUCATION

CULTURALFACTORS

Determinants

MASSMEDIA

personal

HEALTHfactors

PEACE

Requirements

A) The multiciplity of health determinants

ECONOMICFACTORS

JUSTICE


OTTAWACHART(1986)

general principleson health promotion

BUDAPESTDECLARATIO

N(1991)

aims and criteria for

Health Promoting Hospitals

VIENNARECOMMENDATION

S(1997)

strategies for the

implementation of the HPH project and acceptance modalities

HEALTH PROMOTION GLOSSARY

(1998)

definition


B) The semantic context

Person’scentralit

y

CARRIER OFDISEASES (PATIENT)

CLIENT OF THE HEALTH

CARE SERVICES

PROTAGONIST OF HIS OWN

HEALTH

SOCIAL HEALTH ACTOR

THERAPEUTICBENEFITS

QUALITY STANDARDSASSURANCE

HEALTH LITERACY AND HEALTHYLIFESTYLES

RESOURCE FOR THE COMMUNITY

Diagnostic-Therapeuti

cActivities

Continuous Quality

Improvement

Healthpromotion

C) Declination of roles, expectations, activities


HEALTH PARADIGM


- Health determinants multiciplity- Semantic context - Declination of the concept of the person’s centrality

New health governance: Outlines and Open methods (Integrated Health Plans, Health Societies)

HEALTH METHODOLOGY

GOVERNMENTOF HEALTH SERVICES

PERSONS AS PATIENTS AND CLIENTS

NEW HEALTH GOVERNANCE

Activities:DISEASE MANAGEMENT AND QUALITY IMPROVEMENT

The philosophy:BOTTOM LINE

PERSONS (and ASSOCIATIONS) AS PROTAGONISTS OF HEALTH

Activities: HEALTH PROMOTION AND COMMUNITY DEVELOPMENT

The philosophy:BEYOND BOTTOM LINE


FOCUS ON FINAL BALANCE FOCUS ON VALUES-GUIDE

Outlines

HPH PLANNING SKILL

HEALTH PARADIGM

A) International GuidancesB) Net workC) Project work

New health governance: Outlines and Open methods (Integrated Health Plans, Health Societies):


A) Health determinants multiciplityB) Semantic context C) Declination of the concept of the person’s centrality

HEALTH METHODOLOGY

Health Promoting Hospitals Development and Challenges WORLD HEALTH ORGANIZATION

European Office of Barcelona

Putting Health Promoting Hospital policy into action‘L. BOLTZMANN‘ INSTITUTE

for the Sociology of Health and Medicine of Vienna

Network of Health Promoting Hospitals in Denmark

Standards for Health Promotion in Hospitals


A) GENERAL AND SCIENTIFIC GUIDANCES:

HealthPromotingHospital

s

HP Schools

Healthy Cities

(other HP

projects)

LOCALHEALTHPLANS

B) OLONIC NETWORK

(- increased knowledge - common orientation)

HealthEducation

Units


SETTING • cultural•communicativeness• organisational

PROCESSES

• re-engineering• innovation

between:• patients• relatives• professionals• volunteers• partners

RELATIONS

HEALTHGAINHPH

C) PROJECT WORK

(3 levels)

TRAINING

RE-DESIGN

STANDARDS


SETTING

• COMMITTEE• PRIORITY: (post-operation pain)• PROTOCOLS

PROCESSES

• DAILY PAIN MEASUREMENT AND TREATMENT

• COMPETENCES FOR THE STAFF

• ABILITIES FOR THE PATIENTS (pain meter)

RELATIONS

PAINREDUCTIONHPH

PROJECT WORK

(an example:Pain-free Hospitals)

TRAINING

RE-DESIGN

STANDARDS


Bibliografia:

Dahlgren, G. and Whitehead, M (1992) Policies and Strategies to Promote Social Equity in Health, Stockholm; Institute of Future Studies, 1991

Eglier P.- Langeard E.: “Servuction – Le marketing des services” – McGraw-Hill, 1988

Ewles L., Simnet I.:” Promoting health – A practical guide” – Scutari Press, 1992

Morin E.: ‘La methode 5. L’Humanité de l’Humanité. Tome 1, L’identité humaine’, Editions du Seuil, 2001

Morgan G.: ‘ Images of organizations’, 1986

C. Piccardo: “Empowerment – Strategie di sviluppo centrate sulla persona” – R.Cortina Editore, Milano, 1995

Simonelli F.: ‘Promotori di salute, costruttori di pace’ - Janus – Medicina: cultura, culture - n. 9, Roma, 2003

The Tuscany HPH Network and Health Promotion in the conceptual framework of the Complexity Fabrizio Simonelli - Head, Health Promotion Program, ‘A.Meyer’

Documents

health paradigm

idea of health promotion

health promotion program

health care management

complexity slide

hph project

tuscany hph network

community staff patients