We connect two important societal concerns that are rarely addressed in combination: sustainable development and health promotion. Hospitals as central health care providers can minimize their negative side effects and improve health gain by applying a socio-ecological sustainability concept that focuses on health care -hospitals' core businessand is linked to quality management.

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In this article, organizational structures in hospitals are discussed as possible capacities for hospital health promotion (HP) implementation, based on data from the PRICES-HPH study. PRICES-HPH is a cross-sectional evaluation study of the International Network of Health Promoting Hospitals & Health Services (HPH-Network) and was conducted in 2008-2012. Data from 159 acute care hospitals were used in the analysis. Twelve organizational structures, which were denoted as possible organizational health promotion capacities in previous literature, were tested for their association with certain strategic HP implementation approaches. Four organizational structures were significantly (p = 0.05) associated with one or more elaborate and comprehensive strategic HP implementation approaches: (1) a health promotion specific quality assessment routine; (2) an official hospital health promotion team; (3) a fulltime hospital health promotion coordinator; and (4) officially documented health promotion policies, strategies or standards. The results add further evidence to the importance of organizational capacity structures for hospital health promotion and identify four tangible structures as likely candidates for organizational HP capacities in hospitals.

BackgroundThe Baby-Friendly Hospital Initiative (BFHI) aims to promote and support breastfeeding. Globally, around 20,000 facilities have been designated Baby-Friendly. In Austria, however, only 16% of the maternity units have received BFHI-certification. Internationally, few studies have investigated facilitating or hindering factors for BFHI implementation. The need to extend BFHI-certification rates has been investigated previously, but little is known about why maternity units decide to become BFHI-certified, how BFHI is installed at the unit level, and which factors facilitate or impede the operation of the BFHI in Austria and how barriers are overcome.MethodsUsing a qualitative approach, (health) professionals’ perceptions of the selection, installation, as well as facilitators of and barriers to the BFHI were investigated. 36 semi-structured interviews with persons responsible for BFHI implementation (midwives, nurses, physicians, quality manager) were conducted in three Austrian maternity units. Data were analyzed using thematic analysis.ResultsInterviewees mentioned several motives for selecting the BFHI, including BFHI as a marketing tool, improvement of existing services, as well as collaboration between different professional groups. In each hospital, “change agents” were identified, who promoted the BFHI, teamed up with the managers of other professional groups and finally, with the manager of the unit. Installation of BFHI involved the adoption of project management, development and dissemination of new standards, and training of all staff. Although multiple activities were planned to prepare for actually putting the BFHI into practice, participants mentioned not only facilitating, but also several hindering factors. Interpretations of what facilitated or impeded the operation of BFHI differed among and between professional groups.ConclusionSuccessful implementation of the BFHI in Austria depends on a complex interplay of multiple factors including a consensual “bottom-up” selection process, followed by a multifaceted installation stage. Even these activities may be perceived as a hindrance for non-BFHI-certified hospitals. Findings also suggest that despite active preparation, several barriers have to be overcome when BFHI is actually incorporated into routine practices. BFHI seems to pose a great challenge to health professionals’ work routines and, thus, clear structural changes of such routines as well as ongoing monitoring and support activities are required.

A mental hospital and a psychiatric department of a general hospital in the region of Kassel have jointly analysed their basic documentation to produce an overview of hospital treatment of psychiatric patients in the region. Patients from the urban population occupy twice as many beds as those from the rural population which is a hint that standard bed-ratios per population are inadequate. Instead of the unsuitable official definition of duration of stay in hospital we used "days in hospital per person per year". Making allowance for groups of diagnoses this made possible interesting comparisons about the contributions of the two hospitals to the treatment of the psychiatric patients in the region. The two hospitals are not similar and the results show how the patients make use of the possibility of choosing the various specialities of the two hospitals.