Health promoting hospitals: a typology of different organizational approaches to health promotion

Abstract

This paper draws on a review of the literature about the types of health promotion activities conducted by health promoting hospitals and an observation of how some Australian hospitals have structured the organizational arrangements to be more health promoting. This paper also draws on the experiences of one of the authors (A.J.) in managing and evaluating an organizational change process at a major specialist hospital in Adelaide, South Australia, that sought to re-orientate the hospital towards placing more emphasis on health promotion. From these three sources, a typology of four approaches of organizational arrangement to health promotion is presented. These approaches are: 'doing a health promotion project'; 'delegating it to the role of a specific division, department or staff'; 'being a health promotion setting'; and 'being a health promotion setting and improving the health of the community'. For the re-orientation of the specialist hospital to occur and be sustainable, the research indicated that over the case study period of 1994-1998 there had to be strong organizational commitment to change, supported at multiple levels of the organization, and reflected in policy and practice change. The paper concludes that more evaluative research of this type will be important if the rhetoric of healthy settings is to become a reality.

Organisational Change to Health Promoting Hospitals: A Review of the Literature

“…The narrow role of such hospitals in health promotion can be observed, in contrast to the typology proposed by Johnson and Baum [21]. Based on two criteria-the extent to which hospital organisation is involved and the types of health promotion activities that are performed-the authors proposed four types of HPH from an organisational perspective.…”

“…Nevertheless, most of these programs have been limited to education, behavioural change on the part of individuals and health screening for disease by individuals and professionals, often on an ad hoc basis [14,20,24,26]. Furthermore, health promotion programs were conducted as isolated projects or as an assignment to a particular division, without back-up organisational commitment [21].…”

“…However, there is an 'old wine in the new bottle' doubt in that hospitals have used the HPH project as a banner but have not built a supportive organisational infrastructure for health promotion [21]. It has been well recognised that capacity building is key to effective health promotion practices [27,61].…”

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“…In developing strategies, a hospital must first assess a community's health needs, establish the hospital's current and desired positions on its segments' perceptual maps, and finally, choose and implement appropriate positioning strategies. Johnson & Baum (2001) suggested that instead of doing hospital promotion, marketer should focus on health education which can position the image of hospital in the mind of patients and in turn increase its market share.…”

Hospitals as professional organizations: challenges for reorientation towards health promotion

“…When hospitals are expected to reorient their formal structures and work routines towards health promotion, the actual level of organizational change often does not meet initially set requirements: evidence shows that a systematic reorientation of hospitals often remains very limited (Whitehead, 2004;Wise & Nutbeam, 2007). In the literature, it is emphasized that hospi-tals' reorientation towards health promotion is still more a desirable goal than an organizational reality (De Leeuw, 2009;Johnson & Baum, 2001). Healthcare professionals' reluctance to inte-grate health promotion within their work routines with clients (read: patients) has been indicated as a major barrier to health promotion implementation (Lee, Chen, Chien, et al, 2014;Whitehead, 2004).…”