The WHO-HPH recognition project: fast-track implementation of clinical health promotion - a protocol for multi-center RCT

Tønnesen, Hanne; Svane, Jeff Kirk; Groene, Oliver; Chiou, Shu-Ti

doi:10.29102/clinhp.16003

Cited by 5 publications

(25 citation statements)

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“…In the protocol and RCT (paper I + III) (1, 3), the hypothesis was that clinical hospital departments allocated to the operational program for CHP implementation using the Fast-IM (intervention group) would improve compliance with existing quality standards for CHP from the World Health Organization Regional Office for Europe (WHO) (21), increase delivery of CHP services to identified at-risk patients, and improve health status of patients and staff, compared to the control group departments continuing usual implementation routines (1,3).…”

Section: 2: Hypothesismentioning

confidence: 99%

“…Building on the evidence of the effects of SNAP interventions on diseases (7)(8)(9)(10)(11)(12)(13)(14), the evidence on the effect of adding CHP to clinical treatment (22)(23)(24)(25) and recognizing the known challenges related to implementation (1,3,15,18,(26)(27)(28), the research project behind the thesis was planned in 2011 (1). (31).…”

Section: 3: the Research Projectmentioning

confidence: 99%

“…Despite effects (7-11, 14, 53, 80), the increasing evidence for CHP is still not commonplace nor systematically implemented (1,3,15,18,(26)(27)(28). A wide range of factors may offer explanations as to why implementation is not taking place; staff may lack CHP competencies and management support, organizational cultures and structures might be a barrier and resources might be lacking (15,28,81,82).…”

Section: 2: Implementationmentioning

confidence: 99%

“…A wide range of factors may offer explanations as to why implementation is not taking place; staff may lack CHP competencies and management support, organizational cultures and structures might be a barrier and resources might be lacking (15,28,81,82). In addition, SNAP among staff and managers themselves might also play a role (82)(83)(84)(85), and supportive tools or strategies may be needed (1)(2)(3) As recognized by implementation science (37), specific investigation of the implementation of new evidence in practice is warranted (16,20,37,86). It is still a developing area, but one that might become important considering its substantial growth within the past decade (87).…”

Section: 2: Implementationmentioning

confidence: 99%

“…Considering the results of integrating CHP in treatment (22)(23)(24)(25), it seems that attempts to bring more effective CHP to patients are matters of clinical quality (1,2,15,26,27).…”

Section: 3: Quality Improvementmentioning

confidence: 99%

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Fast-track implementation of clinical health promotion

Svane¹

2018

clinhp

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This thesis covers a project on fast-track implementation of clinical health promotion addressing daily smoking, malnutrition and overweight/obesity, hazardous alcohol consumption and insufficient physical activity. It took place in 36 hospitals in 8 countries, all of which were members of the International Network of Health Promoting Hospitals & Health Services (HPH) initiated by the World Health Organization (WHO). The overall aim of the research project was to add new evidence on the implementation of effective clinical health promotion services, such as smoking cessation interventions, in hospitals, for the benefit of patients, staff and communities. The thesis includes the following 4 scientific papers:

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Section: 2: Hypothesismentioning

confidence: 99%

Section: 3: the Research Projectmentioning

confidence: 99%

Section: 2: Implementationmentioning

confidence: 99%

Section: 2: Implementationmentioning

confidence: 99%

“…Considering the results of integrating CHP in treatment (22)(23)(24)(25), it seems that attempts to bring more effective CHP to patients are matters of clinical quality (1,2,15,26,27).…”

Section: 3: Quality Improvementmentioning

confidence: 99%

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Fast-track implementation of clinical health promotion

Svane¹

2018

clinhp

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Staff experiences with strategic implementation of clinical health promotion: A nested qualitative study in the WHO-HPH Recognition Process RCT

2018

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Objectives:Health promotion is on the global agenda. The risks targeted include smoking, hazardous alcohol consumption, nutrition and insufficient physical activity. Implementation of clinical health promotion, however, remains a major challenge. While several processes, models and frameworks for strategic implementation exist, very few have been tested in randomized designs. Testing a strategic implementation process for clinical health promotion was only recently attempted via a randomized clinical trial on the World Health Organization Health Promotion Hospitals Recognition Process. The randomized clinical trial showed that the process improved central parts of implementation. To complement these findings, this nested qualitative study aimed to explore experiences and perceptions of staff and managers, who had completed the process, and generate hypotheses for improvements.Methods:We interviewed a purposeful sample of 45 key informants from four countries, who worked at clinical departments and had undertaken the World Health Organization Health Promotion Hospitals implementation process. The informants included 14 managers, 14 medical doctors, 13 nurses and 4 other clinical staff. Interview transcripts were analyzed using qualitative content analysis and an inductive approach to coding and categorization supported by QSR NVivo.Results:The informants’ experiences and perceptions centered around four global themes concerning (1) awareness, cultural re-orientation and integration; (2) learnings; (3) normalization and legitimacy and (4) a more evidence-based, structured and systematic approach to clinical health promotion. Informants were positive toward the implementation process, although it was sometimes challenging. The suggested improvements to increase acceptability related to the patient survey, time consumption, translation, tailoring to local circumstances and in-advance training.Conclusions:Managers and staff were positive toward the World Health Organization Health Promotion Hospitals process, which was perceived to bring about positive changes and learnings. The findings also suggest that the implementation process may be improved by minor adjustments to process elements and design. It is our recommendation to use the process in clinical departments to further implementation of clinical health promotion.

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A WHO-HPH operational program versus usual routines for implementing clinical health promotion: an RCT in health promoting hospitals (HPH)

et al. 2018

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BackgroundImplementation of clinical health promotion (CHP) aiming at better health gain is slow despite its effect. CHP focuses on potentially modifiable lifestyle risks such as smoking, alcohol, diet, and physical inactivity. An operational program was created to improve implementation. It included patients, staff, and the organization, and it combined existing standards, indicators, documentation models, a performance recognition process, and a fast-track implementation model.The aim of this study was to evaluate if the operational program improved implementation of CHP in clinical hospital departments, as measured by health status of patients and staff, frequency of CHP service delivery, and standards compliance.MethodsForty-eight hospital departments were recruited via open call and stratified by country. Departments were assigned to the operational program (intervention) or usual routine (control group). Data for analyses included 36 of these departments and their 5285 patients (median 147 per department; range 29–201), 2529 staff members (70; 10–393), 1750 medical records (50; 50–50), and standards compliance assessments.Follow-up was measured after 1 year. The outcomes were health status, service delivery, and standards compliance.ResultsNo health differences between groups were found, but the intervention group had higher identification of lifestyle risk (81% versus 60%, p < 0.01), related information/short intervention and intensive intervention (54% versus 39%, p < 0.01 and 43% versus 25%, p < 0.01, respectively), and standards compliance (95% versus 80%, p = 0.02).ConclusionsThe operational program improved implementation by way of lifestyle risk identification, CHP service delivery, and standards compliance. The unknown health effects, the bias, and the limitations should be considered in implementation efforts and further studies.Trial registrationClinicalTrials.gov: NCT01563575. Registered 27 March 2012. https://clinicaltrials.gov/ct2/show/NCT01563575Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0848-0) contains supplementary material, which is available to authorized users.

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The WHO-HPH recognition project: fast-track implementation of clinical health promotion - a protocol for multi-center RCT

Cited by 5 publications

References 7 publications

Fast-track implementation of clinical health promotion

Fast-track implementation of clinical health promotion

Staff experiences with strategic implementation of clinical health promotion: A nested qualitative study in the WHO-HPH Recognition Process RCT

A WHO-HPH operational program versus usual routines for implementing clinical health promotion: an RCT in health promoting hospitals (HPH)

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