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Shu ti (sintesi)

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  • 1. Shu-Ti
    • Shu-Ti Chiou MD, PhD, MSc
    • Director-General, Bureau of Health Promotion, Taiwan
    • Coordinator, Taiwan HPH Network
    • Vice Chair of Governance Board, International Network of HPH and HS
    • Chair and Coordinator, Task Force on HPH & Environment
    Innovative Strategies, Best Practice and Networks: the Experience of Taiwan
  • 2. Outline
    • Introduction to Taiwan HPH Network
    • Implementation of HPH model in Taiwan Network
    • Examples of HP programs in hospitals
    • The way forward
  • 3. Introduction to Taiwan HPH Network
  • 4. Health status, Taiwan & Italy (2009) Source: 1. United Nations, Department of Economic and Social Affairs Population Division, Population Estimates and Projections Section 2.WHO Statistical Information System (WHOSIS) 3. Health at a Glance Europe 2010 4. World Health Statistics 2011 Taiwan Italy Total population 23,162,000 (2010) 59,870,000 (2.6 times of Taiwan’s) % of 65 y/o and above 10.7 (2010) 20 Crude birth rate(‰) 8.3 10 Maternal mortality rate ( per 100,000 ) 4.2 (2010) 5 Neonatal mortality rate(‰) 2.4 2 Infant mortality rate(‰) 4.2 3.7 Life Expectancy 79 82 Male 76 79 Female 82.3 84
  • 5. Hospitals in Taiwan
    • Total = 508 hospitals;
    • Total beds= 135,401beds
    • Distribution of ownership (by hospitals/ by hospital beds):
    Owner % of hospitals % of beds Public 16.1 % 33.6 % Private non-profit 24.2 % 36.8 % Private for-profit 59.6 % 29.6 %
  • 6. Hospitals in Taiwan
    • Average LOS: 7-8 days
    • Provide both outpatient and inpatient services .
    • Patients can have direct access to hospital outpatient care and have a free choice of providers, including specialists and dental care.
    • Hospitals accounted for 43% of preventive services reimbursed by the Bureau of Health Promotion.
    • 59-71% of the adult population had at least one hospital visit in 2008 (ex. 59% of persons aged 30 years or more, 65% of persons aged 50 to 69 years).
  • 7. Universal coverage of healthcare in Taiwan
    • Bureau of National Health Insurance :
    • acute and chronic illness care,
    • medications,
    • surgeries,
    • dental treatment, etc.
    • Bureau of Health Promotion :
    • prenatal checkup
    • neonatal screening
    • well-baby clinic
    • general checkup for adults and elderly
    • cancer screening
    • smoking cessation,
    • preventive dental services, etc.
  • 8. Growth of Taiwan HPH Network
  • 9. Development of Taiwan HPH Network -1
    • 2002 The 1st HPH initiative in Taiwan: Taipei Healthy City Initiative and accreditation for “Healthy Hospitals” (Director-General of Taipei City Health Department)
    • 2005 The 1st WHO HPH member hospital in Taiwan and in Asia (Taipei Municipal Wan-Fang Hospital)
    • 2006 Another 4 member hospitals in Taiwan
    • 2006 Dec. Establishment of Taiwan Network (the Founder)
    • 2007 Aug. Expanded and registered as an NGO in Taiwan with 22 member hospitals (the Chair)
    • 2008 4 th biggest in the world with 61 member hospitals
    • 2 nd highest number of papers in international conference
    • 2009 2 nd highest number of papers in international conference
  • 10. Development of Taiwan HPH Network -2
    • 2009 WHO Winter School in Taiwan (first in Asia)
    • 2010 Taskforce on HPH and Environment was approved for a 4-year term by the General Assembly of HPH International Network.
    • 2010 1 st highest number of papers in international conference
    • 2010 government-initiated special programs on HPH with grant support, such as h ospital cancer control program, smoke-free hospitals, environment-friendly hospitals, age-friendly hospitals, HPH international recognition trial, etc.
    • 2011 1 st highest number of papers in international conference
    • 2011 October: 2 nd largest network with 72 member hospitals
    • 2012 The 20 th International HPH Conference will be held in Taipei (Apr. 2012)
  • 11. Distribution of member hospitals Taipei City 14 New Taipei City 10 Taichung City 7 Yunlin County 4 Changhua County 4 Taoyung County 3 Nantou County 3 Chiayi City 3 Tainan City 3 Pingtung County 2 Miaoli County 3 Keelung City 1 Hsinchu County 1 Yilan County 1 Hualien County 3 Chiayi County 2 Kaohsiung City 7 Total: 72 Taitung County 1 HPH(+) in 18 among 22 counties or cities Lianchiang county 0 Kingmen county 0 Penghu county 0 Hsinchu City 0
  • 12. Characteristics of member hospitals Ownership HPH=72 % in HPH % in all hospitals Public 35 49 16 Private non-profit 28 39 24 Private for profit 9 12 60 Accreditation level Medical Center 8 11 Regional H 47 65 District H 16 22 Non-Hospital 1 1 Size (beds) <=100 3 4 54 101~300 11 15 20 301~600 31 43 11 >600 27 38 16
  • 13. Implementation of HPH model in Taiwan Network
  • 14. Implementation of HPH model in Taiwan Network
    • Start with “leaders of leaders”
    • Clear definition and methodology of HPH: the WHO standards
    • Shared learning activities
    • Self-assessment to become a member
    • Make it an honor
  • 15. Shu-Ti A Health Promoting Hospital and Health Service Is…
    • An organization that aims to improve health gain for its stakeholders by developing structures, cultures, decisions and processes .
    • A setting-based (system-oriented) approach involving changes in structures, cultures, decision-making processes and delivery processes
    • to assure adding of health gain in a systematic and universal way
  • 16. Examples of health gains Shu-Ti Dx Tx Gain, specific (ex.) Gain, generic Pt with OA Arthro-plasty Postoperative rehab., weight loss
    • Smoking cessation
    • Safe drinking,
    • Balanced diet
    • Regular exercise
    • Periodic checkup (such as Pap smear, CRC screening, mammography, BP, Chole, Glu, Depression, BMI, vision, …)
    Asthma medications Home environment modification, self monitoring Diabetes medications SMBG, Target of weight loss, PA, healthy eating AMI PTCA, beta blocker, ASA Cardiac rehab, smoking cessation
  • 17. Methodology of implementing HPH
    • The WHO HPH standards
    • Standard 1. Management Policy
    • Standard 2. Patient Assessment
    • Standard 3. Patient Information and Intervention
    • Standard 4. Promoting a Healthy Workplace
    • Standard 5. Continuity and Cooperation
    • developed by WHO in 2006
  • 18. Consultant Assessments on Hospital support (1 st Accreditation) n=70 Commitment and Support % High 90.0 Mod to high 10.0 Low 0 Allocation of Resources, Team-up, and Mobilization of Staff % Good 54.3 Fair to good 34.3 Fair 11.4 Inadequate 0
  • 19. Consultant Assessments on Hospital support (1 st Accreditation) Potential of future development % Positive and Optimistic 78.6 Somewhat positive and optimistic 21.4 Low expectation 0 Past achievements in HP % Productive 54.3 Somewhat productive 42.9 Need more efforts 2.9 Poor 0
  • 20. Performance Comparison Between the 1 st and 2 nd HPH Evaluation
    • Participants who have passed the certification second time displayed higher scores in each standards.
    2nd: 25 hospitals (re-certification) 1st: 70 hospitals (2 hospitals had missing data)
  • 21. Elements with scores ≤80 from the 1 st visit (all improved in hospitals having the 2 nd visit) 1st 2nd 1.2.2 Operational procedures such as clinical practice guidelines or pathways incorporating HP actions are available in clinical departments 79.2 95 1.3.2 A programme for quality assessment of the health promoting activities is established 80.0 95 3.1.2 Documentation and evaluation of health promotion activities and expected results in the records 80.0 91 4.2.3 The staff performance appraisal system and continuing professional development includes health promotion 72.5 96 4.3 There are HP procedures or programs for staff 77.1 94.3 4.3.2 Smoking cessation programmes are offered to staff 72.1 91 4.3.3 Annual staff surveys are carried out including an assessment of individual behaviour, knowledge on supportive services/policies, and use of supportive seminars 76.4 95
  • 22. Annual Awards
    • Model Hospitals: hospitals showing best implementation of the standards
    • Innovative Health Promotion Projects on
      • Promotion of smoking cessation
      • Tobacco control in psychiatric hospitals
      • Environment-friendliness
      • Physical activity, healthy eating and obesity control
      • Staff mental health promotion
      • Occupational safety
      • Others
  • 23. HP programs in hospitals
  • 24. HP programs in hospitals
    • Hospital cancer control initiative
    • Age-friendly healthcare initiative
    • Environment-friendly hospital initiative
    • HPH and obesity control
    • Staff health survey
    • Smoke-free hospital initiative
    • Baby-friendly Hospital Initiative
    • Health promotion for diabetes by hospitals
    • Etc.
  • 25. Hospital cancer control initiative
  • 26. New National Plan on Cancer Control
    • to achieve 10% of reduction in age-standardized cancer mortality rate by 2015 as compared to 2009 (from 132.5 deaths/100,000 in 2009 to 119.3 deaths/100,000 in 2015).
  • 27. Number of Cancer Screening Services, 1995-2013 ( × 10,000 people ) The new plan expected to achieve a growth of 1.4 folds in volume between 2009 and 2010 Targets of screening 3.01million 4.12million
  • 28. Delivery system: how to increase screening capacity and client demand?
    • Extra budget without extra public health workers .
    • Extra budget without extra primary care clinics .
    • 60-70% of the target population had at least one encounter with hospitals in 2008.
    • =>Mobilizing clinical capacity of hospitals in partnership with public health sector will have great potential to achieve the targets and save more lives
  • 29. Delivery redesign : a structured module The WHO Health Promoting Hospital Model integrating health promotion and prevention into and beyond hospital practices
    • Management policy supporting organized screening
    • Systematic patient assessment on their needs of health promotion and screening
    • Providing information and preventive services
    • Continuity and cooperation for screening, Dx and treatment
    • Creating healthy workplaces
    • developed by WHO in 2006
  • 30. Policies to support delivery redesign
    • Project-based subsidy for hospitals to implement the model and transform hospital practices, including
      • extra personnel ,
      • new IT function for automatic assessment and reminding, and tracking of results,
      • patient education and outreach community services , and
      • self-monitoring and analysis of cancer screening performance;
    • Training for hospital personnel on implementation of the model;
    • External audit, monitoring, feedback and public reporting on hospital performances; and
    • Extra payment for good performance in addition to fee-for-services and project-based subsidy.
  • 31. Comparison on growth of screening volume between subsidized hospitals and non-subsided health services 2.1 16.2 4.4 1.1 All screenings, 2 vs. 1 Both: 1.5
  • 32. Age-friendly healthcare initiative
  • 33. Age-Friendly Hospitals and Health Services
    • Taiwan’s Framework of Age-friendly Hospitals and Health Services is based on:
      • WHO Age-Friendly principles
      • WHO Standards of Health Promoting Hospitals
  • 34. Age-Friendly Hospitals and Health Services
    • VISION: An age-friendly healthcare organization is one which promotes health, dignity and participation of senior people.
    • VALUES: Health, humanity, human rights
    • MISSIONS:
      • To create a friendly, supportive, respectful and accessible healing environment tailored to the unique needs of elderly people;
      • To facilitate safe, health promoting, effective, holistic, patient-centered and coordinated care in a planned manner to the elderly populations;
      • To empower elderly persons and their families to increase control over their health and care.
    published in: Archives of Gerontology and Geriatrics 49 Suppl. 2 (2009) S3–S6
  • 35. Age-Friendly Hospitals and Health Services
    • Strategies toward Aging-friendly Hospital
    • --4 standards, 11 sub-standards, 60 measurable items
    • 1. Management Policy
    • 1.1 Developing an age-friendly policy
    • 1.2 Organizational support
    • 1.3 Continuous monitoring and improvement
    • 2. Communication and Services
    • 2.1 Communication
    • 2.2 Services
    • 3. Care Processes
    • 3.1 Patient assessment
    • 3.2 Intervention and management
    • 3.3 Community partnership and continuity of care
    • 4. Physical Environment
    • 4.1 general environment and equipment
    • 4.2 transportation and accessibility
    • 4.3 signage and identification
  • 36. Environment-friendly hospital initiative
  • 37.
    • The total reduction of carbon dioxide emissions will reduce 13% of annual CO2 emissions by 2020 compared to the level in 2007
    • The amount is CO2 reduction is equivalent to the annual absorbing capacity of 34 New York Central Parks
    128 Taiwanese hospitals said “yes, we can!” on Oct. 23, 2010
  • 38.
    • Energy efficiency
    • Green building design
    • Alternative energy generation
    • Transportation
    • Food
    • Waste
    • Water
    Seven Elements of a Climate-Friendly Hospital
  • 39. HPH and obesity control
  • 40. P romoting healthy eating, exercise and weight loss in hospitals
    • 129 hospitals participated in the kickoff ceremony in March 25 and pledged to lose a total of 135,000 kg of excessive body weight for staff and patients by the end of 2011.
    • Afterwards, a total of 164 hospitals joined the program to lose a total of 156 tons (with 148 tons achieved now).
  • 41.
    • Nov 21, 2011:
    • Total weight reduced inTaiwan= 1,044,886 kg
    • National target : 660,000 kg
    • Completion rate: 158.3 %
    National Weight Reduction Results Hospital : 148,339.9 kg (14.2%) Target: 156,000 kg 95 % complete Others : 45,042.4kg (4.3%) Community :288,807kg (27.6%) School : 75,586.34kg (7.2%) Target: 80,000 kg 95 % complete
    • Workplace :
    • 487,109.7kg (46.6%)
    • Target: 120,000kg
    • 405 % complete!
  • 42. Staff health survey
  • 43. Workplace Health Promotion --Survey for health-promoting healthcare workplaces
    • Survey on Health and Safety Needs of Healthcare Workers was conducted in 2011.
    • Collect data on health risks, occupational hazard exposure, health behavior, expectation and utilization of health promotion resources.
    • 101 hospitals participating in the survey:
      • HPH hospitals: 56
      • Non-HPH hospitals: 45
    • Feedback analysis to hospitals
  • 44. Self Rated Health and Stress Stressors
  • 45. Health Conditions
  • 46. Occupational Hazards Violence
  • 47. Exercise Related Resources and Utilization Dietary Related Resources and Utilization Stress Adjustment Related Resources and Utilization Stress Adjustment Related Resources and Utilization
  • 48. Satisfaction of Work
  • 49. The way forward
  • 50. Hospitals doing HP programs with the Bureau of HP   Total N=515 Participation (%) HPH N=72 Participation (%) Non-HPH N=443 Participation (%) P value Cancer Screening 383 74.4% 71 98.6% 312 70.4% <.0001 Age- Friendly 9 1.8% 9 12.5% 0 0.0% <.0001 Environment-friendly 128 24.9% 57 79.2% 71 16.0% <.0001 Obesity control 161 31.3% 68 94.4% 93 21.0% <.0001 Healthy Workplace 101 19.6% 59 82.0% 42 9.5% <.0001 Smoke- Free 53 10.3% 36 50.0% 17 3.8% <.0001 Baby- Friendly 119 23.1% 53 73.6% 66 14.9% <.0001 Diabetes quality care 134 26.0% 59 81.9% 75 16.9% <.0001 Healthy Communities 139 27.0% 38 52.8% 101 22.8% <.0002
  • 51. The way forward
    • Continue to promote HPH model in HP and NCD care
    • Encourage more hospitals and health services to become members
    • Encourage hospitals to do research and generate evidence of HPH
    • Participate in international research
    • To host the 20 th International HPH conference in Taiwan in 2012, the first being held outside of Europe
  • 52. Welcome to Taiwan in April, 2012
    • Main conference: April 11-13, 2012
    • The Conference Website: www.hph2012.com
    • Deadline of Abstract Submission: Dec 15, 2011
    • Deadline for Early Registration: Jan 31, 2012
    • Registration Fee is much lower than before!
    • Hospital visits for different health issues will be offered
    • Discount system for China Airline air fare is online at the conference website!
  • 53. Registration Fees for the 20th HPH Conference * CEE (Central and Eastern Europe) countries include Estonia, Latvia, Lithuania, Poland, Czech Republic, Slovakia, Hungary, Romania, Bulgaria, Slovenia, Croatia, Bosnia-Herzegovina, Serbia, Kosovo, Albania, Montenegro and Macedonia. Early Registration Till January 31, 2012 Late Registration February 1 ~  March 31, 2012 On-site Registration April 11 ~ 13, 2012 Participants from Western Europe, North America, Australia and developed Asian countries NT$ 4,800.0 US$ 160.0 € 117.9 NT$ 5,800.0 US$ 193.3 € 142.5 NT$ 5,800.0 US$ 193.3 € 142.5 Participants from CEE * countries NT$ 3,000.0 US$ 100.0 € 73.7 NT$ 4,000.0 US$ 133.3 € 98.3 NT$ 4,000.0 US$ 133.3 € 98.3 Participants from developing countries /Students NT$ 2,500.0 US$ 83.3 € 61.4 NT$ 3,500.0 US$ 116.7 € 86.0 NT$ 3,500.0 US$ 116.7 € 86.0 Gala Dinner NT$ 2,500.0 US$ 83.3 € 61.4 NT$ 2,500.0 US$ 83.3 € 61.4 NT$ 2,500.0 US$ 83.3 € 61.4 Accompanying person NT$ 1,500.0 US$ 50.0 € 36.9 NT$ 1,500.0 US$ 50.0 € 36.9 NT$ 1,500.0 US$ 50.0 € 36.9
  • 54. Official Website of the 20th International Conference on Health Promoting Hospitals and Health Services
  • 55. Beds and Equipments Can Make a Hospital Bigger……… ……..but Only Love Can Make a Hospital Greater.
  • 56. T.H.P.H 人 人 臺灣健康醫院學會 Taiwan Society of Health Promoting Hospitals 全人照護 全民健康 全員參與 全球接軌 Adding value and evidence, promoting holistic health Turn Evidence into Practice with Love and Partnership…

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