This document summarizes a presentation given at the 19th International Conference on Health Promoting Hospitals and Health Services in Turku, Finland on June 1-3, 2011. The presentation discussed a self-assessment of psycho-emotional well-being standards conducted in 8 health services in the Friuli Venezia Giulia region of Italy. The assessment examined management policies and healthy workplace promotion. Based on the results, training programs were developed to improve communication, empowerment, and stress management among employees. Preliminary needs identified focused on debriefing, communication, and developing life skills. The goals are to increase organizational and individual resilience through Health Promoting Hospital network initiatives.

1. Improving health gain orientation in all services:
Better cooperation for continuity in care
19th International Conference on Health Promoting Hospitals and Health Services (HPH)
Turku – Finland-
June 1-3, 2011
Stress related work, organizative
and individual resilience: an integrative
self-assessment approach.
HEALTH PROMOTING HOSPITALS & HEALTH SERVICES
Ospedali e Servizi Sanitari per la Promozione della Salute
HPH Una Rete dell’OMS
Dr. Cristina Aguzzoli
ASS 2 “Isontina”
Regione Autonoma Friuli Venezia Giulia
Coordinating Centre HPH Friuli Venezia Giulia Network
ITALY
Program Team: 8 Local Health Units participating in the HPH Network of Friuli Venezia Giulia (Italy)
Coordination Manager of HPH Network of Friuli Venezia Giulia: Aguzzoli Cristina
Participants: Annunziata Maria Antonietta, Bertoli Marco, Beacco Virginio, Bicego Livia, Deangeli Renzo, Ciano Rossana, Della
Vedova Anna, Dudine Luisa, Giacomini Luisa, Masci Silvia, Peresson Maria, Portolan Patrizia, Robotti Mario, Russian Stefano, Sanson
Sara, Scarano Adelchi
Particular thanks to Dr.Carlo Favaretti , for his continuous support
and for his expert advice

2. Index
Stress-distress
Resilience
Psycho-emotional well being
Self Assessment in 8 Health Services Friuli Venezia
Giulia Network
Results
Psycho-emotional standards as training tool for
improvement plans
Management policy actions

3. OCSED REPORT -may 2011-
Organisation for Economic Co-operation and Development BETTER LIFE INDEX
Reality or more awareness…………………??????

4. Stress and distress
According to natural selection , if
"Life exists by maintaining a complex you don’t succeed in getting
homeostasis,
dynamic equilibrium or homeostasis, over the distress conflict - or
which is constantly challenged by intrinsic you are not able to accept the
or extrinsic adverse forces or Stressors"
Stressors" temporary inability - you
Chrousos,
(Chrousos, 1998). perish ……

5. A common
neurobiology
for pain and pleasure.
S. Leknes and I
Tracey.
Nature Reviews.
Neuroscience. Vol. 9:
314-320. April 2008.

6. Self Assessment and Improvement plans
PRIORITY: to Identify areas for well being at
work implementation
Serenity Prayer
"Father, give us courage to change what
Father,
altered,
must be altered, serenity to accept what
cannot be helped, and the insight to know
helped,
other."
the one from the other."
Reinhold Niebhur, american theologian

7. The psychobiology of resilience
Although adverse environments are well known to be a risk factor for
psychopathology, many individuals respond adaptively to such environments. There
is growing interest in the underlying mechanisms involved in such resilience. Several
cognitive-affective processes may be involved, and these may be mediated by particular neuronal
circuits and neurochemical systems. This article summarizes some of the relevant work on the role
of fear conditioning, reward processing, and social behavior in resilience.
Stein DJ, CNS Spectr. 2009 Feb;14(2 Suppl 3):41-7.
es
s
Personality Life style
RESILIENCE
Communication

8. RESILIENCY
ORGANIZATIVE LEVEL INDIVIDUAL LEVEL
Awareness about
Decree with distress level and relaxation
Force of law 81/2008 techniques
Occupational physician programs
MISSION Enjoy projects
MISSION AND Healthy
Setting Smoke free AND VISION:
VISION: workplace
Healthy Food individual
aims
Wellness programs development
of organization
Procedures
Forum Who
Intranet What Communication Life skills
House organ When Training Training : PBL
Why

9. Standard Management Policy
Promoting a Healthy Workplace
Focus on psycho-emotional wellbeing
the evaluation in a flexible system , the resiliency of the system and of the people -
1.4 The organization identifies
the responsabilities for the
health operators’ psycho- 4.4 Environment: safety
emotional well-being 4.5 Environment: comfort
4.6 Environment: the balance-space
1.5 Professional profile and job
4.7 Professional profile
description
4.8 Human profile
1.6 Communication within the 4.9 Monitoring and updating
company: accountability 4.10 Assessment of chronobiology,
between the company and the care models and health impacts.
operators. The clinical risk management
and the relation with work-
related stress.

10. 2009 – 2010 Analysis
First step:
self assessment for Standard
1 “Management Policy “ and
Standard 4 “Promoting
Healthy workplace”+
“Psycho-emotional well
being standards”
8 Hospitals and Health
Services of Friuli Venezia
Giulia HPH network
the point of view of
management area
Second step :
self assessment in
Assistential areas
psychiatric,oncologic patients

11. How self assessment works in our reality
ASS 2 20% 47% 33%
ASS 1 60% STANDARD 4 psychoemotional 2010
7% 33%
STANDARD 1 psychoemotional w ellbeing 2010
AOPN 36,5% 23,5% 40%
AOUD
60% 60%
7% 60% 60% 33%
80% CRO 40% 40% 20%
75% 53%
Burlo 27% 33% 40%
72% 50%
70% 69% ASS 6 47% 27% 53% 20%
60% BENESSERE63% 1 Regione fvg
ST
56% 56% 40% 40% 40%
40% 40%
50% 36,5%
50% 33% 33% 33% 33%
yes yes
30%
40% 27% 27% partly
partly
31% 31% 23,5% no
30% no 20% 20% 20%
25% 25% 25% 20%
20% 19% 19% 19%
16%
13%
yes partly 13% no
13%
10% 10%
6% 6% 7% 7%
0%
0%
ASS 2 ASS 1 AOPN AOUD CRO Burlo ASS 6 ASS 2 ASS 1 AOPN AOUD CRO Burlo ASS 6
ASS 2 13% 72% 16%
N°Operators 31 december 2009 TOT = 15.608
ASS2= 2.079 AOUTS=3.011 BURLO= 763 Operators 2010:
ASS1= 1.309 AOUD= 3.896 CRO= 674
- 409
ASS6= 1.886 AOPN = 1.990

12. SELF ASSESSMENT AS A TOOL FOR WELL BEING TRAINING
9 meetings – may-september 2010 in a Health Service
19 operators set up training on well-being analysis / improvement plans
1st SESSION- ORGANIZATIVE
EMPOWERMENT
FIRST CYCLE 2nd SESSION- ENVIRONMENTAL SECOND CYCLE
1-3 EMPOWERMENT 1-3
february 2011 march 2011
3rd SESSION- INDIVIDUAL
Training/Information EMPOWERMENT Training/Information
30 operators 30 operators
Multiprofessional
Multiprofessional
Managers MD Nurses
Managers MD Nurses
Technicians
Technicians
Identification of a Identification of a
Department Department
Referent for Referent for
Organizative Organizative
Wellbeing Wellbeing

13. RESULTS 2011: PRELIMINARY NEEDS
Self Assessment STANDARD 1 and 4 and Pshyco-emotional wellbeing
Operators of MANAGEMENT AREA
debriefing paths (4.10.2)
Operators of SURGICAL AREA
debriefing paths (4.10.2)
Operators of MEDICAL AREA
empowerment communication
target medical doctors new employees (1.6.1)
Operators of EMERGENCY AREA
accountability for improvement communication
between operators and HPH steering group
(1.6.3)
Operators of HEALTH SERVICES AREA
empowerment on life skills (4.8.3) and
debriefing paths(4.10.2)

14. Conclusions
RESILIENCE OF AN ORGANIZATION
RESILIENCE OF EMPLOYEES
PERSONALITY: Mission of Health Service
1. From Plan to Action: Plan of Prevention 2010-2012 PERSONALITY :Life purpose and
and alliance with HPH network
purpose on job development
2. The committment of managers towards HPH : 3rd
Regional HPH Conference – 5 May 2011 –
STRESS : Awareness of stress distress
STRESS :Link between HPH strategies and law signals, Enjoy Relaxation techniques-
81/2008 Occupational physicians programs
1. Stress related work risk evaluation
2. Risk management LIFESTYLES: Enjoy Lifestyles projects
3. Gender discrimination and mobbing committees
4. Accreditation systems: we are introducing 1°HPH
standard in management policy of regional actions DECISION MAKING: Take part of
2012 Training for Human profile (life skills,
coping)
LIFESTYLES : healthy workplace for physical
activity, healthy food, smoke free setting, balance COMMUNICATION : Sharing Training
spaces Communication
DECISION MAKING : procedures and skills of
manager, ………
COMMUNICATION: Accountability tools, Forum,
Training Plans…
else…
And perhaps something else…..

15. THANKS FOR YOUR ATTENTION!
HEALTH PROMOTING HOSPITALS & HEALTH SERVICES
Ospedali e Servizi Sanitari per la Promozione della Salute
HPH Una Rete dell’OMS
Regione Autonoma Friuli Venezia Giulia
www.retehphfvg.it