Making Health Promotion Our Daily Business A Case Study of Health Oriented Healthcare Management

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1 Making Health Promotion Our Daily Business A Case Study of Health Oriented Healthcare Management Keynote presentation - 21st International HPH Conference Gothenburg, May 2013 Dr. Diane Levin-Zamir, PhD, MPH, MCHES Director, National, Clalit Health Services University of Haifa School of Public Health IUHPE Global Working Group - Health Literacy ( , Pattaya) 1

2 2

3 In this presentation. Systems approach for health promotion in health services Making the best use of resources 3 Case studies with flagship programs - Empowering staff on lifestyle; - Pre-diabetes + diabetes; - Smoking cessation 3

4 4 Clalit Health Services 4.1 million members; 54% of Israel s population 35,000 workers 1,400 primary and specialized care community clinics 14 major teaching hospitals: 8 general, 2 psychiatric, 1 pediatric, 2 geriatric, 1 rehabilitation 416 pharmacies 40 diagnostic imaging centers 67 laboratory centers 83 physiotherapy units 30 occupational therapy units 87 diet & nutrition consultation units 22 mental health clinics, 70 dental clinics 20 alternative medicine clinics 3 HPH and more on the way 2nd largest non-government health care organization in the world

5 Striving for Excellence in Health Promotion - Adopting a Systems Approach Ottawa Charter for Health Promotion - WHO Healthy Public Policy Supportive Environments Community Involvement Developing Personal Skills- Health Literacy Reorientation of Health System 5

6 Clalit Mission Statement + Vision Clalit, Dedicated to a Healthier Israel We are committed to health through the prevention of illness, promotion of healthy lifestyle, quality of care and attention to the needs of the patient and his family. Core values: Respect for each individual, professionalism and excellence, humility, dedication, contribution to the community 6

7 Policy: Strategic Plan Health/medical quality - developing and applying evidenced based quality indicators Excellence in service Innovation Leadership Cost containment 7

8 Policy: Strategic Plan Enhancing hospital community collaboration Prioritizing healthy lifestyle: nutrition, physical activity, smoking cessation Creating continuity of intervention Closing health disparities - reaching the disenfranchised Cross-cutting considerations: health literacy and cultural competence and appropriateness 8

9 Practice: Cooperative Operational Model Hospital Primary Care Services Public Media Private Sector Community settings NGOs 9

10 Making Health Promotion our daily business - Where are the resources? National health insurance law- Basket of services Direct budget - projects In-kind resources 10 - Inter-disciplinary cooperation: health promotion, medicine, nursing & health professionals - Quality improvement + services Developing human resources - Marketing and public relations

11 Making Health Promotion our daily business - Where are the resources? Partnerships Inter-organizational Local and national governmental agencies NGOs International partners Public Private Partnerships (PPP) 11

12 Case study 1 "You Can Make a Difference" An Innovative Program for Empowering Health Care Staff to Motivate Individuals and Communities in Promoting Healthy Lifestyles-

13 Rationale The contribution of healthy lifestyles to health indicators has been unequivocally proven Studies show a significant influence of primary care health teams on the degree of adoption of healthy lifestyles Studies show that the degree to which the health team engages in healthy lifestyles significantly effects their influence on their patients. Goals Positioning healthy lifestyles as central to the roles of interdisciplinary community primary care teams. Developing leadership among the health care team Improvement of health promoting skills in daily work-load. Adoption of healthy lifestyle by health care staff

14 Program Modules Smoking cessation Physical Activity Healthy Lifestyles Nutrition Early cancer detection Dept of Health Education & Promotion

15 Results: 70% improvement in self-efficacy re: instructing fellow staff members on healthy lifestyles Before After Not able to instruct not very able pretty able very able to instruct 0 (Absolute values) Dept of Health Education & Promotion

16 Main Results in-service training High satisfaction from the material and from the in-service training for applying them Significant increase in self-efficacy Improved lifestyle as a result of participation in training (80%) Dept of Health Education & Promotion

17 Results - Over 1200 primary care staff participated in staff meetings in 100 clinics in Implementation of the program continues - - Part of the national Clalit strategy for A tailored intervention program for occupational medicine based on the modules is currently being implemented and researched for impact Dept of Health Education & Promotion

18 Enabling Resources - Partnership with private entities for educational grant. - In-kind expertise for program development: physicians, health promoters, physical therapists, dieticians, nurses, pharmacists. - In-kind expertise for online-continuing education - Using weekly staff meetings for implementing the program - Small budget for healthy refreshments during 18 teaching sessions

19 Case study 2 Smoking Cessation - Adopting a Systems Mind-Body Approach 19 Dept of Health Education & Promotion

20 Case Study 2: Smoking Cessation- Adopting a Systems Approach Policy: As of included workshops / medication in Nat l. Health Insurance basket of services Clinical Quality indicators: Registering the smoking status of every member from 15 years old + Service infrastructure: Guaranteeing access to services on a national basis Ongoing in-service training: Building a base of professional cessation counselors Offering cessation services to Clalit workers beginning with HPH hospitals 20

21 Case Study 2: Smoking Cessation- Adopting a Systems Approach Professional guidelines for brief intervention Cessation Included in medical guidelines: diabetes, hypertension, asthma, heart disease, renal disorders, etc Innovative social media campaigns Significant discounts for nicotine replacement (NRT) Wide distribution of printed material in Hebrew, Arabic, Russian and for ultra-religious population On-line information and expert forum 21

22 Results 17 fold increase in participation in smoking cessation services X different cities/towns 20% in Arab towns 22

23 23 Enabling Resources National Health Tax: Basket of services Commitment of management to enforcing smoke-free hospitals and health services policy Cooperation between Health Promotion, Human Resources etc. Support from supplementary insurance Time commitment from smokers Results: 44-50% sustained quit rate one year after workshop

24 Case study 3 Diabetes management 24 Dept of Health Education & Promotion

25 Case Study 3: Health Promotion and Diabetes 72% of people with diabetes in Israel are insured by Clalit Clalit treats a highly heterogeneous population including elderly, immigrants and cultures in transition, and low socioeconomic status populations 15 year intervention shows significant improvement in rates of HbA1c 7% from 10% to 53% and decrease of HbA1c>9%, 40% to 13% (p<0.0001) 25

26 Overview of Clalit Health Promotion Strategies for Diabetes Health Literacy Patient Ed Kits & Internet, Culturally adapted Lifestyle and Self-Management Workshops Tailored Programs for Special Populations Annual CME for all health teams focusing on evidence based strategies for behavior change and adherence 26

27 Health promotion - chronic care Scope of workshops for diabetics on healthy lifestyle and self care # of participants 27 N=5330

28 Program effectiveness Healthy Lifestyle and self-management workshops for Diabetics - HbA1C measures 70 workshops/year P=< Time 1 intervention 6 mo. following intervention

29 Health Promotion On-Line 29

30 30 Enabling Resources Commitment of management to achieving clinical results Consistent inter-disciplinary cooperation Adopting continuity of care treatment policy: Clalit hospitals and community clinics. Public-Private partnership for support as needed Ongoing research and sharing knowledge on effectiveness strategies.

31 New and Future Challenges Trained, competent and committed HP workforce Keeping evaluation and research on the agenda maintaining standards of excellence Continued investment in HP quality indicators Encouraging public participation in planning Equity in the use of health promoting media Addressing health literacy and cultural appropriateness regionally, nationally, locally Enhance partnerships with even more settings Widening the contribution of health promotion in continuity of care: hospital and community 31

32 Conclusions In order to have a whole-patient approach, you need a whole systems approach; Need to use available resources creatively; There is no substitute for cooperation and partnership If you want to go fast, go alone; if you want to go far, go together African proverb 32

33 Tack! Gracias! Grazie! Merci! Shukran! Todah! 33 Thank you!

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