Health Promoting Hospitals Network Progress Report 2002 ITALY - LOMBARDIA

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1 World Health Organization 2002 Any views expressed by named authors are solely the responsibility of those authors. All rights in this document are reserved by the WHO Regional Office for Europe. The document may nevertheless be freely reviewed, abstracted, reproduced or translated into any other language (but not for sale or for use in conjunction with commercial purposes) provided that full acknowledgement is given to the source. For the use of the WHO emblem, permission must be sought from the WHO Regional Office. Any translation should include the words: The translator of this document is responsible for the accuracy of the translation. The Regional Office would appreciate receiving three copies of any translation. Health Promoting Hospitals Network Progress Report 2002 ITALY - LOMBARDIA Coordinator Dr. Maurizio Amigoni, M.D., Ph.D. Dirigente U.O. Programmazione Direzione Generale Sanità della Regione Lombardia Via Pola, 9/ Italy Phone: Fax: Maurizio_Amigoni@regione.lombardia.it 1. General information 1.1. Official date of establishment of the national/regional network Since 1995, the Vittore Buzzi hospital of Milan (Lombardia Region) collaborates on WHO project Health Promoting Hospitals (HPH), realising some projects coordinated by Dr. Francesco Ceratti. In reference to Buzzi s experience and that one of others who went ahead with the principles of the Ottawa Charter, the Lombardia Region sets as one of the principal aims of health promotion. The Lombardia Region joined the WHO project HPH in 1998 with enthusiasm and it created the HPH Lombardia s Regional Network.

2 1.2. Registered members YEAR Number of officially registered* members Number of unofficial** members * officially registered members are those which have signed a letter of understanding with WHO and have paid the corresponding fee ** unofficial members are those which do not fall in the former category During 2002 the number of officially registered members has fallen from 62 to 57 because 5 hospitals have been unified in already registered hospital trusts. These five hospitals are: LOCAL HEALTH UNIT PROVINCIA DI COMO LOCAL HEALTH UNIT PROVINCIA DI LODI LOCAL HEALTH UNIT PROVINCIA DI PAVIA LOCAL HEALTH UNIT PROVINCIA DI MANTOVA LOCAL HEALTH UNIT PROVINCIA DI MILANO 2 Como Lodi Pavia Mantova Melegnano 1.3. Please describe the organization of the national/regional network (coordinating center, scientific committee, steering group, task forces etc., if available please attach organigram) It has been useful to set up a Scientific management, constituted by experts from academic world and some health director managers of important hospital companies, who daily live all these problems, and thus they can propose solutions to the other health structures of the network. Now, on April 2002, members of the Scientific management are: Dr. Maurizio Amigoni Dr. Saverio D Angeli Dr. Graziano Arbosti Prof. Marisa Arpesella Manager of Planning Service Lombardia Region Health Department (Function of Coordinator) Manager of Communication and Health Education Health Director of Istituto Neurologico C. Besta in Milan Prof. of Pavia University - Department of health promotion Department Dr. Francesco Locati Health Management Physician of Hospital Trust Ospedali Riuniti - Bergamo 2002 Progress Report HPH Network Italy - Lombardia Region 2

3 Dr. Francesco Ceratti Health Director of Hospital Trust Hospital - Luigi Sacco- Dr. Sandro Sottili Chief of Anaesthesia Intensive Care Department of Private Hospital Casa di Cura S. Carlo - Paderno Dugnano Dr. Alessandro Discalzi Health Management Physician of Hospital Trust Luigi Sacco Milan. Dr. Riccardo Massei Chief of Anestesia and Intensive Care of Hospital Trust Ospedale di Circolo - Lecco Dr.ssa Bianchi Health Director of Hospital Trust Istituti Ospitalieri - Cremona Simonetta Dr. Giuseppe Genduso Health Director of Hospital Trust Ospedale di Circolo in Busto Arsizio Prof. Antonio Liverani Prof. Of Milan University - Department Medicine and Surgery Dr. Paolo Perseghin M.D. of the Lombardia Region Health Department Sig.ra Lucia Scrabbi Lombardia Region Health Department administrative officer of Health Education Please list those institutions, enterprises etc. with who you have working relations such as: political system, scientific organizations, NGOs, public/private parts of the health system, other networks etc. No institutions or scientific organizations are involved at the moment in the network activities Funding of network (Sources of funding, amount of overall annual budget in US$) Source: 2001 Regional Health Fund 2002 Regional Health Fund Amount: US$ US $ 24,000 US $ 30, Does the national/regional network set any priority/focus areas for hospital subprojects? If yes, please describe The Scientific Committee has checked the difficulty of many hospitals to collaborate to improve their work with the other ones engaged in the network. For this reason, on March, 2000 the Scientific Committee gave five topics to network s hospitals in order to create specific groups for each topic on which to execute projects. The topics of the hospital s choice were the following: nutrition diabetes smoke-free hospital the intercultural hospital the hospital structure about welcome Progress Report HPH Network Italy - Lombardia Region 3

4 These topics were selected because they are still the most common topics in the hospitals which adhere to the network and also because they belong to the international network. Groups of Experts on planning methodology will support hospital members to plan and carry out stages of the projects. Results from the beguinning of year 1999 up to March 2000 Till today, 62 public and private hospital structures, were linked to the network. They are listed and divided by structure typology in the following table: PUBLIC AND PRIVATE HEALTH STRUCTURES IN LOMBARDIA REGION Structure typology Total n. adhesions structur to HPH e network Local Health Unit endowed with hospital structures 8 7 Hospital Trust Public Institute of Hospitalisation and treatment for Scientific Research 5 3 Private Institute of Hospitalisation and treatment for Scientific Research 13 8 Classified Hospitals 5 3 Private Hospitals Included in public health network TOTAL The 62 network s hospitals have presented 195 projects, planned the next five-year period, 70 of these related to the topic continuity of care, as presented in the following tables: Table A Summary of the 70 projects regarding continuity of care divided by individual area from WHO AREA number 1 Well-being of staff and patients 14 2 Improving quality of services 12 3 Prevention health education and rehabilitation Sanitation and protection of the environment. - 5 Improving relationship with the community and social institution. 8 6 Co-ordination of primary care and hospitals Progress Report HPH Network Italy - Lombardia Region 4

5 Table B: Classification of projects presented from the public and private health structures according to different topics Topics number Improving continuity care 70 Rehabilitation 13 Hospital hygiene 7 Patients well-being 22 Improving links to community 13 Health on the workplace 9 Quality management and quality assurance 20 Interprofessional communication 11 Development of hospitals management 22 Improvement of infrastructure 1 Nutrition 4 Tobacco 3 Health education and consulting 34 Alcohol 1 Baby friendly 1 Diabetes 5 Hepatitis 2 Cancer 20 Cardiovascular diseases 8 CPR 3 In this table is evident the whole situation of projects of structures, which have already adhered to Health Promoting Hospitals Lombardia Region Network. In particular, till today, 27 hospital structures are taking part in five interhospital projects recently proposed, as reported in this table: Topics No. hospital structures engaged Nutrition 2 Diabetes 4 Smoke free hospital 3 The intercultural hospital 6 The hospital structure for welcome 12 TOTAL Progress Report HPH Network Italy - Lombardia Region 5

6 1.6. What are the aims of the network? The aim is to make the admission time to the hospital to become aware of the importance of the life styles on the health keeping, to train about some health issues, to experience new management ways of people health needs What are the objectives? The object is to increase a health awareness What strategies are used to achieve the objectives? To promote a proper use of health facilities On network level, has any evaluation been carried out? To reduce the incidence of risk factors of some important pathologies What strategies have been used? The chosen strategy was to favour the union of more structures to increase the impact and number of people and staff involved. 2. Network Information 2.1. Are key documents (Vienna Recommendations, Ottawa Charter, Information Package etc.) available in the local language? If not, is translation envisaged? The Ottawa Charter and Vienna Recommendations, as well as general information on HPH are available on the network regional hph web page: Please list existing strategies and actual activities to disseminate information (e.g. newsletter issue quarterly, conference proceedings published annually, further publications)? Not yet publised. We give a great importance to the web communication 2.3. Please list meetings and conferences The 3 rd National Conference on HPH was held in Milan, October 1999, during the Salute (Mosan) meeting, a very important exhibition dedicated to problems in Health Care. The Conference gave the opportunity to show the results of the first step of development 2002 Progress Report HPH Network Italy - Lombardia Region 6

7 between the network and WHO regional Office for Europe, headed by Dr. Mila Garcia Barbero. Several hospital structures, from different Italian regions, attended this meeting. 62 of them, related to the four HPH regional networks till now present in Italy, have shown 119 projects, as oral or poster presentation. This meeting gave the opportunity to exchange experiences between the structures and create possibility of partnership. Participation on the 4 th national conference on HPH in Reggio Emilia (November, ): it has been the occasion to present the results of the first phase of the HPH Lombardia network implementation and to compare experiences amongst Italian regional HPH network. Many Lombard hospitals took the occasion to present posters on the results of their projects. Participation in 5 th national conference on HPH in San Remo (December, ): it was presented the experience of the training course about the planning methodology that had been set up with the Local Coordinators Is a listserver available (if yes, please state number of registered users and specify use of the listserver)? No listserver is available 2.5. Has a webpage been set up (please give a link)? Since January 1999 a HPH web page has been put in action at the site: Up to now we have included both in Italian and in English the following documents: constitutive act of the HPH Lombardia network (decree # 68557/98); the formal step that hospitals have to adopt in adhering the network; the list of projects found out and implemented by health structures; and for each project title, co-ordinator name in charge of the project, address, , telephone and fax number are indicated. The health Care Directorate asked each health structure to put in action a HPH web page, like the regional one. All the HPH web pages are linked each other. National homepage: Progress Report HPH Network Italy - Lombardia Region 7

8 3. Training 3.1. Does the national/regional network offer or organize any training activities related to HPH? From October 1999 to February 2000, specific training courses addressed to local HPH Coordinators were engaged by Lombardia Region. These courses were divided into three stages of two days each during a period of three months. Necessity of courses was in order to help hospital structures of the network in setting up an adequate and uniform project methodology. In order to improve the development of projects, several training courses have been engaged. In February 2000, 40 local HPH co-ordinators have been formed. On November 20 further co-ordinators have been formed. The two days courses touched important topics as how to built up a HPH project, how to develop and how to create a set of indicators to evaluate the projects. During October/Novembre 2001 a 2nd level course of three days was planned for coordinators. Unfortunately, due to the constant turnover of the staff in the hospital companies, just a few coordinators, who had already attended the 1st level course, were present. For this reason the course had to be converted into an intermediate level. Altogether 15 people have been trained Does the network issue any guides, e.g. how to implement a smoke-free hospital? The guide lines concerning the interhospital project smoke free hospital have been set up Has any additional analysis, or have surveys been carried out? focus on few issues of first importance promote the training as a basic step of the health promotion process. 4. Expansion of network On march 2000, the Directorate proposed to the health structures to gather in 5 big areas of interest. The goal was to create a real net amongst structures in a way to facilitate exchange of information and experiences. The five topics are: hospitals as promoters of a correct life style within society security in the Hospital smoke free hospitals intercultural hospitals welcoming hospitals Progress Report HPH Network Italy - Lombardia Region 8

9 Results year 2000 During year 2000, 62 health public and private structures have participated to HPH network with project. At the end of the year 2000, 73 projects begun, while several other have been included in other regional projects like health prevention and quality assurance. Table n 1 describes the details. TABLE 1 HEALTH STRUCTURE PROJECTS STRUCTURES Hospital Trust Institute of Hospitalisation and treatment for 15 5 Scientific Research Private Hospitals Included in public health 14 8 system Local Health Unit endowed with hospital 9 5 structures Classified Hospital 3 3 TOTAL The main topics of the projects are: Classification of projects started from the public and private health structure according to different topics Main topics projects Health education and consulting 21 Improving continuity care 14 Patients well-being 13 Development of hospitals management 8 Nutrition 8 Rehabilitation 7 Quality management and quality assurance 7 Improving links to community 6 Inter-professional communication 6 Cardiovascular diseases 6 Hospital hygiene 5 Health on the workplace 5 Diabetes 5 Baby friendly 4 Cancer 4 Tobacco 3 Improvement of infrastructure 1 Alcohol Progress Report HPH Network Italy - Lombardia Region 9

10 For the year 2000, the steering committee proposed the five projects inter-hospitals to increase the commitments of the personnel of the different hospitals. 65 hospitals have jointed the proposal, as indicated in the following table: TOPIC Hospitals involved Hospitals as promoters of a correct life style within society 17 Security in the Hospital 4 Smoke free hospitals 20 Intercultural hospitals 18 Welcoming hospital 11 TOTAL 65 Results year 2001 In the year 2001, following a regional reorganization many local Co-ordinators an Project leaders has moved with a discard of some projects. 69 have been finished and 64 are still running HEALTH STRUCTURE STRUCTURES PROJECTS INTERRUPTED FINISHED IN DEVELOPMENT TOTAL Local Health Unit endowed with hospital structures (Asl) Hospital Trust (A.O.) Public Institute of Hospitalisation and treatment for Scientific Research (IRCCS PUBL) Private Institute of Hospitalisation and treatment for Scientific Research (IRCCS PRIV.) Classified Hospitals Private Hospitals Included in public health network (Case Cura) TOTAL Main topics REPORT PROGETS 2001 TOT. Asl A.O. Case Cura IRCCS PUBL IRCCS PRIV Ospedali Classif Progress Report HPH Network Italy - Lombardia Region 10

11 Health education and consulting Improving continuity care Patients well-being Nutrition Rehabilitation Cardiovascular diseases Hospital hygiene Diabetes Cancer Tobacco Intercultural hospitals 3 3 TOTAL Inter-hospital projects are still running and we do not present reports for the year. One of them (Security in the hospital) was cancelled because of a national law forced all the hospitals to spend resources in these topics Please specify the norms for new members to join The new members have to subscribe an obligation act from the hospitality structure in order to achieve the WHO aims: to identify a coordinator and technical scientific committee for the planning and evaluation of the identified projects; to realize at least three projects with a three years duration in the five years considered; and the plans have to be realized without added economical resources compared to the funds allocated by the Region Are there specific strategies and activities to recruit new members? Since one of the reasons that holds up the involvement of new members is the shortage of funds, the Region is setting up a measure to allow the hospitality structures to receive financial supports from private sponsors ( Foundations and Associations ) In your opinion, how can the network improve supporting member hospitals? Important is to improve the network in order to facilitate information and exchanges of experiences among the projects of the different countries Do you think the national/regional network should set an annual theme (e.g. smoke-free hospitals, evidence, alcohol, mental health)? Yes we do Progress Report HPH Network Italy - Lombardia Region 11

12 4.5. What do you think in your country/region does limit more hospitals to join in the activities of the HPH network? Financial problems: the health costs keeps on raising and therefore the general managers do not want to invest additional human and economic resources in HPH projects; there is a lack of co-ordination among the different projects ( Quality, EBM, ecc ) Please describe the main achievements of the network 1. to encourage the development of the inter-hospitals communication by the network in a way to increment exchange of information; 2. to push the implementation of the inter-hospitals projects to create a huge impact in the field of health promotion and set up a database on the effects of health promoting actions on the population; 3. to implement monitoring and evaluation system of the projects; 4. to start a review process on HPH role inside the health regional system; and 5. to continue to promote HPH initiatives among the hospital not yet involve in the HPH project Please describe the main problems encountered in the network In the time of existence of the Lombardia region network, main problems encountered could be listed as follows: Difficulties in planning projects for lack of economic resources and difficulties in searching sponsorships. Communication difficulties for lack of informatics network in many hospital structures and low grade of knowledge of about the hospital staff. Limited knowledge in planning methodology in the hospital staff. A basic training course is needed in order to make uniformity of the projects. This is the only way to make a comparison and objective evaluation related to flexible models to be applicable in other hospital structures. Difficulties to pool in common resources and different professions, to develop a deep collaboration between public and private hospitals. For these reasons, the five interhospital projects above-mentioned, have been proposed Problems in realising HPH projects due to lack of funds. Reorganisation of the regional department and change of the HPH co-ordinator. Difficulties in sharing projects through internet as mean of exchange information and experiences at national and international level. Low trained level of the personnel involved in the projects, with the necessity to continue training courses both at first and second level, developing topics such as evaluation and set of indicators construction for HPH projects Progress Report HPH Network Italy - Lombardia Region 12

13 Difficulties in building shared projects and in working together. Overlapping with other regional initiatives such as quality assurance implementation projects or health preventive programmes The problems are the same of the previous period. In addition, there are difficulties of co-ordination among the different projects. The hospitality structures, i.e., started many projects for the quality improvement, which are not included among the HPH ones just because they don t have incentives or additional funds, whereas they would have all the characteristics to be included among the HPH projects. 5. National/Regional health policies 5.1. Is health promotion a focus area in national/regional health policies/laws/regulations (if yes, please state referring documents)? Yes, recently ( 13th March 2002) the Socio-Sanitario Regionale Plan (Local-Social Health Plan) has been approved In general, is the national/regional health system context supportive of the development of HPH? Yes, because the Center of Coordinating network is Region Government Health Department Please outline last year s changes in national/regional health policies that directly influence HPH activities. The national politic is evolving to a federalism, thus increasing the Regions responsibility. From a central focused level, this policy allows to give a general line on the health priorities. From a regional level, it allows to integrate these needs with the more specific ones of the district In your opinion, how could the national/regional health policy better improve the HPH idea? by promoting the integration among the assistance levels ( hospital, PHC, general practitioners); and by promoting the determination of health routes Progress Report HPH Network Italy - Lombardia Region 13

14 6. Collaborating with WHO 6.1. How do you think could WHO better meet the needs of the national/regional networks? Implementing European network with common strategies among the few topics, i.e. lifestyles. 7. Activities in hospitals 7.1. In member hospitals, how are subprojects chosen? Are they developed based on formal assessment of need? Each hospital direction issues every year a three-year strategic plan where the primary aims are included and where the HPH could also be included Concerning the implementation of subprojects, which factors were most supportive or obstructive? Supportive: even slowly, the managers are turning to the new HPH culture. Obstructive: lack of economics funds and dedicated operators Please provide a list of member hospitals Starting from 2002, as a consequence of a reorganization of the regional health system, the number of the registered members must be reduced from 62 to 57, as it follows: LIST OF MEMBER HOSPITALS IN LOMBARDIA REGION Structure typology Number Local Health Unit endowed with hospital structures 2 Hospital Trust 24 Public Institute of Hospitalisation and treatment for Scientific Research 3 Private Institute of Hospitalisation and treatment for Scientific Research 8 Classified Hospitals 3 Private Hospitals Included in public health network 17 TOTAL Progress Report HPH Network Italy - Lombardia Region 14

15 Hospitals Hospital Trust: AZIENDA OSPEDALIERA "DESENZANO DEL GARDA" AZIENDA OSPEDALIERA "FONDAZIONE C. MACCHI" AZIENDA OSPEDALIERA "G. PINI" AZIENDA OSPEDALIERA "G. SALVINI" AZIENDA OSPEDALIERA "IST. OSPEDALIERI C. POMA" AZIENDA OSPEDALIERA "ISTITUTI CLINICI DI PERFEZIONAMENTO" AZIENDA OSPEDALIERA "ISTITUTI OSPITALIERI" City Desenzano Varese Garbagnate Milanese Mantova Cremona AZIENDA OSPEDALIERA "LUIGI SACCO" AZIENDA OSPEDALIERA "M. MELLINI" Chiari AZIENDA OSPEDALIERA "NIGUARDA CA' GRANDA" AZIENDA OSPEDALIERA "OSP. DI CIRCOLO" Busto Arsizio AZIENDA OSPEDALIERA "OSP.TREVIGLIO CARAVAGGIO" Treviglio AZIENDA OSPEDALIERA "OSPEDALE CIVILE" Vimercate AZIENDA OSPEDALIERA "OSPEDALE CIVILE" Legnano AZIENDA OSPEDALIERA "OSPEDALE DI CIRCOLO" Lecco AZIENDA OSPEDALIERA "OSPEDALE MAGGIORE" Crema AZIENDA OSPEDALIERA "OSPEDALE S. ANNA" Como AZIENDA OSPEDALIERA "OSPEDALE S.CARLO BORROMEO" AZIENDA OSPEDALIERA "OSPEDALI RIUNITI" Bergamo AZIENDA OSPEDALIERA "S. PAOLO" AZIENDA OSPEDALIERA "S.GERARDO DEI TINTORI" Monza AZIENDA OSPEDALIERA "SPEDALI CIVILI" Brescia AZIENDA OSPEDALIERA 'EUGENIO MORELLI' Sondalo (SO) AZIENDA OSPEDALIERA FATEBENEFRATELLI E OFALMICO Private Hospitals Included in public health system: CASA DI CURA GAVAZZENI Bergamo CASA DI CURA MATER DOMINI Castellanza CASA DI CURA MULTIMEDICA Sesto S. Giovanni CASA DI CURA POLIAMBULANZA Brescia 2002 Progress Report HPH Network Italy - Lombardia Region 15

16 CASA DI CURA S. ANNA Brescia CASA DI CURA S. CARLO Paderno Dugnano CASA DI CURA S. MARIA Castellanza CASA DI CURA VILLA BIANCA Limbiate CASA DI CURA VILLA ESPERIA Salice Terme CLINICA S. ROCCO FRANCIACORTA OME CLINICA ZUCCHI Monza POLICLINICO S.PIETRO Ponte S. Pietro POLICLINICO SAN MARCO Osio Sotto ISTITUTO POLICLINICO SAN DONATO San Donato Milanese ISTITUTO ORTOPEDICO GALEAZZI ISTITUTO CLINICO HUMANITAS ISTITUTO DI CURA CITTÀ DI PAVIA Pavia Classified Hospital: OSPEDALE S. GIUSEPPE DELL'ORDINE S.G. DI DIO OSPEDALE S. ORSOLA DELL'ORDINE S.G. DI DIO Brescia OSPEDALE SACRA FAMIGLIA DELL'ORDINE S.G. DI DIO Erba Private Institute of Hospitalisation and treatment for Scientific Research: S. MARIA NASCENTE. FONDAZIONE PRO JOVENTUTE DON GNOCCHI FONDAZIONE MAUGERI CLINICA DEL LAVORO Pavia FONDAZIONE MAUGERI CLINICA DEL LAVORO FONDAZIONE MAUGERI CLINICA DEL LAVORO FONDAZIONE MAUGERI CLINICA DEL LAVORO FONDAZIONE MAUGERI CLINICA DEL LAVORO ISTITUTO AUXOLOGICO ITALIANO. OSPEDALE S. LUCA ISTITUTO NEUROLOGICO C. MONDINO Montescano Tradate Castel Goffredo Gussago Pavia Public Institute of Hospitalisation and treatment for Scientific Research: ISTITUTO NAZIONALE DEI TUMORI ISTITUTO NEUROLOGICO C. BESTA 2002 Progress Report HPH Network Italy - Lombardia Region 16

17 POLICLINICO SAN MATTEO Local Health Unit endowed with hospital structures: LOCAL HEALTH UNIT PROVINCIA DI SONDRIO LOCAL HEALTH UNIT VALLECAMONICA-SEBINO Pavia Sondrio Breno 2002 Progress Report HPH Network Italy - Lombardia Region 17