Tervise edendamine ja kvaliteedi tagamine Eesti haiglates

1990. aastate keskpaigas algatati Maailma Terviseorganisatsiooni eestvedamisel tervist edendavate haiglate (TEH) liikumine, mille eesmärgiks oli lisaks diagnostikale ja ravile julgus tada haiglaid tegelema rohkem ka haiguste ennetamise ning tervise edendamisega. Tervist edendav haigla peaks kaasa aitama nii oma patsientide kui ka töötajate tervise edendamisele ning seeläbi tagama ka kvaliteetsema tervishoiuteenuse osutamise. Eestis algas TEH-liikumine 1999. aastal, 2005. aasta lõpuks on võrgustikuga ühinenud 22 haiglat. Käesolevas töös on analüüsitud ning võrreldud TEH-võrgustikuga ühinenud ja võrgustikku mittekuuluvate Eesti haiglate tegevust tervise edendamise ja tervishoiuteenuste kvaliteedi tagamise valdkonnas. Eesti Arst 2006; 85 (1): 2–

Health-promoting hospitals in Estonia: what are they doing differently?

The health-promoting hospitals (HPH) movement in Estonia was initiated in 1999. This study aimed to compare the implementation of health-promoting and quality-related activities in HPH and those which have not joined the HPH network (non-HPH). In the beginning of 2005, a postal survey was conducted among the top managers of 54 Estonian hospitals. The questionnaire was based on the WHO standards for HPH and on the set of the national quality assurance (QA) requirements for health services. The study demonstrated some significant differences in the uptake of health promotion and QA activities between HPH and non-HPH. For example, regular patient satisfaction studies were conducted in 83% of HPH and 46% of non-HPH (P < 0.03) and 65% of HPH and 46% of non-HPH cooperated with various patient organizations (P < 0.03). Systems for reporting and analysis of complications were implemented in 71% of HPH and 33% of non-HPH (P < 0.03); also, the implementation of various guidelines was more developed in HPH. All HPH have carried out a risk analysis on the workplace and staff job satisfaction studies were conducted in 89% of HPH and 41% non-HPH (P < 0.05). This study indicates that the concepts of HPH and QA are closely related. Making progress in health promotion is accompanied with QA and vice versa. Implementation of health-promoting activities in hospitals will promote the well-being and health of patients and hospital staff, and creates a supportive environment to provide safe and high-quality health services

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

Background: Implementation 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. Methods: Forty-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. Results: No 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). Conclusions: The 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