participativa
2.6 Al servicio de la mejora continua: balances, valoración y ajustes
tools, interactive offers and membership criteria
General network strategy 1 addresses network activities aiming at supporting member or-ganizations in their organizational development towards HPH, i.e. in their attempts to adapt hospital structures and processes towards health promotion. At least three types of methods by which networks can support the organizational development of their member organiza-tions were identified on the basis of the literature search on health promotion networks (com-pare chapter 4). These are a) the provision of tools and materials to support the organizational implementation of health promotion (sub-strategy 1a), the organization of interactive network offers addressing organizational change (sub-strategy 1b), and the prescription of organiza-tional development-related membership criteria (sub-strategy 1c).
7.1.1.1 Network strategy 1a: Providing tools to support organizational development towards health promotion
According to the network literature, the provision of tools to support organizational change is one of the most frequently used interventions by health promotion networks (com-pare chapter 4). However, while offering a knowledge base to organizations to perform (spe-cific aspects of) health promotion, tools alone would, from a theoretical standpoint, not be expected to have much effect if not combined with other types of interventions or network support, since they don’t create a need for change. The PRICES-HPH network survey assessed the networks’ provision of two types of tools, i.e. HPH implementation tools and HPH evalu-ation tools. Implementevalu-ation tools were provided by 18 networks (64%), evaluevalu-ation tools by 15 networks (54%). 11 networks (39%) provided both types, 6 networks (21%) provided no tools at all (compare Figure 37 below).
Figure 37: Network strategy 1a: Number of networks providing (combinations of) implementation and evaluation tools for HPH (N=28)
If assessing the availability of these tools on hospital level, 83 hospitals (46%) from the PRICES-HPH hospital sample belonged to those 11 networks offering both types of tools.
Implementation tools only were accessible to 66 hospitals from 7 networks (37%), evaluation tools only to 13 hospitals from 4 networks (7%). 18 hospitals (10%) were not offered any tools by their network.
7.1.1.2 Network strategy 1b: Interactive offers to support organizational development towards health promotion
Another strategy frequently reported in the literature on health promotion networks are in-teractive offers organized by the network to support organizational development in their member organizations (compare chapter 4). Following the considerations on network effec-tiveness introduced in chapter 4, such offers would be expected to raise the organizational awareness of health promotion, and to impact on organizational decision premises, by
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Evaluation tools only No tools Implementation tools only Implementation and evaluation tools
strengthening the organizational self-observation of specific aspects of health promotion not only by increasing knowledge and know-how but also through the mechanism of peer pres-sure (thus by changing organizational expectations about the expectations and observation criteria of peer organizations within the network), which would make the organizational adop-tion of health promoadop-tion more likely.
The PRICES-HPH network study assessed four types of such offers with dichotomous yes-no reporting questions. These included network projects (provided by 20 networks or 71%), network task forces or working groups as a specific and very common strategy in HPH (provided by 13 networks or 46%), the organization of annual themes (9 networks or 32%), and organized peer support which specifically relates to the health promotion concept of par-ticipation (compare Rootman 2001) and which was provided least often by only 5 networks (18%) (compare Figure 38 below).
Figure 38: Network strategy 1b: Number of networks providing 4 pre-defined types of interactive of-fers to support organizational development in network member organizations (N=28; several answers possible)
Of the 180 hospitals in the PRICES-HPH hospital sample, 161 (89%) had access to pro-jects, 96 (53%) to task forces and 79 (44%) to annual themes. Organized peer support was available for only 28 hospitals (16%), and 11 hospitals (6%) were provided no interactive of-fers by their network. The accessed ofof-fers were available in 8 combinations. The most com-mon combination, which was available to 50% of hospitals form the PRICES-HPH study, was between projects and task forces.
7.1.1.3 Network strategy 1c: Prescribing organizational development-related membership criteria
The formulation and prescription of membership criteria is probably one of the most direct interventions available to a network to impact on the organizational structures of its member organizations. However, in prescribing membership criteria for a rather voluntary movement like HPH, networks will have to keep a balance between effectiveness and attractiveness: Too
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Organized peer support Annual theme Task forces / working groups Network projects
strict criteria will limit the interest of members to join (unless there is strong support from relevant stakeholders in the national / regional health system or health policy environment of the network) and thus limit network growth and attractiveness, while too general criteria will result in ineffective developments in member organizations, which in turn may also negatively impact on the attractiveness of the network.
In HPH, numerous membership requirements for hospitals and health services are formu-lated by the international HPH network in order to secure a minimum of international com-monality and comparability between the networks, while the national / regional networks can formulate their own criteria in order to adapt networking to their specific national / regional conditions. For measuring network strategy 1c, the adherence of networks to four internation-ally prescribed organizational development-related membership criteria (compare HPH consti-tution and letters of intents of HPH member hospitals in the appendix), as well as the net-works’ prescription of five additional pre-defined national and regional membership criteria, were assessed with dichotomous yes-no reporting questions. Of the 28 networks in the sample, 27 adhered to at least one of the four internationally prescribed membership criteria, and 19 of these 27 networks also prescribed at least one of the five pre-defined additional national / regional membership criteria. The median number of membership criteria in place in the net-works was 3, with a maximum of 9 and a minimum of 0. Of the internationally prescribed criteria, having a hospital coordinator was a membership criterion in 24 networks (86%), while the development of a written HPH policy was prescribed in only 12 networks (43%). Addi-tional naAddi-tional / regional criteria were even less common, with the performance of an organi-zational self-assessment according to the 5 HPH standards (Gröne 2006) as a criterion in 10 networks (36%), and the implementation of specific HPH management structures as a criteri-on in criteri-only 2 networks (7%). (compare Figure 39 below).
Figure 39: Number of networks prescribing 4 pre-defined international (dark-grey bars) and 5 addi-tional naaddi-tional / regional membership criteria (light-grey bars) (N=28; several answers possible)
These figures are mirrored on the hospital level: Of the 9 assessed types of membership criteria, 162 hospitals (90%) were demanded to have a hospital coordinator, while only 10 (6%) were demanded to implement a specific HP management structure (see Figure 40 below).
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Implement HPH management structures Ahdere to specific HPH quality criteria Engage in national HPH projects Implement activities on specific themes
Perform regular HPH standard self-…
Develop a written HPH policy Implement HPH strategies, standards Develop / evaluate a HPH action plan Have a hospital HPH coordinator
Figure 40: Number of member hospitals being prescribed 9 pre-defined network membership crite-ria (N=180)
18 different combinations between these 9 criteria were found in the PRICES-HPH net-works. The most common mix was a combination of 5 criteria, i.e. to have a hospital coordi-nator, to develop /evaluate a HPH action plan, to have a written HPH policy, to implement HPH strategies / standards, and to regularly perform a self-assessment according to the 5 standards of health promotion. This combination was prescribed in 7 or one quarter of all networks and applies to 87 member hospitals (48%).