Shu-Ti

Shu-Ti Chiou MD, PhD, MSc•Director-General, Bureau of Health Promotion, Taiwan•Coordinator, Taiwan HPH Network•Vice Chair of Governance Board, International Network of HPH and HS•Chair and Coordinator, Task Force on HPH & Environment

Innovative Strategies, Best Practice and Networks:

the Experience of Taiwan

2

Outline

Introduction to Taiwan HPH Network Implementation of HPH model in Taiwan

Network Examples of HP programs in hospitals The way forward

Introduction to Taiwan HPH Network

4

Health status, Taiwan & Italy (2009)

Taiwan Italy

Total population23,162,000 (2010)

59,870,000

(2.6 times of Taiwan’s)

% of 65 y/o and above 10.7 (2010) 20

Crude birth rate(‰) 8.3 10

Maternal mortality rate ( per 100,000） 4.2 (2010) 5

Neonatal mortality rate(‰) 2.4 2

Infant mortality rate(‰) 4.2 3.7

Life Expectancy 79 82

Male 76 79

Female 82.3 84Source: 1. United Nations, Department of Economic and Social Affairs Population Division, Population Estimates and Projections Section 2.WHO Statistical Information System (WHOSIS)3. Health at a Glance Europe 20104. World Health Statistics 2011

5

Hospitals in Taiwan

Total = 508 hospitals; Total beds= 135,401beds Distribution of ownership (by hospitals/ by hospital beds):

Owner % of hospitals % of beds

Public 16.1 % 33.6 %

Private non-profit 24.2 % 36.8 %

Private for-profit 59.6 % 29.6 %

6

Hospitals in Taiwan

Average LOS: 7-8 days Provide both outpatient and inpatient services. Patients can have direct access to hospital outpatient care

and have a free choice of providers, including specialists and dental care.

Hospitals accounted for 43% of preventive services reimbursed by the Bureau of Health Promotion.

59-71% of the adult population had at least one hospital visit in 2008 (ex. 59% of persons aged 30 years or more, 65% of persons aged 50 to 69 years).

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Universal coverage of healthcare in Taiwan

Bureau of National Health Insurance:

acute and chronic illness care,

medications, surgeries, dental treatment,

etc.

Bureau of Health Promotion: prenatal checkup neonatal screening well-baby clinic general checkup for adults

and elderly cancer screening smoking cessation, preventive dental services,

etc.

8

Growth of Taiwan HPH Network

100

7264

55

40

22

5

0

20

40

60

80

100

120

2006,Nov. 2007,Aug. 2008,Aug. 2009,Aug 2010,Aug 2011,Oct 2012, Oct

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Development of Taiwan HPH Network -1

2002 The 1st HPH initiative in Taiwan: Taipei Healthy City Initiative and accreditation for “Healthy Hospitals” (Director-General of Taipei City Health Department)

2005 The 1st WHO HPH member hospital in Taiwan and in Asia (Taipei Municipal Wan-Fang Hospital)

2006 Another 4 member hospitals in Taiwan

2006 Dec. Establishment of Taiwan Network (the Founder)

2007 Aug. Expanded and registered as an NGO in Taiwan with 22 member hospitals (the Chair)

2008 4th biggest in the world with 61 member hospitals

2nd highest number of papers in international conference

2009 2nd highest number of papers in international conference

10

Development of Taiwan HPH Network -2

2009 WHO Winter School in Taiwan (first in Asia)2010 Taskforce on HPH and Environment was approved for a 4-

year term by the General Assembly of HPH International Network.

2010 1st highest number of papers in international conference2010 government-initiated special programs on HPH with grant

support, such as hospital cancer control program, smoke-free hospitals, environment-friendly hospitals, age-friendly hospitals, HPH international recognition trial, etc.

2011 1st highest number of papers in international conference2011 October: 2nd largest network with 72 member hospitals2012 The 20th International HPH Conference will be held in Taipei

(Apr. 2012)

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Distribution of member hospitalsTaipei City 14

New Taipei City 10

Taichung City 7

Yunlin County 4

Changhua County 4

Taoyung County 3

Nantou County 3Chiayi City 3

Tainan City 3

Pingtung County 2

Miaoli County 3 Keelung City 1Hsinchu County 1

Yilan County 1

Hualien County 3Chiayi County 2

Kaohsiung City 7

Total: 72

Taitung County 1HPH(+) in 18 among 22 counties or cities

Lianchiang county 0

Kingmen county 0

Penghu county 0

Hsinchu City 0

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Characteristics of member hospitals

Ownership HPH=72 % in HPH % in all hospitals

Public 35 49 16

Private non-profit 28 39 24

Private for profit 9 12 60

Accreditation level

Medical Center 8 11

Regional H 47 65

District H 16 22

Non-Hospital 1 1

Size (beds)

<=100 3 4 54

101~300 11 15 20

301~600 31 43 11

>600 27 38 16

Implementation of HPH model in Taiwan Network

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Implementation of HPH model in Taiwan Network

Start with “leaders of leaders” Clear definition and methodology of HPH: the

WHO standards Shared learning activities Self-assessment to become a member Make it an honor

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Shu-TiA Health Promoting Hospital and Health Service Is…

An organization that aims to improve health gain for its stakeholders by developing structures, cultures, decisions and processes.

A setting-based (system-oriented) approach involving changes in structures, cultures, decision-making processes and delivery processes

to assure adding of health gain in a systematic and universal way

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Examples of health gains

Dx Tx Gain, specific (ex.) Gain, generic

Pt with OA Arthro-plasty

Postoperative rehab., weight loss

•Smoking cessation•Safe drinking,•Balanced diet•Regular exercise •Periodic checkup (such as Pap smear, CRC screening, mammography, BP, Chole, Glu, Depression, BMI, vision, …)

Asthma medications Home environment modification, self monitoring

Diabetes medications SMBG, Target of weight loss,PA, healthy eating

AMI PTCA, beta blocker, ASA

Cardiac rehab, smoking cessation

Shu-Ti

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Methodology of implementing HPH

The WHO HPH standardsStandard 1. Management Policy

Standard 2. Patient Assessment

Standard 3. Patient Information and Intervention

Standard 4. Promoting a Healthy Workplace

Standard 5. Continuity and Cooperation

developed by WHO in 2006

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Consultant Assessments on Hospital support(1st Accreditation)

Commitment and Support

%

High 90.0

Mod to high 10.0

Low 0

Allocation of Resources, Team-up, and Mobilization of Staff

%

Good 54.3Fair to good 34.3Fair 11.4Inadequate 0

n=70

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Potential of future development %

Positive and Optimistic 78.6

Somewhat positive and optimistic 21.4

Low expectation 0

Past achievements in HP %Productive 54.3

Somewhat productive 42.9

Need more efforts 2.9

Poor 0

Consultant Assessments on Hospital support(1st Accreditation)

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Performance Comparison Between the 1st and 2nd HPH Evaluation

89

87.7

89.4

84.1

92.7

98.1

94.9

96.2

96.4

96.4

0 50 100

1. Mng policy

2. Pt assessmt

3. Pt intervention

4. Workplace

5. Continuity &coop.

Participants who have passed the certification second time displayed higher scores in each standards.

2nd: 25 hospitals (re-certification) 1st: 70 hospitals

(2 hospitals had missing data)

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Elements with scores ≤80 from the 1st visit (all improved in hospitals having the 2nd visit)

1st 2nd

1.2.2Operational procedures such as clinical practice guidelines or pathways incorporating HP actions are available in clinical departments

79.2 95

1.3.2A programme for quality assessment of the health promoting activities is established

80.0 95

3.1.2Documentation and evaluation of health promotion activities and expected results in the records

80.0 91

4.2.3The staff performance appraisal system and continuing professional development includes health promotion

72.5 96

4.3 There are HP procedures or programs for staff 77.1 94.3

4.3.2 Smoking cessation programmes are offered to staff 72.1 91

4.3.3Annual staff surveys are carried out including an assessment of individual behaviour, knowledge on supportive services/policies, and use of supportive seminars

76.4 95

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Annual Awards

Model Hospitals: hospitals showing best implementation of the standards

Innovative Health Promotion Projects on1. Promotion of smoking cessation

2. Tobacco control in psychiatric hospitals

3. Environment-friendliness

4. Physical activity, healthy eating and obesity control

5. Staff mental health promotion

6. Occupational safety

7. Others

HP programs in hospitals

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HP programs in hospitals

Hospital cancer control initiative Age-friendly healthcare initiative Environment-friendly hospital initiative HPH and obesity control Staff health survey Smoke-free hospital initiative Baby-friendly Hospital Initiative Health promotion for diabetes by hospitals Etc.

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Hospital cancer control initiative

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New National Plan on Cancer Control

to achieve 10% of reduction in age-standardized cancer mortality rate by 2015 as compared to 2009 (from 132.5 deaths/100,000 in 2009 to 119.3 deaths/100,000 in 2015).

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0

100

200

300

400

500

600

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

iFOBT

Mammography

Oral examination

Pap smear

Number of Cancer Screening Services, 1995-2013（

× 1

0,00

0 pe

ople）

The new plan expected to achieve a growth of 1.4 folds in volume between 2009 and 2010

Targets of screening

3.01million

4.12million

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Delivery system: how to increase screening capacity and client demand?

Extra budget without extra public health workers. Extra budget without extra primary care clinics. 60-70% of the target population had at least one

encounter with hospitals in 2008.

=>Mobilizing clinical capacity of hospitals in partnership with public health sector will have great potential to achieve the targets and save more lives

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Delivery redesign: a structured module

The WHO Health Promoting Hospital Model integrating health promotion and prevention into and beyond hospital practices

1. Management policy supporting organized screening

2. Systematic patient assessment on their needs of health promotion and screening

3. Providing information and preventive services

4. Continuity and cooperation for screening, Dx and treatment

5. Creating healthy workplaces

developed by WHO in 2006

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Policies to support delivery redesign

1. Project-based subsidy for hospitals to implement the model and transform hospital practices, including

extra personnel, new IT function for automatic assessment and reminding, and

tracking of results, patient education and outreach community services, and self-monitoring and analysis of cancer screening performance;

2. Training for hospital personnel on implementation of the model;

3. External audit, monitoring, feedback and public reporting on hospital performances; and

4. Extra payment for good performance in addition to fee-for-services and project-based subsidy.

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Comparison on growth of screening volume between subsidized hospitals and non-subsided health services

0 50 100 150 200 250

Pap, 2010

Pap, 2009

examination of oral mucosa, 2010

examination of oral mucosa, 2009

iFOBT, 2010

iFOBT, 2009

mammography, 2010

mammography, 2009

unit= 1000 persons

non-subsidized hospitals and clinics

subsidized hospitals2.1

16.2

4.41.1

All screenings, 2 vs. 1Both: 1.5

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Age-friendly healthcare initiative

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Age-Friendly Hospitals and Health Services

Taiwan’s Framework of Age-friendly Hospitals and Health Services is based on: WHO Age-Friendly principles WHO Standards of Health Promoting Hospitals

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Age-Friendly Hospitals and Health Services

VISION: An age-friendly healthcare organization is one which promotes health, dignity and participation of senior people.

VALUES: Health, humanity, human rights MISSIONS:

To create a friendly, supportive, respectful and accessible healing environment tailored to the unique needs of elderly people;

To facilitate safe, health promoting, effective, holistic, patient-centered and coordinated care in a planned manner to the elderly populations;

To empower elderly persons and their families to increase control over their health and care.

published in: Archives of Gerontology and Geriatrics 49 Suppl. 2 (2009) S3–S6

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Age-Friendly Hospitals and Health Services

Strategies toward Aging-friendly Hospital --4 standards, 11 sub-standards, 60 measurable items

1. Management Policy 1.1 Developing an age-friendly policy 1.2 Organizational support 1.3 Continuous monitoring and improvement 2. Communication and Services 2.1 Communication 2.2 Services 3. Care Processes 3.1 Patient assessment 3.2 Intervention and management 3.3 Community partnership and continuity of care

4. Physical Environment 4.1 general environment and equipment 4.2 transportation and accessibility 4.3 signage and identification

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Environment-friendly hospital initiative

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The total reduction of carbon dioxide emissions will reduce 13% of annual CO2 emissions by 2020 compared to the level in 2007

The amount is CO2 reduction is equivalent to the annual absorbing capacity of 34 New York Central Parks

128 Taiwanese hospitals said “yes, we can!” on Oct. 23, 2010

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Energy efficiency Green building design Alternative energy generation Transportation Food Waste Water

Seven Elements of a Climate-Friendly Hospital

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HPH and obesity control

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Promoting healthy eating, exercise and weight loss in hospitals

129 hospitals participated in the kickoff ceremony in March 25

and pledged to lose a total of 135,000 kg of excessive body

weight for staff and patients by the end of 2011.

Afterwards, a total of 164 hospitals joined the program to lose a

total of 156 tons (with 148 tons achieved now).

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Nov 21, 2011: Total weight reduced inTaiwan= 1,044,886 kg National target: 660,000 kg Completion rate: 158.3%

National Weight Reduction Results

Hospital: 148,339.9kg (14.2%)Target: 156,000 kg95% complete

Others: 45,042.4kg (4.3%)

Community:288,807kg (27.6%) School: 75,586.34kg (7.2%)

Target: 80,000 kg 95% complete

Workplace: 487,109.7kg (46.6%)Target: 120,000kg 405% complete!

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Staff health survey

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Workplace Health Promotion--Survey for health-promoting healthcare workplaces

Survey on Health and Safety Needs of Healthcare Workers was conducted in 2011.

Collect data on health risks, occupational hazard exposure, health behavior, expectation and utilization of health promotion resources.

101 hospitals participating in the survey: HPH hospitals: 56 Non-HPH hospitals: 45

Feedback analysis to hospitals

Self Rated Health and Stress

Stressors

Health Conditions

Occupational Hazards

Violence

Exercise Related Resources and Utilization

Dietary Related Resources and Utilization

Stress Adjustment Related Resources and Utilization

Satisfaction of Work

The way forward

Hospitals doing HP programs with the Bureau of HP

Total

N=515

Participation

(%)

HPHN=72

Participation(%)

Non-HPH

N=443

Participation

(%)P value

Cancer Screening 383 74.4% 71 98.6% 312 70.4% <.0001

Age-Friendly 9 1.8% 9 12.5% 0 0.0% <.0001

Environment-friendly 128 24.9% 57 79.2% 71 16.0% <.0001

Obesity control 161 31.3% 68 94.4% 93 21.0% <.0001

Healthy Workplace 101 19.6% 59 82.0% 42 9.5% <.0001

Smoke- Free 53 10.3% 36 50.0% 17 3.8% <.0001

Baby-Friendly 119 23.1% 53 73.6% 66 14.9% <.0001

Diabetes quality care 134 26.0% 59 81.9% 75 16.9% <.0001

Healthy Communities 139 27.0% 38 52.8% 101 22.8% <.0002

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The way forward

Continue to promote HPH model in HP and NCD care

Encourage more hospitals and health services to become members

Encourage hospitals to do research and generate evidence of HPH

Participate in international research To host the 20th International HPH conference in

Taiwan in 2012, the first being held outside of Europe

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Welcome to Taiwan in April, 2012

Main conference: April 11-13, 2012 The Conference Website: www.hph2012.com Deadline of Abstract Submission: Dec 15, 2011 Deadline for Early Registration: Jan 31, 2012 Registration Fee is much lower than before! Hospital visits for different health issues will be

offered Discount system for China Airline air fare is

online at the conference website!

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Registration Fees for the 20th HPH ConferenceEarly RegistrationTill January 31, 2012

Late RegistrationFebruary 1 ~ March 31, 2012

On-site RegistrationApril 11 ~ 13, 2012

Participants from Western Europe, North America,Australia and developed Asian countries

NT$ 4,800.0US$ 160.0

€ 117.9

NT$ 5,800.0US$ 193.3

€ 142.5

NT$ 5,800.0US$ 193.3

€ 142.5

Participants from CEE* countries

NT$ 3,000.0US$ 100.0

€ 73.7

NT$ 4,000.0US$ 133.3

€ 98.3

NT$ 4,000.0US$ 133.3

€ 98.3

Participants from developing countries/Students

NT$ 2,500.0US$ 83.3

€ 61.4

NT$ 3,500.0US$ 116.7

€ 86.0

NT$ 3,500.0US$ 116.7

€ 86.0

Gala Dinner NT$ 2,500.0US$ 83.3€ 61.4

NT$ 2,500.0US$ 83.3

€ 61.4

NT$ 2,500.0US$ 83.3

€ 61.4

Accompanying person NT$ 1,500.0US$ 50.0

€ 36.9

NT$ 1,500.0US$ 50.0

€ 36.9

NT$ 1,500.0US$ 50.0

€ 36.9

* CEE (Central and Eastern Europe) countries include Estonia, Latvia, Lithuania, Poland, Czech Republic, Slovakia, Hungary, Romania, Bulgaria, Slovenia, Croatia, Bosnia-Herzegovina, Serbia, Kosovo, Albania, Montenegro and Macedonia.

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Official Website of the 20th International Conference on Health Promoting Hospitals and Health Services

Beds and Equipments Can Make a Hospital Bigger………

……..but Only Love Can Make a Hospital Greater.

T.H.P.HT.H.P.H

人人

臺灣健康醫院學會Taiwan Society of Health Promoting Hospitals

全人照護 全民健康 全員參與 全球接軌全人照護 全民健康 全員參與 全球接軌Adding value and evidence, promoting holistic healthAdding value and evidence, promoting holistic health

Turn Evidence into Practice

with Love and Partnership…