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Re-orientation of Health Promoting Hospitals and Health ...
Transcript of Re-orientation of Health Promoting Hospitals and Health ...
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Re-orientation of Health Promoting Hospitals and Health ServicesLessons from Pandemic: Taiwan experience
Consultant, Hualien Tzuchi HospitalProfessor, Tzuchi UniversityFormer Director General, Health Promotion AdministrationFormer Secretary General, Taiwan Network of Health Promoting Hospital and Health Services
Dr. Yingwei Wang
SDG
Aging
Urbanization
Climate change
Migration
Multimorbidity
Globalization
TechnologyCost NCD 2
The Pandemic 4th Wave
• 1st Wave: Immediate mortality and morbidity of COVID-19.
• 1st Wave Tail: Post-ICU and admission recovery for many patients.
• 2nd Wave: Impact of resource restrictions on non-COVID conditions – all the usual urgent things that people need immediate treatment for – acute.
• 3rd Wave: The impact of interrupted care of chronic conditions (people stayed home).
• 4th Wave: Psychic trauma, mental illness, PTSD, economic injury, burnout, and more.
Joe Babaian in healthcare leadership. https://hcldr.wordpress.com/2020/04/07/the-pandemics-4th-wave/3
Climate (Pandemic) resilience in health care facilities
WHO guidance for climate-resilient and environmentally sustainable health care facilities. Geneva: World Health Organization; 2020. 4
Strategies to strengthen resilience by health system function and stage in the shock cycle
Strengthening health systems resilience: key concepts and strategies (2020) www.euro.who.int
Stages of a shock cycle
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Covid-19 cases no. in Taiwan 2020-2021Lo
cal c
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Covid-19 outbreak in May 2021- but case number dropped to near zero in late September 2021 -
No. of screening for Covid-192020 01 – 2021 10
Number of local Covid-19April – sporadicMay – 400/daySeptember <10/day
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Health system respond to Covid-19 pandemic
National
Local
OrganizationHealth Promoting
Health service
Individual Patient / family
Macro-level
Meso-level
Micro-level
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• Individual: knowledge, attitudes, self-efficacy, health literacy skills, values, personal psycho/social/demographic attributes;
• Interpersonal: people with close relationships to the individual: immediate family, relatives, close friends and co-workers, peer network;
• Organizations: agencies, social institutions, public/private partnerships;
• Community: schools, workplaces, neighborhoods, places of worship, community primary care;
• Policies: national healthcare organizations, governmental ministries, mandates, laws.
IUHPE – Global Health Promotion Vol. 28, No. 2 202110
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How has SARS affected the response to COVID-19
-Taiwan experience -
• “The biggest issue at that time was ignorance” about the virus, Chen says. “We didn’t know how to diagnose it, we didn’t know how many it would kill, we didn’t know how to treat it. We didn’t know anything! This made us very nervous.”
• Another factor contributing to the severity of the crisis in Taiwan was the lack of strong infection-control standards in Taiwan’s hospitals at that time, he notes. The most egregious example was the Taipei Municipal Heping Hospital outbreak in April 2003, when an ineffective shutdown and quarantine procedure resulted in over a hundred infections and dozens of deaths, many among hospital staff.
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The Vice President mentions that the Communicable Diseases Control Act, the statute that sets the standards for quarantine and containment of infectious diseases in Taiwan, had not been updated in decades at the time of the SARS outbreak.
Taiwan’s Centers for Disease Control was an underdeveloped agency when SARS hit. “Our CDC was not well-staffed, didn’t have great equipment, and was not well-prepared.
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Individual level – citizen behavior / professional behavior
• Facial mask not available : • Under report or not report for disease history • Not follow about home isolation • News reporter hided in the hospital to get the first hand information • The Mayor refused the transferred infectious patient • People against the medical wasted • Senior medical officer remoted control/command for the disease control
• Physician / nurse asked for temporary leave
What happen during SAS in 2003
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Meso level – Hospital administration• Many Hospitals refused infectious patient. Hospital was working alone at that time
• No restriction for the discharged patient
• Hospital under reported of infectious cases: in considering of the operation and income of the hospital
• Freely movable of the nursing aid
• Hospital infections control was not the major issue in Hospital Accreditation
• The consideration in private hospital
Macro –level - National level / infectious control policy
• Remote area / island : inadequate health facilities • Referral system broken• Absent of effective infectious control policy
What happen during SAS in 2003
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• “I thought, oh wow, SARS has returned!” he told Taiwan Business TOPICS in an interview. But he said he felt confident that if it did turn out to be another appearance of the SARS coronavirus (of which no cases have been reported since 2004) and were to make its way across the Strait, Taiwan would have no problem defending against it. Taiwan had the experience and would be prepared to keep the contagion under control.
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• “Doctors now ask their patients about their TOCC,” Chen says, using an acronym that stands for travel history, occupation, contact history, and cluster – whether or not they had engaged in any group activities in the time period leading up to their illness.
• “We now have a very good computerized system for customs and immigration that can show us very easily which destinations people have previously visited,” says Chen. “Through data collected from our National Health Insurance system…
Minister of Health and Welfare Chen Shih-chung, left, and Vice President Chen Chien-jen
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Daily press conference
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20 million
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Tracing social contact App
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Comparing 7 different ‘washing hand’ posters by PREDICTIV project
The practice of health literacy
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Local government - New Taipei City
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Health system respond to Covid-19 pandemic
National
Local
OrganizationHealth Promoting
Health service
Individual Patient / family
Macro-level
Meso-level
Micro-level
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What is health promotion?
Health promotion enables people to increase control over their own health. It covers a wide range of social and environmental interventions that are designed to benefit and protect individual people’s health and quality of life by addressing and preventing the root causes of ill health, not just focusing on treatment and cure.
1986 World Health Organization (WHO) Ottawa Charter for Health Promotion
Empowerment
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Key concept of Health Promotion
3 strategies • Enable • Mediate• Advocate
5 Domains • Building healthy public policy• Create supportive environment• Strength community action • Development personal skills• Reorient health services
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• Combined use of the Ottawa Charter strategies are far more effective than single strategy• Combination can be adapted for use in different settings• The population should be involved in the action and decision making process• Learning and communication, granting autonomy to the communities and population.
Development of Health Promotion
Health promoting hospitals Health promoting schools
Safe Community Healthy City Healthy Community
Healthy workplace
Jakarta Declaration on Leading Health Promotion into the 21st Century (1997)
The Bangkok Charter for Health Promotion in a Globalized World (2005)
Ottawa Charter for Health Promotion (1986)
Building Healthy
Public Policy
Creating Supportive
Environment
Strengthening Community
Action
Developing Personal
Skills
Reorient Health
Services
Helsinki Statement (2013), health in all policies, universal health coverage
Shanghai Charter Health Promotion (2016) Healthy cities and Health Literacy
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9th Global Conference on Health Promotion, Shanghai 2016
Health Literacy is an important factor in improving health outcomes
Increase knowledge to help people to make healthiest choice and decision for themselves or theirs family to achieve the goal: Empowering citizens Reducing health
inequities
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Empowerment Framework - 4 dimensions
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Empowerment
Participation
Supportive network
Supportive network
Resources
Training/Information
Training/Information
The first international HPH conference 2007 The first membership certificate 2005
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HPH Regional and National Networks 2006
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The development of HPH in Taiwan
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50
100
150
200
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2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
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61 67 79 93
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142 140
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184202Health Promotion Hospital
Healthy Hospital
NO.
2006Joint WHO
HPH international
network
2008HPH accredication
2012Empower local
government to joint the program
2017Integrating health
hospital
The milestone of HPH development
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1. 管理政策2.病人評估3.病人的資訊與介入4.推動健康職場及確保臨床健康促進的能力5.執行與監測6.高齡友善7.以人為中心之照護8.氣候行動
管理政策 病人評估 病人的資訊與介入 推動健康職場 執行與監測
1. 管理政策2.病人評估3.病人的資訊與介入4.推動健康職場及確保臨床健康促進的能力5.執行與監測6.高齡友善7.節能減碳
2006-2016
2017-2020
2021-
HPH certification
Healthy Hospital(HH) certification 1.0
Healthy Hospital(HH) certification 2.0
Level of Health Hopital (HH) hospital
Healthy Hospital-Advance level
WHO-HPH-46 items Age-friendly Healthcare-18 items Tobacco Free Hospital-48 items Environment-friendly Hospital-10 issues
38 items
Healthy Hospital-Basic level
Using PFM(patient-
focused method)
UsingPaper review
Or PFM
Pay for performance
Service indicator1. Responsibility2. Quality of care 3. health literacy
Demonstration Center
Cancer diagnosis and treatment quality certification hospital
Baby-Friendly Hospital Tobacco Free Hospital
2020 Healthy Hospital Certification 2.0 Simplify & integrates (27 items) Aging-friendly Person-centered care Climate Action Certified by Gold/Silver
Regular reporting and health information
Healthy hospital 2017 Integration of different certification
Health Hospital Accreditation 健康醫院認證 (2017)
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StandardLow carbon hospital
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Policy and Leadership
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Patient Assessment
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Patient Information and Intervention
Promoting a Healthy Workplace and Ensuring Capacity for CHP
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Implementation and Monitoring
Age-friendly Healthcare
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Health literacy social ecological model (HLSEM)健康識能的社會生態模式
43McCormack, et al., Improving low health literacy and patient engagement: A social ecological approach, Patient Educ Couns 2017 Jan;100(1):8-13
病人參與 健康識能
Health Literate OrganizationGuidebook and Toolkit
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Healthy Hospital Accreditation 2.0 (2021)
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Policy and Leadership
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Patient Assessment
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Standard
Patient Information and Intervention
Promoting a Healthy Workplace and Ensuring Capacity for CHP
04Implementation and Monitoring
Age-friendly Healthcare
05 People-centered health care
Climate action
Healthy Setting
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Hospital
Medical CenterRegional HospitalDistrict Hospital
Primary care
ClinicPublic Health Center
Long term care
Long-term Care FacilitiesNursing Homes
Health Promotion and Health Services Health Literacy Age-friendly Health Promotion Environment-Friendly Tobacco-free Person-centered
HH 2.0
Certification of Age-friendly
Certification of Age-friendly
Certification of Age-friendly
New HPH standards from International Network (2020)
• Standard 1: Demonstrating organizational commitment for HPH – Substandard 1: Leadership – Substandard 2: Policy– Subdimension 3: Monitoring, implementation,
and evaluation
• Standard 2: Ensuring access to the service– Substandard 1: Entitlement and availability – Substandard 2: Information and access– Substandard 3: Socio-cultural acceptability
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• Standard 3: Enhancing people-centered health care and user involvement– Substandard 1: Responsiveness to care needs – Substandard 2: Responsive care practice– Substandard 3: Patient and provider
communication – Substandard 4: Supporting patient behavioral
change and patient empowerment– Substandard 5: Involving patients, families,
caregivers, and the community– Substandard 6: Collaborating with care
providers
• Standard 4: Creating a healthy workplace and healthy setting– Substandard 1: Staff health needs,
involvement, and health promotion– Substandard 2: Healthy setting
• Standard 5: Promoting health in the wider society– Substandard 1: Health needs of the
population – Substandard 2: Addressing community health – Substandard 3: Environmental health– Substandard 4: Sharing information, research,
and capacity
New HPH standards from International Network (2020)
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What happens after Covid-19 on HPH-at early stage of Pandemic -
Outpatient clinic visit decreased 5 million /Jan-March 2020
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The impact of Covid-19 on NCD, Age, Gender
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• The risk factors for COVID 19 mortality
– Male: 1.76 X
– > 65 Y/O: 6.06 X
– Smoking: 2.51 X
– DM: 3.68 X
– Hypertension: 2.72 X
– CV disease: 5.19 X
– Respiratory :5.15 X
Z. Zheng, et al., Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis, Journal of Infection,https://doi.org/10.1016/j.jinf.2020.04.02
Today:
• Italy: Among those dying of COVID-19 in hospitals, 68% had hypertension and 31% had type 2 diabetes.
• India: 30% fewer acute cardiac emergencies reached health facilities in rural areas in March 2020 compared to the previous year.
• Netherlands: The number of people newly diagnosed with cancer dropped by 25% as a result of the lockdown.
• Spain: Among patients with severe COVID-19 disease, 43% had existing cardiovascular diseases.
Since the COVID-19 outbreak, people living with NCDs are more vulnerable to becoming severely ill or dying from COVID-19
Source: https://www.who.int/teams/ncds/covid-19
SDG 3.4
The world is at a critical juncture. The execution of a forward-looking strategy inclusive of NCDs is required to build back better.
Build back better tomorrow:
• Build bridges between national humanitarian emergency plans and NCDs responses
• Address the historic underinvestment in NCDs, call for new international funding patterns, a reset of global initiatives, and build new partnerships for NCDs.
• Develop systematic approaches to digital health care solutions for NCDs
2019 2030
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https://www.bertelsmann-stiftung.de/en/topics/aktuelle-meldungen/2018/januar/patients-value-dr-googles-versatility/
NCD – Video consultation
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Diabetes self-management APP-
Recording personal healthy number
- human coaching- education information
Develop healthy life style Manage and reduce the risk of type
2 diabetes
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My Health Bank
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Heightening the awareness
of self-care
Reaching self-data anytime
anywhere
Telemedicine, eHealth, telehealth, telecare and mHealth
Int. J. Environ. Res. Public Health 2014, 11, 1279-1298
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Prospect of 3P
Person-Centered Care
Practice-oriented
Person Digital Health
Get a modern PowerPoint Presentation that is beautifully designed.
Health Literacy SDM
Integrate Multimorbidity ICOPE
Mobile Health for Ageing (mAgeing)
PHR (Personal health record))
Health system respond to Covid-19 pandemic
National
Local
OrganizationHealth Promoting
Health service
Individual Patient / family
Macro-level
Meso-level
Micro-level
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Life after Covid-19 pandemic
People will have to change their behaviorto prevent second waves of the virus.
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Source: https://www.economist.com/international/2020/07/04/covid-19-is-here-to-stay-the-world-is-working-out-how-to-live-with-it; https://www.atlassian.com/blog/teamwork/lessons-of-pandemic-change-company-culture
How the new normal will change company culture for good. Remote work will be normalized (finally) Business strategy will focus on adaptability
How Culture Affects Your Decision to Wear a Mask?
EAST
WEST
(Source: https://kknews.cc/zh-cn/entertainment/5g64o58.html; https://m.juksy.com/archives/91228; https://www.scmp.com/news/china/society/article/3075211/face-masks-and-coronavirus-how-culture-affects-your-decision)
https://www.thelancet.com/journals/lanwpc/homehttps://doi.org/10.1016/j.lanwpc.2020.100044
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Source: English Island
Social isolation Social distancing Physical distance
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社交疏離 社交距離 地理疏離
Regarding older people and also those with underlying health conditions, having been identified as more vulnerable to COVID-19, and to be told that you are very vulnerable, can be extremely frightening and very fear-inducing.
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Eating together through internet –Social connection
Reflection- Confronting the “Multiple Existential Threat” -
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COVID-19 and SDGs
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“devastating” effect on human health
Source:impact hub taipei
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The relevance of healthy goal and other goals
HealthGoal 1: End povertyTarget 1.3: Implement social protection system for all
Goal 1: End povertyTarget 1.3: Implement social protection system for all
Goal 4: Ensure inclusive and equitable education…Target 4.2: ensure to access to early childhood development, care and pre-primary education…
Goal 4: Ensure inclusive and equitable education…Target 4.2: ensure to access to early childhood development, care and pre-primary education…
Goal 5: Achieve gender equality and empower all women and girlsTarget 5.2: end all forms of violence against all women and girl…
Goal 5: Achieve gender equality and empower all women and girlsTarget 5.2: end all forms of violence against all women and girl…
Goal 6: Ensure availability and sustainable management of water and sanitation for allTarget 6.1: achieve universal and equitable access to safe and affordable drinking water
Goal 6: Ensure availability and sustainable management of water and sanitation for allTarget 6.1: achieve universal and equitable access to safe and affordable drinking water
Goal 2: End hunger, achieve food security and improve nutritionTarget 2.2: end malnutrition, achieve target for reductions child stunting and wasting
Goal 2: End hunger, achieve food security and improve nutritionTarget 2.2: end malnutrition, achieve target for reductions child stunting and wasting
Goal 16: Promote peaceful and inclusive societies for sustainable development…Target 16.1: reduce all forms of violence and related death rates everywhere
Goal 16: Promote peaceful and inclusive societies for sustainable development…Target 16.1: reduce all forms of violence and related death rates everywhere
Reference:The Sustainable Development Goals: The implications for health post-2015
Other goals and targets e.g. 10(inequality), 11(cities), 13(climate change)Other goals and targets e.g. 10(inequality), 11(cities), 13(climate change)
People, planet and participation: The
Kuching Statement
• People: People’s physical, mental and social wellbeing is the core business of cities. . . . successful cities put the focus on quality of life.
• Planet: People cannot thrive without the Earth’s support systems or the biodiversity of natural ecosystems.
• Participation: In order to put people and the planet at the heart of governance, healthy, just and sustainable cities engage fully with their citizens and community organizations.
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“We cannot re-write the chapters of history already past, but we can learn from them, evolve and adapt. The new normal may even be a better normal, certainly a different normal”
A quote from Ian Davis, Managing Partner at McKinsey, in his article ‘The New Normal’
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Healthy At Home
• Eating healthily• Staying physically active
Digital Health Reforms
• Digital interactive technology platform
• Personal App for self-management
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• Can “HPH 2.0” develop a more resilience health service in the
changing world?
• Do we need “HPH 3.0”?
Einstein is quoted as having said that if he had one hour to
save the world he would spend fifty-five minutes defining
the problem and only five minutes finding the solution.
Take home message
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促進健康 Promotion,預防疾病 Prevention,安全防護 Protection,共同參與 Participation,夥伴合作 Partnership!
⺠眾參與Person engagement ⺠眾增能Person empowerment
⺠眾為中⼼的照顧Person-Centered Care
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