Integrating health promotion with quality improvement in a Swedish hospital

Implementing Organizational WHP Into Practice: Obstructing Paradoxes in the Alignment and Distribution of Empowerment

Background: According to policy and theory, there is need for organizational workplace health promotion (WHP) to strengthen working conditions for all employees. However, earlier studies show it is hard to implement in practice. The aim was to critically analyze and identify interacting mechanisms and obstacles behind failures of organizational WHP projects from system perspectives. Methods: A holistic case study was performed, to critically analyze data from an organizational WHP project approach at a public health care organization. The qualitative data was collected over 5 years and included interviews with key actors (n = 80), focus groups (n = 59 managers), structured observations (n = 250 hours), continuous field observations and documents (n = 180). Questionnaires to employees (n = 2,974) and managers (n = 140) was complementing the qualitative-driven mixed method approach. Results: The analysis shows obstructing paradoxes of alignment and distribution of empowerment during the process of implementation into practice. The obstacles were interacting over system levels and were identified as: Governance by logics of distancing and detaching, No binding regulation of WHP, Separated responsibility of results, Narrow focus on delegated responsibilities, Store-fronting a strategic model, Keeping poor organizational preconditions and support for developments and Isolate WHP from other organizational developments. Conclusions: The following premises can be formulated regarding successful organizational WHP programs. Consider (1) the uncertainty a distributed empowerment to all system levels may create; (2) the distributed impact to define the target and allow broader areas to be included in WHP; and (3) the integration into other development processes and not reducing the organizational WHP to the form of a project.

Learning Processes as Key for Success in Workplace Health Promotion Interventions in Health Care

There is limited previous research on how learning processes contribute to the outcomes of workplace health promotion (WHP) leadership interventions. The aim of this study was to identify the outcomes of a system-based WPH education program for managers and investigated what impact the intervention program had on health-oriented leadership, improvement work, and employee well-being, as well as what factors (i.e., how manager's active work following the intervention and organizational learning climate) contributed to these outcomes. A mixed-methods approach was applied, including qualitative interviews with 23 managers and process leaders, as well as questionnaires to employees and managers representing 17 public health care units in Sweden. The results showed that health-oriented leadership, improvement work, work satisfaction, and vitality increased at workplaces that worked actively to implement WHP following the program. Working actively with WHP and health-oriented leadership was of central importance for success and was a covariate with improved social learning climate, improved developmental leadership, and increased degree of improvement work. All included factors of learning during the intervention were associated with improved job satisfaction, while the increase in vitality seemed unrelated to program implementation. In conclusion, successful outcomes of WHP interventions interact with dimensions of organizational learning climate in the workplace.

Evaluating health promotion standards at the Farshchian heart center of Hamadan, Iran

OBJECTIVE

Farshchian Heart Center is the fifth health-promoting hospital and the first center of its type in Western Iran that officially joined the International Network of Health Promoting Hospitals and Health Services (HPH) in 2016. The purpose of the present study is to evaluate the health promotion standards at this center in 2018.

METHODS

We conducted this cross-sectional study at Farshchian Heart Center of Hamadan. The main data collection instruments included questionnaires obtained from indicators of five different main standards of health-promoting hospitals developed by the World Health Organization (WHO) which were evaluated from three different perspectives: Management staff, hospital employees, and patients. The data were analyzed by SPSS version 21 software.

RESULTS

We evaluated 111 hospital employees, 109 patients, and 6 management staff. Nurses (46.8%) comprised the majority of the hospital staff respondents. Less than half (42.3%) of the hospital staff expressed awareness of hospital health promotion policies; however, only 13.5% had attended various health promotion programs. Only 51.4% of patients knew about the hospital health promotion policies and 17.4% of them participated in relevant programs. The mean score for patient satisfaction with the hospital health promotion programs according to the visual analogue scale (VAS, range: 0-10) was 7.16 ± 2.45, which was significantly higher in outpatients (8.16 ± 1.85) compared to inpatients (6.44 ± 2.59, p = 0.001). Two thirds (66.7%) of the management staff expressed awareness of implementation of these programs.

CONCLUSION

The results of this study demonstrated that health promotion policies based on WHO standards were not well-recognized among patients, hospital employees, and management staff in Farshchian Heart Center of Hamadan, Iran.

A novel Kaizen technique for service quality: case study in educational organization

Purpose

The development and application of systematic procedures enabling Kaizen methodology development are still very rare, especially in the service industry. The purpose of this paper is to suggest a set of innovative improvement methodologies of service quality to enhance the extent and depth of Kaizen in the service domain.

Design/methodology/approach

Combining the importance-performance analysis (IPA) method with impact matrix cross-reference multiplication applied to a classification (MICMAC), which is more convenient in calculation and application, and Fuzzy theory not only effectively integrates opinions of multiple experts, but also improves the conventional MICMAC method, which can only make binary judgment on the mutual influence of elements, by making it able to judge the degree of influence, thereby delivering more accuracy in evaluating the results.

Findings

This innovative method which integrates Fuzzy-MICMAC with IPA displayed its usability in the analysis and research of a certain university library on service quality, and significant differences were found on comparing it with the conventional IPA method. The comparison and suggestion were proposed.

Research limitations/implications

The number of the experts involved and samples under investigation were limited, hence findings were not comprehensive enough and cannot be generalized. This sets the direction for future research.

Originality/value

This proposed method helps in overcoming the lack of systematic procedures enabling Kaizen methodology for service quality. It has the advantage of integrating existing tools and models effectively, which not only improve the shortcomings of the conventional methods, but also result in more convenient calculation and application, to promote Kaizen in service domain.