SCOPE & PURPOSE

Since WHO defined health promotion as the "process of enabling people to increase control over, and to improve their health" (Ottawa Charter 1986), the use of this approach which is also known as "empowerment", has been widely discussed for health enhancing strategies like the development of communities, healthy workplaces and settings, as well as individual lifestyle changes.
But how effective, acceptable and applicable are empowerment strategies with their focus on self-responsibility, self-determination and participation in the everyday routines of expert organisations like modern hospitals? According to practical experiences and scientific research, empowering interventions offer many potentials for improving health outcomes of patients, as well as health impact on hospital staff. This especially holds true for vulnerable and often rather "powerless" groups of patients and staff.
How then can hospitals implement empowering interventions in their everyday structure and culture, and what would be supportive (financial and quality) frameworks for enabling hospitals to become "empowering organisations" for patients, staff, and citizens? In the last 15 years, a considerable amount of knowledge and experiences around these issues has been developed within the International Network of HPH. These will be presented and discussed at the 13th International Conference on HPH in Dublin, with two Irish Networks of Health Promoting Hospitals as local hosts who have the issue of empowerment high on their agenda.

How can hospitals use empowerment to improve patients' health?

Improving the health of patients is the core business of hospitals. For this purpose, what added value can empowerment strategies provide, in addition to the established medical, nursing and therapeutic interventions? There is already a tradition of investing in additional (educative) services for improving patients' ability to live with (chronic) disease, and for developing healthy lifestyles. But hospitals can also use empowerment to enhance the quality of their core services: Enabling patients - and their relatives, or social network - to actively co-operate in diagnostics, therapy and care, as well as to take responsibility for their basic physical, mental and social health needs during hospital stay, can contribute to reduce complications, drug consumption, and length of stay.

Specific issues to be discussed on the basis of models of good practice and research will include:
•••• Empowerment in clinical interventions: Strategies include patient education, information, training and counselling for informed consent, shared decision-making, enhancing compliance, co-operation and co-production of health;
•••• Strategies for empowering patients to take care of their basic health needs during hospital stay, e.g. by providing orientation about hospital services, day schedules, opportunities for communication, infrastructures;
•••• Services for empowering patients to better manage (chronic) diseases: Education, information, training and counselling concerning major chronic conditions (coronary heart disease, stroke, cancer, diabetes melli-tus, COPD, …) but also concerning rehabilitative services;
•••• Services for empowering patients to develop health promoting life styles: Strategies include education, information, training and counselling concerning smoking, nutrition, exercise and other lifestyle issues.

How can empowerment contribute to improve the hospital's impact on staff health?

As workplaces, hospitals represent a number of considerable health risks for their staff. In addition to the traditional strategies of health protection, disease and accident prevention at the workplace, research shows a considerable positive effect of participatory, empowering management and teamwork styles, including the participatory organisation of work processes, on staff health. Strategies in line with these findings are also enhanced by the European Network of Workplace Health Promotion and by the European Agency for Safety and Health at Work.

Specific issues to be discussed on the basis of models of good practice and research will include:
•••• How can hospitals (further) develop supportive leadership competencies and health enhancing teamwork, including conflict management, mutual support, mobbing prevention?
•••• What can be done to enable individual staff members for health promoting work performance, e.g. by providing opportunities for continuous professional education and training; by encouraging staff to suggest ideas on the improvement of work organisation; by providing working hours and recreation periods that fit personal needs (with regard to family life, age); by providing decision-making authority for areas of personal job responsibilities, etc?
•••• How can staff be empowered and supported to develop health promoting individual strategies for managing health risks or for coping with already existing health problems?

How can hospitals empower specific vulnerable groups like elderly, migrants and ethnic minorities, and persons with mental health problems?

All issues of empowerment are especially important for members of socially vulnerable groups. Patients - and staff - from these groups have the greatest needs and offer the largest potential for health improvement by empowerment strategies. Based on recent demographic and epidemiological trends, this conference will have a specific focus on empowering the elderly, migrants and ethnic minority groups, and persons with mental health problems - three groups which will be increasingly represented amongst hospital patients (and staff). As patients who belong to these groups offer a considerable risk for additional irritation, conflicts and stress in the hospital, strategies that allow to better adapt to their needs will also contribute to improve the health impact on hospital staff, as well as the efficiency of hospital services.

Specific issues to be discussed on the basis of models of good practice and research will include:
•••• How can hospitals develop empowering clinical services for vulnerable groups of patients like screening for specific risks and needs already at admission; encouraging patients to communicate expectations concerning professional behaviour; adapting clinical communication to patient expectations, language and hearing problems; adapting existing patient information, training and counselling services and material for vulnerable tar-get groups?
•••• What can hospitals do to create supportive settings for vulnerable groups, e.g. by enabling them to communicate their specific needs with regard to food, day schedules, religious services, and by adapting hospital routines and infrastructures to meet these needs?
· What information and education do staff need to be enabled to meet the needs of vulnerable groups?
•••• How can hospitals improve cooperation with other health care and community services in order to support continuous and integrated support of vulnerable patients?

How can financial regulations and quality criteria be adapted to "empower hospitals for empowerment"?

If hospitals are expected to change their structure and culture towards empowerment, they need supportive frameworks to do so: Financial incentives and quality criteria, as formulated in legal regulations, standards of accrediting bodies, and professional organisations, must make it feasible, reasonable and necessary to develop in this direction.

Specific issues to be discussed on the basis of models of good practice and research will include:
•••• Financial frameworks to allow hospitals to invest in the empowerment of patients, staff and vulnerable groups: How can health promotion and empowerment strategies be introduced in DRGs, in payment systems which are oriented at performance indicators and targets, in payment by results, in fee for service practice, and in other financial frameworks?
•••• Quality criteria: What experiences do exist in Europe with regard to incorporating health promotion and em-powerment as quality criteria for hospital core services into national, regional and professional quality systems like EFQM, balanced score card, standards, guidelines, monitoring, accreditation, and reporting?
•••• What is the impact of centralising or decentralising strategies (e.g. hospital clusters), and of patient involvement in strategic decision making, on the development of financial frameworks and quality criteria?

	PROGRAM ELEMENTS

Conference topics will be presented and discussed in keynote lectures and panels, paper sessions, workshops, and a poster session. In addition, a number of satellite events will be organised (all of which will take place in the same venue as the main conference).

	TARGET GROUPS OF THE CONFERENCE

The conference provides a forum for exchange and further development of knowledge and experiences for the following target groups:

•••• Health care professionals from the medical, nursing and therapeutic fields;
•••• Hospital and health care managers;
•••• Representatives from patient organisations and other NGOs;
•••• Representatives from health policy and health administration;
•••• Public health actors and experts;
•••• Health and health promotion scientists and practitioners; and
•••• Health care consultants.

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