Today, partnerships with patients and families are at the forefront of health care service delivery and quality improvement efforts globally. Yet, within the International Network of Health Promoting Hospitals and Health Services (HPH Network), a systematic strategy to involve patients, families and citizens in health promoting healthcare is still under development. In comparison, the World Health Organization (WHO) with its Declaration of Alma Ata (WHO 1978), its Ottawa Charter for Health Promotion (WHO 1986) and its Declaration on the Promotion of Patients' Rights in Europe (WHO 1994) has played a decisive role in initiating and supporting partnerships with patients, families and citizens for decades. More recently, the WHO Strategy on People-centered and Integrated Health Services spells out clearly the importance of partnering with and involving patients and health service users to achieve health services that are responsive to and appropriate for people’s needs (WHO 2015). WHO has developed a formal position that defines patient and family engagement (PFE) as essential for patient safety and quality improvement efforts (WHO 2016). 

In summary, integrated people-centered health services means putting the comprehensive needs of people and communities, not only diseases, at the center of health systems, and empowering people to have a more active role in their own health. This goal is aligned with the HPH objectives set out in the current Work Group on HPH and Patient and Family Engaged Care, to both set norms and standards for patient engagement in hospitals and health service, and to promote and support the necessary organizational level structures, functions and practices associated with successfully engaging patients in their own health promotion. Once developed and then integrated into HPH standards, effective dissemination and uptake by HPH Network members and others will truly drive more people-centered health systems.

Carme Hernández, PhD, MSc, RN, FERS, is the coordinator of the Integrated Care Unit under the Medical and Nursing Administration Council.  Dr. Hernández has published more than 40 articles, reviews and editorials, over 15 book chapters and guidelines, and she has participated in several European projects. Currently she is a collaborator of the H2020 projects H2020 Selfie and Connecare, and the regional project RIS3CAT Nextcare.

Her research lines focus on integrated chronic care models, patient stratification and complex patients.

Over the last years, the epidemics of non-communicable diseases and the need for cost-containment are triggering factors for a profound transformation of the way we approach delivery of care for chronic patients. The Chronic Care model is widely accepted as a conceptual framework to effectively address the burden of Non-Communicable Diseases, with Integrated Care Services (ICS) being one of its core components. Large scale deployment and adoption of ICS services in Europe seek health efficiencies with simultaneous reduction of outcome variability within and among regions. 

The development of Integrated Care Services at Hospital Clinic dates back to year 2000. The initial randomized controlled trials (RCTs) generated evidence on efficacy of the novel services: i) Home Hospitalization and Early Discharge and; ii) Prevention of Hospitalizations. These initial experiences had an important impact, leading to the creation of a dedicated facility, the Integrated Care Unit (2006) to provide transversal care services and to explore and exploit potential benefits of bridging between hospital-based specialized care and community care with support of information and communication technologies (ICT). 

In parallel, a broader strategy promoting organizational change aiming at care coordination in the health care sector of Barcelona-Esquerra (AIS-Be, 540.000 citizens) was also initiated in 2006. The main driver of the AIS-Be program is the need for enhancing efficiencies of specialized care through transference of care complexities from hospital to home. 

The current presentation relies on seminal contributions on chronic care management generated at the Hospital Clinic. The primary objective was to evaluate transferability of complex care from the hospital to the community and to identify strategies to foster more widespread implementation of the new model of care for chronic patients. The lecture covers the following areas, namely: (i) the results of two ICS (HH/ED and EC) deployed in Barcelona, together with an overall assessment of project results; and, (iii) analysis of necessary developments for the future regional deployment.

In its "Global Strategy and Action Plan on Ageing and Health", 2016, WHO pointed out that the health system needs to be aligned to the needs of older populations by orienting health systems around intrinsic capacity and functional ability, developing and ensuring affordable access to quality older people-centered and integrated clinical care, and ensuring a sustainable and appropriately trained, deployed and managed health workforce. 

Taiwan’s Framework of Age-friendly Health Care was developed in 2009 with an aim to provide systematic guidance on management policy, communication and services, physical environments, and care processes for health services to promote health, dignity and participation of all older people they served. This framework takes a life-course perspective and population approach. It contains 4 standards, 11 sub-standards and 60 measurable elements, and can be used for self-assessment, implementation and external recognition. 

Together with the framework, several tools on execution of its priority areas, performance indicators for monitoring and benchmarking, and an organizational implementation pathway were also developed and shared. The priority topics include integrated lifestyle management and non-communicable diseases control, medication safety, fall prevention, frailty intervention, mental wellbeing, patient engagement and shared decision making (especially on end-of-life decisions), high-risk geriatric assessment for hospitalized patients, inter-facility coordination and continuity of care, etc. 

To scale up diffusion of the re-oriented model of care, the government launched a set of strategies including synchronized collective change with shared learning, competition & awarding; grant support coupled with governance and accountability; advocacy, political engagement and synergy between age-friendly communities, age-friendly health care and age-friendly long-term care; and creation of an enabling environment including payment reform and accreditation reform. 

Taiwan’s framework of age-friendly health care has been applied to more than 300 health service organizations including 169 hospitals, 76 primary health centers and 64 long-term care institutions, and has been validated and translated into English, German, Estonian, Greek, etc. While the momentum of age-friendly initiative is growing globally, age-friendly health care initiative should continue to support and collaborate with the widespread age-friendly city initiatives. Scientific evaluation on the effectiveness and value of age-friendly health service reform would be the key for future dissemination. 

Key words: age-friendly health care; health promoting hospitals; ageing and health; health service delivery reform; UHC; integrated, people-centred health services 

In 2017/2018, the Task Force on Health Promotion for Children and Adolescents in and by Hospitals and Health Services started working on Standards and Indicators on Health Promotion for Children and Adolescents in Hospitals and Healthcare Services. The goal was to give a specific contribution on children’s and adolescents’ specific health promotion needs in hospital and healthcare services.
The standards and indicators took inspiration from the concepts, guidelines and outcomes of the WHO Standards for Health Promotion in Hospital (2004) and from the Child Rights-based Approach developed by the UN Agencies (WHO, UNICEF, UNESCO). The Task Force produced a document to assist professional with the Standards implementation process. This document has been peer-reviewed and the standards have been tested in five Children’s Hospitals and Healthcare services.
After the testing phase conclusion, the TF Standards and indicators have been revised taking into account professionals’ evaluation and comments and they have been shared with the rest of the Task Force.
At this point the main issue for this and other tools is how to make them be effectively used by organizations: it is time to overcome professionals’ resistances towards their implementation, as health promotion should always accompany clinical activities. Are children’s and adolescents’ views perceived as fundamental for re-orienting healthcare services?
As a matter of fact a critical approach and possibly an international debate on this issue could be useful in order to understand the reasons behind possible hindrances and hesitations of professionals in implementing children’s rights and health promotion tools in hospitals and healthcare services, both at planning and at operational level. How can these tools have an impact on children’s and adolescents’ health if they are not considered as part of healthcare services protocols? Children’s specific needs must be intended as part of an efficient and inclusive Healthcare service in order to help building child friendly policies and practices.