Implementationsforschung rückt immer stärker in den Fokus der Gesundheitsförderungsforschung. Sie zielt darauf, innovative und wirksame Gesundheitsprogramme der Praxis zugänglich zu machen und deren effektive Umsetzung sicherzustellen. Für das Setting der stationären Altenbetreuung wurden bislang kaum Studien durchgeführt, die aufzeigen, welche Faktoren den Implementationsprozess von Gesundheitsförderungsprogrammen begünstigen oder behindern.

In this article, organizational implementation capacities are discussed as facilitators for hospital health promotion (HP) activities, based on data from 159 sampled hospitals of the PRICES-HPH study. PRICES-HPH is a cross-sectional evaluation study of the International Network of Health Promoting Hospitals and Health Services (HPH-Network) and was conducted from 2008 to 2012. Hospitals applying elaborated HP implementation capacities such as 'regular health promotion projects and organization-wide programs', 'established health promotion management systems' or the 'integration of health promotion in existing quality management systems' have better HP activity scores as compared with hospitals that implement HP on the basis of occasional projects only. Organizational capacities are associated with considerably higher chances for the successful implementation of a multiplicity of different HP activities in hospitals. The results add further evidence to the importance of capacity building in hospital HP.

BACKGROUND:The Baby-Friendly Hospital Initiative (BFHI) aims to promote and support breastfeeding. Globally, around 20,000 facilities have been designated Baby-Friendly. In Austria, however, only 16% of the maternity units have received BFHI-certification. Internationally, few studies have investigated facilitating or hindering factors for BFHI implementation. The need to extend BFHI-certification rates has been investigated previously, but little is known about why maternity units decide to become BFHI-certified, how BFHI is installed at the unit level, and which factors facilitate or impede the operation of the BFHI in Austria and how barriers are overcome.METHODS:Using a qualitative approach, (health) professionals' perceptions of the selection, installation, as well as facilitators of and barriers to the BFHI were investigated. 36 semi-structured interviews with persons responsible for BFHI implementation (midwives, nurses, physicians, quality manager) were conducted in three Austrian maternity units. Data were analyzed using thematic analysis.RESULTS:Interviewees mentioned several motives for selecting the BFHI, including BFHI as a marketing tool, improvement of existing services, as well as collaboration between different professional groups. In each hospital, "change agents" were identified, who promoted the BFHI, teamed up with the managers of other professional groups and finally, with the manager of the unit. Installation of BFHI involved the adoption of project management, development and dissemination of new standards, and training of all staff. Although multiple activities were planned to prepare for actually putting the BFHI into practice, participants mentioned not only facilitating, but also several hindering factors. Interpretations of what facilitated or impeded the operation of BFHI differed among and between professional groups.CONCLUSION:Successful implementation of the BFHI in Austria depends on a complex interplay of multiple factors including a consensual "bottom-up" selection process, followed by a multifaceted installation stage. Even these activities may be perceived as a hindrance for non-BFHI-certified hospitals. Findings also suggest that despite active preparation, several barriers have to be overcome when BFHI is actually incorporated into routine practices. BFHI seems to pose a great challenge to health professionals' work routines and, thus, clear structural changes of such routines as well as ongoing monitoring and support activities are required.

In this article, organizational structures in hospitals are discussed as possible capacities for hospital health promotion (HP) implementation, based on data from the PRICES-HPH study. PRICES-HPH is a cross-sectional evaluation study of the International Network of Health Promoting Hospitals & Health Services (HPH-Network) and was conducted in 2008-2012. Data from 159 acute care hospitals were used in the analysis. Twelve organizational structures, which were denoted as possible organizational health promotion capacities in previous literature, were tested for their association with certain strategic HP implementation approaches. Four organizational structures were significantly (p = 0.05) associated with one or more elaborate and comprehensive strategic HP implementation approaches: (1) a health promotion specific quality assessment routine; (2) an official hospital health promotion team; (3) a fulltime hospital health promotion coordinator; and (4) officially documented health promotion policies, strategies or standards. The results add further evidence to the importance of organizational capacity structures for hospital health promotion and identify four tangible structures as likely candidates for organizational HP capacities in hospitals.

Background. Health promotion and self help (patient) groups share many goals. The article investigates how their relationship has been developed in concepts and practice of the international network "Health Promoting Hospitals and Health Care Services" (HPH).Methods. Analysis of basic documents of the HPH-movement and conference documentations was complemented by data from an international survey of HPH-member organizations as well as a special survey of network coordinators.Results. In strategic papers of HPH and in the international conference discourse a referral to self help (patient) groups is scarce, yet everyday HPH-practice in various degrees seems to promote cooperation with self help (patient) groups to strengthen them as a complementary resource for patients.Conclusion. For developing cooperation between HPH and self help (patient) groups a comprehensive strategy of cooperation including six progressive steps is recommended. For implementation the initiatives for "Self help friendly health care" in Germany and Austria provide valuable experiences.

Gesundheitsförderung und Selbsthilfegruppen weisen gemeinsame Wurzeln und Entwicklungen auf. Untersucht wird die Frage, wie sich dieses Verhältnis in der Programmatik und Praxis des internationalen Netzwerks „Gesundheitsfördernder Krankenhäuser und Gesundheitsseinrichtungen“ (HPH) darstellt.

Background There is agreement in the literature that the work of national / regional networks and member hospitals of the International Network of Health Promoting Hospitals and Health Services (HPH) is under-documented and lacking systematic description and evaluation. A reaction to this deficit was PRICES-HPH (Project on a Retrospective, Internationally Comparative Evaluation Study). Methods This paper presents the PRICES-HPH evaluation model which was developed for theoretical guidance of the study. It includes capacity building efforts of networks and hospitals in form of specific infrastructures, resources and strategies. 35 national/ regional networks were invited to fill in a comprehensive online questionnaire for networks, and 529 member hospitals to fill in a hospital questionnaire. The network and hospital coordinators reported the data retrospectively. The outcomes were the degree of implementation of HPH strategies and to which degree participation in HPH had strengthened this implementation. Results The response rate was 80% for networks and 34% for hospital members. There was a pronounced variety in both the degree of implementation and the degree of perceived strengthening – both for specific HPH strategies and for member hospitals belonging to different networks. Most of the responding hospitals had implemented at least some of the HPH standards and strategies. About half had perceived that the implementation was strengthened by participation in HPH. Conclusion Overall, the national / regional HPH networks and their member hospitals have implemented HPH strategies to a substantial degree and they see participation in HPH networks as a relevant influence for that purpose. The extents varied by type of HPH strategy and by affiliation to networks.

Although sustainable development is closely interrelated with health and health promotion, in health care systems these themes are hardly ever discussed and even more rarely implemented in combination. We see opportunities for sustainable development and health promotion, particularly in hospitals, since they play a central role in health care systems. Furthermore, hospitals have significant and growing economic, social, and environmental impacts, which in turn cause adverse effects upon health. In a transdisciplinary project involving scientists and health care practitioners we examined how sustainability can be conceptualized for hospitals in line with both a socio-ecological understanding of sustainable development and with "hospitals' reality". Our approach aims at avoiding unintended long-term and side effects of health care – hospitals' core business – by expanding quality criteria for decision making to include sustainability and health gain improvement. An example demonstrates that a hospital can thereby improve its future viability and contribute to global sustainability.