Using the settings approach to health promotion in hospital and health services to support collaboration, engagement, and partnership in integrated care systems.
Authors: Katsaros Keriin , Groene Oliver 
Published: January 2024

Introduction: Hospitals and health services within integrated care systems can implement the 2020 Standards for Health Promoting Hospitals and Health Services to promote the mutual values reflected in the nine pillars of integrated care, such as shared vision and multisectoral action, improving population health, people-centered care, community participation, staff health, leadership, and quality improvement. After the impact of the COVID-19 pandemic, a shift towards these shared values is needed to better address burnout and a decreasing workforce.
Intervention: The International Network of Health Promoting Hospitals & Health Services’ (HPH) 600 members from 33 countries work towards supporting the integration of health promotion into the organizational structure and culture of organizations to create health promoting settings. To operationalize this vision and guide decision makers in transforming their institutions into settings that support collaboration, engagement, and partnership, the 2020 Standards for Health Promoting Hospitals and Health Services and complimentary Self-Assessment tools were conceived.
Five overarching standards, 18 substandards, and 86 standard statements resulted from a methodological consolidation of existing HPH standards (addressing equity, mental health, the environment, health literacy, patient-centered care, groups such as the elderly, children, and adolescents) and from two Delphi consultation rounds with HPH subject experts. The standards reflect over 30 years of knowledge and international experience in health promotion implementation across various areas of policy, practice, and evidence within the International HPH Network. Complementary self-assessment tools, developed with input from 14 countries, can be used to identify key members of multidisciplinary steering teams, to compare data and monitor progress, and develop targeted quality improvement plans based on data collected. Currently, the Standards are available in 11 languages on the HPH website.
Outcomes: Hospitals and health services who adopt a comprehensive health promotion approach are agile, better able to respond to challenges and are receptive to change. During Delphi consultation rounds to define the standards, high ratings of relevance were given to population health needs, organizational commitment, and environmental health amongst countries contributing to the design of the Standards. The standards, therefore, strongly focus on organizational collaboration; engagement of patients, family, staff, and the community; and building alliances and partnerships between stakeholders along a patients’ care pathway. Organizations adopting this holistic approach are efficient, leading to better health outcomes, satisfaction for all involved, and lower costs, which are shared aims of integrated care. Health promoting settings are supportive of integrated care and can be implemented as a first step in a system-wide transformation.