The aim of this research project is to look into the possibility of using the hospital
quality improvement and accreditation process (HA process), which has been well accepted
by a large number of hospitals in the country, to help develop health promotion (HP) in
hospital setting. A study was conducted with two-fold objectives: (1) To study health
promotion in HA accredited hospitals, looking for the relationship between HA process and HP
and other factors including concept of HP, and (2) To form a learning network of hospitals to
clarify the above relationship in order to utilize it in facilitating the HP movement in hospitals.
Soft Systems Methodology fits the purpose of this study. It is an action research
methodology that involves developing “a learning system” (Model) to be used as a tool of
inquiry, with declared world-views (the HA process, the Thai HPH standards, and the
empowering core strategies from the WHO Working Group). The model was used to study 8
selected HA accredited hospitals.
The findings included: (1) Traditional health promotion services and activity-based HP
were evident in all hospitals. None of the hospitals used the concept of empowerment in HP.
However, they realized that some parts of HA overlap with HP such as the issues of “Health
of personnel” and “Environment”. Those hospitals which determined to become HPH obviously
put much greater effort into program-based HP activities. (2) None of the hospitals was aware
of care-based HP. However, quality development of patient cares was evident in all hospitals.
Health or quality of life of patients was used as target. The process used was empowering,
including self-care and self-help groups; patients, family and even community participation.
These were obviously health promotion but never referred to as such. This finding should be
crucial for establishing a link between HA process and HP. 3) Hospitals were confused as to
their roles in health promotion. Clarification regarding care-based HP could lessen some of the
problems particularly among tertiary-care hospitals. Other issues, such as the definition of
“community” that includes “group of people having same characteristics or same purposes”
would help hospitals realize that they are already providing HP in many areas, and could see
them as their meaningful and satisfying roles. (4) PDCA, a tool provided by HA was used only
in isolated CQI projects. Promotion of its use for “learning by doing” could be expected to
connect HA process to HP. (5) HP activities were carried out sporadically and unrelated to one another. System thinking was another concept from HA that could be expected to help
HP.
A learning network was formed during the last phase of the study to include a
volunteered group of 11 hospitals (main target group) and 29 associate members which were
willing to join the learning process. The majority of the hospitals appreciated learning by doing
within the network. The most important lessons learned were the concept of health promotion
and empowerment. They became comfortable with the use of care-based HP. This subjective
assessment was confirmed objectively by a large number of presentation of programs that
emphasized “empowerment’, and later “empowerment and PDCA” to epitomize the
connectedness between HA process and HP. It is recommended that care-based HP should
be the starting point to use HA as a tool to develop HP in hospitals.