collaboration: Introducing the ASAP scheme
6.8 Network context
In addition to the structural characteristics introduced so far, the networks have, according to health promotion concepts (compare e.g. Boonekamp et al. 1999; Donchin et al. 2006), to be regarded in the context of their relevant national / regional environments. This perspective is also supported by sociological systems theory according to which interorganizational net-works can be understood as a structure of loosely coupled organizations, which, individually and total, reproduce themselves also through ongoing exchange with their relevant environ-ments (compare chapter 3). This perspective is also in line with the political opportunity structures-paradigm of social movement research (compare Hellmann 1998 and chapter 3), as well as with the literature on whole networks which frequently draws on the importance of political sup-port (e.g. Turrini et al. following Milward & Provan 2006). Furthermore, the capacity frame-works proposed in chapter 5 on the basis of Bell Woodward et al. (2004) and Hawe et al.
(NSW Health Department 2001) also point to the relevance of supportive capacities in the network environments.
In the PRICES-HPH network study, this dimension was measured as the perceived general relevance of health promotion in the network countries / regions, as the reported existence of legal and financial frameworks for health promotion, and via the existence or non-existence of legal health promotion mandates of the network member hospitals, as reported by the hospital coordinators.
6.8.1 General relevance, legal and financial regulations for health promotion in the network countries / regions
The PRICES-HPH network questionnaire had asked the network coordinators to give their perception of the general relevance of health promotion in their network country / re-gion, and of the relevance of health promotion in healthcare, on a 4-partite scale, from 1 (very high) to 4 (inexistent). The overall assessment was quite good (with 22 coordinators or 79%
rating the relevance rather high or high, as opposed to 6 coordinators or 21% rating it as low).
The assessment of the relevance of health promotion in healthcare was more critical, with 68% of coordinators rating it as high or very high, as opposed to 32% judging it as low to inexistent (compare Figure 27 below).
Figure 27: The general relevance of health promotion and the relevance of health promotion in healthcare in the network countries / regions, as perceived by network coordinators, on a 4-partite scale (1= very relevant, 4 = relevance inexistent) (N=28)
Of the 28 networks in the PRICES-HPH network sample, 25 (89%) reported some con-crete form of supportive framework for health promotion in a relevant external environment.
An inclusion of health promotion in the vocational training of healthcare professionals was reported most often (14 networks or 50%), funding options for health promotion in healthcare were reported least often by only 4 networks or 57%. The median number of sup-portive factors available within a network was 2 in the sustainable but only 1 in the vulnerable networks.
Another environmental condition of potential relevance to network viability are the man-dates of their member hospitals to perform health promotion. These were assessed for the three HPH target groups patients, staff, and community. Sufficient data to allow for compari-son between networks are available, from the PRICES-HPH hospital survey, for 23 of the 28 networks in the sample, and from a total of 176 member organizations. Amongst these 23 networks, legal mandates for health promotion for staff were reported from at least one hospi-tal in 22 networks (96%), for patients from at least one hospihospi-tal in 21 networks (91%), and for the community from at least one hospital in 19 networks (83%). Obviously, hospitals belonging to one and the same network had, in most cases, different perceptions of the existence of legal mandates for health promotion. This either indicates different degrees of awareness of the hospital HPH coordinators of the legal frameworks in their country / region, or points to the fact that the frameworks of individual hospitals are strongly impacted by specific policies of the hospital owner or trust a given hospital belongs to. Across the networks, the median per-centage of hospitals reporting legal mandates for patients and staff was 66.7%, respectively, and 50% for the community.
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6.8.2 The international HPH network as context of the na-tional / regional HPH networks
The international HPH network can and has to be perceived as a specific environment of the national / regional HPH networks, formulating specific demands and duties to the nation-al / regionnation-al HPH networks, but nation-also providing particular types of support. According to arti-cle 1, paragraph 2 of the International HPH Constitution, the purpose of the international HPH network is defined as follows:
“The International HPH Network shall promote and assist the dissemination of the concept of health promotion in hospitals and health services (as defined in the mission above) and support implementation within countries and re-gions, internationally, through technical support to members and the initiation of new national / regional networks.”
(International HPH Network 2008; compare appendix)
To pursue this purpose, the International HPH Network has numerous structures and ac-tivities in place which can be allocated to the 5 general network strategies of the expanded PRICES-HPH evaluation model, as introduced in chapter 4:
Support for organizational development of member organizations is provided by internation-ally defined membership criteria, by specific quality tools, and international projects.
Support for personnel development is provided by international events such as the annual HPH conference and international summer school, and information media like the In-ternational HPH Newsletter and inIn-ternational websites.
Lobbying, partnership and alliance-building is a.o. pursued via the annual international HPH network conferences which have a strategy of inviting relevant international organiza-tions to co-organize the conference.
Support for public awareness is also provided via the media and events of the international HPH network.
Knowledge development and dissemination is pursued via international research projects and resulting publications and, since 2011, via an official scientific journal of the HPH network, “Clinical Health Promotion”.In the perspective of the HPH network coordinators, of 8 pre-defined offers by the inter-national HPH network, general assemblies – i.e. the involvement of inter-national / regional HPH networks in decision-making on the international level – and network conferences were best utilized (26 networks or 93% each), international summer schools were least often used (7 networks or 25%) (compare Figure 28 below).
Figure 28: Number of national / regional HPH networks utilizing 8 pre-defined offers by the inter-national HPH networks (N=28; several answers possible)
Each national / regional network in the PRICES-HPH network sample utilized at least 2 of the 8 pre-defined international offers, the median being 6 and thus comparably high.
The utilization of offers appears to be mirrored by the network coordinators’ judgment of the usefulness of the offers on a six-partite scale (1 = most useful, 6 = least useful). Confer-ences – as the most often utilized offer – had a mean perceived usefulness rating of 1.8. Sum-mer schools – as the least utilized offer – were rated with 3.3 (compare Figure 29 below).
Figure 29: Network coordinators’ mean ratings of the perceived usefulness of 7 pre-defined offers by the international HPH network (N=28)
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Conferences Tools Task forces Newsletters Website Vienna WHO-CC Website Copenhagen WHO-CC Summer schools