Michael S. Chen

Achieving organizational change: findings from a case study of health promoting hospitals in Taiwan

The Taiwanese Network of Health Promoting Hospitals (HPH) has been in place since 2006 and developing rapidly. The criticism of inadequate evaluation of the HPH approach taken elsewhere also holds true for the Taiwan HPH Network. Organizational change is a key to sustainable and effective health promotion, and it is also an important aspect in the European HPH movement. Therefore, this study aims to evaluate changes in organizational capacity for the implementation of HPH in Taiwan. All 55 HPH coordinators were invited to participate in the study, and 52 of them completed the questionnaires. The survey covered seven dimensions of HPH organizational capacity, and a total score of each dimension was calculated and converted to a figure on a scale of 10. This study has shown that HPH made a positive impact on HP hospitals in Taiwan regarding organizational change in capacity building for HPH. Leadership, organization culture and mission and strategy received the top three highest mean scores (8.19 ± 1.25, 8.08 ± 1.39, 7.99 ± 1.42), while staff participation received the lowest score (7.62 ± 1.26). The high level of organizational change was associated with the high satisfaction levels of organizational support from the viewpoint of the HPH coordinators. Based on a cluster analysis, a majority of the HP hospitals in Taiwan seemed to have adopted the addition model in putting the HPH initiative into practice; a few hospitals appeared to have accepted HPH initiative well through the integration model. These results presented evidence that HPH contributed to organizational capacity building of hospitals for health promotion.

NHI-PharmaCloud in Taiwan—A preliminary evaluation using the RE-AIM framework and lessons learned

OBJECTIVES The aim of this article is to present the preliminary impact of a medication monitoring program, PharmaCloud, in Taiwan and analyze the embedded factors that have contributed to the performance thereof. This article also compared PharmaCloud with similar international programs in order to draw lessons learned. METHODS The five domains of the RE-AIM framework - reach, effectiveness, adoption, implementation, and maintenance - were examined using qualitative and quantitative data. A difference-in-differences model was applied to analyze the quantitative impact of PharmaCloud on drug utilization and drug expenses. The qualitative impact was evaluated by document analysis based on field reports from the participating medical institutions. RESULTS Reach and adoption: although all of the major hospitals adopted PharmaCloud and some of the hospitals had high inquiry rates, more time and incentives are needed to raise the overall inquiry rate. Effectiveness: during the study period of 3 months, the number of medications per prescription declined in the intervention group was 0.15 more than that of the general population, and the drug expense per person declined in the intervention group was NT

Barriers to and facilitators of the implementation of health promoting hospitals in Taiwan: a top-down movement in need of ground support

567 (US

Organisational Change to Health Promoting Hospitals: A Review of the Literature

18.9) more than that of the general population. The potential savings could be between 2% and 5% of the total pharmaceutical expenditure. Medication duplication was found to have decreased more in the intervention group. IMPLEMENTATION a variety of innovations in care delivery are being developed in which the pharmacists play a more significant role. Maintenance: the embedded National Health Insurance would lend strong support for PharmaCloud to grow and thrive. CONCLUSION PharmaCloud owes its effectiveness to the embedded National Health Insurance (NHI) program, which is universal and provides a comprehensive benefit package including more than 16,000 prescription drugs. An effective medication program is one that operates under the principle of universality and comprehensiveness, facilitates innovations, and has a substantial level of interoperability with the intra-hospital health information systems.

Self-reported changes in the implementation of hospital-based health promotion in Taiwan.

This study investigates barriers to and facilitators of health promoting hospitals (HPH) in Taiwan. The findings are based on a cross-sectional questionnaire survey involving 55 hospitals committed to health promotion (HP) as of the end of 2009, and 52 of them completed the questionnaire. The five most reported barriers are inadequate national health insurance coverage of HP, staff detachment, incoherence of government policies, weak inter-sectoral link and resistance to change. The five most reported facilitators are support from hospital superintendents, support from unit/department directors, HP-inclusive hospital development mission and goals, funding from the government, founding of HP-related committees, resources and healthy policies. The study also found that organizational capacity building (OCB) had a significantly negative association with the number of barriers and a positive association with the number of facilitators. Stepwise linear regressions further found that OCB in structure was a significant predictor of the fewer number of barriers and that in-staff participation was a significant predictor of the more perceived facilitators. It also confirmed the significant role of organizational capacity building and that of coordinators in the effective implementation of HPH. The transformational factors as well as transactional factors are very much at work as facilitators, but the transactional factors are trapped in a less-than-friendly environment. Comprehensive support from transformational factors as well as transactional factors is essential and further support for daily routine operations and staff participation are required to sustain the implementation of HPH in Taiwan.

My Health Bank 2.0—making a patron saint for people's health

The Health Promoting Hospitals (HPH) initiative, as a setting approach, was launched by the World Health Organisation in 1988, and widespread expansion and development throughout the world ensued. This paper elaborates on and clarifies the concept of HPH and highlights the development of health-promoting settings in hospitals. This review also examines the enabling and hindering roles of organisational factors in reorienting hospitals towards health-promoting settings. This paper reaffirms the significance of organisational change in building capacity for health promotion during the development of HPH and notes that hospitals require systematic organisational support to fulfil their roles in promoting population health. Nevertheless, this review suggests that many of the identified barriers are related to insufficient organisational support. In particular, the low prioritisation of health promotion in hospital missions, shortages of resources, ineffective project management, lack of communication, poor coordination and integration and inappropriate job–person matches were six major reported barriers. Organisational capacity building for health promotion must be considered if hospitals are to adopt the HPH initiative.

Mainstream Health Care in Taiwan's Prisons: A Model for Expanding Medicaid Coverage to Incarcerated Americans.

Purpose. To evaluate the pattern of perceived changes in the implementation of the Health Promoting Hospital (HPH) Initiative. Design. This was a cross-sectional study with a self-administered questionnaire, asking the correspondents what changes they perceived before and after adopting the HPH initiative. Setting. This study was conducted with 55 hospitals committed to the HPH in Taiwan, and 52 completed the questionnaire. Subjects. One coordinator in each of the 55 hospitals served as subject. Intervention. HPH seeks to improve health gains for its stakeholders by developing structure, cultures, decisions, and process conducive to health promotion. Measures. Perceived changes were measured in the areas of more resource inputs, changing work models, realigned implementation strategies, more programs, higher service volume, and improved quality control. Regarding realigned strategies, emphasizing the impact of healthy public policies, supportive environments, staff participation, individual knowledge and skills, and reorienting health services were measured. Analysis. Descriptive analysis was used to examine the pattern of “prevalence of changes.” Results. Changes were more prevalent in the domains of patients and community (both with averaged ranks = 1.8); “realigning strategies” was the area in which more changes were perceived (average rank = 1). Emphases on healthy public policies and reorienting health services were the leading changes (both averaged ranks = 2.4) regarding realigning strategies. Conclusion. The HPH initiative appeared to be an effective approach to build organizational capacity for health promotion.

Uncompensated hospital care payment and access for the uninsured: evidence from New Jersey.

As health information technology advances, more and more innovations are being developed to engage people with their health data for various health-enhancing applications. Notable innovations include Blue Button adopted in the US, My Health Record, or Personally Controlled Electronic Health Record in Australia, and Summary Care Record under the United Kingdom’s National Health Service. Such a system is also under development in Taiwan, making use of its unified databank generated by its universal, comprehensive and single-payer programdthe National Health Insurance (NHI). The original version of My Health Bank (MHB 1.0 hereafter) was put in place in September 2014 and, under layers of protection for data security, allows the insured individuals to retrieve their health data stored on the NHI’s data warehouse to facilitate their health management and to keep track of their insurance status. MHB 1.0 can be best understood as a pilot program of its kind that aims to return health data to the people and let people care for their health. Based on the experience of this trial version, a far more inclusive, readily interactive, and iconographically rich version, MHB 2.0, is now under development, and shall be put into use soondhopefully sometime in the middle of 2016.

Strengthening health promotion in hospitals with capacity building: a Taiwanese case study

The authors argue that Taiwans health insurance reform initiative in 2010, which allows prison inmates to be covered under Taiwans National Health Insurance (NHI) program, can be used as an example of how to expand Medicaid health insurance coverage to incarcerated individuals in the U.S. as of 2016. According to the article, the U.S. Patient Protection and Affordable Care Act provides incentives for American states to expand Medicaid eligibility to certain nonpregnant, nondisabled adults.