Program Team: 8 Local Health Units participating in the HPH Network of Friuli Venezia Giulia (Italy) Coordination Manager of HPH Network of Friuli Venezia Giulia: Aguzzoli CristinaParticipants: Annunziata Maria Antonietta, Bertoli Marco, Beacco Virginio, Bicego Livia, Deangeli Renzo, Ciano Rossana, Della Vedova Anna, Dudine Luisa, Giacomini Luisa, Masci Silvia, Peresson Maria, Portolan Patrizia, Robotti Mario, Russian Stefano, Sanson Sara, Scarano Adelchi

Improving health gain orientation in all services:Better cooperation for continuity in care19th International Conference on Health Promoting H ospitals and Health Services (HPH)Turku – Finland-June 1-3, 2011

Dr. Cristina AguzzoliASS 2 “Isontina”

Coordinating Centre HPH Friuli Venezia Giulia Network

ITALY

Particular thanks to Dr.Carlo Favaretti , for his continuous supportand for his expert advice

Stress related work, organizativeand individual resilience: an integrative self-assessment approach.

HEALTH PROMOTING HOSPITALS & HEALTH SERVICES Ospedali e Servizi Sanitari per la Promozione della Salute

HPH Una Rete dell’OMS

Regione Autonoma Friuli Venezia Giulia

Index

Stress-distress

Resilience

Psycho-emotional well being

Self Assessment in 8 Health Services Friuli Venezia Giulia Network

Results

Psycho-emotional standards as training tool forimprovement plans

Management policy actions

OCSED REPORT -may 2011-

Organisation for Economic Co-operation and Development BETTER LIFE INDEX

Reality or more awareness…………………??????

Stress and distress

According to natural selection , if

you don’t succeed in getting

over the distress conflict - or

you are not able to accept the

temporary inability - you

perish ……

""""Life Life Life Life existsexistsexistsexists bybybyby maintainingmaintainingmaintainingmaintaining a a a a complexcomplexcomplexcomplexdynamicdynamicdynamicdynamic equilibriumequilibriumequilibriumequilibrium or or or or homeostasishomeostasishomeostasishomeostasis, , , ,

whichwhichwhichwhich isisisis constantlyconstantlyconstantlyconstantly challengedchallengedchallengedchallenged bybybyby intrinsicintrinsicintrinsicintrinsic

or or or or extrinsicextrinsicextrinsicextrinsic adverseadverseadverseadverse forcesforcesforcesforces or or or or StressorsStressorsStressorsStressors" " " "

((((ChrousosChrousosChrousosChrousos, 1998). , 1998). , 1998). , 1998).

A common A common neurobiologyneurobiologyforfor painpain and and pleasurepleasure..

S. S. LeknesLeknes and I and I TraceyTracey..Nature Nature ReviewsReviews. . NeuroscienceNeuroscience. Vol. 9: . Vol. 9: 314314--320. 320. AprilApril 2008.2008.

Self Assessment and Improvement plans

PRIORITY: to Identify areas for well being at

work implementation

Serenity Prayer""""FatherFatherFatherFather, , , , givegivegivegive usususus couragecouragecouragecourage totototo changechangechangechange whatwhatwhatwhat

mustmustmustmust bebebebe alteredalteredalteredaltered, , , , serenityserenityserenityserenity totototo acceptacceptacceptaccept whatwhatwhatwhat

cannotcannotcannotcannot bebebebe helpedhelpedhelpedhelped, and the , and the , and the , and the insightinsightinsightinsight totototo knowknowknowknow

the one the one the one the one fromfromfromfrom the the the the otherotherotherother."."."."

Reinhold Niebhur, american theologian

The psychobiology of resilience

Although adverse environments are well known to be a risk factor for psychopathology, many individuals respond adaptively to such environments. There is growing interest in the underlying mechanisms involved in such resilience. Several cognitive-affective processes may be involved, and these may be mediated by particular neuronal circuits and neurochemical systems. This article summarizes some of the relevant work on the role of fear conditioning, reward processing, and social behavior in resilience.

Stein DJ, CNS Spectr. 2009 Feb;14(2 Suppl 3):41-7.

RESILIENCERESILIENCE

essess

Personality Life styleLife styleLife styleLife style

Communication

RESILIENCY

MISSION AND VISION: aimsof organization

Decree withForce of law 81/2008Occupational physician programs

Awareness aboutdistress level and relaxationtechniques

Setting Smoke freeHealthy FoodWellness programs

ProceduresWhoWhatWhenWhy

ForumIntranetHouse organ

CommunicationTraining

MISSION AND VISION:individualdevelopment

Enjoy projectsHealthyworkplace

Life skillsTraining : PBL

ORGANIZATIVE LEVEL INDIVIDUAL LEVEL

Standard Management PolicyPromoting a Healthy WorkplaceFocus on psycho-emotional wellbeing

the evaluation in a flexible system , the resiliency o f the system and of the people -

1.4 The organization identifies the responsabilities for the health operators’ psycho-emotional well-being

1.5 Professional profile and job description

1.6 Communication within the company : accountability between the company and the operators.

4.4 Environment : safety4.5 Environment : comfort4.6 Environment : the balance-space4.7 Professional profile4.8 Human profile 4.9 Monitoring and updating4.10 Assessment of chronobiology,

care models and health impacts. The clinical risk managementand the relation with work-related stress.

2009 – 2010 Analysis

First step: � self assessment for Standard

1 “Management Policy “ and Standard 4 “PromotingHealthy workplace”+ “Psycho-emotional wellbeing standards”

� 8 Hospitals and HealthServices of Friuli Venezia Giulia HPH network

� the point of view of management area

Second step : self assessment in Assistential areaspsychiatric,oncologic patients

How self assessment works in our reality

yes partly no

ASS 2 13% 72% 16%

BENESSERE ST 1 Regione fvg

13%

72%

16%

25%19%

56%

25%

13%

63%

13%

56%

31%

19%

75%

6% 6%

25%

69%

50%

31%

19%

0%

10%

20%

30%

40%

50%

60%

70%

80%

ASS 2 ASS 1 AOPN AOUD CRO Burlo ASS 6

STANDARD 1 psychoemotional wellbeing 2010

yes

partly

no

ASS 2 20% 47% 33%ASS 1 60% 7% 33%AOPN 36,5% 23,5% 40%AOUD 7% 60% 33%CRO 40% 40% 20%Burlo 27% 33% 40%ASS 6 27% 53% 20%

20%

47%

33%

60%

7%

33%

36,5%

23,5%

40%

7%

60%

33%

40%40%

20%

27%

33%

40%

27%

53%

20%

0%

10%

20%

30%

40%

50%

60%

ASS 2 ASS 1 AOPN AOUD CRO Burlo ASS 6

STANDARD 4 psychoemotional 2010

yes

partly

no

N°Operators 31 december 2009 TOT = 15.608

ASS2= 2.079 AOUTS=3.011 BURLO= 763

ASS1= 1.309 AOUD= 3.896 CRO= 674

ASS6= 1.886 AOPN = 1.990

Operators 2010: - 409

SELF ASSESSMENT AS A TOOL FOR WELL BEING TRAINING

Training/Information 30 operators

MultiprofessionalManagers MD Nurses

Technicians

Identification of a DepartmentReferent forOrganizativeWellbeing

Identification of a DepartmentReferent forOrganizativeWellbeing

FIRST CYCLE

1-3 february 2011

SECOND CYCLE

1-3 march 2011

9 meetings – may-september 2010 in a Health Service 19 operators set up training on well-being analysis / improvement plans

1st SESSION- ORGANIZATIVE EMPOWERMENT

2nd SESSION- ENVIRONMENTAL EMPOWERMENT

3rd SESSION- INDIVIDUAL EMPOWERMENT Training/Information

30 operators

MultiprofessionalManagers MD Nurses

Technicians

RESULTS 2011: PRELIMINARY NEEDS

Operators of MANAGEMENT AREAdebriefing paths (4.10.2)Operators of SURGICAL AREAdebriefing paths (4.10.2)Operators of MEDICAL AREAempowerment communicationtarget medical doctors new employees (1.6.1)Operators of EMERGENCY AREAaccountability for improvement communicationbetween operators and HPH steering group(1.6.3)Operators of HEALTH SERVICES AREAempowerment on life skills (4.8.3) and debriefing paths(4.10.2)

Self Assessment STANDARD 1 and 4 and Pshyco-emotional wellbeing

ConclusionsRESILIENCE OF AN ORGANIZATION

PERSONALITY : Mission of Health Service1. From Plan to Action: Plan of Prevention 2010-2012

and alliance with HPH network2. The committment of managers towards HPH : 3rd

Regional HPH Conference – 5 May 2011 –

STRESS :Link between HPH strategies and law81/2008

1. Stress related work risk evaluation2. Risk management 3. Gender discrimination and mobbing committees4. Accreditation systems: we are introducing 1°HPH

standard in management policy of regional actions2012

LIFESTYLES : healthy workplace for physicalactivity, healthy food, smoke free setting, balancespaces

DECISION MAKING : procedures and skills of manager, ………

COMMUNICATION: Accountability tools, Forum, Training Plans…

RESILIENCE OF EMPLOYEES

PERSONALITY :Life purpose and purpose on job development

STRESS : Awareness of stress distresssignals, Enjoy Relaxation techniques-Occupational physicians programs

LIFESTYLES : Enjoy Lifestyles projects

DECISION MAKING: Take part of Training for Human profile (life skills, coping)

COMMUNICATION : Sharing Training Communication

And And And And perhapsperhapsperhapsperhaps somethingsomethingsomethingsomething elseelseelseelse…………........

THANKS FOR YOUR ATTENTION!

www.retehphfvg.it

HEALTH PROMOTING HOSPITALS & HEALTH SERVICES Ospedali e Servizi Sanitari per la Promozione della Salute

HPH Una Rete dell’OMS

Regione Autonoma Friuli Venezia Giulia