In How Far Is the Health Promoting Hospital a Salutogenic Hospital, and How Can It Be Developed?

Abstract

Our contribution to this book focuses on applying concepts of “salutogenic” or “health promoting” to a specific type of organization, namely the hospital, by drawing on experiences from the International Network of Health Promoting Hospitals and Health Services (HPH). We differentiate between “healthy”, “health promoting” and “salutogenic” perspectives towards organizational health interventions. Against this background we address three questions: First, what is a health promoting or salutogenic organization or hospital? Second, how can hospitals as a specific type of organization be developed in this direction? Third, how can interventions aiming at achieving this kind of change be researched? To answer these questions, we use concepts from three theoretical paradigms: the theory of autopoietic social systems, especially organizations, in the tradition of Niklas Luhmann; organizational quality models; and organizational theories of relevance to understanding hospitals, especially Mintzberg’s theory of professional bureaucracies. From our systems theory orientation follows that organizational health interventions and their effects cannot be understood in a simple input-output manner but have to follow a more complex model taking autopoiesis of involved systems into account. Following quality concepts, health promoting or salutogenic organizations can be conceived of as organizations that (have to) meet specific health promoting or salutogenic quality criteria for their structures, processes and outcomes. From the cited organizational theories follows that (local) organizational management, in hospitals, has only limited impact on or control over the performance of core processes by professionals. Therefore, attempts to change professional performance need to go beyond classical change interventions into organizations.