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BMBF Sachbericht Selbsthilfefreundliches Krankenhaus

 

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Stefan Nickel, Silke Werner, Alf Trojan
Universitätsklinikum Hamburg-Eppendorf, 
Institut für Medizin-Soziologie
Martinistraße 52, 
20246 Hamburg
Tel. (040) 7410-52881, 
Fax -54934, 
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Quality concept “self-help-friendly hospital” as an approach of patient-oriented, participatory care arrangement: Development and testing of evaluation instruments for the cooperation between patients and hospitals

The theme of the project is the lasting structural anchoring of patient orientation through the institutionalised cooperation between hospitals and self-help collaborations. The starting point of the research is the quality concept “self-help-friendly hospital”, which has only become more systematically developed in the last few years and which is aimed at the initiation, successes, effects and maintenance of participatory care arrangement in hospitals. The goal of our empirical study was to develop an instrument to measure self-help-related patient orientation from the perspective of patients and hospital employees. A further goal was to identify possible conducive and impeding factors for the intensification and stability (sustainability) of patient orientation in the framework of structured cooperation between hospitals and self-help collaborations.

 

The study design contained a longitudinal study at two time points in both of the pilot hospitals in Hamburg, which were awarded the quality seal of “self-help-friendly hospital” in 2006, as well as cross-sectional studies in hospitals in North Rhine-Westphalia. In methodological terms, a mix of quantitative and qualitative procedures was applied. First of all, expert interviews and group discussions with 23 leading physicians and carers as well as 11 contact persons from self-help groups were conducted. On the basis of these interviews and a comprehensive literature review, a measurement instrument was developed which encompasses the four dimensions of individual and solidarity-based self-help support (participate and enable; include self-help groups). The SelP-K questionnaire was implemented in approx. 650 employees from two Hamburg hospitals and approx. 150 members of self-help groups at two measurement time points. Moreover, the instrument was applied in two further hospitals from the model project “self-help-friendly hospital North Rhine-Westphalia” with 10 specialist departments for the chronically ill.

 

The validation of the SelP-K questionnaire for the evaluation of self-help-related patient orientation in the hospital (22 core items) took place predominantly on the basis of 405 responders in the personnel surveys. It resulted in good to satisfactory psychometric properties. The internal consistency (Cronbach’s alpha) amounts, according to the respective subscale, to between 0.72 and 0.93; the theoretically postulated multidimensionality of the self-helped-related patient orientation in the hospital is also broadly confirmed with the model of exploratory factor analysis. In terms of the comparison of the evaluations of the two survey groups, which was only possible to a limited degree, few significant differences were found in individual aspects of the dimension “include self-help groups”. The analysis of conducive and impeding factors broadly confirmed the eight criteria of a “self-help-friendly hospital”, which were developed in the Hamburg model project. Both groups emphasised a climate of mutual recognition and appreciation as conducive. On the part of the personnel, time restrictions were mentioned as the most frequent obstacle.

 

The newly developed SelP questionnaire is suitable for the evaluation of self-help-based patient orientation and participation in hospitals. Limitations concern the practicability, measured according to the response and acceptance of individual questions (or question complexes), as well as the low problem-sensitivity in terms of questions on individual self-help support. Nevertheless, the use of the measurement in the framework of the network “self-help friendliness and patient orientation in the health care system” (SPiG) can serve to optimise and disseminate the approach of participatory care arrangement in other establishments.

 

http://selbsthilfefreundlichkeit.de

 

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