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Health Promotion and Organizational Development

Ralph Grossmann, Klaus Scala


The concept of health promotion aims at creating prerequisites and widening options for health in society. These options and prerequisites are greatly determined by organizations. The organizational conditions for successfully implementing policies related to the concept and principles of health promotion are an increasingly popular subject for international discussion. Health promotion is on the way to generating organizations. In many cases health promotion means implementing a process of planned organizational change.
Successful implementation in various areas of society such as politics, administration, research, education and grassroots initiatives in several countries has spawned numerous models of good practice and opened up organizational options for health promotion. New partners for health have appeared: leaders in city administrations, heads of schools, managers of businesses, physicians and nurses in senior positions in hospitals.

Awareness of the importance of organizations for health promotion is profound; they affect the conditions for health, and health promotion demands organizational change. This is the foundation of the widely discussed settings approach to health promotion. Developing settings for health means dealing with organizations; this requires a special type of intervention and implementation. It is usual to motivate, train and teach individuals and groups, but not organizations. There is a great demand for a better understanding of change processes and how to introduce them.

This document shows the dimensions of organizational development and their links with health promotion utilizing our know-how in organizational theory and consultancy and on the other hand our experience in health promotion trainings. It describes how organizations change and how social systems can be developed to,«ards health promotion. This document is intended to stimulate and strengthen the reader's awareness in observing, analyzing and understanding the complex processes of change. As projects have become very powerful instraments for the development of organizations, the basic fundaments of project ~ management are introduced. The knowledge to initiate organizational change joins other qualifications in the mixture required for health promotion. The document should stimulate the discussion of implementation strategies; it should also contribute to the improvement of the professional Standards of people active in health promotion.

The audience for this document includes:

Experience in organizational development and project management in various fields is the professional background of the authors. They have trained for many years leaders and people who are responsible for the management of projects. Working at the IFF (Institute for Interdisciplinary Research and Continuing Education) the authors shape the profile of the department Health and Organizational Development of this institute. In cooperation with WHO/Europe trainings in project management for health promotion have been developed and carried out since a few years. WHO/Europe also encouraged the department to present its know-how through this document to a broader public and to apply for the status of a WHO Collaborating Centre in this field.
The views presented here are based on recent developments in Systems theory and the systemic approach to organizational consultancy. The discussions of the theoretical aspects of this approach are limited to what seems necessary for practical use. The document gives no review on general organizational theory but focuses on dimensions of organizations that are essential for implementation strategies of health promotion. In this regard, we consider the usual wide gap between social Scientists and practitioners as a fundamental weakness in both. We believe that successful organizational development must be based on sound theory; such a theory must not only meet scientific standards but also be useful for activists. We have tried to bridge this gap, taking the risk that scientists will find the document unscientific and activists will ask for more detailed guidelines. We think, however, that people are working to promote health in so many different settings, organizations and cultures, that it is best to provide a basic understanding of organizational dynamics and to enable people to create manuals suitable to their special situations.

We want to express our thanks to people in various contexts: We are grateful for sharing work on theories about organizations as well as experience in consultancy of projects to Alfred Janes, Herbert Schober, Monika Veith, Michael Schulte-Derne and Rudolf Wimmer. Karl Krajic, Hubert Lobnig, Peter Nowak and Jürgen M. Pelikan from the Ludwig Boltzmann-Institute for the Sociology of Health and Medicine have developed with us the theoretical foundations for the links of health promotion and organizational development; we also cooperate with them in the Vienna WHO-modelproject "Health and Hospital”. We thank Ilona Kickbusch, Lowell Levin, Bo Pettersson and Erio Ziglio as experts in the WHO context for their ideas, suggestions and comments and Andreas Heller for supporting our effort in publishing the document.

Ralph Grossmann, Klaus Scala and Dagmar Untermarzoner

Euro 10,-