Friuli Venezia Giulia

HPH Progress Report 2017-2018: Friuli Venezia Giulia




The HPH Constitution (2008) for the International Network of Health Promoting Hospitals and Health Services states that one of the tasks of a National/Regional HPH Network is: “To periodically deliver a progress report to the Governance Board.” (Refer to 1.4. Mission and Obligations, HPH Constitution)


For the purposes of this activity:


  • The period for progress reports to be delivered is every two years.

  • A progress report is defined as a report on efforts to assist hospitals/health services to ”incorporate the concepts, values, strategies and standards or indicators of health promotion into the organizational structure and culture of the hospital/health service." (Refer to Mission, HPH Constitution)


The aims of Progress Reports are:

  1. To provide a mechanism for HPH networks and taskforces to share information, knowledge and experience

  2. To contribute to an assessment of the achievement of objectives by the International HPH Network

  3. To help identify priorities for future action by the International HPH Network.

This survey refers to activities in the period 2017-2018.


All data will be made publicly available.



INSTRUCTIONS: Keep the text that in black color. Change the text in grey colour (Green text is hyperlinks for your reference)





Part 1: Administrative information



1A. Network contact details

  • Network Coordinator name: Cristina Aguzzoli

  • Phone: +39 481 592595 +39 3478310881

  • E-mail:;;

  • Address: Via Vittorio Veneto 174 Gorizia -Via Pozzuolo 330 Udine

  • Website: (under reconstruction)

  • Name of Coordinating Institution: Azienda per l’Assistenza Sanitaria N° 2 Bassa Friulana-Isontina

  • Address: Via Vittorio Veneto 174 Gorizia -Via Pozzuolo 330 Udine

  • E-mail (If different from coordinator’s):;

  • Phone (If different from coordinator’s): +39 481 592501

  • Institution Website:


1B. Network administrative details

  • Network establishment: 08/11/2003

  • Expiration of network agreement: 08/11/2021

  • Number of current Network members: 9

  • My list of members on is up to date: yes

  • Number of new members in 2017: 1

  • Number of new members in 2018: 4

  • Number of ceased members in 2017: 6

  • Number of ceased members in 2018: /





Part 2: Network progress



2A. To what degree has my network put the HPH mission, purpose and objectives into practice?


  1. Choose one option

  • Not at all

  • A little bit

  • Moderate

  • Quite a bit

  • Completely

Please elaborate here:

During 2017 we wrote a chapter for the Regional Action Plan 2018 (DELIBERA N. 2667  28/12/2017). This is the action plan: during 2018 we will proceed as follows.

- each AAS / ASUI / IRCCS will identify a local HPH Coordinator, which will also be part of the HPH regional Committee (by February)

- the DCS will reconstitute the Regional HPH Coordination Committee (by April)

- the regional HPH Coordination Committee will establish a regulation, which will be formalized by the DCS,for the composition and functioning of the company guidance committees (by June)

- the regional HPH Coordination Committee will propose to DCS the worklines to be implemented progressively in hospital and health services organizations and an action plan for 2019 and the following years (by November to be included in the Guidelines for the management of the SRG of 2019)

- each AAS / ASUI / IRCCS will activate the Company Steering Committee (by November)

During 2018  we wrote also two regional acts about HPH governance .

The first (Decreto n° 937/SPS del 29/06/2018) is dedicated to the revision and establishment of the regional network,  the second (Decreto n° 1100/SPS 31/07/2018) is dedicated  to describe the regulation of the network, including the job descriptions of coordinators and links professional for health promotion (2018).Then we wrote a HPH chapter for the action regional plan 2019 (Delibera 2514 28/12/2018) : Chapter 3.7 health promotion in hospitals and health services: the HPH network. Her we wrote: In 2019 we intend to move on to the operational phase, which translates into practice the values ​​and principles present in the reference documents concerning the health promotion of patients and operators. The aim is to integrate and stabilize over time the planning of health promotion paths according to the logic of quality, intersectionality, multidisciplinarity and evaluation of process and result. Furthermore, paths will be launched dedicated to the operational translation of the most recent scientific evidence concerning the fight against chronic non-communicable diseases, emerging from the logic of the simple contrast to the disease to promote real conditions of well-being perceived by the population. In 2019, the structuring of the HPH FVG Network is to be continued, with particular reference to the identification and formation of link professionals; in addition, the regional HPH network website will restart, replicating the model already adopted for the Cure Sicure FVG – Risk management network. Finally, we intend to launch projects concerning the following 3 types of subjects: - employees - patients - citizens

The way to act:

After the governance level, we have describes three priorities to put in action in 2019.

1)Employees and the subjective well-being and psycho-physical dimensions:  

occupational physicians and regional coordination of the HPH network identify a strategy to implement the assessment of subjective well-being during the periodic visits;

at the time of the periodic visit, the occupational physician measures the dimensions of psycho-physical well-being
the occupational physicians collaborate with the HPH committee in which they are an integral part, for the recognition of the corporate offer concerning healthy lifestyles and stress management

experiment a check list to detect prevalence of Medically Unidentified Symptoms in a pilot sample, to plan an improvement project for 2020

2)Patients abstention from tobacco smoking in the peri-operative phase

-all smokers to whom surgery is scheduled are informed about the benefits of smoking cessation, in the weeks before and after, on recovery after surgery and are asked to abstain

3)Citizens - promotion of physical activity and healthy eating at hospital and territorial assistance centers; continuity of dialogue between HPH and Schools for Health in Europe Network



In Bologna (HPH International Conference 2018) we emphasize the representation of the Friuli Venezia Giulia network achievements  at the newcomers Workshop.

We experimented a specific training  of a psychologist in order to understand the role of health promoter psychologist. She has completed a thesis on the HPH standards and the school network (System What’s Up) emphasizing the new role of the psychologist in an health promoting setting (2017 )

As infrastructure of health promotion, we are invited to explain our results about the topic of distress and governance of health promoting settings during the childhood and adolescence, in a National Round Table in the Senate of the Republic in Rome (2017).

A psychologist working in Wellbeing Coordination (System What's Up) published an article to spread some of the results Kosic, M. (2018). Media literacy and for the net generation. International Journal of Emotional Education, 10 (1), 68-88.

It’s important to understand that in our region didn’t exist a network for Health promoting School, we hope that under the expertise born we will have a network in 2019.We began advocacy strategy in 2015. Despite the lack of this network, we tried to link the standards of Schools for Health in Europe (SHE network) with HPH standards. We noticed that the time to root the Health Promotion strategy in schools is 3/4 years, as reported in leterature .

The System What's Up, that represent the linking strategy,  was activated in the 2015/16 and it is subject to continuous improvements. At the moment all the schools of every order and degree of the territory of the province of Gorizia are involved in the network (17.000 students). Similar experiences are being implemented throughout the regional territory

  • 2018 Firenze -Workshop “Stress management” National Forum about Risk Management in collaboration with National Institute of Health 2018 -

  • 2018, Bologna. How to get started with HPH. International Newcomers Workshop [Pre Conference] 26^International Conference on Health Promoting Hospitals and Health Services (HPH)

  • Article : Stress : how to help patientsAguzzoli C, De Santi A.Clinical Management Issues 2018; 12(1) © 2018 The Authors. Published by SEEd srl.

  • 2017, Udine. System What’s Up: governance in setting based approach. Regional Day about safety and quality of healthcare




  • 2017, Gorizia . “Risk at work: stress management” Training about safety in Hospitals and Health Services

  • 2017, Gorizia. Workshop “Growing together with What’s Up” training for psychologist and pedagogists

  • 2017, Udine. “Life skills: to inform, educate, convince or involve? Risk factors and resilience factors.” Schools programmes. Training about life skills

  • From 01/3/2017 to 20/12/2017.How we can coordinate the Health Promoting Hospitals & Health Services Network in Friuli Venezia Giulia : the new standards and the strategy . Monthly meetings with Multidisciplinar group in Regional network

  • From 1/3/2017 to 20/12/2017. Implementation of health promotion programs with WHO Tools .Monthly meetings with Multidisciplinar group in AAS

  • 2017, Vienna “Resilience of th HPH network during the health reform” 25th International Conference on Health Promoting Hospitals & Health Services



2B. How is my network organized and how do we work?


Please elaborate here:The coordinating Centre is located in the Healthcare services named AAS2 Bassa Friulana isontina, a company constituted by an Health Service and 4 hospitals Since 2018 the role of the Coordinating Centre is enhanced by the Central Management of health, social policies and disability, where we are working in order to stabilize the commitment for the health system in the entire region.

The articulation is as follow:

• HPH Regional Coordinator and the Regional Multidisciplinary Committee

• HPH Local Coordinators and the Local Multidisciplinary Committees

• Leaders of the regional working groups

• Link Professionals in the following areas: Prevention Department, Districts, Hospitals departments, Healthcare Platform, Mental health Department, Addiction department.

Tools:Working GroupsHPH Multidisciplinary steering group Website (upgrade in progress) Training Communication Planning


2C. What has been the aim of my network?


Please elaborate/list projects here:

In this years we were focusing in order to enhance the structure of health promotion in the health care setting in the face of numerous healthcare reform. Another focus was to consolidate the value and principles of health promotion, often stuffed by quality or prevention and  that misunderstand the keywords of empowerment, advocacy, and re orientation of the healthcare system.In practice we worked in two main fileds:

Healthy Workplace standard to tackle the aging and distress of employees

The self assessment of the pshyco-physical and emotional wellbeing of the employees. Emphasizing the role of the employees as key factor for the motivation to change behavior in patients. Emphasizing the role of the employees as key factor for the motivation to change behavior in patients. Coherence and testimonial in crisis, too often in paradoxal situation of bad mood and bad behaviors to face distress.

Mental Health and Life skills for children and the young people because of the prevalence of multiple complaint in Italian young people about psychophisical symptoms during school aged

A recent study by UNICEF has shown that the proportion of adolescents in Europe with mental health symptoms is rising ( Bruckauf 2017).

One in four adolescent children (23%) reported experiencing two or more psychological symptoms more than once a week. The highest rates reported in Bulgaria (33%) and Italy (37%).




2D. What were my network's main achievements and lessons learned?



Healthy Workplace standard to tackle the aging and distress of employeesFor the well-being of the operators we have written a procedure that implements the 4th standard of the manual with particular reference to toxic stress. At the moment we are working on the integration of the different worklines : climate analysis, training of the occupational physicians about distress and medically unexplained symptoms,healthy setting chance, through a dedicated workline in the HPH regional strategy. Mental Health and Life skills for children and the young people The experience of the infrastructure for health promotion dedicated to the young people (integration of HPH and SHE networks) faced a great challenge after the first health reform in 2015. Tthe union between two healthcare services, one of them it was member of the HPH network, the other no, has caused the stop of the three working groups dedicated, but the resilence of the system transformed this temporary stop in an improvement plan. At the moment we have only one working group that meet monthly as well the schools and health services as well the private psychologist that enter in the schools. The psychologists may call the healthcare services counselling in presence of problematic situation, but their main commitment is health promotion.We try to avoid medicalization of adolescence, we prefer work in terms of resilience advocate a schools and health services working together model. This working group absorbed the three of the past. We learned that -a great effort at the beginning of a multidisciplinary program to set up the process, it's a garancy to mantain the common vision also in challenge time. At the moment we need to rebuild the working group about salutogenesis in the healthcare setting.-for the evaluation it's important to choose a systemic panel of indicators, in order to avoid redutionistic approach. We use together a top down ( governance) and bottom up ( empowerment) system-the intersectoral direction holds up if the staff of the strategic management enhances the HPH path. If it feels like a threatening duplication of other work groups, it tends to suffocate it, making it an empty symbol. It is necessary to reason in terms of a common denominator between the disciplines. -the multi-professional language of health promotion must always be updated, as misunderstandings produce vagueness of results, dysfunctional overlaps and poor management attention. One of the key factors is basic culture, mutual respect and clarity of mandate.- It is very important to set up a task force in each healthcare service about children and adolescent health and disease, in order to built a common framework in the dialogue with schools and community. We are waiting for the born of the Health promoting Schools network in Friuli Venezia Giulia to enhance the HPH and SHE dialogue. The two Ministery of Health and of Education had signed an agreement in 2019 pursuing this aim. We aim to consolidated the collaboration about health promotion. It would be important to sign an agreement about HPH and the health promotion national strategy of the Ministery of Health. We have a lot of good practices to share, but we need a simply form to summarize the key elements of the projects.For example as soon as possible we will publish on the new website: The Educational Library for oncologic patients The cardiologic rehabilitation pathcare including health promotion strategyThe Network of occupational physicians One private healthcare system with great experience about Healthy WorkplaceOne private school founded by an occupational physician (affiliated member) that is experimenting a bilingual school based on life styles and emotional intelligenceand many others.<you can answer in writing or by, for instance, adding a video presentation here>



2E. Global HPH Strategy 2016-2018


My network worked with the Global Strategy: yes


Specifically, priority was given to

  • (Priority 1 on implementation of updated WHO-HPH Standards: NB not applicable due to delay with document)

  • Priority 2 on HPH awareness and capacity: yes

  • Priority 3 on HPH development and sustainability: yes

My network supported members with fulfilling the Global Strategy: yes


My network acheived the following strategy goals

  • Priority 2 on HPH awareness and capacity

A-I) Organised at least 1 local HPH day: we participated in the Regional Quality Day in 2017. We collaborated in the success of the BOLOGNA International HPH Conference in 2018 and in the Italian network workshop. In the meantime we have addressed the issues of stability of governance.

A-II) Local policy level participated in HPH day:no

A-III) Informed local policy level of HPH: yes


B-II) Members received the translated/locally adapted final document: yes

C) Stakeholder analysis made by network: yes

D-I) Members received translated/locally adapted HPH Member Packages: yes

D-II) At least 2 local decision makers received translate/locally adapted HPH package: yes

E) Own website updated at least 4 times with news, information and experiences: no (under reconstruction)

F) Best practices/good ideas collected and reported at HPH general assembly, or here in progress report: yes

  • Priority 3 on HPH development and sustainability

A-I) Participated in discussion and development of member benefits: yes

A-II) Translated/locally adapted HPH brochure describing the benefits of membership received by my members: yes

B-I) Hospitals nationally/regionally with potentially interest in HPH were listed: yes

B-II) Contact was established and HPH information was sent to at least 2 potential new members: yes

C) Best practices/good ideas collected and reported at HPH assembly, or here in Progress Report: yes


If you wish to share your experiences in this regard, please feel free to elaborate here:

<you can answer in writing or by, for instance, adding a video presentation here>



2F. How did my network use the WHO-HPH Standards?


My network prioritized working with the standards: yes


If yes, priority was given to

  • Standard 1 on Management policy: yes

  • Standard 2 on Patient assessment: yes

  • Standard 3 on Patient information and intervention: yes

  • Standard 4 on Promoting a healthy workplace: yes

  • Standard 5 on Continuity and cooperation: yes

My network has supported members with using the standards for quality improvement: yes


The status in my network is that members have implemented

  • Standard 1 on Management policy

1.1. The organization identifies responsibilities for HP: implemented

1.2. The organization allocates resources for the implementation of HP:partly implemented

1.3. The organization ensures availability of procedures for HP data collection/evaluation: implemented

  • Standard 2 on Patient assessment

2.1. The organization ensures procedures for all patients to assess their need for HP: partly implemented

2.2. The HP needs assessment is done at first contact, reviewed and adjusted: partly implemented

2.3. The HP needs assessment includes external info and is social/cultural sensitive: partly implemented

  • Standard 3 on Patient information and intervention

3.1. Based on needs, patients are informed and HP plan is agreed: partly implemented

3.2. The organization ensures access to general information on factors influencing health: implemented

  • Standard 4 on Promoting a healthy workplace

4.1. The organization ensures a healthy and safe workplace: implemented

4.2. The organization ensures a HR Strategy that includes HP: implemented

4.3. The organization ensures procedures to develop/maintain staff awareness on health: implemented

  • Standard 5 on Continuity and cooperation

5.1. The organization ensures HP services are coherent with regional health policy plans: partly implemented

5.2. The organization ensures HP for out-patients and after discharge:partly implemented


If you wish to share your experiences in this regard, please elaborate here:


An Example of report with standard and indicators useful for benchmarking:


CRO National Cancer Institute Aviano

Project: Library for Patient Education & Empowerment


Standard 1 Management Policy.  Table 3 -Indicator 2

  • in 2018, 48 meetings/classes were held with patients and family members, 446 participants, and 244 respondents to the satisfaction questionnaire; 46 operators involved as speakers

  • 17 booklets were produced and printed ( CROinforma series): informational material for patients and citizens about different issues related to cancer, also to support the care path. The editoral process is defined by a co-production process between content experts, competent persons in plain language and technical aspect of the booklets. The booklets are  reviewed by at least one patient / citizen to evaluate understandability and transparency and practical utility.



Standard 2  Patient assessment. Table 7- Indicator 6

Patient education material, CROinforma series, arising from the health professionals ‘requests of materials to improve patients awareness about specific aspects of their condition and promote their autonomy.
In 2018 17 booklets/brochures were printed and made online available

The distribution of some information material is up to health professionals, who use them as a support for their dialogue (consolidating empowerment).


2G. Standards developed by HPH Task Forces and other relevant standards


My network has worked with standards from the HPH Task Forces on

  • Equity/migrants: no

  • HPH Children/Adolescents Standards: partly implemented

  • Environment: no

  • Age-friendly healthcare:

  • My network has worked with other relevant standards: Psychoemotional wellbeing A focus on 1st and 4 th Self Assessment HPH


If you wish to share your experiences in this regard, please feel free to elaborate here:

We published about 40 improvement plans about the organizational wellbeing at the workplace




Part 3: Sharing of knowledge and experience



3A. Additional strategy, priorities and focus areas of my network

My network focused on:

<you can answer in writing or by, for instance, adding a video presentation here>

  • Stress Management and Life Styles

  • Networking with occupational physicians and Employees aging

  • Library for patients education

  • Cardiovascolar healthcare path including health promotion


3B. My network's connection to National/Regional health policies and strategies

  • HPH is a priority nationally/regionally in health policies, laws and regulations: yes. It was not, it became a regional line from 2018

  • Changes in national/regional health policies have directly influenced my network's activities: yes

  • The national/regional health system is supportive of the development of HPH: yes

  • My network has received recognition/acknowledgment from public authorities/health systems: yes.

  • My network has received recognition/acknowledgment from public authorities/health systems: Not as network, but we received recognition by Ministery of Education and by the Senate of the Republica for a program based on HPH and SHE network integration.

If you wish to share your experiences in this regard, please feel free to elaborate here:

<you can answer in writing or by, for instance, adding a video presentation here>



3C. Availability of key HPH documents in my local language


In my local language the following documents exist

In my local language, I would like the following HPH documents to be made available: Name documents



3D. My network's untapped resources and needs for further support


My network has untapped resources that could help contribute to the International HPH Network’s fulfilment of its objectives by:

Elaboration data and technology

Software dedicated to the rapid evaluation of the standard and indicators

Way to visualize thee results in a simply way to see the trend

Publication on Clinical health promotion of the data : check list to collect the data necessary to the publication in order to plan the project and save time

We need to enhance our new identity. Some of the HPH Local coordinators are new entry. We have to simplify the criteria to belonging, avoiding the sensation that health promotion is all and there are no rules to put in action. The risk we run is to think that it's a matter of luxury strategy that is impossible when you have to save resources, beacuse of a lack of upgrade of the healthcare system about the health promotion tools.


The International HPH Network, the HPH Governance Board and the HPH Governance Assembly could better support my network by:

advocacy with Ministery of health

Advocacy tools upgraded

Check list in order to activate rapid recognition of stakeholders 

Check list in order to activate alliance with other settings

Availability of a Rapid Assessment Tool on line(only for HPH members)  in order to do self assessment and check the results in a spider diagram to build trend


3E. Final comments and ideas


Final comments and ideas from my network are:


  • At the moment the fragmentation of the resources and the worklines, obstacles the common plan.

  • The truth is that the mainstream has not awareness about the evidence on life skills and lifestyles efficacy as the main protective factor for empowerment of individual and setting in every field of healthcare.

  • Often we see a lot of the resources used on bureaucracy in order to manage the different worklines, to describe the efforts, without share a common vision between the political, organizative, operative level. We are working on this. But

  • Establish a standard form for spreading results during the international conferences

  • Set of headed paper with joint secretarial actions that start from the coordinator towards members and ministries (intra and extra communication)

  • Rapid assessment Tool for standard evaluation and visualization of trend

  • Standard form for "take home message" during conference: what works for who

  • A key point may be to create an orizontal line of resources( a common budget taken outside of the the vertical work lines dedicated to disease -prevention or management) in order to stabilize educational training and partecipation at the conferences with a major number of young professionals.






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