Fifty-six years of HOPE in Europe


The European Hospital and Healthcare Federation (HOPE) is an international non-profit organisation. It represents both national, public and private hospital associations as well as hospital owners, either federations of local and regional authorities or national health services. Today it covers institutions from the 28 Member States of the European Union, as well as Switzerland and the Republic of Serbia, writes Eamonn Fitzgerald.

HOPE promotes and performs comparative activities. Research topics are identified by members’ representatives, the overall purpose being to help share knowledge and expertise throughout Europe. 

Eamonn Fitzgerald

Origins and evolution

In 1950, the European Coal and Steel Community was created with the aim of uniting both economically and politically six European countries (Belgium, France, Germany, Italy, Luxembourg and the Netherlands) in order to secure lasting peace. Later, in 1957, the six signed the Treaty of Rome setting up the European Economic Community (EEC), establishing a “Common Market” among its Member States. 

In 1966, representatives of hospital associations of the six EEC countries decided in Rome to create the Study Committee of the Hospital Organizations in the Common Market and to meet regularly to discuss issues and challenges related to hospitals. 

Six years later the Study Committee became the Hospital Committee of the Common Market, renamed in 1975 the Hospital Committee of the European Economic Community (HCEEC). The aim of the HCEEC was further developed at this stage, with a mandate to start working as a source of influence both at the national and community level. 

The main objective was then to promote the exchange of experiences and information among the different countries and to identify problems and propose solutions based on the ideas developed within the HCEEC. In addition, the idea was also to shape an EEC hospital policy, by establishing and maintaining relations with the EEC institutions and by anticipating problems that might arise at Community level. 

As a result of this development, the organisation started to consolidate its relations with the EEC institutions, other European stakeholders and also other international organisations, obtaining in 1977 the consultative status with the Council of Europe and leading to the establishment in 1989 of a working relation status with WHO-Europe. 

By 1973, the organisation had also started to extend to countries joining the European Community. The United Kingdom, Ireland and Denmark were the first to join the initial group of six members. Later Greece, and then Spain and Portugal became formal members. 

The association’s first publications included a glossary of hospital terminology (1974), two studies on costs, one on daily costs of health care provisions (1975) and one on strategy, tactics and costs of health care provision (1976). 

One of the first major outcomes of the HCEEC pioneering work in patients’ rights was the adoption in 1979 during its plenary session in Luxembourg of the Charter of the Hospital Patient. The Charter is a statement about patients’ basic rights in the hospital setting, such as the right to self-determination, the right to information, the right to privacy, the right to religious and philosophical freedom. The year 1981 marked an important historical date as it represented the beginning of one of the organisation’s core activities. An “Exchange Programme” was launched to pursue the HCEEC historical objective of promoting the exchange of knowledge and good practices. This programme, lasting originally three months, was aimed at understanding how healthcare and hospital systems within the EU and neighbouring countries work. It targeted hospital professionals and established twinning links among European hospitals. 

Besides the Exchange Programme there have been over the years multiple bilateral exchanges initiated on specific requests and under the responsibility of members. The Secretariat acted as information centre in support of these spontaneous projects. 

Until 1988, the HCEEC played a rather “think tank” role on the European health scene, enabling the exchange of relevant information and accomplishing thematic work. From this moment on, the HCEEC decided to play a more important and active role in the social development of Europe and thus redefined its scope of action. 

On May 7, 1989, during the 30th Plenary Meeting in Lisbon, the statutes adopted in 1975 were amended. Changes included the new name Hospital Committee of the European Community(HCEC) and the setting of some strategic objectives for the organisation. These objectives are still guiding HOPE’s activities today:

  • Act as a source of advice and information about hospital affairs to the European Parliament and the European Commission.
  • Develop and maintain information about operations and planning of hospital services. 
  • Advise members about the most important issues. 
  • Promote exchange programmes and provide a source of training and experience within the European context. 
  • Maintain links with hospital professionals across the European Community. 
  • Communicate and cooperate with international bodies on health matters.
  • Engage in any other activity designed to further the best interests of the hospital services in the European Union and of the health systems within which they function.

A new structure was implemented in order to pursue these objectives. It was composed of the Plenary Assembly, the decision-making body, the Executive Committee composed of the presidency and the heads of the national delegations and two Sub-Committees, one on Community Coordination, and the other one on Economics and Planning. The first Sub-Committee dealt with quality related hospitals issues and discussed the impact of European Community legislation. The second one focused on quantitative and economics aspects. 

On this occasion, an Action Programme called “HOPE” was launched to further stimulate the debate around the role played by hospitals in promoting citizens’ health. The mission of HOPE Action Programme, which still serves as the pillar of HOPE’s today activities, was to create of a more proactive Europe based on cooperation and activities linked to common interests in the European hospital and healthcare sector. 

Indeed, the HOPE Action Programme contained a series of proposals for concrete actions not only concerning the hospital sector but also the wider field of healthcare. It advocated a more holistic view of the healthcare sector where hospitals are not at the centre but part of a complex ecosystem. The Programme advocated that hospitals and healthcare should contribute to a healthy society and economy rather than just being a consequence of the internal market and a mere cost item.  

Furthermore, as a consequence of the EEC’s growing influence on the hospital sector, the HOPE Action Programme reshaped advocacy activities. It was based on a broad bottom-up approach, recognising that hospitals alone cannot effectively influence European social policies. Hospitals need to create synergies with other actors in the health field if they want their voice and concerns to be heard. 

1991: the first Europe-wide HOPE Health Agora 

The HOPE Action Programme was based on the idea that more synergies had to be created with the wider healthcare community. In line with this, it included the idea to launch a European wide health forum. 

This forum was intended to provide European organisations involved in health and healthcare with a space where their members could meet, get to know each other and gain knowledge about the state of play of health in Europe. This initiative aimed at creating a European Healthcare Network, where HCEC could express its aims and intentions toward the EU institutions and European citizens, as well as demonstrate its willingness to cooperate with existing fellow associations.

The first HOPE Agora, called “Europe and health, a common future?” took place in Paris in December 1991. More than 250 persons of 20 nationalities, belonging to more than 50 different associations, met with representatives of the EU institutions. 

This Agora was organized a few days before the Maastricht summit, where EU Ministers agreed on a new Treaty, the first to devote a specific article to public health.

The most important conclusions of the forum were: 

  • A positive reaction to the public health chapter in the Maastricht Treaty 
  • A negative assessment of the health situation in Europe 
  • A dissension for overregulation and a call for stimulated voluntarism and subsidiarity
  • A need for more consistent data and information 
  • A need for cohesion between European associations
  • Proposals concerning some European health priority issues (quality of patient care and other patients’ rights, human resources, exchange programmes, scientific research)

It was also set out that subsequent Agoras would have a more thematic basis, in order to better focus on the main issues of the moment, impacting the sector. 

At the same time, at the beginning of the ‘90s, the collapse of the Berlin’s wall and the German reunification prompted Member States to strengthen their collaboration with central and eastern European countries. 

Therefore, at the end of 1989 HOPE decided to include central and eastern European hospitals in seminars and specific programs. 

This decision was followed up by a seminar on “Inter-hospital Cooperation between Eastern and Western Europe” organised in Berlin in November 1990, as part of a WHO-HOPE working collaboration initiated in 1989 and hosted by the German Hospital Federation (DKG). The aim of the event was to share information and experiences on medicine, healthcare, technology and efficiency issues. 

One hundred and twenty three participants from 22 countries agreed on a series of specific recommendations about setting up individual partnership between hospitals (known as twinnings).

The common philosophy for implementing these twinings consisted in a bottom-up approach and relied on the subsidiarity principle. Indeed, the decision-making process was left to the interested hospitals, with the HCEC, WHO and the European Community having a coordination and support role. 

Within this framework a “European Hospital Twinning Project” was established in 1993. A European Joint Committee of the HCEC and the WHO established a network of national coordinators (the HCEC for its members and, provisionally, WHO-liaison officers for Central and Eastern Europe), to create a “Clearing house” and issue a periodic newsletter. 

In the same period, the HCEC was also requested by the European Union to cooperate in its PHARE and TACIS technical assistance programmes as project coordinator, both aiming to provide vast technical assistance to the eastern European countries and the countries of the former Soviet Union. In March 1994, the HCEC concluded its first contract with the European Union for hospital twinning in Albania, which mainly focused on organisation and management of hospitals. 

The period from 1995 to 2013 saw an escalation in the membership of the European Union with the enlargement to sixteen new countries. This resulted in new members joining the HCEC at this time since their countries, now part of the European Union, were impacted by EU policies at national level.

As the European Community formally changed its name into European Union with the Maastricht Treaty, in 1995, the HCEC adopted a new statute, and its Assembly finally created an international association for social gain named Standing Committee of the Hospitals of the European Union, with HOPE (Hospitals for EurOPE) as its operational acronym. 

In 2003, the Standing Committee’s Central Office moved from Leuven to Brussels, to be closer to the EU Institutions. 

One year after, during the extraordinary plenary assembly of November 29, 2004 in Berlin, a new statute was adopted changing the organisation’s name to its current one: European Hospital and Healthcare Federation (HOPE).

This change in name and scope was decided to better reflect the reality of the organisation’s members that extends beyond hospitals, and the work and actions initiated with the HOPE Action Programme in 1989.

HOPE has since then been organised around a Board of Governors, a President’s Committee, Liaison Officers, a network of National Coordinators of the HOPE Exchange Programme and a Central Office. The Board of Governors (BoG) consists of the President and the Governors, one from each Member State, and is the forum for all major policy decisions. The President’s Committee (PsC) consists of the President, the Vice-President and a minimum of three Governors. The PsC oversees the implementation and execution of the Board of Governors’ decisions, co-ordinates the work, acts for HOPE and authorises legal representation. HOPE’s work is organised around a network of Liaison Officers, one for each member organisation. These Liaison Officers meet three times a year. The network of National Coordinators of the HOPE Exchange Programme meets twice a year to prepare the HOPE Exchange Programme under the authority of the Chief Executive. The Central Office is based in Brussels (Belgium). It is organised and run by the Chief Executive, with an EU Policies Officer and a Health Economist. 

HOPE is still working to the strategy adopted in 2004 when members were looking for more lobbying and a revised approach for the comparison activities, including more EU co-financed projects.

From 2004 on, HOPE intensified its representation and lobbying activities since there were a growing number of issues on the European Union agenda affecting the organisation and operation of hospital and healthcare services. HOPE positioned itself on various occasions, promoting the values and interests of its members and expressing its view towards EU Institutions. 

In 2010 HOPE moved office from the outskirts of Brussels to its present location in the European quarter.

With 37 members from 30 European countries, HOPE today represents a perfect example of the diversity of European health systems. A majority of HOPE members are national hospital federations. Where there is no national hospital federation, members are national federations of local and regional authorities as hospital owners, or representatives of national health systems. HOPE covers around 80% of the hospital sector in Europe but also a growing part of the other components of healthcare services as well as of the social sector. 

Over the past 50 years, HOPE has been very active in different areas, producing and sharing knowledge on issues relevant for the hospital and healthcare sectors and representing the values and priorities of its members. It has also sought to engage with a wider community by participating in projects and research resulting in a clear added value for the healthcare sector. 

Knowledge and Exchange

An objective at the heart of HOPE is to develop and maintain information about the hospital and healthcare sector. To achieve this, various activities have been developed. Comparative studies were first conducted internally and through the years also in collaboration with other organisations, including within EU co-funded projects. HOPE also contributed to other exchange activities with the preparation of study tours and conferences and the organisation since 1981 of an annual Exchange Programme for health professionals.

Comparative studies

When its activities started in 1966, only limited information was publicly available on health systems and the situation of hospitals in each country. To gather this knowledge, the organisation has undertaken comparative activities and published reports and studies on a number of relevant topics relevant for the hospital and healthcare sector such as:

  • Organisation of health systems: role of the hospital, accessibility and solidarity in healthcare, waiting lists.
  • Organisation of healthcare activities: organ transplants, disaster medicine, quality of hospital care.
  • Financing: DRGs, rationing in healthcare, cost containment, health as a growth factor.
  • Human resources: European health workforce, hospitals and occupational health, hospital pharmacy, nursing.

Thanks to these comparative activities, HOPE has forged ties with other organisations and institutions such as the Organisation for Economic Cooperation and Development (OECD), various universities and research centres. 

Since 1998, HOPE has published its official and yearly reference book “Hospital Healthcare Europe.” It contains in‐depth management reviews, informed articles and case studies.

Hospital Healthcare Europe” contains one section ‐ the HOPE bulletin – devoted to HOPE articles and individual sections on: cardiology, clinical care, nursing and patient care, facilities management, IT and communications, laboratories, pharmacy and therapeuticsm radiology and imaging, theatre and surgery. 

Nowadays, relevant information is provided either by HOPE members or by using existing data of international organisations, such as the World Health Organization and the OECD. As this knowledge is spread across different sources, HOPE has developed a mechanism to make updated information easily available through its website and publications.

European projects

In an effort to collaborate with a larger number of stakeholders, including researchers and academics, HOPE has participated and remains involved as a partner or advisor in several EU co-funded projects. By participating in such projects, HOPE has been able to contribute to research and to join partnerships on topics which have a clear added value for hospitals and healthcare services.

 Some of the topics addressed by these projects were related to the improvement of patient safety and quality of care, eHealth development, health workforce planning and forecasting, health crisis management etc. 

Focus on key areas of involvement: Patient Safety and Quality of Care 

Patient safety and quality of care are a long-term interest for HOPE. Indeed it is a pioneer in hospital patients’ rights and has a remit to improve the healthcare of citizens throughout Europe and to promote high standards of hospital care.

In an effort to foster partnerships and to contribute to knowledge and research, HOPE has taken part in a number of EU co-funded projects on patient safety (i.e. SIMPaTIE, EUNetPaS, PaSQ) and quality of care (i.e. MARQuIS, DUQuE, MANAGED OUTCOMES…).

More recently HOPE has participated to the joint action PaSQ (European Union Network for Patient Safety and Quality of Care) aimed at sharing knowledge, experience and good practices between Members States, European health stakeholders and relevant international bodies. Within PaSQ, 220 health care organisations from 18 countries implemented some selected safe clinical practices and more than 400 good practices were collected for an online database. In support of the idea of a permanent network on patient safety, HOPE will continue in the future to collaborate with PaSQ partners, contributing to the promotion of safe hospital care across the EU.

HOPE Exchange Programme 

As illustrated throughout this article, a clear objective for HOPE since its foundation has been to promote exchange of knowledge and good practices. 

Accordingly, in 1981 the organisation started to participate in a general European Community co-funded “Exchange Programme for young workers”. Under the umbrella of this general programme, HOPE set up its specific exchange programme for young hospital administrators focusing on hospital and healthcare management. Its specific “Exchange Programme for Hospital Administrators,” aimed at promoting international understanding and cultural openness, cooperation and free movement of staff as well as understanding of the organisation and functioning of health systems within which hospitals operate.

As the participation in this exchange programme was restricted to experienced young hospital administrators, it was soon decided to initiate a parallel and wider exchange programme. The “HOPE Exchange Programme” was then opened to all categories of health professionals as well as administrative hospital staff. It also accepted participants from countries that were not yet members of the European Community. 

More than 30 years later, this programme is going strong. Several thousands of professionals have now participated, thus contributing to the programme’s success. Over the years, the number of participants rose from 22 in 1981 to more than 100 currently. And the number of countries is up, from seven to around 20. 

Today, the objectives of the HOPE Exchange Programme are in keeping with the initial objective: to enhance cooperation in Europe by sharing experiences and good practices, and to encourage collaboration and free movement of staff between hospitals in different countries.

During their four week stay abroad, HOPE Exchange Programme participants discover a different healthcare institution, a different healthcare system as well as other ways of working.

Every year since 1988, HOPE has organised an evaluation meeting to assess the outcomes of the exchange programme. In the middle of the 2000s, HOPE decided to merge the HOPE Agora with the exchange programme evaluation meeting. Every year, the HOPE Agora attracts a wide range of stakeholders including representatives of EU institutions, international organisations and the main European health stakeholders. 

Study tours

In 2007, HOPE decided to create a new exchange tool – HOPE study tours – for those who are unable to join the Exchange Programme. These study tours gather healthcare professionals around a specific topic covering organisation and management. Topics covered in the past have been related to same day admission, organ donation, health services’ planning and contracting, developments in curative care, the healthcare ecosystem model and quality of care. Participants spend a maximum of three days together, not only to learn from the country they are in but also to learn from each other. The topic is decided in agreement with the HOPE Board members on a supply and demand basis. 

Since 2007, seven study tours have been organised in various member countries. The last one took place in Dartford, Kent (UK) on October 29 and, 30, 2015 where healthcare professionals from Spain, Italy, Portugal, Belgium, Germany, Latvia and Estonia discussed how to maintain and improve the quality of care delivered to patients across Europe. 

Conferences and events

By organising European conferences and other events, HOPE raises awareness about the hospital and healthcare sectors’ needs and specificities. Such events can also facilitate calls for action from EU institutions. 

These gatherings indeed represent the opportunity to meet representatives from EU institutions, health stakeholders, academics, and other relevant players for discussing current health-related topics and developing partnerships. 

HOPE has been and remains actively involved in conferences and events (congresses, workshops, forums, etc.), either as an organiser, speaker or active participant.

A landmark event: the East/West Hospital Cooperation seminar

The East/ West Hospital Cooperation seminar constituted a landmark event organised by HOPE. Indeed, in November 1990, one year after the fall of the Berlin Wall, HOPE organised a seminar on “Inter-hospital cooperation between Eastern and Western Europe” hosted by the German Hospital Association in Berlin. 

This event reflected HOPE’s decision to include Eastern and Central European hospitals in its actions. Furthermore, this seminar was held under the auspices of the WHO and showed the increasing collaboration between HOPE and the WHO Regional Office for Europe. 

Following this seminar, a report was published gathering specific recommendations from 123 participants from 22 countries. The event was also an opportunity to set up individual partnerships between hospitals in order to provide the basis for sharing information and experiences in medicine, health care, technology and efficiency. 

Influence and Representation

When HOPE was created, health issues had a limited coverage in the European Union. With the development of the internal market, both the direct and indirect influence of European Union policies and legislation on hospitals and healthcare services dramatically increased. 

Hospitals are complex ecosystems. Thus, the impact of European Union policies and legislation covers a wide range of areas such as human resources (working time, safety, health workforce, professional qualifications), pharmaceuticals (pharmacovigilance, access to medicine, clinical trials, personalised medicine), medical devices, eHealth, tissues, cells, blood, organs, etc. 

To make sure the concerns and specificities of the hospital and healthcare sector are taken into account, HOPE expresses its view to European Union institutions and monitors EU policies and legislative developments, constantly informing HOPE members and asking them for feedback. 

HOPE represents its members in various arenas such as the EU Health Policy Forum, the Health Forum Gastein, and relevant working groups. HOPE also joins forces with other health stakeholders building alliances on matters of common interest.

Finally, apart from the EU institutions, HOPE also liaises and co-operates with international bodies active in the health arena, particularly with the European office of the World Health Organisation, the Organisation for Economic Cooperation and Development and the Council of Europe.

Pascal Garel Chief Executive Hope 

Eamonn Fitzgerald Hope Board Governor, Vice President Hope, VP Health Services

UPMC Ireland / International.