Special Interest Session 2: Putting the Person at the Centre: Would the Esther Approach Work for Scotland?

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See more on the 2013 NHSScotland Event website http://www.nhsscotlandevent.com/resources/resources2013/resources

See more on the 2013 NHSScotland Event website http://www.nhsscotlandevent.com/resources/resources2013/resources

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  • 1. “Finding the words, changing the conversations.” Developing the Principles of Person- Centred Care and Support for the Person- Centred Health and Care Collaborative Audrey Birt Person-centred health and care champion
  • 2. People in relationship Compassion and kindness, to enable well being Equality, mutuality and individuality Flexible and empowering culture and system Trust, respect and empathy
  • 3. Esther
  • 4. Challenge Person centered care Complexity Delivering a service that is truly patient- centered is an enormous challenge which……can only be overcome by actively engaging patients as valuable resource. GREENHALGH, T., HUMPHREY, C. & WOODARD, F. 2011. User involvement in health care, Chichester, John Wiley & Sons, Ltd. Health care systems are complex, and repairing them is complex. GLOUBERMAN, S. & ZIMMERMAN, B. 2002. Complicated and complex systems: what would successful reform of Medicare look like? Changing Health Care in Canada: The Romanow Papers, 2, 21-53.
  • 5. Höglandet, Esther network 110 000 inhabitants 7 Municipalities 7 Primary care regions Hospital ca 7000 employees Senior citizens organizations
  • 6. How could this happen?
  • 7. Vision Esther A durable and energetic network results so that Esther can feel confident and independent Esther: • Gets care in or close to her home • See us as the same provider of care • Has the same possibilities to get care all over the region • Knows where and who to turn to Höglandet’s care: • All personnel are concerned and committed • Support for each other to achieve the best of Esther • Increase competence in the whole care chain • Continuous improvement of quality
  • 8. A customer is the most important visitor on our premises, he is not dependent on us. - We are dependent on him. He is not an interruption to our work. - He is the purpose of it. He is not an outsider in our business. - He is part of it. We are not doing him a favor by serving him. - He is doing us a favor by giving us an opportunity to do so. Mahatma Gandhi Who is the customer?
  • 9. Basic idea What is best for Esther ? Esther… no matter where We will be there!
  • 10. Individual values • What does Esther need/ want? • What is important for Esther when she gets sick? Partners • Who has to cooperate to fulfill Esther’s needs? Changes in the environment • Changes in the system of health care? • New methods? How do new medicine and methods influence the process and cooperation between caregivers? • New technology? • Changes in population?
  • 11. Vision Values Actions Energetic network and cooperation Person centeredness No hierarchy Thinking about the next provider Your problem is my problem Mutual responsibility for the person Mutual meetings and education Multi professionalism. Openness and learning
  • 12. Improvement agent 94 years old
  • 13. Esther start • Hospital admissions fell from approximately 9,300 in 1998 to prognostic 7,300 in 2003. • Hospital days for heart failure patients decreased from approximately 3,500 in 1998 to 2,500 in 2000. • Waiting times for referral appointments with neurologists decreased from 85 days in 2000 to 14 days in 2003. • Waiting times for referral appointments with gastroenterologists fell from 48 days in 2000 to 14 days in 2003.
  • 14. Coordinator Contact with from General Practitioner to the Dept. of Int. Medicine. Before the patient arrives to hospital. Discussion about the patient – where should the patient go? Direct to the acute clinic, via X-ray, direct to the nursing ward, to an office hour visit, giving advice, or needs the patient not to be lodged. To get correct care level – from the beginning!
  • 15. Quality time for Esther Every week, 30 min. 52 times a year
  • 16. Welcome back home package • Staff from municipal social care already there when Esther returns from the hospital • Make sure the home is in order, that Esther has got food and a clean bed. • That Esther got the tools required and right drugs • If needed, put and test a personal alarm around the wrist • Check again the care and social plan together with Esther, make changes when needed.
  • 17. On an national level readmissions > 65 year within 30 days are 20 %.
  • 18. Coach Coaching … offers a potential platform for an applied positive psychology and for facilitating individual, organizational and social change. GRANT, A. M. & CAVANAGH, M. J. 2007. Evidence-based coaching: Flourishing or languishing? Australian Psychologist, 42, 239- 254. s 239
  • 19. Plan Check Act Do Our reality
  • 20. Who are the Esther coaches 2013? Profession Municipality County council Privat practise Nursing assistans 70 11 Nurse 4 17 Physiotherapist 4 4 1 Occupational therapist 4 5 1 Social worker 4 2 Administrator 3 6 Human relations worker 0 1 Chief 3 5
  • 21. Successfactors • Personcenteredness • One story, one vision, one value • Meetingplaces, site visits • Participation of all personell • Improvement together with partners • Simple rules • Open minded • Say yes, embrace the positive energy • Trust is a must, hang on.
  • 22. Reflections • What, in this Esther concept, is useful for you and your work? • In your context, how do you strengthen the frontline in everyday work? • How do you keep good ideas alive?
  • 23. What tells Inge? http://www.lj.se/infopage.jsf? childId=15205&nodeId=31372
  • 24. Next step, please write down What are you going to do this week to move the idea of Esther networking just a tiny little step further in your organisation?
  • 25. www.lj.se/esther
  • 26. Esther café, systemic meetings with our customers
  • 27. Esther Coach Course • 8 days; learning by doing. • Making their own personal improvement project. ( PIP) • Making an improvement at their own working place • Coachingskills – solutionfocus approach • Site visits in other organisations in and outside Healthcare.
  • 28. Networks that are alive contain • The group asks versus share • Knowledge management • Recognition management • Celebration
  • 29. • Total openness (take everything people bring) • Focus on value • Constantly seeking and tapping energy • Creating a shared sense of system (shared map and shared narrative) • Letting go of need to control – an ecosystem, not a hierarchy (trust) Networks that are alive contain
  • 30. Networks that are alive contain: • Crisp aims and priorities • Shared optimism • Creativity and opportunism • Simplicity • Profound respect for logistics ( ”Amateurs discuss strategy…..”) J.McCannon &R Perla 2009 Learning networks for sustainable, large scale improvement Joint commision on quality and patientsafety
  • 31. Nursing assistans as coaches The trivial Matters. Everyday power in Swedish elder care. Tove Harnett. Dissertation School of health Sciences, Jönköpings university, 2010 The performance of the larger system can be no better than the performance of the microsystems of which it is composed. Microsystems in Health Care, Joint commission Journal on Quality and safety, 2003
  • 32. The Esther coach is a living example for our vision. Every day in their own work places but also in other groups. Every day is a new training experience. Esthers expectations are our possibilities
  • 33. November 2011
  • 34. Statements of the Chiefs 2009 • Good to have a drive • Would like to have one in every team • We see how they develop and grow together with the organisation • Create a creative climate • Coaches are our future, they are close to Esther, they can influence their collegues more than I can as a chief. • Their strengths are structure and method • They listen. They are awake and catch ideas • They are Esther grandchildren and always stand up for her • They dare to question todays reality and be provocativ in a constructive manner. No hierarchy.
  • 35. The Heart and Pearls of Esther “They are my tools to get the message out” Important to have Esther Coaches in the field as improvement resource “Esther Coaches help the leader get improvement done.” “Esther Coaches make connection between daily work and improvement” Woven Within The Fabric of the Micro, Meso and Macrosystem M.Godfrey 2010
  • 36. Esther improvement Coach program 2011 March Personal improvement project Vision, values, systemunderstanding, solutionsfocused approach Clientfocus, improvement knowledge, measurements Internat 2 dagar: Systemunderstanding,Lean, Solutionfocused coaching Communications skills and groupdynamics Spread Presentation tecnics examination Grow, networking Esther Coach identity OctoberMaj Esthers improvement project Site visitSite visit Examination september
  • 37. Esther improvement coach Spread Improvementwork Vision • Internationell • Nationell • Care chain • Intern • principles • Embody values and attitudes Wackerberg 2010
  • 38. Ideas Will Patientinvolvement Customfocus Multiprofessionell groups Challenges in daily work( frontline) Patientinvolvement KASAM Own driving force Open minded Good group climate Support av chief Group tolerans to test Execution Sustainability Patientinvolvement Communications skills Solutionfocus approach Groupdynamics Improvement tools Scheduled time for improvement Patientinvolvement KASAM Networking Systemunderstanding Solutionfocused approach ”Anchoring” Leadership Communication canals Modell: T. Nolan (2007), modifierad av N. Vackerberg 2012
  • 39. Involvement of a senior citizen an important factor with growing potential What did he do? What was mentioned as the result Was always there, every meeting Omproved clientfocus Observed and reflect every time Increased insights Brought new perspectives Breadth i learning Encouraged to be concrete Made it easier to start acting and not only talking. Gave continious positive confirmation Inspiration, motivation, courage Showed ”real” intrest and commitment Positive learning climate
  • 40. Esther steering commité Esther and family Staff close to esther Esther improvementgroups Esther competence centerEsther coordinationgroup Esther board Seniorcitizens organizations
  • 41. Högland’s hospital average days Average days in hospital 2009 2010 2011 2012 2013 Surgery 3,6 3,6 3,6 3,5 3,4 Gynecology 2,1 2,0 1,9 2,0 2,1 Internal medicine (3,9 – 4,4 period 2001 – 2009) 4,0 4,3 4,3 4,3 4,6 Orthopedics 4,3 4,0 4,4 4,8 5,4 Rehabilitation 20,0 19,4 17,8 12 10,7 Total 4,6 4,7 4,6 4,5 4,6