CNO Summit 2017, Day 1, 12.20pm Anna Carlbom, ESTHER co-ordinator The Graham Care Group and Kent and Meadway Integration Pioneers. Oena Windibank, Chief Offcier Thanet Integrated Accountable care Organisation

1. @6CsLive #cnosummit
Implementing the ESTHER model in
Kent and Medway
and Pilot at Hawkinge House Care
Home
Anna Carlbom; ESTHER co-ordinator The Graham Care Group and Kent
and Medway Integration Pioneers
Oena Windibank; Chief Officer Thanet Integrated Accountable Care
Organisation

2. @6CsLive #cnosummit
What is best for ESTHER?
• The ESTHER Network was founded in 1997
• ESTHER is a fictitious patient in need of care from more than
one provider
• Two main goals
• Smoother and safer care pathways for ESTHER
• Better use of the providers resources
• Cannot be done without including ESTHER

3. @6CsLive #cnosummit
Why?

4. @6CsLive #cnosummit
ESTHER’s journey scenario B

5. @6CsLive #cnosummit
How did we move from scenario A to scenario B?
• Bridged the gaps by seeing ourselves as ONE provider
• Meeting places
• ESTHER as a natural partner from day 1
• All providers involved
• Lack of prestige when co-operating with other providers and
ESTHER
• Respect each other and our different knowledge and competence

6. @6CsLive #cnosummit
Implementing at Hawkinge House Care Home in
the Graham Care Group
• All members of staff, regardless of profession, were given a 2 hour introduction in
the ESTHER model
• An ESTHER improvement coach training followed
• The trainees were a mix of volunteers and staff members picked by manager and
ESTHER coordinator
• 4 sessions of training, person centred working, improvement knowledge,
improvement tools, measurements, group dynamics
• Learning by doing, identify and implement an improvement at own workplace,
coaching and including work team

7. @6CsLive #cnosummit
Further roll out
• The Graham Care Group:
• Introduction and Coach training for the quality team
• Ongoing evaluation of outcomes at Hawkinge House
• Introduction and Coach training at the other homes in the group

8. @6CsLive #cnosummit
Thanet Integrated Accountable Care Organisation
• Pilot site for the ESTHER model
• Training 25 coaches across provider organisations at all levels
• Coaches identified workplace improvement projects
• Future cohorts identified; Targeting of hospital staff /GPs, Clusters trained
• ESTHER ambassadors trained to support coaches
• Bi-monthly ESTHER cafés
• ESTHER roadshows around Kent to raise awareness of the model
• Thanet Diabetes café supporting self care
• Executive Board agenda setting

9. @6CsLive #cnosummit
Individual care
Service development Operational
management and
performance
Governance Structures
EST H E R
a t t h e
centre of
e v e r y
decision
Personal care meeting my needs
No change without my voice
How do I know I am making a difference?
How do I know that bureaucracy won’t get in the way?

10. 10
CONFIDENTIAL – WORK IN PROGRESS
The K&M Local care model for frail ESTHER
Source: K&M Local Care
Esther’s care will be…
Consistent and well organised:
I am visited by friendly faces who are familiar with my
needs
Inconsistent and overlapped: Unfamiliar staff provide
similar services and do not fully understand my health and
care needs
Decided with me: I am involved with all decisions made
regarding my care and communication regarding decisions is
clear
Decided without my involvement: I feel excluded from all
major care decisions and don’t get to say what I would like
Simple to access: I have one phone number that I am
confident can help me in any way required
Difficult to access: There are multiple, confusing points of
contact for different services when I have a health or care
issue
Assessed by an expert without me having to go to the
hospital: I am quickly provided with the specialist opinion
or diagnostic results needed without going to hospital
Only assessed by a specialist when I visit hospital: When I
quickly needs diagnostic tests or an expert opinion, I have
to travel to multiple outpatient appointments
Currently, Esther tells us her care is…
Focused only on my health needs: I don’t understand the
wider community support available to me
Focused on me: My wider health and social needs are
understood and it is easy for me to access any community
support I or my family needs

11. @6CsLive #cnosummit
Indicative Performance Measures
ESTHER manages her own Well Being at Home.
She is Enabled to look after herself.
ESTHER has fewer Acute Admissions
Reduction in NELs and Length of Stay
ESTHER has access to Crisis Care in a timely fashion, she knows how to get help when she needs it Reduction in NELs / crisis mental health placements and A&E attendances
Reduction in ambulance conveyances
ESTHER has less “Crisis” Reduction in long term Care packages
Clear anticipatory care plans in place, used appropriately, CPA plans measured
ESTHER would take appropriate medication Reduction in medication related admissions and complications
ESTHER has earlier Diagnosis and Treatments Increased Access to Advanced Care Planning. MDT process in place and measured
ESTHER Receives consistent Quality Care and has a positive environment/support framework ESTHER uses the employment/Housing/Meaningful Activity Resources she has access to appropriately
Increased access to services locally
Increased community support
ESTHER is adequately supported by consistent high quality staff Improved Recruitment & Retention
Improved Experience Reported by ESTHER
Reduction in SI’s and near missed events

12. @6CsLive #cnosummit
QUESTIONS?