Special Interest Session 2: Putting the Person at the Centre: Would the Esther Approach Work for Scotland?
“Finding the words, changing
Developing the Principles of Person-
Centred Care and Support for the Person-
Centred Health and Care Collaborative
Person-centred health and
kindness, to enable
Trust, respect and
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.
110 000 inhabitants
7 Primary care regions
ca 7000 employees
A durable and energetic
so that Esther can feel
confident and independent
• Gets care in or close to
• See us as the same
provider of care
• Has the same possibilities
to get care all over the
• Knows where and who to
• 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
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.
Who is the customer?
What is best for
Esther… no matter where
We will be there!
• What does Esther need/ want?
• What is important for Esther when she gets sick?
• 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
• New technology?
• Changes in population?
Energetic network and cooperation
Thinking about the next provider
Your problem is my problem
Mutual responsibility for the person
Mutual meetings and education
Openness and learning
• 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
• Waiting times for referral appointments with
gastroenterologists fell from 48 days in 2000 to 14 days
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!
Quality time for Esther
Every week, 30 min. 52 times a year
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
• Check again the care and social plan together with
Esther, make changes when needed.
On an national level readmissions > 65 year within 30 days are 20 %.
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
Who are the Esther
Profession Municipality County
Nursing assistans 70 11
Nurse 4 17
Physiotherapist 4 4 1
4 5 1
Social worker 4 2
Administrator 3 6
Chief 3 5
• 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.
• What, in this Esther concept, is
useful for you and your work?
• In your context, how do you
strengthen the frontline in
• How do you keep good ideas
What tells Inge?
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?
systemic meetings with our customers
Esther Coach Course
• 8 days; learning by doing.
• Making their own personal improvement
project. ( PIP)
• Making an improvement at their own
• Coachingskills – solutionfocus approach
• Site visits in other organisations in and
Networks that are alive contain
• The group asks versus share
• Knowledge management
• Recognition management
• Total openness (take everything
• 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
Networks that are alive
• Crisp aims and priorities
• Shared optimism
• Creativity and opportunism
• 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
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
Microsystems in Health Care, Joint commission Journal
on Quality and safety, 2003
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
Esthers expectations are our
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
• 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.
The Heart and Pearls of Esther
“They are my
tools to get the
Coaches in the
help the leader
Woven Within The Fabric of the Micro, Meso and Macrosystem
Coach program 2011
Personal improvement project
Vision, values, systemunderstanding, solutionsfocused approach
Clientfocus, improvement knowledge, measurements
Internat 2 dagar:
Communications skills and groupdynamics
Presentation tecnics examination
Esthers improvement project
Site visitSite visit Examination
Challenges in daily
Own driving force
Good group climate
Support av chief
Group tolerans to test
Scheduled time for
Modell: T. Nolan (2007), modifierad av N. Vackerberg 2012
Involvement of a senior citizen
an important factor with growing
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
Esther steering commité
Esther and family
Staff close to esther
Esther competence centerEsther coordinationgroup
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