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

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?

27. www.lj.se/esther

30. Esther café,
systemic meetings with our customers

31. 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.

32. Networks that are alive contain
• The group asks versus share
• Knowledge management
• Recognition management
• Celebration

33. • 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

34. 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

35. 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

36. 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

37. November 2011

38. 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.

39. 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

40. 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

41. Esther improvement coach
Spread
Improvementwork
Vision
• Internationell
• Nationell
• Care chain
• Intern
• principles
• Embody values
and attitudes
Wackerberg 2010

42. 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

43. 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

44. Esther steering commité
Esther and family
Staff close to esther
Esther improvementgroups
Esther competence centerEsther coordinationgroup
Esther board
Seniorcitizens organizations

45. 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