Leading change

A Care Coordinator led the implementation of the internationally recognised Esther care model, initially within a care home at the Graham Care Home Group after they identified unwarranted variation in practice in relation to how residents were involved in their care planning. The Graham Care Group (GCG) is a group of nine care homes. By changing practice, the Esther Coordinator has improved the quality of care delivered in the home, ensuring a person-centred approach and partnership working with the residents, which has led to improved experience and better use of resources.

Where to look

Before the pilot, care plans in the home were primarily task focused and aimed to ensure residents received good quality care from an objective perspective of the carer. Very few focused on the resident’s view of care or how they wanted to achieve their daily tasks or be supported. Other care staff at the Graham Care Group, along with the Esther Coordinator identified the opportunity to improve this area of practice and undertook to pilot Esther methodology, a tool that could be used to personalise care and pathways of care. The model also empowers residents to engage in shared decision making, supporting staff at the home to address unwarranted variation in care provision.

The Esther methodology is a Swedish model of care which strives to improve patient care for the elderly. Esther was a real person who became seriously unwell and was admitted to hospital. In her case there were delays in diagnosis, treatment and care planning and Esther’s overall experience of her care was not good. The resulting approach aimed to ensure improvements were made and others could learn from Esther’s experience to deliver high-value patient -centred care.

What to change

Following agreement with the care home owner, the coordinator identified the need for staff education of the new methodology, so they could begin working differently. Care staff have always been at the centre of the work, leading on the care and the care plans, and ensuring resident care was optimal. The new element of this process was that now care staff worked to ensure residents’ views over their care were heard and represented in care plans and care delivered.

How to change

The Esther methodology, now being adopted across Kent, was introduced to the home and all staff were offered an introductory education session to the model. Initially, in excess of eighty percent of staff took up the offer. Following this the home manager and the coordinator selected a number of staff members from various professions for improvement coach training. This gave them comprehensive knowledge of person-centred care, tools to use for improvement work and coaching skills to get their teams on board. These coaches then took a baseline measurement of practice before implementing the change and then ongoing measurements during and after the change so they could identify any improvements in care and care planning.

During the training all trainees identified an improvement opportunity that would change resident’s lives, find out how to make the change and implement it together with the team.

Following this the coaches deliver two hour-long Esther introduction sessions, where after the attendants become Esther ambassadors.

Adding value

Better outcomes – Due to its success the pilot model is being rolled out across Kent. In October 2018 there were six hundred and eighty five Esther ambassadors across the region.  Within the pilot care home there are two trained Esther coaches. Evidence suggests that the more personalised the care, the more effective the treatment. Patients have had more input so are likely to be more responsive and it suits their needs more. In other areas this has shown reduction in referrals to hospital and in lengths of hospital stays, which is positive.

Better experience – This patient-centred approach gives individuals input on the care they receive – their experience is improved and will also likely have an impact on both resident safety and clinical effectiveness. One example is ‘I like boards’ that every resident has in their room, which is a photo frame sharing the residents likes and dislikes. This gives topics for conversations with the resident and helps staff see the person behind the dementia and other diagnoses. It has led to more personalised care and better mood amongst the residents.

Positive feedback has been received from residents’ families – feedback has included “I can see you look at my parent as a person, not just another Alzheimer person.”

Better use of resources – Staff time is saved as colleagues do not need to ask each other or the resident the same questions. Quality of care has improved alongside this through the approach.

Challenges and lessons learnt for implementation

• Do not go to fast, make sure the everyone feels included and even better, feel ownership of the improvement, even if they are not the improvement leader. The biggest challenge is to get the whole team on board.
• Ensure staff are encouraged to use their knowledge and training in practice and that there is adequate support from the nurse leader and coaches.

Learning from the pilot is planned to influence the model’s roll out to other care homes in the group and across Kent.

Further information can be found on the Kent County Council website.

Find out more

For more information contact:

• Anna Carlborn, ESTHER Co-ordinator, anna.carlbom@kent.gov.uk