The management of the Singapore HealthServices (SingHealth),oneoftheregional healthsystems (RHS) in Singapore, visited theJönköpingCountyCouncil on1stand2ndOctober2014 to review the best pracGces in careintegraGoninternaGonally. Following their brieftrip,SingHealthwasinspiredbyEstherNetwork

to develop a localised Esther Network inSingapore.

This aLachmentwassubsequently organisedforthreemedical social workers fromdifferentRHSinSingapore,withthepurposeofgainingfurtherunderstandingofEstherNetwork.

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Newsletter – No. 4 – 2015

SingaporeMedicalSocialWorkers’ALachmentatEstherNetwork(18Septemberto22October)

Thethreemembersintheteamare:TanJieBinfromSingaporeGeneralHospital,KarenPohfromTanTockSengHospital,andMuhammadMuzzammilfromChangiGeneralHospital.

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EstherNetworkWhatisbestforEsther?–Fromcareprovidersinthemunicipality, tostaff in theacute hospitalsandprimary care, andpoliGcians inthecountycouncil, this is the constant quesGon that wehave heard throughout our five weeksaLachmentattheEstherNetwork.“WhatisbestforEsther?”was consistentlyheardlike a chorus,connecGng the various care systems together,creaGng a symphonic piece that deliverscoordinatedcareforEsther.Thecareproviders’unwavering commitment toprovidingthebestcare forEstherappearedtousasthecentralofEstherNetwork.Esther, who is o_en overlooked in the caresystems because of professional and bureau-craGc agendas, has had a greater voice in thecaresystemsbecause oftheEstherNetwork.Thepredecessors of the Esther Network and thecurrent leading coordinators have, over theyears, managed to draw emphasis to theimportance of involving Esther in her care.Involving Esther andallowingher toparGcipateinhercarehavenowgaineddeeperrootsintheconsciousnessofcareproviders.By doing so, the Esther Network is developedinto an open, common, and neutral plabormthatbrings togethermunicipaliGes,primarycareproviders, and acute hospitals in the region toprovidewell-coordinatedcareforEsther.By syncreGzing the spirit of conGnuous qualityimprovement and that of person-centred careinto the essence of the Esther Network, staffworking closest to Esther have been able tochampion improvement works to enhance thecareprovidedforEsther.Staffareempoweredtocarry out quality improvement projects withintheir insGtuGons andinter-insGtuGons,revealingthe synergisGc benefits of the network andinvolvementofEsther.

OurFiveWeeksJourneyWe have spent a total of five weeks inJönköping, Sweden. The highlights of our firstweek were meeGng with the father of EstherNetwork, DrMatsBojesGg, being introducedtothe Swedish health and social care system, as

well as aLendinganEsthercafé andparGcipaGnginanEsthercoachretreat.ThefirstweekgaveusbeLer insights of Esther Network and thecontext in which Esther Network sits in,facilitaGng our under-standing of theworks ofthemunicipality, primary care, andhospitals inthefollowingweeks.Duringoursecondweek, thefocuswas learningfrom staff of Qulturum about tools andmeasurements for quality improvementprojects. We have benefiLed much from thegenerous sharing of the experts in qualityimprovement at Qulturm. We were also giventhe opportunity to learn about the Eksjömunicipalityandhowelderlycareandsocial careare organised. In addiGon, we were veryprivilege to shadow nursing assistants tounderstandtheirdailywork.Wewere amazed at the quality of homecare

provided for elderly living at home and wereinspiredtowork towardimproving thecare forourelderlyinSingapore.Duringour thirdweek,we aLendedthe annualEsther Network strategy day. There, we wererefreshed by the passion and enthusiasm ofleaders and workers in pledging theircommitmenttoimprovingcareforEsther.WealsovisitedvariousunitsintheEksjöhospitalas well asTranås municipality inthe thirdweekto gain further understanding of theworks ofstaff in these organisaGons. Our favouritesegment of the third week would be theengagingdialoguewithanEstherwhois acGvelyinvolvedinEstherNetwork:MrIngerWerner.

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NewsletterNo. 4 – 2015

Wewere spell-bounded by his endless energy,wiiness,andhisgreatcapacitytolove.In the following week, we were warmlywelcomedatGGVV, specifically inGislavedandGnosjö municipality. We had the pleasure ofmeeGng many passionate staff who arededicated toward providing quality care forelderlyintheircommunity.Wewere parGcularlyintrigued by the employment of technology toaidstaffintheirworkinGGVV.Toward the end of our stay, we had theopportunitytovisittheprimarycareinVetlanda.Itwasaneye-openingexperiencelearningaboutthe varied responsibiliGes and works that theprimarycarecentrehasengagedin.This alsoopensupourmindstothe possibiliGesandpotenGal of thefuturedevelopmentof ourprimarycare.For our final week of stay, we had theopportunitytosharewithourSwedishfriends onour learning journey and reflecGons of theEsther spirit,whichwehopetobringbackwithus.

BiddingFarewellAmidst the cold autumn, we felt the Swedishwarmthwhereverwewent.Weareimmenselygrateful toall thefriendswhodrove us between meeGng points, helped usfigure out theSwedish systems (health, social,andtransport), andmadeusfeel at home.Wewouldlike tothankeveryone whohavehelpedto make this trip possible for us with all theliaisons, arrangement for our schedules andaccommodaGons.Weknowthisis hardworkandwereallyappreciateitverymuch.

Returning toSingapore,we hopetoembarkonthenextphrasetosharewithourcolleagues andpartners aboutthe EstherNetwork.We hopetoconGnueengagingyouinSwedenbysharingourreflecGons andlearningexperiencesontheblog(hLps://qulturum.wordpress.com/2015/09/16/bringing-esther-to-singapore/).Welook forwardtodeveloping our ownEstherNetworkandforthe efforts ofimprovingcareforEsthertoconGnuedeveloping.

Viönskareralllyckaochtacksåmycket!

EUmodelsofcare

TheNHS EuropeanOffice is workingwithNHSEngland to provide support to the IntegratedCare Pioneers, vanguards, and IntegratedPersonalCommissioningsites.This package of support aims to help NHScolleagues developlinks andshare learningwithorganizaGons at theleadingedgeof integratedcareinotherpartsofEurope.

During 2015/16, we will be focusing on fourdifferent EUmodels that couldbeof interesttoNHS colleagues looking to transform how theyprovidecarefortheirpopulaGons:

· AlzirainSpain· BuurtzorginTheNetherlands· TheEstherNetwork,Jönköping,Sweden· GesundesKinzigtalinGermanyWecompletedaseries ofwebinars on eachofthe four models. Colleagues wereable tohearfrom, and quesGon, the European leadersresponsible for developing and evolving theirparGcularmodelofhealthcare.

YoucanlistentothewebinarsathLp://www.nhsconfed.org/eumodelsofcare

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NewsletterNo. 4 – 2015

“I became interested in dehydraGon in theelderlywhenIwasworkingata hospital whileIwas an undergraduate nursestudent. I realisedhowliLlewas donetohelpthesepeopledrink.HydraGonshouldbeseenas apart ofnutriGon,but is o_en treated as a separate issue. Thiscertainly seemed to be true in the hospital IworkedwheremyenGre Gmeasacareassistantwas spent providing personal care such aswashingandtoileGngwitha breakforprotectedmeal Gmes devoted to providing adequatenutriGon (not hydraGon). I then also realisedthere was also very liLle literature addressingthis issue. A fewyears later,a_er compleGng asystemaGcreviewonnutriGonal intervenGons toprevent healthcare associated infecGons in theelderly,the issueappearedagain.There werenopapers that described promoGng opGmalhydraGontopreventthese infecGons; thereforethisbecameafocusofmystudy.I chosecarehomesfora fewreasons.OpGmisinghydraGonshouldbeanongoingprocess anditisunlikely wewouldsee a significant change in afew days most paGents spend in hospital. Thequality of hydraGon care in care homes hasalwaysbeen a concern and I found therewasvery liLle academic literature on hydraGon incarehomesinUK.”(QuoteAggieBakUK)Shortsummaryofherfindings:What Aggie found as shewas trying to find acarehomethatwas interestedinparGcipaGngina hydraGonprojectwas that therewereseveralreasonsforthelackofhydraGonandinterest inthesubject.Lackofresources,lackofknowledgeand competence in the care home staff andissues with communicaGon. The big challengeshesawwas that neither nurses or carehomestaff was aware of most of that but thoughtknowledgeandcompetencewasgoodenough.Aggie has a_er this extended her research toinclude depth interviews with staff as well asresidentsandtheirfamilies.

Whenthat isfinishedshewill createaprocessmaptoinformthenextsteps.Ifyouare interestedinknowingmoreabouttheproject you are welcome to email Aggie at:aggie.bak@uwl.ac.uk

WewishyouallMerryChristmas

andaHappyNewYear!

EstherNetworkworkgroup

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HydraGonprojectforcarehomeresidents(UK)

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NewsletterNo. 4 – 2015

@EstherNtverk