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Reading: Esther: person centred integrated system change


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Esther: person centred integrated system change


Anne Tidmarsh ,

Kent County Council, GB
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Robert Stewart

Design and Learning Centre for Clinical and Social Innovation, GB
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Title: The Design and Learning Centre for Clinical and Social Innovation ( DLC)  is “Making out-of-hospital care safer and more integrated for both citizens( ESTHERs)  and the professionals” and transforming the health and social care system through a process of asking “what matters to ESTHER” .

Background: Needs for health and social care are recognised to be increasing everywhere and that new ways of delivering service are required.

The Design and Learning Centre is “Making out-of-hospital care safer for both citizens and the professionals” by finding solutions to challenges set by commissioners and providers of health and social care

The DLC has developed a methodology to find innovative solutions to challenges that are co-designed by citizens and professionals. These are then tried out and evaluated and, if better, safer and cheaper, co-implemented across our region of 1.8 million citizens. This process is programmed to take a maximum of 365 days from defining the challenge to producing an evaluated solution.

These solutions make the person empowered to take more control of their health and wellbeing, including making maximum use of technology as an enabler.

Method: Our ESTHER program acts as a catalyst to change culture and strategy  enabling  workforce  change for the person with complex medical, mental health and social care needs.

Using 4 levels of continuous quality improvement where change needs to occur:

1- The person (ESTHER) - making them part of the Multidisciplinary Team.

2- Care professional - creating a social & clinical movement to support the implementation of the ESTHER culture by identifying over 500 ESTHER Ambassadors

3- MDT – training 88 ESTHER Coaches to ensure that each team meeting asks the question “What matters to ESTHER?”

4- The System – holding Community ESTHER Cafes listening to stories of people (ESTHERs)  going through the system, discussing how their experience could  improve, feeding back the conclusions to commissioners ,organisations and ESTHERs who have told their story

Result: Our ESTHER Transformation program has reduced the need for piloting  by developing ownership and trust of professionals, citizens and communities in the solutions and is accepted as System Change methodology.

The DLC has hosted a Junior Doctor training programme putting ESTHER at the centre of medical training and  will be supporting implementation of  Multi Disciplinary Teams and Integrated Care Planning as part of  STP System change. 

Summary: Our Design and Learning Centre has been able to learn from Sweden and implement their model locally without the need for further piloting.

This has been possible by identifying 4 levels of continuous quality improvement starting with the citizen , the professional, the team and the system.

Further developing the brand, creating an ESTHER kitemark and ESTHER app.

Our ESTHER program development uses the same methodology of innovation workshops  co-designing and engaging with citizens and professionals enabling the adoption of new ways of working and system change.

Our presentation/ workshop will explain what the ESTHER programme is aiming to achieve, how it is implemented and how the programme is delivering the transformation of integrated care.

How to Cite: Tidmarsh A, Stewart R. Esther: person centred integrated system change. International Journal of Integrated Care. 2019;19(4):175. DOI:
Published on 08 Aug 2019.


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