How the Esther Network model for coproduction of person-centred health and social care was adopted and adapted in Singapore: a realist evaluation
Objectives The Esther Network (EN) model, a person-centred care innovation in Sweden, was adopted in Singapore to promote person-centredness and improve integration between health and social care practitioners. This realist evaluation aimed to explain its adoption and adaptation in Singapore.Design...
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BMJ Publishing Group
2022-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/12/e059794.full |
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| author | Julian Thumboo Johan Thor Boel Andersson Gäre Esther Li Ping Lim Giat Yeng Khee Monika Allgurin |
| author_facet | Julian Thumboo Johan Thor Boel Andersson Gäre Esther Li Ping Lim Giat Yeng Khee Monika Allgurin |
| author_sort | Julian Thumboo |
| collection | DOAJ |
| description | Objectives The Esther Network (EN) model, a person-centred care innovation in Sweden, was adopted in Singapore to promote person-centredness and improve integration between health and social care practitioners. This realist evaluation aimed to explain its adoption and adaptation in Singapore.Design An organisational case study using a realist evaluation approach drawing on Greenhalgh et al (2004)’s Diffusion of Innovations in Service Organisations to guide data collection and analysis. Data collection included interviews with seven individuals and three focus groups (including stakeholders from the macrosystem, mesosystem and microsystem levels) about their experiences of EN in Singapore, and field notes from participant observations of EN activities.Setting SingHealth, a healthcare cluster serving a population of 1.37 million residents in Eastern Singapore.Participants Policy makers (n=4), EN programme implementers (n=3), practitioners (n=6) and service users (n=7) participated in individual interviews or focus group discussions.Primary and secondary outcome measures Outcome data from healthcare institutions (n=13) and community agencies (n=59) were included in document analysis.Results Singapore’s ageing population and need to transition from a hospital-based model to a more sustainable community-based model provided an opportunity for change. The personalised nature and logic of the EN model resonated with leaders and led to collective adoption. Embedded cultural influences such as the need for order and hierarchical structures were both barriers to, and facilitators of, change. Coproduction between service users and practitioners in making care improvements deepened the relationships and commitments that held the network together.Conclusions The enabling role of leaders (macrosystem level), the bridging role of practitioners (mesosystem level) and the unifying role of service users (microsystem level) all contributed to EN’s success in Singapore. Understanding these roles helps us understand how staff at various levels can contribute to the adoption and adaptation of EN and similar complex innovations systemwide. |
| format | Article |
| id | doaj-art-d9532fd21ef74792854daee81edf5b7d |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-d9532fd21ef74792854daee81edf5b7d2025-08-20T02:14:34ZengBMJ Publishing GroupBMJ Open2044-60552022-12-01121210.1136/bmjopen-2021-059794How the Esther Network model for coproduction of person-centred health and social care was adopted and adapted in Singapore: a realist evaluationJulian Thumboo0Johan Thor1Boel Andersson Gäre2Esther Li Ping Lim3Giat Yeng Khee4Monika Allgurin51 NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore1 School of Health and Welfare, Jönköping University, Jönköping, Sweden1 School of Health and Welfare, Jönköping University, Jönköping, Sweden1 School of Health and Welfare, Jönköping University, Jönköping, Sweden3 Department of Pharmacy, Singapore General Hospital, Singapore1 School of Health and Welfare, Jönköping University, Jönköping, SwedenObjectives The Esther Network (EN) model, a person-centred care innovation in Sweden, was adopted in Singapore to promote person-centredness and improve integration between health and social care practitioners. This realist evaluation aimed to explain its adoption and adaptation in Singapore.Design An organisational case study using a realist evaluation approach drawing on Greenhalgh et al (2004)’s Diffusion of Innovations in Service Organisations to guide data collection and analysis. Data collection included interviews with seven individuals and three focus groups (including stakeholders from the macrosystem, mesosystem and microsystem levels) about their experiences of EN in Singapore, and field notes from participant observations of EN activities.Setting SingHealth, a healthcare cluster serving a population of 1.37 million residents in Eastern Singapore.Participants Policy makers (n=4), EN programme implementers (n=3), practitioners (n=6) and service users (n=7) participated in individual interviews or focus group discussions.Primary and secondary outcome measures Outcome data from healthcare institutions (n=13) and community agencies (n=59) were included in document analysis.Results Singapore’s ageing population and need to transition from a hospital-based model to a more sustainable community-based model provided an opportunity for change. The personalised nature and logic of the EN model resonated with leaders and led to collective adoption. Embedded cultural influences such as the need for order and hierarchical structures were both barriers to, and facilitators of, change. Coproduction between service users and practitioners in making care improvements deepened the relationships and commitments that held the network together.Conclusions The enabling role of leaders (macrosystem level), the bridging role of practitioners (mesosystem level) and the unifying role of service users (microsystem level) all contributed to EN’s success in Singapore. Understanding these roles helps us understand how staff at various levels can contribute to the adoption and adaptation of EN and similar complex innovations systemwide.https://bmjopen.bmj.com/content/12/12/e059794.full |
| spellingShingle | Julian Thumboo Johan Thor Boel Andersson Gäre Esther Li Ping Lim Giat Yeng Khee Monika Allgurin How the Esther Network model for coproduction of person-centred health and social care was adopted and adapted in Singapore: a realist evaluation BMJ Open |
| title | How the Esther Network model for coproduction of person-centred health and social care was adopted and adapted in Singapore: a realist evaluation |
| title_full | How the Esther Network model for coproduction of person-centred health and social care was adopted and adapted in Singapore: a realist evaluation |
| title_fullStr | How the Esther Network model for coproduction of person-centred health and social care was adopted and adapted in Singapore: a realist evaluation |
| title_full_unstemmed | How the Esther Network model for coproduction of person-centred health and social care was adopted and adapted in Singapore: a realist evaluation |
| title_short | How the Esther Network model for coproduction of person-centred health and social care was adopted and adapted in Singapore: a realist evaluation |
| title_sort | how the esther network model for coproduction of person centred health and social care was adopted and adapted in singapore a realist evaluation |
| url | https://bmjopen.bmj.com/content/12/12/e059794.full |
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