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10 Apr 2018


Starting on this page and spilling onto others, you will read a confronting story of Esther. Elements of this story ring true. We rural doctors will recognise Esther immediately. The Canadian version of Esther’s story has been Australianised by author Dr Janelle Trees, an Aboriginal GP. She tells me the story is all too true, she agrees it is appropriate to share it with you. I beg you to soldier on past the first few paragraphs no matter how offensive it reads.

Esther first came into being in Sweden in the late 1990s. It is a story based on an elderly woman caught between bureaucracies, receiving fractured and non-patient focussed care. In the process of her acute admission to hospital, she repeated her story 36 times, received care that was focussed on systems, care that was “Not best for Esther”. The Swedish Healthcare took this sad story and made system-wide changes. The changes always focussed on the question: “What is best for Esther?”

They now have a non-hierarchical voluntary network of over 7000 members from health and social services. The outcomes are staggering. For example, in 2004, hospital admissions fell from 9300 to 7300, the number of unnecessary days in hospital decreased from 1113 to 62 in 2011. The Esther Project received a national Swedish award for quality improvement.

Then last year, the NorthWest Territories (NWT), Canada took the story and put a First Nations spin on it. This is the story I was shown by an executive from Stanton Hosptial, Yellowknife. I have been given permission to share it with you. There is no known author.  The story is so engrained in NWT Health that everyone knows Esther. 
I don’t know that there is a firm plan established to incorporate Esther in the culture of Stanton, but because her story is ‘preached’ from the highest levels, and the trickle-down method is in place. 

In contrast, Kent in the UK, and Singapore are now planning to follow the Swedish model, focussing on patient-centred, coordinated care for the elderly.

The First Nations focus resonates with me. I love how Dr Trees has Australianised it.  Sadly the Indigenous health issues, poverty, social situations, and the ‘stuck’ mindsets are the same despite 15,000 km and 75-80 degree difference in temperature.

So now, rural doctors, I challenge you. Take Esther to your next staff meeting; invite Esther into the lunch room; write about Esther.  Find at least two or three Esthers.  Did you know Esther is both a boy's name and girl's name?

Start small, always ask Esther for opinions, follow a patient’s story from beginning to end, talk about improvements.

And always ask: “What is best for Esther?”


* Look for Esther (in Australia) in the National News pages of this site. 

Published: 10 Apr 2018