Table 2

Context, mechanisms and outcomes configurations explaining the decision to adopt the Esther Network (EN) model in SingHealth

ContextMechanismsOutcomes
Macrosystem
(1) Demand from changing demographics to adopt a new care modelSingHealth leaders capitalised on the opportune time to introduce EN supported by its good track recordCollective decision to adopt EN in SingHealth
(2) A process and structure are needed to operationalise person-centred care in population healthThe logic of EN, ‘What is Best for Esther?’, resonated with what clinicians intuitively want for their patientsCollective decision to adopt EN in Singapore
Mesosystem
(3) Dissatisfaction with the busy-ness and target-oriented healthcare modelLearning trip to Jönköping by key SingHealth leaders reinforced a group and community spiritCollective alignment
(4) Organisational tagline ‘Patients at the heart of all we do’ often interpreted differently by staff groupsThe simplicity of the brand name Esther was perceived to be easily understood by staff and service usersEN symbolised hope that service users’ participation will shape better care
Microsystem
(5) Workforce less engaged; the top-down and formal approach reduced work satisfactionLeaders recognised that the EN model promoted coproduction between staff and patientsEngaged and activated workforce