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New Health Care Delivery Models are Redefining the Role of Nurses


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By Linda Beattie, contributor 

Everyone is trying to do more with less these days, but it can be especially difficult in the area of health care. Hospitals, health systems, medical clinics and health plans across the country are asking themselves, “How can we be more efficient while delivering even better patient care?”

New Health Care Delivery Models Redefine Nurses' Roles
Recent research initiatives discovered that some of the most innovative nursing-driven models of health care involved elevating the role of nurses from caregivers to "care integrators."

Their quest for answers has led to a number of innovative solutions, including new health care delivery models that are redefining the role of nursing. In many cases, nurses have gone beyond the role of caregivers to become key integrators, care coordinators and efficiency experts who are redesigning the patient experience.

“We’re facing the perfect storm, considering the shortage of health care workers, economic pressures and quality initiatives that health care providers must deal with on a daily basis,” said David Cherner, M.B.A., M.P.H., managing partner of Health Workforce Solutions (HWS), a San Francisco-based consulting firm, and project director of a recent national study of innovative health care models. “Leaders have recognized that health care workers need new tools to work more effectively and efficiently.”

“Nurses drive a lot of the change in health care,” he continued, “and we had discovered from a previous research project that there were some successful care models out there that were already proven and could be replicated by others.” The challenge was to find the winners and make them accessible.

So, with more than $700,000 in grant money from the Robert Wood Johnson Foundation, HWS set out to identify and profile some of the most innovative, nursing-driven models of health care delivery that emphasize interdisciplinary collaboration, could be widely replicated and offer promise for new methods of workforce organization into the future.

After the initial research inquiry, interviews and leadership roundtables, the HWS team started with 171 projects to consider, narrowed the field to 60, and then selected 24 care delivery models for in-depth study. They focused on acute care models and transitional care models, and enlisted outside nurse leaders to help guide the work.

HWC published their findings in a white paper, Innovative Care Delivery Models: Identifying New Models that Effectively Leverage Nurses, and have showcased each model on a comprehensive Web site created for the project.

The research team found innovation throughout the health care system, from urban academic medical centers to for-profit health plans to rural health associations. Whether it was the team-nursing model at Virginia Mason Medical Center, the primary care coordinator role at UPMC Shadyside or the Living Independently for Elders (LIFE) program at the University of Pennsylvania School of Nursing, each model demonstrated a practical and innovative approach to one or more real problems.

“Nurses form the backbone for most of these delivery models,” said Cherner, “and although each model is different, there were several key themes that the investigators discovered.”

Eight common themes found among the care delivery models included:

1. Elevating the role of nurses and transitioning from caregivers to “care integrators.” In 23 of the 24 models, the organization created at least one new role for nurses and often elevated the RN role to one of integrating care for the patient.

2. Taking a team approach to interdisciplinary care.

3. Bridging the continuum of care outside of the primary care facility.

4. Defining the home as a setting of care. (Six of the models rely on a patient's home as the primary location for care delivery.)

5. Targeting high users of health care, especially older adults.

6. Sharpening focus on the patient, including an active engagement of the patient and her or his family in care planning and delivery, and a greater responsiveness to patient wants and needs.

7. Leveraging technology.

8. Improving satisfaction, quality and cost. All of the models were developed in response to specific problems or concerns about patient quality, patient and provider satisfaction or unsustainable costs and utilization.

“In most cases, change didn’t happen overnight,” said Cherner. “Some of these models took years to develop. But we found that when nurses want to make improvements and can get buy-in from leadership, they can make important changes.”

“Our hope is that nurses and health leaders will look at these models and use them to begin to drive change from within their own organizations,” he continued. “Some models are ready to be replicated ‘as is,’ and others can generate ideas for building new models and inspiring more innovative solutions to today’s health care problems.”

For more information on the research project, details of the 24 models studied, and to download the white paper, visit the Innovative Care Models Web site .

© 2009. AMN Healthcare, Inc. All Rights Reserved.