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This study found that primary nursing is the most common care delivery model (CDM) in acute care. Changes to CDMs are often reactive, driven by factors like staffing shortages, rather than strategic planning.

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Area of Science:

  • Healthcare Management
  • Nursing Administration
  • Health Services Research

Background:

  • Acute care settings face persistent challenges including workforce shortages, operational inefficiencies, and variable patient outcomes.
  • Care delivery models (CDMs) are crucial for organizing healthcare, but innovation and research in this area are limited.
  • Understanding current CDMs and their variability is essential for improving healthcare delivery.

Purpose of the Study:

  • To identify prevalent care delivery models (CDMs) in acute care environments.
  • To explore the factors contributing to variability in CDMs at unit, hospital, and system levels.
  • To analyze the drivers influencing changes in care delivery models.

Main Methods:

  • Employed a multimethod research design.
  • Conducted a survey of 294 nurse leaders.
  • Performed 34 qualitative interviews.
  • Utilized logistic regression and content analysis to identify influencing factors.

Main Results:

  • Primary nursing emerged as the most frequent CDM, utilized by 61.6% of participants.
  • Key drivers for CDM changes included staffing shortages, hospital size, and leadership roles.
  • A distinct typology of drivers at unit, hospital, and system levels was identified.

Conclusions:

  • Care delivery model adjustments in acute care are frequently reactive, lacking strategic or evidence-based foundations.
  • Recognizing organizational drivers is critical for intentional CDM implementation.
  • Aligned metrics are necessary for effective evaluation of care delivery models.