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Published on: February 16, 2011
Care Delivery Models in Acute Care Hospitals: A Multimethod Study
Heather V Nelson-Brantley1, Bret Lyman, Esther Chipps
1Author Affiliations: Associate Professor, Director of Nurse Executive DNP Pathway, and Director of Nursing Health Systems Leadership MSN Pathway (Dr Nelson-Brantley), School of Nursing, University of Alabama at Birmingham; Professor (Dr Lyman), School of Nursing, Brigham Young University, Salt Lake City, Utah; Clinical Nurse Scientist and Professor of Clinical Nursing (Dr Chipps), The Ohio State University Wexner Medical Center, The Ohio State University College of Nursing, Columbus; Nurse Scientist (Dr Weaver), NJ Collaborating Center for Nursing and Ann May Center for Nursing, Hackensack Meridian Health, Neptune, New Jersey; Associate Professor (Dr Farag), College of Nursing, University of Iowa, Iowa City; Chief Nursing Officer (Dr Moore), MercyOne, Davenport, Iowa; Statistician (Dr Sinnott), The Ohio State University College of Optometry, Columbus; and Clinical Professor and Director of DNP & MSN Health Systems Administration and Executive Leadership Programs (Dr Joseph), College of Nursing, University of Iowa, Iowa City.
Objective:
The aims of this study were to identify care delivery models (CDMs) currently used in acute care settings and explore sources of variability at the unit, hospital, and system levels.
Background:
Despite efforts to improve healthcare delivery, acute care settings continue to face challenges such as workforce shortages, inefficiencies, and inconsistent patient outcomes. Care delivery models define how care is organized and delivered, yet current research on CDM innovation is sparse.
Methods:
A multimethod design was used, including a survey of 294 nurse leaders and 34 qualitative interviews. Logistic regression and content analysis identified factors influencing CDM changes.
Results:
Primary nursing was the most common CDM (61.6%). Care delivery model changes were driven by staffing shortages, hospital size, and leadership position. A typology of unit-, hospital-, and system-level drivers emerged.
Conclusions:
Care delivery model changes are often reactive rather than strategic or evidence based. Understanding organizational drivers and having aligned metrics can aid in more intentional implementation and evaluation of CDMs.
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