Nurse-Designed Care Models and Culture of Health

Recognizing that health care is just one of many factors that contribute to the health and wellness of individuals and communities, the Robert Wood Johnson Foundation (RWJF) recently made a commitment to advancing a national Culture of Health—an action framework developed by RWJF that focuses on well-being and equity with the goal of empowering and supporting people to lead healthier lives where they live, learn, work, and play, now and in generations to come. To better understand the role that health care providers can play in this initiative, RWJF has been scanning the nation for examples of current models of care that promote a Culture of Health.

Given their unique education and training, their rich history of advocacy and social action on behalf of patients' health, and their focus on patient-centered care, nurses are well positioned to provide care that is consistent with and contributes to a Culture of Health in their communities. RWJF contracted with the American Academy of Nursing (the Academy) to explore the ways that innovative nurse-designed models of care are currently advancing a Culture of Health, and the Academy in turn subcontracted with the RAND Corporation to research and document findings from case studies of three nurse-designed care models that have been recognized as innovative by the Academy's Edge Runner program. This program identifies and designates as Edge Runners those nurses who have designed innovations to remedy challenges in the delivery of health care or address an unmet health need of a population, and who can demonstrate positive clinical and financial outcomes. To develop these case studies, we used data collected from an environmental scan of documents, an online survey, key informant interviews, and site visits. We describe each Edge Runner model, how each addresses a Culture of Health, and the particular facilitators and barriers to each model's success.

We found that nurse-designed models of care focus extensively on activities in the four different “action areas” set forth in RWJF's Culture of Health framework: making health a shared value; fostering cross-sector collaboration to improve well-being; creating healthier, more equitable communities; and strengthening integration of health services and systems. Strong leadership (in the form of a “champion” nurse) and broad community support were key to the success of each of these models. A persistent challenge was identifying a sustainable funding mechanism for community-level efforts aimed at addressing social determinants of health—most of these efforts are currently grant-funded.

The findings and themes have a number of useful implications for public policy, health care providers' efforts aimed at addressing a Culture of Health, and the future of health professional education. Activities needed to address a Culture of Health require multisector partnerships. Health care providers will not be able to address the breadth of a Culture of Health on their own. Instead, the future role of health care providers may be to identify unique resources within each community, promote communal self-efficacy, and help enable communities to devise their own unique responses at that level.

Furthermore, to varying degrees, each model struggled with a consistent source of funding to sustain the scope of the program. Current trends in domestic health care policy that make providers responsible for overall patient outcomes, such as accountable care organizations, offer potentially promising approaches to make community-level interventions more sustainable. Additionally, health care workforce development must focus on ensuring that care professionals are prepared to be skilled partners and leaders in building a Culture of Health.

Taken together, these Edge Runner models offer important examples of work that promotes a Culture of Health, and they present a useful context for examining how other providers might contribute to a Culture of Health in the communities where they work.