This report presents findings from case studies of three nurse-designed care models that have been recognized as innovative by the Academy's Edge Runner program and that help foster a culture of health — an action framework developed by The Robert Wood Johnson Foundation 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 the future.

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Nurse-Designed Care Models and Culture of Health

Review of Three Case Studies

by Grant R. Martsolf, Diana J. Mason, Jennifer Sloan, Cheryl G. Sullivan, Antonia M. Villarruel

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Research Questions

  1. How do nurse-designed care models align with the RWJF COH?
  2. What barriers and facilitators do these nurse-designed models face when addressing a COH?
  3. What can RWJF and communities learn from these nurse-designed models to more clearly define possible roles and contributions of the health sector to advancing a COH?

The Robert Wood Johnson Foundation (RWJF) recently made a commitment to advancing a national culture of health (COH) — 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. Nurses are well positioned to provide care that is consistent with, and contributes to, a COH in their communities. RWJF contracted with the American Academy of Nursing (the Academy) with a subcontract to the RAND Corporation to explore the ways that innovative nurse-designed models of care are currently advancing a COH. This report presents findings from case studies of three nurse-designed care models that have been recognized as innovative by the Academy's Edge Runner program, which identifies 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. Findings indicate that nurse-designed models of care focus extensively on activities in the four different "action areas" set forth in RWJF's COH framework: making health a shared value; fostering cross-section collaboration to improve well-being; creating healthier, more equitable communities; and strengthening integration of health services and systems. Strong leadership 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.

Key Findings

Nurse-Designed Care Models Align Well with the RWJF COH

  • Using various methods we selected three models for our case studies. Our final selections serve a range of populations — pregnant women; teachers, students and parents; and low-income patients.
  • All three models focus to varying degrees on all aspects of the COH framework, but the findings from these case studies have important implications especially in the areas of making health a shared value and strengthening integration of health services and systems.

The Models Have Similar Facilitators and Face Similar Barriers

  • 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.

Recommendations

  • These findings suggest that RWJF and other interested stakeholders should continue to help health care providers and communities better understand and translate how their work is consistent with making health a shared value, continue looking for ways to advance in this specific area, and continue to highlight the importance of working with communities to better foster a shared value of health.
  • More work should be done to aggregate and synthesize the work on evidence-based interventions that focus on all aspects of a COH.
  • Emphasizing interdisciplinary learning and collaboration in health professions' education would help prepare the workforce to work together across silos and within communities to create a COH. Specifically, nurses should be included whenever possible in COH-related initiatives, as they are well positioned to contribute given their leadership skills, holistic framework and philosophy centered on the patient (individual, family, community), relationship-building skills, and public trust.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Background and Setting

  • Chapter Three

    Methodology

  • Chapter Four

    Case Study 1: Sharon Rising and CenteringPregnancy

  • Chapter Five

    Case Study 2: Sandee McClowry and INSIGHTS

  • Chapter Six

    Case Study 3: Donna Torrisi and the Family Practice and Counseling Network

  • Chapter Seven

    Cross-Cutting Themes

  • Chapter Eight

    Discussion

  • Appendix A

    Survey Tool

  • Appendix B

    Interview Protocol

The research described in this report was conducted by RAND Health.

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