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.

Nurse-Designed Care Models and Culture of Health

Review of Three Case Studies

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

ResearchPublished Apr 19, 2017

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.

Topics

Document Details

Citation

RAND Style Manual
Martsolf, Grant R., Diana J. Mason, Jennifer Sloan, Cheryl G. Sullivan, and Antonia M. Villarruel, Nurse-Designed Care Models and Culture of Health: Review of Three Case Studies, RAND Corporation, RR-1811-AAN, 2017. As of October 6, 2024: https://www.rand.org/pubs/research_reports/RR1811.html
Chicago Manual of Style
Martsolf, Grant R., Diana J. Mason, Jennifer Sloan, Cheryl G. Sullivan, and Antonia M. Villarruel, Nurse-Designed Care Models and Culture of Health: Review of Three Case Studies. Santa Monica, CA: RAND Corporation, 2017. https://www.rand.org/pubs/research_reports/RR1811.html.
BibTeX RIS

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

This publication is part of the RAND research report series. Research reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND research reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit www.rand.org/pubs/permissions.

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.