Beyond the Rhetoric : what do we mean by a model of care?

Background: Contemporary health care systems are constantly challenged to revise traditional methods of health care delivery. These challenges are multifaceted and stem from: (1) novel pharmacological and nonpharmacological treatments; (2) changes in consumer demands and expectations; (3) fiscal and resource constraints; (4) changes in societal demographics in particular the ageing of society; (5) an increasing burden of chronic disease; (6) documentation of limitations in traditional health care delivery; (7) increased emphasis on transparency, accountability, evidencebased practice (EBP) and clinical governance structures; and (8) the increasing cultural diversity of the community. These challenges provoke discussion of potential alternative models of care, with scant reference to defining what constitutes a model of care. Aim: This paper aims to define what is meant by the term ‘model of care’ and document the pragmatic systems and processes necessary to develop, plan, implement and evaluate novel models of care delivery. Methods: Searches of electronic databases, the reference lists of published materials, policy documents and the Internet were conducted using key words including ‘model*’, ‘framework*’, ‘models, theoretical’ and ‘nursing models, theoretical’. The collated material was then analysed and synthesised into this review. Results: This review determined that in addition to key conceptual and theoretical perspectives, quality improvement theory (eg. collaborative methodology), project management methods and change management theory inform both pragmatic and conceptual elements of a model of care. Crucial elements in changing health care delivery through the development of innovative models of care include the planning, development, implementation, evaluation and assessment of the sustainability of the new model. Conclusion: Regardless of whether change in health care delivery is attempted on a micro basis (eg. ward level) or macro basis (eg. national or state system) in order to achieve sustainable, effective and efficient changes a well-planned, systematic process is essential