Model of care for a changing healthcare system: are there foundational pillars for design?

Abstract

Currently, healthcare organisations are being challenged to provide optimal clinical services within budget limitations while simultaneously being confronted by aging consumers and labour and skill shortages. Within this dynamic and changing environment, the ability to remain responsive to patient needs while managing these issues poses further challenges. Development or review of the model of care (MOC) may provide a possible solution to support efficiencies in service provision. Although MOC are not readily understood or appreciated as an efficiency strategy, they can be more easily explained by considering several recurring pillars when developing or redesigning an MOC. Generic and recurring foundational pillars include integrated care models, team functioning and communication, leadership, change management and lean thinking. These foundational pillars should be incorporated into the development and application of MOC in order to achieve desired outcomes. However, sustainability requires continuous review to enable improvement and must be integrated into routine business. Moreover, successful review of MOC requires collaboration and commitment by all stakeholders. Leaders are critical to motivating clinicians and stakeholders in the review process. Further, it is imperative that leaders engage stakeholders to commit to support the agreed strategies designed to provide efficient and comprehensive healthcare services. Redesign of MOC can significantly improve patient care by applying the agreed strategies. In the current healthcare environment, these strategies can favourably affect healthcare expenditure and, at the same time, improve the quality of interprofessional health services. What is known about the topic? Clarity concerning ‘model of care’ (MOC) terminology, how the healthcare professional interprets the framework and the implications for practice are not well understood. There is significant literature postulating the value of speciality MOC, but there is minimal literature that identifies the common foundational pillars that can be used in any review or development of MOC. What does this paper add? Extensive review of MOC literature and the resultant synthesis of these data have been undertaken to appreciate the essential components that support best patient outcomes. This paper proffers the value of five critical and consistent foundational pillars that should be incorporated into the development or revision of all MOC in order to support efficiencies and improvement of the patient experience. What are the implications for practitioners? Inclusion of these five foundational pillars into the development or revision of MOC will potentially generate increased staff satisfaction, synergistic team processes and improved flexibility and responsiveness to service demand. In addition, positive effects on healthcare expenditure and enhanced quality of interdisciplinary healthcare services should be realised.