1. Model of care design: Relationship-based care
By: Rachel Peltier

2. Introduction Model of Care MidMichigan Health
Professional Practice Model
Relationship-based care
MidMichigan Health is a health system with four acute care hospitals within its organization. The mission statement for MidMichigan Health is “to provide excellent health services to improve the quality of life for people in our community” ( The values at MidMichigan Health are integrity, accountability, excellence and teamwork; these organizational values are consistent with it’s nursing values. A model of care should be consistent with the health care organization’s mission, vision and values as well as the philosophy of nursing (Winsett & Hauck, 2011). MidMichigan Health began the process to achieve Magnet certification in Part of this process is the identification and implementation of a professional practice model; this is a required source of evidence for Magnet certification (Magnet Model Handbook, 2014). The American Nurses Credentialing Center (ANCC) (2014) defines a professional practice model as “the overarching conceptual framework for nurses, nursing care, and interprofessional patient care (p. 21). The part of the definition that is most significant to MidMichigan Health is the interprofessional component to the professional practice model. It is felt that this aligns with the organization values of integrity, accountability, excellence and teamwork as well as fostering the mission statement. The professional practice model that is being considered for full implementation is the relationship-based care model which was “written, coordinated, and published by Creative Health Care Management” (Koloroutis, 2014, p. ix).

3. Description
Relationship-based care is built on providers relationships with others
Relationships with patients and families
Relationships with self
Relationships with colleagues
As stated in the previous slide, the relationship-based care professional practice is being heavily considered by the nursing executive team at MidMichigan Health. Relationship-based care is made up of three “crucial relationships” (Koloroutis, 2014, p. 4). These relationships are the care providers 1) relationships with patients and families, 2) relationships with self and 3) relationships with colleagues (Koloroutis, 2014). The American Nurses Association discusses caring and nursing practice in 2010 edition of Nursing Scope and Standards of Practice. The theories of Watson, Leininger, and Swanson are all discussed in this text; it is no coincidence that these theories are also found woven in the relationship-based care model. These theorists based their work on caring and relationships; the relationship-based care model describes the “how” to achieve the care that is described by these theorists (as well as others).
The relationship-based care model is designed to assist leaders, once it is implemented, achieve the outcomes that are desired (Koloroutis, 2014). These outcomes include financial outcomes, quality outcomes and organizational outcomes; these all will lead to improved patient outcomes (Koloroutis, 2014). The fact that outcomes can be impacted correlates to the MidMichigan values of excellence, integrity and accountability. The relationship-based care model is not unique only to nursing; this fact also makes the implementation of relationship-based care intriguing as it can be put in place across all disciplines (Koloroutis, 2014). This exemplifies the MidMichigan value of teamwork.

4. Concept Map: Relationship-Based Care
Patient and family are the central point
A caring and healing environment includes mind, body and spirt
All of the elements intertwine with each other
All must be in place for relationship-based care
Koloroutis, 2014
This concept map illustrates the components necessary for relationship-based care. Patient and family are the central point; the other elements of the model are dependent on each other and each are “organized around the needs and priorities of patients and their families” (Koloroutis, 2014, p. 15). The element on this concept map that speaks to me the most is teamwork. It is important for all disciplines, every individual who has an encounter with the patient and their families, to understand relationship-based care and to have the skill set to provide care that is consistent with MidMichigan values. This being said, it is natural that the next element that is discussed is leadership. It will take a transformational leader, a leader with vision and purpose to empower and support their staff to make decisions that are focused on the patient and their families (Koloroutis, 2014). In my opinion, once the elements of leadership and teamwork are truly understood, the other elements will follow is succession.

5. Implementation Creative Health Care Management Two-year strategic plan
Expense=commitment
Evaluation of effectiveness
MidMichigan Health has consulted Creative Health Care Management for coordination of the implementation of relationship-based care in all four acute care hospitals. A detailed list of deliverables has been provided by Creative Health Care Management. The service agreement outlines the intervention and purpose of each deliverable. The cost to implement relationship-based care is indicative of the commitment that leadership has to this professional practice model. The key piece that is noted to be missing is an evaluation process by Creative Health Care Management during the 2-year process that is described. It will be the responsibility of MidMichigan Health to formally evaluate their outcomes; this is an excellent opportunity to gather data, analyze the findings and publish the findings. Data that will be collected by MidMichigan Health will be related to patient outcomes, quality measures and staff retention.

6. Implementation Relationship-based Care (RBC); Year 1
Practicum: Five Leaders/Five Days
Cultural/Organizational Assessment (Wave 1 of implementation identified); identify councils
Implement RBC in Wave 1 departments; orientation, progress checks
“Re-igniting the Spirit of Caring” workshop for Wave 1
Training of Wave 2 councils
The plan provided by Creative Health Care Management demonstrates that relationship-based care will be implemented throughout multiple departments at MidMichigan Health. Wave 1 will be made up of nursing units; wave 2 will be nursing departments and other ancillary departments such as lab, radiology dietary and housekeeping. Wave 3 will consist of registration and scheduling, patient accounting among others.
Creative Health Care Management, personal communication, October 24, 2015

7. Implementation Relationship-based Care (RBC); Year 2
Support of Wave 2 implementation
“Re-igniting the Spirit of Care” training; train the trainer workshop
“See Me as a Person” workshop of Wave 1
Training of Wave 3 councils
Support of Wave 3 implementation
Implementation of relationship-based care throughout the acute care setting is important to MidMichigan Health. As stated earlier, teamwork is a value of MidMichigan Health. Teamwork is a part of the relationship-based care concept model; “teamwork requires a group of diverse members from all disciplines and departments to define and embrace a shared purpose and to work together to fulfill that purpose” (Koloroutis, 2014, p. 290).
A concern that I personally have with implementing this throughout the health system is the sustainability of this culture change. The plan for implementation must be kept fluid and trainers/coordinators of relationship-based care must be willing to change and/or update the plan in order to achieve the end goal (Schneider & Fake, 2010).
Creative Health Care Management, personal communication, October 24, 2015

8. Business Perspective Return on Investment Improved patient outcomes
Increased patient encounters
Staff retention
It would seem that a tangible return on investment would be difficult to ascertain; the evaluation of the effectiveness of relationship based care is initially based primarily on observable behaviors. The ultimate consequences would be to improve patient outcomes, improve patient and family satisfaction which in turn would lead to an increase in patient encounters and to decrease staff turnover as a result of this.
In a qualitative study found in The Journal of Nursing Administration, St. Mary’s Medical Center in Evansville, Indiana implemented relationship-based care model within nursing beginning in The rollout of the model was completed in six months; direct observation of nursing behaviors were evaluated prior to implementation as well at 3 and 12 months after implementation. The survey sample included a total of 137 nurses; the same nurses were not necessarily followed throughout the evaluation process. Findings were conclusive that caring behaviors increased after implementation; this in turn led to a substantial decrease in nurse turnover (from 9.4% to 1.9% at the one year post-implementation mark). Patient satisfaction scores also improved to the 99th percentile after one year of implementation. Relationship-based care was such a success at St. Mary’s that this model of care was introduced and instituted in all departments (Winsett & Hauck, 2011).
Another study, found in the Journal of PeriAnesthesia Nursing, actually references the research and consequent success that I just discussed as part of the reason for implementation of relationship-based care in the perioperative nursing unit. A quantitative study was conducted and it focused on the relationships that were established during their perioperative visit and their consequent satisfaction with nursing care. With the implementation of relationship-based care, meaningful questions were asked of the patient and family during the perioperative stay; this in turn led to improved patient satisfaction (Carabetta, Lombardo, & Kline, 2013).
Based on the lectures that I have heard on relationship based care, the book that I have read on relationship based care, as well as the research that I have read on the outcomes of relationship based care, I do not feel that I would change any part of this professional practice model. As I stated earlier, I am skeptical of sustainability with a culture change, but this does not mean that I would change the model as it is written.

9. Relationship-based care
Conclusion
Relationship-based care
In summary, MidMichigan Health is working on achieving Magnet certification. A part of this certification is the identification and implementation of a professional practice model. The relationship-based care model is being considered as the professional practice model to be implemented. The relationship-based care model is consistent with the MidMichigan Health values of integrity, accountability, excellence and teamwork. Implementation of the relationship-based care model will take place throughout all departments within the health system; implementation must be methodical and planned in order to achieve sustainability. Full implementation of the relationship-based care professional practice model also makes sense from a business perspective. Relationship-based care has been shown to impact financial outcomes, quality outcomes and organizational outcomes (Koloroutis, 2014). This impact will then in turn foster improved patient outcomes, patient satisfaction and increased staff retention.

10. References
American Nurses Association. (2010). Scope and standards of practice; nursing (2nd ed.). Silver Spring, MD: Nursesbooks.org.
Carabetta, M., Lombardo, K., & Kline, N. E. (2013). Implementing primary care in the perianesthesia setting using a relationship-based care model. Journal of PeriAnesthesia Nursing, 28(1),
Creative Health Care Management, personal communication, October 24, 2015
Koloroutis, M. (Ed.). (2014). Relationship-based care; a model for transforming practice. Minneapolis, MN: Creative Health Care Management.

11. References
Schneider, M. A., & Fake, P. (2010). Implementing a relationship-based care model on a large orthopaedic/neurosurgical hospital unit. Orthopaedic Nursing, 29,
The magnet model components and sources of evidence; magnet recognition program (Rev. ed.). (2014). Silver Spring, MD.
Winsett, R. P., & Hauck, S. (2011). Implementing relationship-based care. The Journal of Nursing Administration, 41,

12. Rubric Content Criteria Points Introduction to model of care 10
Description and conceptual map 20
Critique of model related to business perspective
Critique of model related to alignment to mission and values of select organization
Critique of model relating to interprofessional concerns
Proposed revised model and plan for evaluation
Implementation plan
Summary and conclusion 5
Support for ideas 15
Structure
Up to 20 point deduction
APA, spelling, grammar, punctuation, syntax, clarity