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Relationship-Based Care: A Critique of the model
Kelli Benson, BSN, RNC-MNN Ferris State University
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Objectives To discuss the Relationship-Based Care model and its associated concepts. To critique the model as it relates to the business perspective of the organization. To critique the model as it relates to the mission and values of the organization. To critique the model as it relates to interprofessional perspectives. To propose changes to the model and present a plan for implementation of the changes.
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Relationship-Based Care (RBC)
Cropley, 2012 Ledesma, 2011 Winsett & Hauck, 2011
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Relationship with Self
Self-knowing Values & beliefs Personal growth Self-awareness Balance of mind, body, & spirit Intentional caring Thought & purpose Ledesma, 2011
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Relationship with Colleagues
Caring relationship Nurse/Leadership Nurse/Nurse Nurse/Provider Interprofessional team Communication Respect Trust Caring Relationship Cropley, 2012 Ledesma, 2011 Winsett & Hauck, 2011
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Relationship with Patient/Families
Who is the patient? Know patient as a person What is important to the patient? Patient has significant influence on experience What is the patient’s goal? Nurse assists with maintenance of health & wellness Cropley, 2012 Ledesma, 2011
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Marshall, 2011 University of North Carolina Health Care (UNCHC), 2010
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Patient Care Delivery Commitment to Caring Swanson Caring Theory
Five Pillars of UNC Health Care Swanson Caring Theory Knowing Being with Doing for Enabling Maintaining belief Carolina Care Behaviors & practices Relationship-Based Care Delivery System Self, colleagues, patient/families The patient care delivery component of the practice model consists of several elements and in evaluating them, it is apparent that they are interrelated and that relationship-based care and patient-centered practice is central to care. Commitment to Caring is based on the five pillars of people, quality, finance, growth, and innovation and is the foundation of UNC goals. Patient care delivery also includes components such as Swanson Caring Theory, Carolina Care, and Relationship-based Care Delivery System (UNCH, 2015). According to UNC the patient care delivery model is based on Dr. Kristen Swanson’s Caring Theory made up of knowing, being with, doing for, enabling, and maintaining belief. Linked to the Swanson caring process is Carolina Care which is behaviors and practices at the core of how patients are treated and it involves departments and staff throughout the organization (UNCH, 2015). UNCHC, 2010
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Concept Map Professional Relationships Professional Nursing Values
Compensation & Rewards Patient Care Delivery Leadership Accreditation Standards Carolina Care Commitment to Caring Swanson Caring Theory Relationship-based Care Magnet Standards Evidence-based Practice Compassionate Nurse & Colleagues Nurse & Self Nurse & Patient/Family Therapeutic Consistent Collaborative UNCHC, 2010
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Business Perspective Accountability Reimbursement Retention
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Reimbursement Patient satisfaction Value-based purchasing Retention Increased staff satisfaction = decreased turnover Cost to replace a nurse: $10,000-$64,000 Turnover decreased from 9.4% to 1.9% Cropley, 2012 Winsett & Hauck, 2011 Yoder-Wise, 2014
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Mission Statement “The mission of Nursing at the University of North Carolina Hospitals is to be a leader in providing compassionate, quality care focusing on the unique needs of patients and their families”(University of North Carolina Medical Center [UNCMC], 2007,para. 1).
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Core Values My Patient My Team My Hospital My Community My Profession
The needs of our patients and their families guide our nursing care. My Team We are committed to fostering an environment that promotes respect , positive communication, and collaboration among all members of the patient/family/healthcare team. My Hospital Our practice reflects the Hospital’s vision of “Leading, Teaching, Caring”. My Community We are dedicated to serving the people of North Carolina and all who come to us for care, honoring their unique and diverse needs. My Profession We are committed to excellence in nursing by creating a culture of lifelong learning that integrates evidence-based practice, research and professional development. (UNCMC, 2007, para. 2)
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Interprofessional perspective
Positive Collaboration & teamwork Improved communication Nurse/physician Nurse/nursing assistants Improved patient outcomes Shared decision making Negative Outpatient setting Difficult for staff to ascertain commitment of patient’s willingness to participate in care Difficult for patient process information Guglielmi, Stratton, Healy, Shapiro, & Duffy, 2014 Lancaster, Kolakowsky-Hayner, Kovacich, & Greer-Williams, 2015 Winsett & Hauck, 2011
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RBC Change proposal Consistent Collaborative Nurse & Self Nurse &
Compassionate Therapeutic Nurse & Self Nurse & Patient/Family Nurse & Colleagues Consistent Collaborative
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Plan for implementation of change
Model for Improvement (MFI) Structure for foundational questions Accelerates improvement Plan, Do, Study, Act (PDSA) Small tests of change Institute for Healthcare Improvement (IHI), 2015 Roussel, Thomas, & Harris, 2016
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PDSA Act Plan Do Study Carry out a test of change
Observe and document results Analyze data Compare to predicted outcomes What was learned? Objectives Develop plan Predict outcomes Decide to adopt new plan or make changes Use information for next cycle Act Plan Do Study IHI, 2015
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summary RBC UNC Medical Center Patient-centered Relationships
Self, colleagues, patient/families Business sense Interprofessional acceptance UNC Medical Center Professional Practice Model RBC for patient care delivery model Aligned with UNC mission and core values Improvement needed in support of self & colleague relationships PDSA cycle
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references Cropley, S. (2012). The relationship-based care model: Evaluation of the impact on patient satisfaction, length of stay, and readmission rates. The Journal of Nursing Administration, 42(6), doi: /NNA.0b013e ed Guglielmi, C. L., Stratton, M., Healy, G. B., Shapiro, D., & Duffy, W. J. (2014). The growing role of patient engagement: relationship-based care in a changing health care system. Association of Perioperative Registered Nurses, 99(4), doi: /j.aorn Institute for Healthcare Improvement. (2015). Science of improvement: How to improve. Retrieved from Lancaster, G., Kolakowsky-Hayner, S., Kovacich, J., & Greer-Williams, N. (2015). Journal of Nursing Scholarship, 47(3), doi: /jnu.12130 Ledesma, C. R. (2011). Relationship based care: A new approach. Nursing 41(2), doi: /01.NURSE e
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references Marshall, E. S. (2011). Transformational leadership in nursing: From expert clinician to influential leader. New York, NY: Springer Publishing Company. Roussel, L., Thomas, P. L., & Harris, J. L. (2016). Management and leadership for nurse administrators (7th ed.). Burlington, MA: Jones & Bartlett Learning. University of North Carolina Health Care. (2010). UNC Health Care nursing professional practice model. Retrieved from University of North Carolina Medical Center. (2007). Nursing mission, core values, philosophy. Retrieved from Winsett, R. P. & Hauck, S. (2011). Implementing relationship-based care. The Journal of Nursing Administration, 41(6), Doi: /NNA.0b013e31821c4787 Yoder-Wise, P.S. (2014). Leading and managing in nursing. (5th ed.).St. Louis, MO: Elsevier.
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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
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