Nurse-Designed Care Models and Culture of Health: Review of Three Case Studies.

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 article 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.