The Patient Care Delivery Model--an open system framework: conceptualisation, literature review and analytical strategy

J Clin Nurs. 2011 Jun;20(11-12):1640-50. doi: 10.1111/j.1365-2702.2010.03391.x. Epub 2010 Nov 30.


Aims and objectives: This paper presents the Patient Care Delivery Model to illustrate interrelationships between model components and to support its application in research using advanced analytical techniques, including structural equation modelling.

Background: Many complex factors contribute to the nature of healthcare environments and to nurse, patient and system outcomes. A better understanding of these factors and their interrelationships would provide insight for decision-makers to develop strategies to improve outcomes.

Design: A literature review approach was used to address the objectives.

Method: A threefold approach used existing theory to explicate a comprehensive conceptual framework, reviewed empirical studies of the proposed relationships and considered the application of advanced analytical techniques to inform future research directions.

Results: As per general system theory, inputs (patient, nurse and system characteristics) to the Patient Care Delivery Model interact with throughputs (nursing interventions, work environments and environmental complexity) to produce intermediate (staffing levels) and distal outputs (patient, nurse and system outcomes). Application of the model in research and its relevance for healthcare settings is supported in the current literature. Statistical techniques that allow model testing and the investigation of multiple relationships simultaneously have demonstrated the interconnections among the model components.

Conclusions: Development of the Patient Care Delivery Model is a step towards understanding work environments and providing healthcare managers with evidence-based management tools. Formal testing of comprehensive, multilevel conceptual models will provide empirical linkages between inputs and outputs and will identify potential mediators between predictors and outcomes to offer new insight into organisational practices.

Relevance to clinical practice: A better understanding of how factors in the work environment impact clinical outcomes can facilitate care processes in the nursing unit. Future studies using comprehensive conceptual frameworks and sophisticated analytical approaches will enhance professional nursing practice and improve clinical outcomes in healthcare organisations.

Publication types

  • Review

MeSH terms

  • Delivery of Health Care / organization & administration*
  • Models, Theoretical*