In 1998, nursing care of patients in the newly merged Ottawa Hospital was being carried out through various organizational models of nursing care delivery. These models included total patient care, primary nursing, team nursing, functional nursing and case management. Each model brought with it different means of decision-making and communication throughout the hospital.
In 2000, nurses from all practice domains at The Ottawa Hospital (MoNCP© Work Group Committee) began to rethink how nursing practice could be aligned to one model to ensure high quality, safe, evidence-based patient care. Together with patients and academic partners, nurses developed The Ottawa Hospital Model of Nursing Clinical Practice (TOH-MoNCP©).
The development process included three phases of activities:
Phase One: Development of the Guiding Principles, including:
- an extensive review of the literature on different nursing care delivery models since 1940;
- a survey of 22 Magnet Hospitals in the United States that are recognized for their ability to recruit and retain nursing staff;
- a comprehensive review of studies of organizational models and their impact on patients, nurses and organization;
- a review of six peer Academic Health Sciences Centres in Ontario examining their models of nursing care delivery;
- after analysis and discussion of findings, a consensus decision to create a unique model, taking the best of all existing models; and
- the development of a set of Guiding Principles for the organization of nursing care delivery at TOH.
Phase Two: Field Testing, including:
- an extensive internal consultation and feedback process regarding the Guiding Principles;
- a review of relevant theories to determine the potential impact the new Model would have on each unit; and
- pilot testing of various tools developed to support implementation.
Phase Three: Recommendations for Implementation, including:
- The creation of a Steering Committee and 12 subgroups to guide the implementation of the Model and develop relevant tools
- Senior Management endorsement of the implementation of TOH MoNCP©; and
- the development of strategies that would enhance the professional practice environment and facilitate communication and decision-making across the clinical units.