Summary: This article attempts to differentiate a Model of Care (MoC) from a Service Model. It seeks to help those involved in service design have greater clarity when using these terms with stakeholders. This is important because the MoC plus the Service Model dictates the patient’s experiences of the care they receive.
MoC vs. Service Model:
A Model of Care is what hands-on clinicians use to deliver treatments to their patients. It involves a tacit set of arrangements (formal and informal) that sees clinicians interacting daily to try to get the best outcomes for their actual patients/clients. The MoC draws on constructs such as best-practice and research evidence. A MoC may include:
- Screening
- Intake and assessment
- Diagnosis i.e., investigations, imaging, pathology, etc.
- Urgency categorisation
- Treatment planning
- Treatment delivery i.e., medication, procedures
- Review
- Discharge / Transfer/ Continuity of Care Referrals
A Service Model however involves another set of actors- the Service Managers. Service Managers work to help patient-facing clinicians deliver the Model of Care. In a healthcare setting, Service Managers will:
- Secure and monitor funding
- Staff the service
- Maintain facilities, equipment, and consumables
- Establish access and eligibility criteria
- Maintain relations with the partner services (internal and external) needed to deliver the MoC
- Establish mechanisms for information sharing with service partners
- Ensure clinical governance
Service Managers are known variously, depending on the healthcare setting. For example, they may be called Nurse Unit Managers, Service Coordinators, Centre Managers, Service Directors, Business Managers, etc.
Discussion:
- In reality, hands-on clinicians will often work as Service Managers, in a dual capacity.
- MoC and Service Model are terms used interchangeably, but this can create confusion
- Sometimes clinicians will feel compelled to subvert the official Service Model when they feel that specific patients/clients are not getting what they need. As such, the MoC and the Service Model are often in tension
- A good MoC focuses on patient outcomes. Service Models tend to focus on service inputs and processes.
- Best patient outcomes are achieved when the MoC and the Service Model are well aligned, and underpinned by a shared logic model
- The MoC and the Service Model need to be considered together to optimise the patient experience and reduce the burden of treatment
Key take-aways:
- The MoC and the Service Model are inextricably linked, but they are not the same thing
- Hands-on clinicians deliver the MoC to their patients/ clients
- Service Managers maintain the Service Model to support the clinicians and their chosen MoC
- Natural tensions exist between clinicians advocating the best MoC for patients and Service Managers who need to deal with the constraints associated with scarcity of resources and other real-world limitations
- Clinicians will sometimes disagree on aspects of the MoC. This can often be attributed to generational changes in practice
- The MoC and the Service Model collectively determine the ‘patient’s journey’- their experience of the care and treatments received
- Service designers should actively seek to reduce the burden of treatment placed on patients
- The overarching Service Philosophy is a major determinant of both the MoC and the Service Model
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