An essential part of achieving strong quality and a great patient experience is a care delivery system that facilitates exemplary care.


The core of Relationship-Based Care is implementing a care delivery system that supports knowing the patient as a person, great collaboration among clinicians, and smooth transitions among caregivers. The care delivery system within RBC is one in which the patient experiences the close attention and care coordination of a “primary caregiver” within each discipline. Based on the time-tested principles of Primary Nursing, this evidence-based care delivery system is effective for inpatient care, outpatient settings, and ambulatory clinics.  Creative Health Care Management has been partnering with organizations to redesign care delivery for over 30 years based on a commitment to strong continuity of care which happens with the greatest consistency when a primary caregiver accepts responsibility for providing personalized, patient-driven care.

Below you will find content related to care delivery design with primary relationships, care delivery design for trans-disciplinary coordination, and care delivery design for medical home.

Care Delivery Design with Primary Caregivers

Based on the classic work by Marie Manthey on Primary Nursing, and expanded to include caregivers in all professional disciplines, the system of primary caregivers enables patients to know who is responsible for coordinating their care within each discipline. One caregiver in each setting or service is designated as primary nurse, primary therapist, primary social worker, and so on.  The implementation of this care delivery system is designed by front line staff and is adapted for each unique care setting. Implementation of primary caregivers is directly responsible for important outcomes, including:

  • Improved patient experience
  • Emotional safety
  • Earlier identification of changes in patient’s condition
  • Reduced workload for clinicians as they care for the same patients
  • Better communication among disciplines and with physicians

Primary Nursing

Primary Nursing the heart of any Care Delivery System with Primary Relationships. Primary Nursing is a care delivery system that supports professional nursing practice. Within Primary Nursing, a therapeutic relationship is established between a registered nurse and an individual patient and his or her family. The relationship is initiated by the RN and is in effect for an episode of care or service.

A defining component of Primary Nursing is clarity of the RN’s acceptance of responsibility for decision-making regarding the nursing care the patient receives during a health event. The primary relationship is known to the patient and family, and the safeguarding of that relationship becomes a priority for other members of the care team. The Primary Nurse does not provide all patient care. In partnership with the patient, the RN identifies the patient’s unique health needs and priorities, establishes an individualized plan of care, provides direct care as appropriate, and communicates the plan to other members of the team. The associate nurses are responsible to follow the plan of care unless a change in patient condition warrants an adjustment of the plan.

WikipediaRead about Primary Nursing on Wikipedia



To learn about the Primary Nursing One-Day Intensive, click here.


Care Delivery Design for Patient-Centered Medical Home

Implementation of a patient-centered medical home model requires system redesign on a large scale. Relationship-Based Care includes a delivery system in which patients are cared for by a consistent team of primary caregivers along with the infrastructure to implement and sustain a medical home for patients.  A consistent team of physicians, nurses, medical assistants, and specialists achieves outcomes that reduce re-admissions and provides better preventative and chronic care.  The expert physicians and nurses at Creative Health Care Management have experience that will make your patient centered medical home successful.

Care Delivery Design for Trans-disciplinary Coordination
Communication and full collaboration between caregivers in all disciplines must be built into the system of care delivery.  As a part of Relationship-Based Care, the primary caregivers for each discipline have systems that facilitate collaboration, ideally including the patient or family. The clinical setting determines the optimal system, and the electronic medical record is harnessed to facilitate comprehensive communication of what is most important to the patient, and to convey this and other significant information about the patient to the individuals who will function as the primary caregiver in the next level of care.

Patients receive the full scope of expertise for each discipline as clinicians implement Relationship-Based Care.  Front-line clinicians design innovations that will work in their setting, whether that involves care conferences, interdisciplinary rounds, electronic communication, or some other innovative idea.