The Ottawa Hospital (TOH) is a large academic health sciences centre that employs over 4,300 nurses. TOH came into existence in 1998 with the provincially mandated merger of five academic and community hospitals. In addition to the challenges of merging competitive cultures and differing work processes, patient care was carried out at the different campuses through diverse delivery models. This proved to be problematic in the program management model adopted by the amalgamated organization.

It was felt that a single model of care was ideal to create a corporate nursing culture based on a strong professional practice mandate, one that would be easily recognized by all providers of care and one that would encompass the concepts of patient-centredness, autonomy, accountability and working to full scope. Ultimately, this model would support the integration of nurses in their workplace, improve their mobility between clinical areas, enhance their collaboration with other healthcare professionals and empower them professionally.

This article describes the selection and development of a model of care, the planning for and undertaking of its implementation and the evaluation of its impact. We hope that the description of this process may help guide other organizations embarking on cultural change in complex healthcare environments.

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