Monday, June 1, 2015

Magnet Aspirations Can Give Hospitals a Path to Excellence

Ann Kutney-Lee, PhD, RN, FAAN and Linda H. Aiken, PhD, RN, FAAN

More than 400 hospitals nationwide have been recognized as Magnet hospitals by the American Nurses Credentialing Center for demonstrating excellence in nursing. The link between Magnet status and better patient outcomes and better working environments for nurses when compared with hospitals that have not achieved Magnet status is well-established.(1) What is less clear is whether hospitals that have attained this status were already excellent or whether they achieved excellence through the rigorous process of working toward Magnet certification.

We conducted and recently published one of the first longitudinal studies to address that question, and the answer is that the work that must be done during the extensive application and review process to attain Magnet status substantially improves nurse work environments and better outcomes for patients and for nurses result.(2)

We analyzed 1999 to 2006 data for 136 Pennsylvania hospitals (11 hospitals that went through the Magnet review process and 125 that did not). And overall, those hospitals that pursued and obtained Magnet status made significant and lasting change at the patient, nurse and organizational levels.

The study, “Changes in Patient and Nurse Outcomes Associated With Magnet Hospital Recognition,” recently published in Medical Care, found that in 1999, hospitals pursuing Magnet status performed at the same level as or worse than non-Magnet hospitals on a range of measures, including risk-adjusted rates of mortality 30 days after surgery, and failure-to-rescue. By 2006, emerging Magnets had progressed significantly ahead of their non-Magnet counterparts, demonstrating markedly greater improvements including 2.4 fewer deaths per 1,000 patients for 30-day surgical mortality, 6.1 fewer deaths per 1,000 patients for failure-to-rescue, and lower adjusted rates of nurse burnout, job dissatisfaction, and intent to quit.

While becoming a Magnet hospital is a significant undertaking – and can be a costly one – our findings, coupled with the body of research documenting that Magnet hospitals provide higher quality care, establish a strong business case for pursuing Magnet status. Even the process of working toward certification boosts patient safety and increases retention of nursing staff, which saves the cost of recruiting and training new hires. Further, our results are consistent with another recent study published in Medical Care that demonstrates the economic benefits associated with Magnet status.(3).

We undertook a longitudinal study because nearly all previous studies of Magnet hospitals have relied on a cross-sectional design, which limits the researchers’ understanding of the causal relationship between Magnet status and improved outcomes.  With this longitudinal evidence, our study can give hospital leaders a different perspective on the potential for improvement. And the take-away for them is that pursing Magnet status is an investment that’s well worth it.

1. McHugh MD McHugh MD, Kelly LA, Smith HL, Wu ES, Vanak J, Aiken, LH.  2013.  Lower mortality in Magnet hospitals.  Medical Care.  51:382-388. 
2. Kutney Lee A, Stimpfel A, Sloane DM, Cimiotti J, Quinn LW, Aiken LH.  2015.  Changes in patient and nurse outcomes associated with Magnet hospital designation.  Medical Care.  53(6):550-557.
3. Jayawardhana J, Welton JM, Lindroth RC. 2014. Is there a business case for Magnet hospitals? Estimates of the cost and revenue implications of becoming a Magnet. Medical Care.52:400-404.

Ann Kutney-Lee, PhD, RN, FAAN, is an assistant professor of nursing at the University of Pennsylvania School of Nursing and Linda H. Aiken, PhD, RN, FAAN, is a professor and the director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. Their study was funded by the Robert Wood Johnson Foundation Initiative on the Future of Nursing.

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