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.

Becoming a Magnet Hospital Can Increase Revenue, Offset Costs of Achieving Magnet Status

Several studies have found that Magnet Hospitals have lower mortality rates, shorter lengths of stay, higher patient satisfaction, and better patient outcomes than non-Magnet Hospitals. They are also more likely to adopt National Quality Forum-approved patient safety practices. Until recently, though, little was known about the effect of Magnet status on hospital revenue.

A study funded by INQRI and published in the May issue of Medical Care finds that achieving Magnet status is worth the investment - increasing hospital revenue by an average of $1,229,770 to $1,263,926 annually.

On average, it takes a hospital 4.25 years to complete the process of attaining Magnet Status, at an average cost of $500,000 annually, for an average total investment of $2,125,000. At that cost, the researchers calculate that hospitals begin to realize payback from achieving Magnet Status in two to three years.

“Since Magnet Hospitals have better patient outcomes, we suspect that these increases in revenue reflect increased reimbursement rates from private insurers, relative to non-Magnet Hospitals,” said co-principal investigator Richard Lindrooth, PhD, associate professor in the Department of Health Systems, Management and Policy in the Colorado School of Public Health, University of Colorado Anschutz Medical Campus. “That increased premium is related to the perceived higher quality of care and the desirability of including high-quality hospitals in insurers’ networks. The higher costs likely reflect a combination of the cost of providing high quality care and, to a lesser extent, a shift toward treating more complex cases.”

The study finds that, the increase in revenue overshadowed changes in patient costs.  Net patient revenue increased on average by 3.89 percent compared to non-Magnet hospitals, while costs increased only by 2.46 percent.

The research team data from 1998-2006 for 2,541 non-Magnet Hospitals and 141 Magnet Hospitals from the American Hospital Association Annual Survey, the Hospital Cost Reporting Information System from the Centers for Medicare & Medicaid Services, and the American Nurses Credentialing Center (ANCC). Data included information on hospital characteristics, as well as utilization, costs, charges, and other relevant financial information.

The interdisciplinary research team was led by Jayani Jayawardhana, PhD, assistant professor of health policy and management, University of Georgia; John M. Welton, PhD, RN, professor in the College of Nursing, University of Colorado Anschutz Medical Campus; and Lindrooth.

 

Better Nurse Staffing, Education and Work Environment Contribute to Magnet Hospitals' Patient Outcomes

A new study in Medical Care, conducted by Matthew McHugh, an RWJF Nurse Faculty Scholar, finds that the lower mortality rates at Magnet Hospitals are achieved in part because of investments in nursing. This study reflects many of the findings of INQRI studies into the impact of nurse staffing, work environment and education on quality of patient care.

McHugh and his colleagues compared investment in nursing and patient outcomes at Magnet and non-Magnet hospitals in California, Florida, Pennsylvania and New Jersey. They found significant differences in nursing at Magnet hospitals, including better work environments, higher nurse-to-patient staffing ratios, and higher proportions of nursing with bachelor's degrees and specialty certification. Magnet hospitals also had better patient outcomes, including lower "failure to rescue" and mortality rates. They also reported that the Magnet application process may also play a role in promoting higher quality care.

A summary of the study is on Science Codex.

Nurse Staffing Mandates Debated at Hospitals

Over the weekend, Ben Sutherly, staff writer for the Dayton Daily News, reported on the different viewpoints hospital administrators and nurses have on nurse staffing mandates in the state of Ohio and around the country. Mr. Sutherly cites the work of renowned nursing workforce scholar and INQRI NAC member, Linda Aiken, to support the argument that nurse staffing levels should be mandated at the state level. Dr. Aiken's research found that there would be 14% fewer surgical deaths in Pennsylvania if the state were to adopt nurse staffing mandates that are similar to those in California, the only state that has mandated nurse-to-patient ratios. However, Mr. Sutherly also presents the case for hospitals as they argue that the quality of the health care workforce is much more important than having a minimum nurse-to-patient ratio in order to provide the highest quality of care.

Click here to read the whole article.

Click here to read more blogposts relating to nurse staffing.

The Effect of Magnet Hospitals on Quality

INQRI National Advisory Committee member Linda Aiken, PhD, FAAN, FRCN, RN, the Claire M. Fagin Leadership Professor in Nursing, Professor of Sociology, and Director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania has a piece featured in the July/August edition of The American Journal of Nursing. Co-authored by Donna Havens, PhD, RN and Doug Sloane, PhD, "The Magnet Nursing Services Recognition Program: A Comparison of Two Groups of Magnet Hospitals" discusses the effect of magnet hospitals on patient care quality and the delivery of nursing care.

Please click here to download a PDF of the article.

For more information on Linda's work, please click here.