Jun 02, 2015

Magnet Aspirations Can Give Hospitals a Path to Excellence

June 2, 2015

Melissa Blair
Gretchen Wright

New study shows that rigors of the recognition process can improve outcomes for patients, nurses, and organizations.

Over the past two decades since the American Nurses Credentialing Center introduced the Magnet Recognition Program to identify hospitals that demonstrate excellence in nursing, the number of Magnet hospitals in the United States has grown to more than 400. The body of research on Magnet hospitals has grown over time, too, showing an association between Magnet status and better outcomes for both patients and nurses.

Research has not, however, clearly shown if Magnet status reflects recognition of hospitals that are already excellent, or if the challenging Magnet application and peer-review process results in improved patient outcomes. A new study, one of the first longitudinal studies of Magnet hospitals, addresses that knowledge gap and suggests that when hospitals pursue Magnet status, they make lasting change at the patient, nurse, and organizational levels, challenging the assertion that Magnet hospitals have better outcomes because they were excellent to begin with.

The study, “Changes in Patient and Nurse Outcomes Associated With Magnet Hospital Recognition,” published in the  June issue of Medical Care and funded by the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing, examined 1999-2006 data from 136 Pennsylvania hospitals: 11 “emerging Magnets” that undertook the year-long application review process and 125 non-Magnets.

The University of Pennsylvania Center for Health Outcomes and Policy Research  team 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.

The authors of the paper include Ann Kutney-Lee, PhD, RN, FAAN, assistant professor of nursing and  Linda H. Aiken, PhD, RN, FAAN, professor and  director of the Center for Health Outcomes and Policy Research at Penn’s School of Nursing.

“Our results add to the body of literature that links the quality of the nurse work environment to better patient outcomes and nurses’ ability to provide high quality care,” said Kutney-Lee. “This research offers a new angle to support the business case for pursuing Magnet status. We’re seeing how the process itself can boost safety for patients and stability for nursing staffs.”

Nearly all existing studies of Magnet hospital studies have relied on a cross-sectional design, limiting the understanding of the causal relationship between Magnet status and improved outcomes. “By contributing longitudinal evidence where there had been little of it, this study can give hospital leaders a different perspective on the potential for improvement,” Aiken said. “Becoming a Magnet hospital is a significant undertaking. The message is that it’s an investment that’s well worth it.”

The RWJF Initiative on the Future of Nursing, rooted in the recommendations of the landmark Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health, complements the Future of Nursing: Campaign for Action, a collaboration between RWJF and AARP focused on transforming health care through nursing. Through the Initiative, RWJF supports the report’s research agenda and implements recommendations in the areas of nurse training, education, professional leadership, and workforce policy.

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For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are striving to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.