Opps forgot to post reference
Levine, J.F., Herbert, B., Mathews, J., Serra, A., & Rutledge, V., (electronically published 2011)Use of triple aim to improve population health. North Carolina Medical Journal. 72, 201-204
I remember when St Joes became the first Magnet Hospital in Atlanta (1980’s) and if I am not mistaken some of the most well respected nurse leaders with business acumen worked there. So surely it was a financial decision to pursue Magnet status at the time. I am wondering if Magnet has kept up with the times. Yes it improves patient care/ satisfaction and nurse satisfaction but has the accreditation articulated how it decreases patient costs (cost benefit analysis) – improving Medicare/Medicaid bottom line or the hospitals readmission rates or the utilization of other expensive services. And how does Magnet contribute to population health (are magnet institutions required to provide effective transitions programs) or provide linkages to home and community based services? I read an article about how one hospital started their processes of meeting the Triple Aim (improving population health) by first focusing on the health of their employees. This would certainly improve nurse satisfaction if they felt their employer cared about their health. We discussed some of this amongst our selves yesterday at semester Saturday. Seems like Magnet certification provides some real opportunities in helping hospital meet some of the Federal mandates.
I think using a balanced scorecard is an appropriate analysis of Magnet status. There are several hospitals in Houston with Magnet status. Your post got me thinking about what Magnet priorities there are for APRNs. It turns out (as far as I could find on the AANC website) pretty much nothing! The one thing listed related to APRNs is a priority to research APRNs as human resource for knowledge, which is one of the purposes of the CNS role. Adding in requirements for hospitals to improve APRNs practice would be a nice touch, since hospitals give us some of the most problems with restricting our practice. This gives me a few ideas, actually. I think I will be sending an email to Jesse Bushman, who is ACNM’s Director of Advocacy and Government Affairs to see if they have considered this angle as a way to get more CNMs and other APRNs on Medical Staff with admitting privileges.
Retrieved from American Nurses Credentialing Center. (2014). National magnet research priorities. http://www.nursecredentialing.org/Magnet/ResourceCenters/MagnetResearch/NationalMagnetResearchAgenda.html
That should be ANCC, not AANC above.
Although many hospitals sek magnet status, as you indicated, it is a costly venture requiring many resources. The premise is, that by creating a Magnet culture, not only does employee satisfaction increase, but with that the quality of patient care, and the attraction of patients to seek care at that hospital. But is is sustainable?
Ulrich, et. al. (2007), point out that although many positive changes during the process of acheiving Magnet status, there is much to do to maintain the comparative advantages for Magnet hospitals. In their study, RN view of the work environment as Magnet vs. Non-Magnet hospitals, although many postive differences were reported, they are no better at weathering nursing shortages than non-Magnet hospitals.
Personally, I have worked at both Magnet and non-Magnet hospitals, and many enjoyed as many non-Magnet hospitals. Magnet hospitals can offer much, but sometimes they do not maintain the very things that made them Magnet in the first place, which can be disappointing.
Ulrich, B.T., Buerhaus, P.I., Donelan, K.S., Norman, L., Dittus, R.. (2007). Manget status and registered nurse views of the work environment and nursing as a career. The Journal of Nursing Administration. 37(5): 212-220. doi:10.1097/01.NNA.0000269745.24889.c6.
Measurability and Sustainability
My DNP project seeks to transform the obstetric triage and admissions process at Ben Taub General Hospital into one that is safe, highly reliable, patient centered, and cost effective. The scope of the project is dependent on the institution, but above all, I hope to change the culture of the obstetric intake area to one of respect, not only for patients and families, but also for residents, nurses, and others.
In order to make any changes sustainable, I must be able to show that the changes benefit the hospital financially, as well as key stakeholders such as patients and staff (Fraser, 2007). I must also engage the leadership of the organization, and align the project with the priorities of the hospital, because sustainable projects have full support of an organizations leadership (Bodenheimer, 2007).
One way to measure the improvement that would include measuring the cost-effectiveness of the project is a balanced score card. Because Ben Taub is a not-for-profit community hospital, the framework would include customers & stakeholders, employee organization capacity, internal business processes, and financial elements, all coming from the strategy of improvement for obstetric triage and admissions (Rohm, H., n.d.).To develop the performance measures, the improvement team can search the literature for evidenced-based performance measures, and select relevant measures for each of the four areas of the balanced scorecard framework (Safdari et al., 2014). In order to prioritize the measures, we can create a Pareto chart, which will help us identify the interventions likely to have the most impact, as well as survey key stakeholders (Fraser, 2007; Safdari et al, 2014).
Ensuring that the project is aligned with the organizations values and mission makes it more likely that the improvement will be adopted (Greenhalgh et al., 2004). The mission of the Harris Heath System, of which Ben Taube General Hospital is a part, is: “We improve our community’s health by delivering high-quality healthcare to Harris County residents and by training the next generation of health professionals” (Harris Health System, n.d.) My DNP project goals easily align with this mission, but emphasizing the alignment could serve to further engage the leadership, which is key to the projects sustainability (Bodenheimer, 2007).
Bodenheimer,T. (2007). The science of spread: How innovations in healthcare become the norm. Oakland, California: California Healthcare Foundation. Retrieved from https://classes.emory.edu/webapps/portal/frameset.jsp?tab_group=courses&url=%2Fwebapps%2Fblackboard%2Fcontent%2FcontentWrapper.jsp%3Fcontent_id%3D_2314971_1%26displayName%3DLinked%2BFile%26course_id%3D_92580_1%26navItem%3Dcontent%26attachment%3Dtrue%26href%3Dhttps%253A%252F%252Fclasses.emory.edu%252Fbbcswebdav%252Fpid-2314971-dt-content-rid-2706800_2%252Fxid-2706800_2
Fraser, S. (2007). Undressing the elephant: Why good practice doesn’t spread in healthcare. Raleigh, NC: Lulu.
Greenhalgh, T., Robert, G., MacFarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematice review and recommendations. The Milbank Quarterly, 82(4), 581-629. Retrieved from http://www.jstor.org/stable/4149085
Harris Health System (n.d.) Mission, vision & values. Retrieved from https://www.harrishealth.org/en/about-us/who-we-are/pages/mission-vision-values.aspx
Rohm, H. (n.d.) A balancing act. Perform: Performance Measurement in Action. 2(2), 1-8. Retrieved from http://balancedscorecard.org/Portals/0/PDF/perform.pdf
Safdari, R., Ghazisaeedi, M., Mirzaee, M., Farzi, J., & Goodini, A. (2014). Development of balanced key performance indicators for emergency departments strategic dashboardsfollowing analytic hierarchical process. 33(4), 328-34. doi: 10.1097/HCM.0000000000000033.
Sustainability of a Magnet Culture Using a Balanced Scorecard Framework
In order to sustain a Magnet® culture within an organization, careful strategic planning and team member commitment are crucial. From an organizational perspective, the balanced scorecard framework may serve as a sustainability method within a given institution. Organizational success related to resource and quality management in Magnet® institutions is heavily dependent upon sustainability of nursing excellence (Vartanian, Bobay, & Weiss, 2013). Costs associated with attainment of Magnet® designation are significant, depending upon the size of the institution. Additional time and human resources are also needed in order to successfully implement and sustain the Magnet® model as the application process can take between 2-4 years to complete. In an effort to sustain this prestigious designation, the balanced scorecard framework may serve as a structured outline whereby an institution of Magnet designation may adopt.
Balanced scorecards measure performance in four areas: customer perspective, financial perspective, internal processes (including human resources) and learning and growth (Finkler, Jones, & Kovner, 2013). Hospitals must weigh the costs and benefits of pursuing Magnet® recognition which involves careful strategic planning and decision making at the organizational level (Finkler, Jones, & Kovner, 2013). Vartanian, Bobay, & Weiss (2013) surveyed a group of chief nursing officers and determined that key themes for sustaining a Magnet® environment included management’s “relentless quest for quality, commitment to care, support of staff education infrastructure supports, and resources for empowerment” (p. 167). In applying these themes to the balanced scorecard framework, the organization can closely monitor progress while having a more holistic perspective to guide decision-making.
From a customer perspective, patient satisfaction related to nursing care may be examined as Magnet® emphasizes the quality of nursing care. Financial and internal processes as previously mentioned including analyzing application, salary and turnover costs should be included in the balanced scorecard. Lastly, initiatives to measure learning and growth on a periodic basis will also contribute to the sustainability of a Magnet® culture. Organizational involvement including non-nursing staff is crucial to the success of sustaining any complex large-scale development.
Finkler, S., & Jones, C. (2013). Financial management for nurse managers and
executives (Fourth ed.). St. Louis, MO: Elsevier.
Vartanian, H. K., Bobay, K. L., & Weiss, M. E. (2013). Nurses Perceptions of
Sustainability of Magnet® Efforts. The Journal of Nursing
Administration, 43(3), 166-71. doi: 10.1097/NNA.0b013e318283dca7
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