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THE MAGNET credential is recognition of nursing and organizational excellence. Of the 5815 registered hospitals reported in the American Hospital Association's 2008 annual survey,1 today there are 382 hospitals and health care organizations in the United States and 4 international organizations that have achieved Magnet recognition. Nine of the 14 hospitals listed on US News & World Report's 2010 Best Hospitals Honor Roll are Magnet.2 In the past decade demand has grown for increased accountability for the outcomes of care. Our health care system is challenged by increased demand, cost, and variation in the quality of care delivered. Increasingly not only is nursing being recognized as having a major contribution to quality and safety in patient care, but a growing body of research supports positive results in avoiding costs in clinical outcomes using the Magnet framework and model to create a culture of excellence.
With the release of the 2008 Magnet model and corresponding application manual, the Magnet Recognition Program placed greater emphasis on measurement and improvement in select nurse-sensitive outcomes. Magnet organizations are required to contribute to external databases that compare the organization's performance against national benchmarks over multiple quarters. Specifically organizations must demonstrate how their performance compares against the midpoint of the comparative national database. Depending on the database, the midpoint might be the mean, the median, or the 50th percentile. A benchmark is the rate that most organizations strive to achieve. However, Magnet organizations are expected to achieve above average performance in the top half of the comparative benchmarking database. Falls and pressure ulcers are 2 patient-focused nursing-sensitive clinical indicators that all Magnet organizations must demonstrate above average performance.
Magnet organizations use evidence-based standards and frequent measurement, monitoring, and reporting to keep all members of the health care team knowledgeable of the current performance. By assessing prevalence and incidence and creating initiatives to address assessment, staff education, shift-to-shift monitoring, and documentation, many facilities report success.
Compared with the reported fall rates of 3.73 per 1000 patient days, Dunton's 2007 study using NDNQI data reports fall rates in Magnet hospitals 10.3% lower than in non-Magnet hospitals.3 In 2008, the Center for Medicare and Medicaid Services (CMS) reported the cost for treating pressure ulcers (stages III and IV) at $43180 per hospitalization and falls at $33894 per hospitalization.4 Since 2008, CMS has paid hospitals less for treatment of complications that arise related to falls and pressure ulcers. Preventing falls, falls-related injuries, and pressure ulcers represents a significant opportunity for avoidable costs to hospitals and patients if the evidence-based practices and innovations employed in successful hospitals are disseminated to all hospital settings to evaluate for implementation.
One transferring lesson emerging from Magnet organizations is the relationship between outcomes and a culture that focuses on nurse autonomy, collaboration, and a professional practice environment. Organizations seeking the Magnet credential prepare documents rich in evidence-based innovations. However, we know that the gap between knowledge and incorporation into practice is large. Specialized knowledge provides the basis for professional practice and is a central aspect of professionalism. Just as important is the communication of knowledge to achieve broad health goals. As a part of its mission to disseminate best practices, at the 2009 National Magnet Conference, the Magnet Recognition Program announced a new initiative to create Magnet communities of learning. Web-based knowledge communities, structured on the Magnet model, would be designed to provide evidentiary structure, process, and outcome exemplars in each model component: transformational leadership, structural empowerment, exemplary professional practice and new knowledge, innovations and improvements. In addition, current research findings and the opportunity to discuss current topics with thought leaders and recognized nursing experts would be added community features. After completing a pilot of 21 hospitals in spring 2010, the program plans to open access to the communities in 2011. The pilot revealed the value of exchange of ideas and potential to speed adoption of new practices by increasing accessibility to innovations and new knowledge emerging in Magnet organizations daily.
Accountability for the outcomes of care whether inpatient or outpatient is the most important mandate in health care today. As we shift from treating sickness to managing health and prevention, knowledge resources will be invaluable. We must overcome the lag between awareness of new knowledge and translation into practice. Berwick5 in his article on disseminating innovations in health care examined 3 areas of influence on the rate of diffusion of innovations within an organization: the perceptions of the innovation, characteristics of the individuals who adopt the change or fail to do so, and contextual factors that encourage and support or discourage and impede change within the organization. Given that innovation is essential to moving nursing practice forward, sharing knowledge, disseminating potentially breakthrough practices, and adopting change early will enable us to deliver the best care we can and shape the future of health care.
1. American Hospital Association. Fast Facts on US Hospitals. http://www.aha.org/aha/resource-center/Statistics-and-Studies/fast-facts.html. Accessed September 12, 2010. [Context Link]
2. US News and World Reports. US News Best Hospitals 2010-2011. http://health.usnews.com/best-hospitals/rankings. Accessed Retrieved 12, 2010. [Context Link]
3. Dunton N, Gajewski B, Klaus S, Pierson B. The relationship of nursing workforce characteristics to patient outcomes. Online J Issues Nurs. 2007;12(3). http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/ofo. Accessed September 12, 2010. [Context Link]
4. Department of Health and Human Services. Centers for Medicare and Medicaid Services. Federal Register, Vol 73, No 161, August 19, 2008, in Rules and Regulations, p 48473. http://edocket.access.gpo.gov/2008/pdf/E8-17914.pdf. Accessed September 12, 2010. [Context Link]
5. Berwick DM. Disseminating innovations in health care. JAMA. 2003;289(15):1969-1975. [Context Link]
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