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  1. Jeffery, Alvin D. PhD, RN
  2. Mosier, Sammie MA, BSN, RN
  3. Baker, Allison MS
  4. Korwek, Kimberly PhD
  5. Borum, Cindy MSN, APRN, FNP-C
  6. Englebright, Jane PhD, RN


Background: Hospital medical-surgical (M/S) nursing units are responsible for up to 28 million encounters annually, yet receive little attention from professional organizations and national initiatives targeted to improve quality and performance.


Objective: We sought to develop a framework recognizing high-performing units within our large hospital system.


Methods: This was a retrospective data analysis of M/S units throughout a 168-hospital system. Measures represented patient experience, employee engagement, staff scheduling, nursing-sensitive patient outcomes, professional practices, and clinical process measures.


Results: Four hundred ninety units from 129 hospitals contributed information to test the framework. A manual scoring system identified the top 5% and recognized them as a "Unit of Distinction." Secondary analyses with machine learning provided validation of the proposed framework.


Conclusions: Similar to external recognition programs, this framework and process provide a holistic evaluation useful for meaningful recognition and lay the groundwork for benchmarking in improvement efforts.