Impact of Magnet®: Financial, Quality, Safety & Employee

Engagement

Pamela Duchene, PhD, APRN-BC, NEA, FACHE

Vice President of Patient Care Services & Chief

Nursing Officer

Hallmark Health System, Inc.

William J. Doherty, MD, FACHE

Executive Vice President and Chief Operating Officer

Hallmark Health System, Inc.

Melrose-Wakefield Hospital

174 inpatient beds including:

Medical/surgical care

Mother/baby and special care nursery

Oncology/hematology

Inpatient psychiatric care

Bariatric surgery

Hallmark Health System

Outpatient services including:

Emergency care

Cardiac care and catheterization lab

Diabetes management and treatment

Surgical Day Care and Endoscopy

Hallmark Health System

Lawrence Memorial Hospital

of Medford

98 inpatient beds

Medical/surgical care

Hallmark Health System

Outpatient services including:

Emergency care,

Urgent care

Cardiology

Diabetes management and treatment,

Surgical Day Care and Endoscopy

Geriatrics/medical-psychiatry

Center for Weight Management and Weight

Loss

Sleep Center

Hallmark Health System

1. Melrose-Wakefield Hospital

2. Lawrence Memorial Hospital

3. Stoneham Outpatient Campus

CHEM Center for MRI

CHEM Center for Radiation Oncology

Hematology and Oncology Center

Comprehensive Breast Center

Montvale PET/CT

4. Hallmark Health Medical Center, Reading

5. Malden Family Health Center

6. Hallmark Health VNA and Hospice

7. The Dutton Center/Adult Supportive Day Care

8. Hallmark Health Medical Associates

Hallmark Health System

Hallmark Health System & Magnet

Hallmark Health System achieved Magnet

Designation in April, 2014 following a more than

five year journey

There is a

business case for

achieving and

maintaining

Magnet

designation

Historical Perspective

1980 American Academy of

Nurses study identified

factors associated with

attraction and retention of

nurses

165 hospitals nominated

42 hospitals designated

Identified as “Magnet” Hospitals

given that they could attract

and retain nurses

Historical Perspective

1990 American Nurses Association (ANA)

Board of Directors approved a new Magnet

Hospital Recognition Program

1991 American Nurses Credentialing Center

(ANCC), a branch of ANA, assigned program

oversight to the ANCC Commission on

Magnet Recognition

1994 Pilot project (study) with 5 hospitals

using new standards

Historical Perspective

2017

448 designated

Magnet facilities in 45

states,

3 in Australia,

2 in Saudi Arabia,

1 in Canada and

1 in Lebanon

Magnet Trivia

States with the most Magnet Hospitals Illinois………….41

Texas………………35

Pennsylvania………..….30

Ohio…………………….….…29

California………………….…….33

New York…………………..………..25

Florida………………………..……………22

New Jersey………………….…….………….21

Virginia……………………………………………..20

Indiana…………………………………….……………14

Michigan………………..…………………..……………..12

Wisconsin………………….….…………………..…………..11

Massachusetts…………….…………………………….……....9

Magnet Process

Cost of Magnet

Time:

Average of 4.25 years to attain Magnet

status (Jayawardhana, 2014)

Expenses:

ANCC fees

NDNQI costs

Document preparation

Site visit expenses

Annual estimate: $100,000 to

$600,000 depending on size of

organization

Cost of Magnet

Other expenses:

Structural changes:

Shared governance meetings

Non-productive and administrative

time and expense

Benefit expenses:

Certification support

Tuition reimbursement

Support for flexible scheduling

Investment in research

Support for evidence based

practice

Cost of Magnet – The Positive

Magnet designation is positively & significantly

linked with inpatient revenues (RWJF, 2014)

Estimated 3.89% increase in net inpatient

revenue

Cost of Magnet – The Positive

Revenue increase attributed to improvements

in:

Nursing productivity

Patient outcomes with impacts on length of stay

Innovations in care

Improvements in nurse-sensitive aspects of care

Improvement in expense control:

Reduced nursing turnover

Decreases in nursing vacancy rates

Hallmark Experience

Estimated annual expense:

$50,000 which includes ANCC fees, NDNQI expense,

research initiatives and document preparation

Hallmark Experience

Impact on achievement of BSN rates:

Hallmark Experience

Impact on achievement of nursing certification

rates:

2015 2016

Series1 28% 31%

26%

27%

28%

29%

30%

31%

32%

% o

f E

lig

ible

Nu

rses C

ert

ifie

dCertified RNs

Hallmark Experience

Impact on professional nursing practice

Quality Impact of Magnet

Magnet hospitals

have:

Fewer falls with injury

Lower risk of hospital

acquired pressure

ulcers

Decreased mortality

rates

Shorter lengths of stay

Quality Impact of Magnet ~ Evidence

Hospital acquired pressure ulcers Stage II or

greater

Berquist: Risk 32% lower in Magnets P <0.001

Goode: Risk slightly less P <0.10

Mills: No difference P 0.282

Hallmark Experience with Quality

Wound care champion program implemented in

4th quarter of 2015 with wound care champions

on every unit.

Hallmark Experience with Quality

Fall issue noted on the Medical and Surgical units

during 1Q16. As a result the Falls Team was re-

energized

Employee Engagement and Magnet

Turnover

Cost of turnover per RN is $42,000 to $64,000

(Advisory Board)

Cost estimated at 0.75 to 2 times the RN salary

Magnet

Vacancy

Magnet vacancy 3.64% versus 8-16% nationally

Agency Use

Cost estimated at additional $40-60 per hour

differential for each position

Hallmark Experience with Employee

Engagement Nursing turnover:

reduced from 12% to

8.6%

Nursing vacancy:

reduced from 10% to

2%

Nursing agency use:

reduced from $250,000

to $0

Hallmark Experience with Employee

Engagement - Turnover

Avg. 9.29%

Hallmark Experience with Employee

Engagement - Turnover

Avg. 4.56% (System 6.26%)

Hallmark Experience with Employee

Engagement - Turnover

Hallmark Experience with Employee

Engagement – Staffing Agency Use

Hallmark Experience with Employee

Engagement – Nursing Satisfaction

Hallmark Experience with Employee

Engagement – RN to RN Interaction

Summary

The evidence is clear:

Magnet focuses on engaging and retaining

an effective nursing workforce

The Hallmark experience parallels that of

other Magnet hospitals in realization of:

Improved patient outcomes

Increased nursing productivity

Improved patient experience

Questions?

The national nursing

shortage is estimated to

reach from 500,000 to 1

million in the next 15 years

Investing in improvements within the nursing

enterprise is logical and prudent

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