nursing at michigan institutional assessment for magnet designation margaret m. calarco, phd, rn...

Nursing at MichiganInstitutional Assessment for

Magnet DesignationMargaret M. Calarco, PhD, RN

Health System Clinical Quality Committee

January 10, 2012

Institutional Assessment for Magnet Designation: Acknowledgements

• Sharon Smith, PhD, RN• Leah Shever, PhD, RN• Kathleen Moore, MBA• Denise Kotsones, MSN, RNBenchmarking Partners:• Johns Hopkins – Karen Haller, PhD, RN• Massachusetts General Hospital – Jeanette

Ives Erickson, MSN, RN, FAAN• Clarian Health Partners – Linda Everett, PhD,

RN, FAAN

Institutional Assessment for Magnet Designation: Strategic Goals

Creating the future of health care through discovery • Create the ideal patient care experience• Attain market leadership in key areas• Generate margin for health system investment• Translate knowledge into practices and polices that

improve health and access to care• Engage in groundbreaking discovery and innovative

scientific collaboration• Cultivate an interdisciplinary, continuous learning

environment learning environment• Promote diversity, cultural competency and

satisfaction among faculty, staff and students

Institutional Assessment for Magnet Designation: The Value of Magnet Criteria

• Magnet represents top 5% of country’s hospitals (391 hospitals are currently designated)

• Promotes quality in a milieu that supports professional practice and identifies excellence in the delivery of nursing services to patients and families

• Provides a mechanism for the dissemination of “best practices” in nursing services

• Reflects the presence of both organizational, as well as nursing, excellence

• Criteria is based on evidence of a professional practice environment

Institutional Assessment for Magnet Designation: The Value of Magnet Criteria

• Magnet standards serve as a framework for structure, process, and ultimately outcomes for excellence in patient care

• The principles of nursing engagement in problem solving for quality and safety, decision making, and autonomy in practice to meet current demands in care are clearly supported

• Magnet status reflects presence of both organizational and professional excellence, quality and safety

Institutional Assessment for Magnet Designation: Potential “Benefits”

People • Increased RN retention and lower nurse

burnout • (Aiken & Sloane, 1997)

• Decreased RN vacancy rate• (McConnell, 1999; Upenieks, 2003; Jones & Gates,

2007)

• Decreased RN turnover rate• (Upenieks, 2003; Aiken & Sloane, 1997; Jones & Gates,

2007; Lacey & Cox, 2007) (2009 American Nurses Credentialing Center)

Institutional Assessment for Magnet Designation: UMHS Vacancy Rates

UMHS Vacancy Rate• FY 2012 Q1 - 2.4 %• FY2012 Q2 - 2.1%• For calendar year (Jan1 to Dec 31 2011) our overall vacancy

rate was 4%

National Vacancy rate• The overwhelming majority of hospitals (85.4%) reported a

vacancy rate less than 7.5%.• Sixty-one percent have a vacancy rate of less than 5% (National Healthcare & RN Retention Report, 2011)

Institutional Assessment for Magnet Designation: UMHS Turnover rates

UMHS Termination (Turnover) Rate• FY 2012 Q1 - 2%

Voluntary Termination = 1.9% Termination minus retirement = 1.6%

• FY 2012 Q2 -1.4% Voluntary Termination 1.3% Termination minus retirement = 1.1%

• FY 2011 - 6.9% Voluntary Termination 6.4% Termination minus retirement = 5.5%

Institutional Assessment for Magnet Designation: UMHS Vacancy and Turnover rates

National Turnover Rate• Approximately 82% of US hospitals say their annual

RN attrition is between 1 and 20%, with an average rate of about 14%

(AACN website: “ Nurse Turnover in Hospitals” posted June 8, 2011)

• Magnet Hospitals Vacancy rate – 3.64% vs non-Magnet Hospitals – 8.1 – 16% (UMHS - 4% with expansion)

• Magnet Hospitals Turnover rate – 11.4% vs non-Magnet Hospitals – 15 - 18% (UMHS – 6.9%)

(Drenkard , et al., 2010)


Service• Increased patient satisfaction

• (Gallup, 2008)

• Increased RN satisfaction • (Brady-Schwarz, 2005; Waldman, 2004, Gallup, 2008)

(2009 American Nurses Credentialing Center)


RN Satisfaction• NDNQI Survey includes the PES-NWI along

with many other variables measuring satisfaction

• Practice Environment Scale – Nursing Work Index (PES-NWI) (Lake, 2011)

• UMHS - PES – NWI overall composite score for all Inpatient Units & the ED (2009) was 2.86

• In various studies comparing Magnet vs non-Magnet hospitals, overall composite scores vary, but UMHS scores usually are better than non-Magnet and slightly lower than Magnet in some studies, with the most recent Magnet study reporting a composite score of 2.85 for a sample of Magnet hospitals (Kelly, et al., 2011)

Quality • Decreased mortality rates

• (Aiken, 1994, 1997, 1999; Aiken, Smith & Lake, 1994)

• Decreased pressure ulcers • (VA, 2004; Mills, 2008)

• Decreased ALOS • (Aiken, Smith & Lake, 1994)



Quality • Decreased Falls

• (NDNQI, Dunton, et al, 2009)

• Patient Safety – improved communication • (Hughes, Chang & Mark)



The Impact of Magnet Status on Patient Outcomes (Goode, et. al. (2011) , JONA)

• 19 Magnet hospitals were compared to 35 non-Magnet hospitals in the University Health System Consortium using the 2005 UHC operational and clinical database

• Total HPPD and RN mix were compared along with outcomes which included :

• Mortality rates for CHF and MI

• Failure to rescue

• Hospital-acquired pressure ulcers

• Infections

• Postoperative sepsis and post-op metabolic derangement

• LOS


• With the exception of slightly better outcomes for pressure ulcer prevention in Magnet hospitals, non-Magnet hospitals demonstrated better outcomes on all other measures than Magnet hospitals

• Statistically better outcomes for postoperative sepsis, hospital-acquired infections, and postoperative metabolic derangement were demonstrated by non-Magnet hospitals


• Total HPPD and RN skill mix were higher in non-Magnet hospitals for general care units and RN skill mix was higher in the ICUs for non-Magnet hospitals

• General Care units in non-Magnet hospitals had on average three 8-hour shifts and one 6-hour shift more RN hours per week than Magnet hospitals

• Intensive Care units in non-Magnet hospitals had on average three 8-hour shifts and one 5-hour shift more RN hours per week than Magnet hospitals


• These staffing findings are consistent with other studies which have demonstrated higher RN skill mix in non-Magnet hospitals (Hickey, et. al., 2010) and the impact of RN hours per patient day associated with decreased falls ( Lake, et. Al., 2010)

• Few studies compare Magnet and non-Magnet hospitals on patient outcomes and findings have been mixed

• The authors of this study while surprised by the results, in the end believe that this study adds to the evidence that “staffing matters”

• US News and World Report Rating

• Leapfrog


US News and World Report Rating

1. Johns Hopkins

2. MGH

3. Mayo

4. Cleveland Clinic

5. UCLA

6. NY Presbyterian - No

7. UCSF - No

8. Brigham & Women’s - No

9. Duke

10. U. of Pennsylvania

11. Barnes Jewish

12. UPMC (Shadyside & St. Margaret)

13. U of Washington

US News and World Report Rating• UMHHC analysis completed by Matt

Comstock suggested we could increase our ranking in each specialty by about two positions and move our ranking in the Honor Roll by two positions


US News and World Report Rating (Mott)The weighted points by specialty for magnet status are as follows:• Cancer: 0.3• Endocrinology: 0.6• Gastroenterology: 0.5• Cardiology& Cardiac Surgery 0.7• Kidney: 0.3• Neonatology: 0.4• Neurosciences 0.6• Orthopedics: 1.2• Pulmonology: 0.8• Urology: 0.6


US News and World Report Rating (Mott)In 2010 the addition of the above points in their category would have improved rankings in the following way:• Endocrinology: Up 2 spots (Would be tied for #24)• Cardiology& Cardiac Surgery: Up 1 spot (Would be #3)• Neonatology: Up 1 spot (Would be #21)• Orthopedics: Up 1 spot (Would be #12)• Urology: Up 3 spots (Would be #25)• No Movement in Cancer, Gastroenterology, Kidney,

Neurosciences, and pulmonology (Scott Marquette )


Implement critical components of a well-designed nursing workforce that mutually reinforce patient safeguards, including the following:• A nurse staffing plan with evidence that it is adequately

resourced and actively managed and that is effectiveness is regularly evaluated with respect to patient safety.

• Senior administrative nursing leaders, such as a Chief Nursing Officer, as part of the hospital senior management team.

• Governance boards and senior administrative leaders that take accountability for reducing patient safety risks related to nurse staffing decisions and the provision of financial resources for nursing services.

• Provision of budgetary resources to support nursing staff in the ongoing acquisition and maintenance of professional knowledge and skills.

Leapfrog Designation:NQF Safe Practice 9: Nursing Workforce

391 Magnet designated hospitals nationally• Beaumont Hospital 2009 • Bronson Methodist Hospital 2009 • Holland Community Hospital 2007 • Munson Medical Center 2006 • Oaklawn Hospital 2009 • Sparrow Hospital 2009 • Spectrum Health- Blodgett , Butterworth & DeVos 2009 • Northern Michigan Regional Hospital 2011• VHS – Children’s Hospital 2008• VHS – Detroit Receiving & Huron Valley Sinai 2009

Magnet Designated Hospitals in Michigan

The Magnet Journey to Excellence

• Phase One: Gap Analysis and Follow-up

• Phase Two: Submission of Application

• Phase Three: Written Documentation

• Phase Four: Site Visit

• Phase Five: Commission Vote

• Ongoing: Interim reports after two years

and full recertification process

every four years

The Magnet Journey: Requirements

Additional NDNQI participation• Pediatric and Psychiatric nursing indicator collection and

analysis

• Nurse Satisfaction Survey across all areas

Designated Roles• Magnet Coordinator

• Administrative support

• Data analyst and programmer

• Additional staff time for data collection & preparation

The Magnet Journey: Requirements

Direct Magnet Expenses• Magnet application fee and manuals– $4,200• Appraisal fee (based on bed size) – $57,850• Appraiser fees (4 day survey with 4 surveyors) -

$29,600• Travel costs of appraisers (hotel + airfare) – $10,000

(estimated)• Document review fees: Team leader and three

reviewers – $8,500

Estimated Direct Magnet Expenses - $110, 150

The Magnet Journey: UMHS Overview

Three year journey - July 2012 – June 2015• Timing related to Nursing negotiations is required• Magnet requirements have significantly shifted from

process measures to outcome measures• NDNQI and other nationally benchmarked

comparisons are required in all categories• Most indicators require submission of two years of

data• Unfair labor Practices (ULPs) need to be monitored

and may impact evaluation and/or designation *• Requires significant focus across entire organization

The Magnet Journey: UMHS Overview

Three year journey - July 2012 – June 2015• Must integrate the Magnet measures with the final

Michart and centricity planned abstraction of the final list for meaningful use and other required data

• Must align any activities required for Magnet preparation with the work being done in our professional practice model development

The Magnet Journey: UMHS Estimated Expenses

Year One ( July 2012 – June 2013) • Major Activities

• Establishing the infrastructure• Readiness assessment and gap analysis• Action plans to address gaps• Adding the required NDNQI component• Initial collection of evidence

• Estimated Expense - $583,941


Year Two ( July 2013 – June 2014 *) • Major Activities

• Completion of evidence for submission• Review of documents (Magnet)• Participation in NDNQI• Mock Survey

• Estimated Expense - $584,708• Negotiations year


Year Three ( July 2014 – June 2015) • Major Activities

• Submit completed application after ratification

• Review of documents (Magnet)• Site visit

• Estimated Expense - $677,394

• Three Year Estimate – $1,846,044


Ongoing annual expenses• $568,944

Recertification required every four years• Annual expenses plus full certification

expenses

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nursing at michigan institutional assessment for magnet designation margaret m. calarco, phd, rn...

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