using magnet® as a framework for healthcare facility design · using magnet® as a framework for...

Using Magnet® as a Framework for Healthcare Facility Design

Session E 62, 16 Nov 2015, 3:20-4:20pm

Jaynelle F. Stichler, DNS, RN, NEA-BC, EDAC, FACHE, FAANCo-Editor of HERD Journal

Consultant Research & Professional Development Sharp HealthCareProfessor Emerita, San Diego State University

[email protected]

Objectives

• Learn about the importance of the Magnet designation to healthcare organizations

• List the Magnet Components and their relationship(s) to design

• Discuss how firms can use the Magnet language in their work with healthcare clients

• Use Magnet components to validate nurses’ active participation in the design processes.

Magnet Recognition Program

• Magnet Recognition Program was initiated in late 1980s and formalized in 1993

• ANCC designation & recognition for nursing excellence

• Only 7% of all registered hospitals in the US have ANCC Magnet Recognition status (AHA Fast

Facts on US Hospitals, 2015)

Program Growth

Annual Magnet Conference

• Recognition of newly designated & re-designated hospitals

• Presentation of best practice examples in nursing practice– Programs to enhance clinical nurse engagement

– Improvements in patient outcomes (nurse sensitive indicators)

– Professional Development of clinical nurses

Importance of Magnet Recognition to Healthcare Organizations

Magnet Designated Hospitals

• Attract & retain top talent in nursing

– Higher percentages of satisfied RNs

– Lower RN turnover & vacancy rates

• Have a Collaborative culture

• Demonstrate advanced nursing standards & practice

– Improved clinical or patient outcomes (satisfaction, nurse sensitive indicators, HCAHPS scores)

– Improved patient satisfaction

National Recognition of Magnet

• US News & World Report uses Magnet designation as a primary competence indicator in the assessment & ranking of nearly 5,000 hospitals for best medical centers in 16 specialties

• Leapfrog Hospital Survey compares hospitals performance in safety, quality & efficiency– Magnet hospitals earn a full credit for Safe Practice #9

Nursing Workforce. – Scores hospitals on their commitment to staffing with

highly trained nurses & putting nurses in leadership positions that allows substantial input on patient safety issues.

Goals & Guiding Principles

Magnet Recognition Program advances 3 goals in health care organizations

1. Promote quality in a setting that supports professional practice

2. Identify excellence in the delivery of nursing services to patients/residents

3. Disseminate best practices in nursing services

Magnet Components

Magnet Components & Design: including nurses is no longer just a “nice” thing to do; hospitals must

document how clinical nurses were included in the design process

Transformational Leadership

• 9 sources of evidence required with examples• TL2 – Nurse leaders (NL) and clinical nurses

advocate for resources to support unit/org goals• TL3EO- CNO influences organization wide change

beyond scope of nursing• TL4 – CNO is a strategic partner in the

organizations decision making• TL5 – NL lead change effectively • TL9EO- NL use input from clinical nurse to

influence change in the practice environment

Structural Empowerment

• 11 sources of evidence required with examples

• SE1EO – CN are involved in interprofessional decision-making groups at the organizational level

• SE3EO- The organization supports nurses’ continuous professional development

• SE4EO – Nurses participate in professional development activities designed to improve their knowledge, skills and/or practices in the workplace

Exemplary Professional Practice

• 23 sources of evidence required with examples

• EP8EO – Nurses use internal & external experts to improve the clinical practice setting

• EP16- Nurses have the authority & freedom to be involved in decision-making processes pertaining to work environment or patient care

New Knowledge, Innovations & Improvements

• 6 sources of evidence required with examples• NK2 – Nurses disseminate the organizations nursing

research findings to internal & external audiences• NK6EO- Nurses are involved in the design &

implementation of workflow improvements & space design to enhance nursing practice• Evidence & supporting graphs to demonstrate:

• Operational improvement• Waste reduction• Clinical efficiency• Improved patient outcomes

NK6EO – Kaizen to Improve Workflow in PACU before Design Process

Pre-Survey Mean 3-month 1 year 18 months

Find supplies 2.75 2.52 2.53 2.5

PACU Space utilized 3.35 2.37 2.35 2.2

Annex utilized 3.94 2.78 2.76 2.3

Finding a bed 2.44 2.26 2.06 1.9

PACU appearance 2.88 2.21 2.82 2.19

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Me

an

Sc

ore

s

PACU Kaizen Mean Scores

4 = poor 3 = marginal 2 = good 1 = excellent The lower the score, the better!


Pre-Kaizen3 Months

Post-Kaizen1 Year

Post-Kaizen18 MonthsPost-Kaizen

RN total time spentlooking for supplies

(minutes)90 75 60 50

0

10

20

30

40

50

60

70

80

90

100

Min

ute

sRegistered Nurse Time Spent Supply

Searching


Pre-Kaizen

3 MonthsPost-

Kaizen

1 YearPost-

Kaizen

18Months

Post-Kaizen

Average PACU patientlength of stay (hours)

2.8 1.8 1.7 1.5

0

0.5

1

1.5

2

2.5

3H

ou

rsPACU Patient Length of Stay

Empirical Outcomes

Examples with supporting data & graphs to demonstrate the actual outcomes achieved

STORIES• Background/problem• Goal Statement• Description of the intervention/initiative/activity• List of the participants• Outcomes – data display

Empirical Outcomes

Name Credentials Job Title Department

Jan Stichler DNS, RN, EDAC, FACHE, FAAN

Research Consultant Nursing Administration

Joe Designer MA, ACHA Designer HAPE Architects, Inc.

Jessie Interiors MA, Interior Designer BUTE Interiors,Inc.

Kathy Product BA Equipment Consultant Good EQ, Inc

Nancy Nurse BSN, RNC-NIC Clinical Nurse NICU

Rachelle Specialist MSN, APRN, CNS, RNC-NIC

Clinical Nurse Specialist NICU

Bob Goodnurse MSN, RNC-NICU Clinical Nurse NICU

Carmen Mendez PhD, RN, NEA-BC CNO Children’s Hospitals

Shelly Executive MHA, RN, FACHE CEO Children’s Hospitals

Participants

Empirical Evidence - Outcomes

How Can Firms Use the Magnet Language in their Work with

Healthcare Clients?

How can you help your clients be Magnet ready??

• Marketing materials & presentations– List your experience with Magnet hospitals

– Give examples of how you have integrated CLINICAL NURSES into the design process

– Provide EVIDENCE of how your designs have made a difference• Length of stay

• Provider (nurse) satisfaction

• Patient satisfaction

• Improvement in HCAHP scores related to facility

• Improvement in Nursing Specific Indicators

Use the Magnet® Language!

Showing the Evidence

You Can’t Have Evidence Unless You Measure Outcomes

What can I measure?

• Satisfaction levels – patients, providers

• Nurse Sensitive indicators– Fall numbers or rates

– HAI numbers or rates

• HCAHPS scores – Hospital Environment Scores– Cleanliness of Room

– Quietness at night

Figure 1. Conceptual model for healthcare design

Copyright © 2015 Journal of Nursing Administration. Published by Lippincott Williams & Wilkins. 26

A Conceptual Model for Healthcare Facility Design

Stichler, Jaynelle F.

Journal of Nursing Administration. 44(6):321-325, June 2014.

doi: 10.1097/NNA.0000000000000076

Note: A slightly different model is presented by:

Ulrich, R.S., Berry, L.L., Quan, X. & Parish, J.T. (2010). A conceptual Framework for the domain of evidence-based design. HERD, 4(1),

95-114.

http://journals.lww.com/jonajournal/Fulltext/2014/06000/A_Conceptual_Model_for_Healthcare_Facility_Design.5.aspx

Table 1

Table 1. Antecedent Variables for the Project


Antecedent Variables


Stichler, Jaynelle F.Journal of Nursing Administration. 44(6):321-325, June 2014.doi: 10.1097/NNA.0000000000000076


Table 2. Examples of Structure Variables for a Project





doi: 10.1097/NNA.0000000000000076

Independent or Predictive Variables

Structure –Design Features


Table 3. Examples of Process Variables for a Project





doi: 10.1097/NNA.0000000000000076

Process Variables






doi: 10.1097/NNA.0000000000000076

Table 4: Patient Outcome Variables


Table 5. Examples of Provider Outcome Variables for a Project





doi: 10.1097/NNA.0000000000000076

Table 5: Provider Outcome Variables


Table 6. Examples of Organizational Outcome Variables for a Project





doi: 10.1097/NNA.0000000000000076


Conclusions

• Speak the language of healthcare

• Value what your clients value

• Help your clients achieve their goals

• Measure the outcomes of your designs– informs you for future designs

– Creates the evidence for EBD

• Disseminate empirical outcomes from your designs– Strengthens your position among competitors

ReferencesANCC (2014). 2014 Magnet Application Manual. Silver Spring, MD: ANCC.

Aiken, L.H., Clarke, S.P., Sloane, D.M., Lake, E.T. & Cheney, T. (2009). Effects of hospital care environment on patient mortality & nurse outcomes. Journal of Nursing Administration, 38(5), 223-229.

Haenke, R. & Stichler, J.F. (2015). Applying Lean Six Sigma for Innovation Change to the Post-Anesthesia Care Unit. Journal of Nursing Administration, 45(4), 185-187

HCAHPS or Hospital Consumer Assessment of Healthcare Providers & Systems http://www.hcahpsonline.org/surveyinstrument.aspx

Kelly, LA, McHugh, MD, Aiken, LH. (2011). Nurse outcomes in Magnet and Non-Magnet hospitals. Journal of Nursing Administration, 41(10), 428-433

Stichler, J.F. (2015). Using Magnet as a Framework for Nurse Participation in Facility Design. Journal of Nursing Administration, 45(1), 11-13.

Stichler, J.F. (2014). A conceptual model for healthcare facility design. Journal of Nursing Administration, 44(6), 321-325.

Ulrich, R.S., Berry, L.L., Quan, X. & Parish, J.T. (2010). A conceptual framework for the domain of evidence-based design. HERD, 4(1), 95-114.

http://www.hcahpsonline.org/surveyinstrument.aspx

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