Journal of Nursing Administration:
Departments: Magnet(R) Perspectives
Author Affiliation: Director, Magnet Recognition Program®, American Nurses Credentialing Center, Silver Spring, Maryland.
The author declares no conflict of interest.
Correspondence: American Nurses Credentialing Center, 8515 Georgia Avenue, Suite 400, Silver Spring, MD 20910 ( email@example.com).
The director of the Magnet Recognition Program® provides a comprehensive look at the Magnet® Model component Empirical Quality Outcomes. This article examines the importance of outcomes data that the organization already collects and how these should be used. Quantitative benchmarks should be established. These outcomes will represent the “report card” of a Magnet-recognized organization and a simple way of demonstrating excellence.
Florence Nightingale got it right when she said “I think one’s feelings waste themselves in words; they ought to all be distilled into actions which bring results.”1
Increasingly, society and the healthcare industry, especially payors, are looking for the “so what” of the activities that nurses provide. Accountability for outcomes has increased as the cost of providing care has increased. Consumers want to know what they are getting for their money.
In response to the outcomes movement in healthcare, the Magnet Recognition Program® aligned the requirements and the new model with expectations for accountability and evidence. The introduction of Empirical Outcomes as the 5th component of the new Magnet® Model was the most significant change to the criteria contained in the 2008 Magnet Program Application Manual.2 The original Magnet Recognition Program focused on structure and processes with an assumption that good outcomes would follow. As the Magnet model has evolved, the Commission on Magnet placed greater emphasis on Magnet hospitals’ ability to show specific outcomes reflecting advanced knowledge and changing national imperatives. The Sources of Evidence require that hospitals demonstrate not just the structures and processes in place but also proof of exemplary outcomes. The Magnet standards are the only credential that recognizes organizations for comprehensive excellence—demonstrated by patient satisfaction, nurse satisfaction, and clinical outcome measurement.3
Outcomes are defined as quantitative and qualitative information related to the impact of structure and process on the patient, nursing workforce, organization, and consumer. They are dynamic and include areas of improved performance and those requiring ongoing effort.2 The development of organizational culture and infrastructure to assist with measuring, monitoring, and improving outcomes has been a challenge for many organizations seeking initial designation or redesignation.
Transformational leadership is required to inspire a culture to shift its sole focus from the structure and process of how things are done to a balanced attention on the outcome of those indicators impacted by the process. This dual focus assists in developing a culture of inquiry as part of the planning process before implementing any change initiative. Exemplar Magnet practices include the collection of information or data before the implementation of a change. The collection of data establishes a baseline against which the impact of the change initiative will be measured. Hospitals must demonstrate data that are above the 51st percentile for the majority of the 8 quarters of the reporting period, when benchmarked against comparable national databases, for clinical outcomes (especially nurse-sensitive indicators), patient experience, and nurse satisfaction. Evidence of an organization’s ability to establish baselines for measures and track progress over time compared with the baseline and national benchmarks is essential to achieving and maintaining Magnet recognition.
An essential element of an organization’s ability to attain and demonstrate sustained positive empirical outcomes is the use of benchmarking and best practice sharing between excellent organizations. The Magnet community is a great place to learn, compare, and implement changes in practice. In Magnet organizations, this work is based on a well-developed professional practice model (PPM). The PPM will have a structure of diversified focus in the areas of nursing practice, nursing research, and nursing-sensitive quality measures, with a spirit of interdisciplinary collaboration to improve care. The involvement of nurses at all levels of the organization identifying issues of concern, developing action plans, monitoring, and evaluating outcomes is an important component of nurses truly owning their practice. The increase in involvement and understanding of their practice facilitates ongoing efforts to raise the bar of the impact on the work environment and the quality of care provided to patients.
A challenge for the future is shifting efforts from retrospectively gathering data to collecting and reporting information concurrently. The ability to have real-time data, visualize and analyze the trending and benchmarking of such information, and perform rapid cycle action planning will prove to be beneficial to further enhancing clinical quality, customer experience, and work environment outcomes. Another more challenging ambition is to raise the level of benchmarking goals from the 51st percentile. Encourage your organization to set goals and compare itself to benchmarks at the 75th or 90th percentile. Do not settle for simply having indicators that exceed the benchmarks for the majority of quarters during a 2-year monitoring period. Many Magnet organizations set their sights on exceeding benchmarks for 75%, 90%, or 100% of the reporting period.
Magnet organizations are in a unique position to serve as pioneers of the future, demonstrating solutions to numerous problems inherent in our healthcare system today. Their inventiveness advances excellent quality patient care, safe patient care, and the creation of environments that contribute to high nurse and patient satisfaction. The question for the future is not “What do you do?” or “How do you do it?” but rather “What difference have you made?” Empirical outcomes seek to answer this question with concrete examples of how hospitals and nurses have positively impacted patients, communities, and the nursing profession. In turn, they demonstrate the benefits of a transformational nursing environment, a structure supporting empowered nurses, and one that focuses on research and evidence-based practice to provide exemplary care.
2. Magnet Recognition Program® Application Manual. Silver Spring, MD: American Nurses Credentialing Center; 2008.
3. Drenkard K, Wolf G, Morgan S. Magnet The Next Generation-Nurses Making the Difference. Silver Spring, MD: American Nurses Credentialing Center; 2011.
© 2012 Lippincott Williams & Wilkins, Inc.