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Adoption of National Quality Forum Safe Practices by Magnet® Hospitals

Jayawardhana, Jayani PhD; Welton, John M. PhD, RN; Lindrooth, Richard PhD

JONA: The Journal of Nursing Administration: September 2011 - Volume 41 - Issue 9 - p 350-356
doi: 10.1097/NNA.0b013e31822a71a7

Background: Magnet® hospitals (MHs) are known for their high retention rates of nurses and positive work environment, yet little is known about whether MHs also have higher levels of safe practice adoption rates compared with non-Magnet hospitals (NMHs).

Methods: In this study, we investigate adoption of National Quality Forum (NQF) Safe Practices in 34 regions during 2004 to 2006 that were part of the Leapfrog Group initiative to improve quality of hospital care. We conducted a secondary data analysis by combining multiple data sets from the American Hospital Association Annual Survey, Healthcare Cost Reports Information System, and Leapfrog Group Annual Hospital Survey. A composite safe practice score (CSPS) was constructed from the Leapfrog annual survey and ranged from 0 (no adoption) to 1,000 (complete adoption) of the 30 NQF Safe Practices. A descriptive analysis and a regression with Heckman correction to control for selection bias were used to determine the effect of Magnet status and other hospital and market characteristics on differences in CSPS over the 3-year period.

Results: There were 140 MHs and 1,320 NMHs reporting data for the CSPS. In 2004, MHs had a mean CSPS of 865 versus 774 for NMHs (P < .001). By 2006, NMHs improved their CSPS from 774 to 872 (98 points), whereas MHs improved their CSPS from 865 to 925 (60 points, P < .001). Regression analysis showed a positive and significant effect of Magnet status of hospitals on the adoption rates of NQF Safe Practices as measured by the CSPS. Our results also indicated that smaller hospitals (in bed size), hospitals with larger share of Medicare patients, higher nurse intensity levels (mean hours of nursing care per day), and higher levels of competition among hospitals in Leapfrog rollout regions were associated with higher CSPS.

Conclusion: Magnet hospitals in the urban areas of 34 Leapfrog rollout regions were more likely to have higher adoption rates of NQF Safe Practices in comparison to NMHs in the same demographic areas during the time frame of the study, but other hospitals nearly closed the gap by 2006.

Author Affiliations: Assistant Professor (Dr Jayawardhana), College of Public Health, University of Georgia, Athens; Dean (Dr Welton), School of Nursing & Health Sciences, Florida Southern College, Lakeland; Associate Professor (Dr Lindrooth), Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora.

Funding: This study was funded by a grant from the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative.

The authors declare no conflict of interest.

Correspondence: Dr Jayawardhana, College of Public Health, University of Georgia, Health Policy and Management, 110 E Clayton St, Suite 300, Athens, GA 30602-7396 (

© 2011 Lippincott Williams & Wilkins, Inc.