Nursing at Michigan
Institutional Assessment for
Magnet Designation
Margaret M. Calarco, PhD, RN
Health System Clinical Quality Committee
January 10, 2012
Institutional Assessment for Magnet
Designation: Acknowledgements
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Sharon Smith, PhD, RN
Leah Shever, PhD, RN
Kathleen Moore, MBA
Denise Kotsones, MSN, RN
Benchmarking 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
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Magnet represents top 5% of country’s hospitals
(391 hospitals are currently designated)
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Promotes quality in a milieu that supports
professional practice and identifies excellence in the
delivery of nursing services to patients and families
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Provides a mechanism for the dissemination of “best
practices” in nursing services
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Reflects the presence of both organizational, as well
as nursing, excellence
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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
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The overwhelming majority of hospitals (85.4%) reported a
vacancy rate less than 7.5%.
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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
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FY 2012 Q1 - 2%
 Voluntary Termination = 1.9%
 Termination minus retirement = 1.6%
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FY 2012 Q2 -1.4%
 Voluntary Termination 1.3%
 Termination minus retirement = 1.1%
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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
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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)
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Magnet Hospitals Turnover rate – 11.4% vs non-Magnet
Hospitals – 15 - 18% (UMHS – 6.9%)
(Drenkard , et al., 2010)
Institutional Assessment for Magnet
Designation: Potential “Benefits”
Service
• Increased patient satisfaction
• (Gallup, 2008)
• Increased RN satisfaction
• (Brady-Schwarz, 2005; Waldman, 2004, Gallup, 2008)
(2009 American Nurses Credentialing Center)
Institutional Assessment for Magnet
Designation: Potential “Benefits”
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)
Institutional Assessment for Magnet
Designation: Potential “Benefits”
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)
(2009 American Nurses Credentialing Center)
Institutional Assessment for Magnet
Designation: Potential “Benefits”
Quality
• Decreased Falls
• (NDNQI, Dunton, et al, 2009)
• Patient Safety – improved communication
• (Hughes, Chang & Mark)
(2009 American Nurses Credentialing Center)
The Impact of Magnet Status on Patient
Outcomes (Goode, et. al. (2011) , JONA)
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19 Magnet hospitals were compared to 35 non-Magnet
hospitals in the University Health System Consortium using
the 2005 UHC operational and clinical database
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Total HPPD and RN mix were compared along with outcomes
which included :
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Mortality rates for CHF and MI
Failure to rescue
Hospital-acquired pressure ulcers
Infections
Postoperative sepsis and post-op metabolic derangement
LOS
The Impact of Magnet Status on Patient
Outcomes (Goode, et. al. (2011) , JONA)
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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
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Statistically better outcomes for postoperative sepsis, hospitalacquired infections, and postoperative metabolic derangement
were demonstrated by non-Magnet hospitals
The Impact of Magnet Status on Patient
Outcomes (Goode, et. al. (2011) , JONA)
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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
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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
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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
The Impact of Magnet Status on Patient
Outcomes (Goode, et. al. (2011) , JONA)
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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)
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Few studies compare Magnet and non-Magnet hospitals on
patient outcomes and findings have been mixed
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The authors of this study while surprised by the results, in the
end believe that this study adds to the evidence that “staffing
matters”
Institutional Assessment for Magnet
Designation: Potential “Benefits”
• 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
Institutional Assessment for Magnet
Designation: Potential “Benefits”
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
Institutional Assessment for Magnet
Designation: Potential “Benefits”
US News and World Report Rating (Mott)
The weighted points by specialty for magnet status are as follows:
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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
Institutional Assessment for Magnet
Designation: Potential “Benefits”
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 )
Leapfrog Designation:
NQF Safe Practice 9: Nursing Workforce
Implement critical components of a well-designed nursing
workforce that mutually reinforce patient safeguards, including the
following:
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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.
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Senior administrative nursing leaders, such as a Chief Nursing
Officer, as part of the hospital senior management team.
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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.
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Provision of budgetary resources to support nursing staff in the
ongoing acquisition and maintenance of professional
knowledge and skills.
Magnet Designated Hospitals in
Michigan
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
The Magnet Journey to Excellence
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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
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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
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Magnet application fee and manuals– $4,200
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Travel costs of appraisers (hotel + airfare) – $10,000
(estimated)
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Document review fees: Team leader and three
reviewers – $8,500
Appraisal fee (based on bed size) – $57,850
Appraiser fees (4 day survey with 4 surveyors) $29,600
Estimated Direct Magnet Expenses - $110, 150
The Magnet Journey: UMHS Overview
Three year journey - July 2012 – June 2015
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Timing related to Nursing negotiations is required
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NDNQI and other nationally benchmarked
comparisons are required in all categories
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Most indicators require submission of two years of
data
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Unfair labor Practices (ULPs) need to be monitored
and may impact evaluation and/or designation *
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Requires significant focus across entire organization
Magnet requirements have significantly shifted from
process measures to outcome measures
The Magnet Journey: UMHS Overview
Three year journey - July 2012 – June 2015
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Must integrate the Magnet measures with the final
Michart and centricity planned abstraction of the final
list for meaningful use and other required data
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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
The Magnet Journey:
UMHS Estimated Expenses
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
The Magnet Journey:
UMHS Estimated Expenses
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
The Magnet Journey:
UMHS Estimated Expenses
Ongoing annual expenses
• $568,944
Recertification required every four years
• Annual expenses plus full certification
expenses
Comments & Questions