Magnet quality in health care the focus of forum
31 March 2004
Magnet quality in health care the focus of national forum
About 200 health professionals are expected to descend on Wellington tomorrow to discuss 'Magnet' principles of quality health care.
Patient safety, job satisfaction and quality care are core principles of the magnet approach to health care and these will be explored further at the first national Magnet New Zealand forum in the capital on 1 April.
The approach is already being explored at Hutt Valley District Health Board, which is awaiting its evaluation by the American Nurses Credentialing Center (ANCC). Elsewhere Lakes and MidCentral DHBs are also working towards becoming Magnet hospitals, while other boards are showing interest.
The forum has been designed to be practical and evidence-based. Guest speaker is American nurse leader Kim Sharkey who has been associated with Magnet for nearly a decade and is an active participant with the American Nurses Association in the Magnet Recognition Program for Excellence in Nursing Services.
Magnet NZ chairperson Christine Payne says the 15 member group works collaboratively to support and shape the introduction of magnet principles, coordinating activities to introduce Magnet in health organisations.
Ms Payne says the health sector is showing a lot of interest.
"The Magnet concept has been identified as a significant evidence-based nursing workforce and organisational improvement model that has dramatic and scientifically measurable benefits for patient outcomes, organisational culture and all disciplines, not just nursing," says Ms Payne, who is also Director of Nursing Practice at Bay of Plenty DHB.
"Quality and safety in health care is paramount. Health professionals don't often have time to sit down and read research on concepts like Magnet, so we hope this forum will serve as a very practical, evidence-based workshop where they can listen to those involved with Magnet and hear the research, pick-up the main points, and think about how they could apply Magnet principles to their workplace."
Magnet NZ member Dr Peter Leslie says working on excellence of care and patient outcomes can also help recruitment and retention of staff.
"Although Magnet was initiated primarily by the nursing sector, it has potential for positive spin off for all health professional and ancilliary staff within an organisation", says Dr Leslie who is also Chairperson of the NZ Council of Medical Colleges.
The Ministry of Health supports the Magnet concept as an effective way of addressing issues facing nursing in New Zealand. The Ministry provides the secretariat for Magnet NZ of which Chief Advisor Nursing, Dr Frances Hughes, is a member.
Magnet - Questions and Answers
What is Magnet New Zealand?
In 2002, the New Zealand Magnet Advisory Network was established. The network was initially a group of professional nursing leaders working collaboratively to support and shape the introduction of magnet principles in New Zealand. In 2003, the group reformed to become a more inclusive Magnet NZ.
Magnet NZ has an executive and a core group. The executive comprises of the Chairperson and Deputy Chairperson, the Chief Advisor Nursing, and a researcher. The core group comprises of representatives from nursing and other health professional groups, District Health Boards, and other health provider organisations. The Ministry of Health provides the secretariat for Magnet NZ, and Chief Nursing Advisor Dr Frances Hughes is a member.
What is the Ministry of Health's role in relation to Magnet NZ?
The Ministry provides the secretariat for Magnet NZ. Its role in assisting the implementation of magnet standards and principles includes:
-· Disseminating information and providing advice to DHBs, Non-Governmental Organisations (NGOs), and services interested in Magnet
-· Advising on and assisting with implementation and communication plans
-· Development of research and evaluation requirements
-· Monitoring the development of Magnet in health services.
Where does 'Magnet recognition' come from?
In the early 1980s, the American Academy of Nursing undertook a study of US hospitals to identify organisational characteristics of hospitals that were able to attract and retain nurses during a shortage. These hospitals were called Magnet hospitals and further work was done on characteristics to distill a set of principles that they shared. Standards were then developed against these principles and an accreditation process established so hospitals could determine what they would need to do to be recognised as a Magnet hospital.
Research into Magnet hospitals has been based on the impact of registered nurses on patient outcomes. The research on patient and nurse outcomes has been ongoing and has identified that these hospitals have lower Medicare mortality rates, lower AIDS mortality, shorter lengths of stay, higher patient satisfaction, lower rates of nurse burnout, lower rates of needlestick injuries among nursing staff, higher rates of nurse job satisfaction, and higher nurse ratings of quality of care. They also have improved nurse physician relationships.
When did the Magnet Recognition Programme commence in the United States?
Since 1994, the American Nurses Credentialing Center (ANCC) has designated magnet status by way of the Magnet Recognition Program process. It provided a framework to recognise excellence in:
-· Management philosophy and practices of nursing services.
-· Adherence to standards for improving the quality of patient care.
-· Leadership of the chief nurse executive in supporting professional practice and continued competency of nurses.
-· Attention to the cultural and ethnic diversity of patients, their families as well as health care providers.
Why is there a drive in New Zealand to establish Magnet principles in health organisations?
For many years New Zealand nursing leaders and key academics have followed the research and literature linking nurse staffing, patient outcomes and hospital environments. The Magnet model has been identified as the only evidence-based nursing workforce improvement management model that has dramatic, and scientifically measurable, benefits for patients and nurses.
Have any hospitals or health organisations in New Zealand adopted Magnet principles yet?
The Hutt Valley DHB's Board approved the organisation's participation in the magnet programme in April 2003 and since then work has progressed rapidly.
Self-assessment against magnet principles as well as a formal application to the American Nurses Credentialling Centre (ANCC) have been completed. Hutt Hospital is working towards achieving magnet status in 2005. A full-time project officer has been appointed and she has visited the United States to see magnet hospitals for herself. Magnet champions have been appointed in each hospital department and magnet teams are now working on providing documented evidence of Hutt Hospital's readiness for magnet status.
Several DHBs are now actively pursuing the possibility of introducing magnet concepts in New Zealand's health and disability sector. Interested DHBs have purchased copies of the magnet standards and are now at various stages of determining the level at which they currently meet magnet standards.
Who are the members of Magnet NZ?
Christine Payne (Chair) - Director of Nursing, Bay of Plenty District
Health Board, NENZ
Anita Bamford - Director of Nursing, Capital and Coast DHB, NENZ
Jane Brosnahan - College of Nurses Aotearoa
Taima Campbell - Director of Nursing, Auckland DHB, NENZ
Rhondda Knox - Director of Nursing, Hutt Valley DHB
Mary Ross - Director of Nursing, Canterbury DHB, NENZ
Kate Stewart - Directors of Mental Health Nursing
Valerie Sugrue - NZ Private Hospitals Association
Puti Nicholls - National Council of Maori Nurses
Peter Leslie - NZ Council of Medical Colleges
Jane O’Malley - NZ Nurses Organisation
Margaret Cain - NZ Nurses Organisation
Mary Finlayson - Auckland University
Frances Hughes - Chief Advisor Nursing, Ministry of Health.
What is Magnet NZ's role?
The role of Magnet NZ is to work collaboratively to support and shape the introduction of magnet principles and the Magnet Recognition Programme in New Zealand. It also aims to ensure national consistency, and puts into context the standards and processes to meet our unique culture. Magnet NZ provides strategic direction for health care organisations and nursing in New Zealand and acknowledges Mäori aspirations for improved health outcomes and actively supports Mäori leadership and participation.
Magnet NZ is involved in co-ordinating and supporting activities nationally relating to the introduction of Magnet principles in any health organisations in New Zealand. It also monitors and evaluates the impact on nursing workforce and patients / communities. The group has close linkages with the International Magnet Advisory Committee and American Nurses Credentialing Center.
What is its vision?
Its vision is to improve the health of all New Zealanders through developing health care environments using evidence-based standards to improve patient outcomes, increase patient safety, and provide high quality nursing.
What work has Magnet undertaken to date?
Since its establishment in 2002, Magnet NZ has:
-· Commissioned a review of Magnet principles and standards.
-· Hosted two international visitors - the Executive Director of the ANCC and the principal researcher involved in studies regarding magnet hospitals - to further magnet consultation in New Zealand.
-· Worked with the ANCC regarding the possibility of implementing Magnet principles and standards in the New Zealand health and disability sector.
-· Facilitated the introduction of Magnet principles and standards to District Health Boards.
Magnet NZ is facilitating a national forum on 1 April 2004.
What are the proven benefits and outcomes for organisations that adopt magnet principles?
Hospitals with magnet organisational characteristics have demonstrated better patient outcomes (lower mortality and morbidity rates, reduced infection rates and medication errors) and higher patient satisfaction because of 'patient-centred care' than matched non-magnet hospitals. Costs are reduced because of lower staff turnover and shorter lengths of stay. Research has demonstrated a positive impact on organisational culture and increased institution stability. In terms of nursing outcomes, magnet hospitals have demonstrated enhanced recruitment and retention of highly qualified nurses, lower rates of needlestick injuries, higher rates of nurse job satisfaction, higher nursing ratings of quality of care, and significantly lower rates of nurse burnout.
What are the management and administration principles of "Magnet" organisations?
-· Participation and supportive management style
-· Well-prepared and qualified senior nurse leaders
-· De-centralised organisational structure
-· Adequate nursing staff
-· Deployment of clinical specialists.
-· Clinical career opportunities.
What are the principles for professional practice and professional development?
-· Professional practice models of delivery of care.
-· Professional autonomy and responsibility.
-· Availability of professional advice.
-· Emphasis on teaching responsibilities of staff.
-· Teamwork and collaborative relationships.
-· Planned orientation of staff.
-· Emphasis on in-service and continuing education.
-· Competency-based clinical pathways.
-· Management development.
Why would New Zealand's health sector benefit from Magnet principles?
There is currently a drive to contain health spending and costs. There is no evidence to suggest that magnet hospitals cost more. Turnover of nurses in New Zealand is approximately 19 percent across DHBs and 45 percent for new graduate nurses. In 2002 a pilot study to establish the cost of nursing turnover found that identifiable turnover costs were $50,000 over a six-month period for a surgical and medical hospital unit. Lower turnover results in substantial savings.
Magnet hospitals have more favourable patient to nurse ratios but no mandatory fixed ratio / better patient outcomes result in lower overall resource use per patient (fewer ICU days, shorter lengths of stay, lower ancillary costs). In addition, magnet principles are applicable across disciplines and organisations and the focus in on quality health care and evidence based practice.