As a nurse, there's probably one or more times in your career when either yourself personally or another nurse "saved the day" on behalf of a physician. Research backs this trend with studies that confirm programs which foster excellence in nursing care have sweeping impacts throughout healthcare systems, in particular, on the patients' perceptions of physicians' performance.Hospitals which have implemented nursing care models with initiatives focused on improving nursing care see among other benefits:
- Higher rates of retention and nurse satisfaction
- Improved patient safety and experience
- Decreased mortality
- Increased profit and revenue
- Improved perceptions of physicians' performance
Harvard Study Finds Nursing Excellence Leads to Improved Physician Performance
Recently, Harvard researchers added to the body of evidence by demonstrating that there is a positive association between nursing excellence and physicians' performance.In order to review the findings of the Harvard Business Review data, it's important to first have a look at one of the more intensive and rigorous nursing-excellence initiatives, the Magnet Recognition Program. This is a programdeveloped by theAmerican Nurses Credentialing Center (ANCC), which is a subsidiary of the American Nurses' Association. The study conducted at Harvard focused only on a group of hospitals which have achieved "Magnet" designation.
Background of the Magnet Recognition Program
In 1983, there was a study conducted by the American Academy of Nursing task force which evaluated which factors contributed to the shortage of nurses in a specific region and evaluated ways to improve the nursing care model. Out of this study grew the Magnet Recognition Program, which was developed by the task force who identified 14 shared similarities among the hospitals that were considered "high-performing". Later, these characteristics were organized into a five-component "magnet model" framework for nursing research and practice. This framework is used as a type of roadmap for organizations who wish to achieve Magnet recognition. The five characteristics are:
- Transformational leadership that creates a vision for the future and the systems and environment for achieving it
- Structural empowerment — the policies and programs that support staff as they pursue organizational goals
- Exemplary professional practice
- Innovation
- "Empirical quality results” categorized in terms of clinical outcomes related to nursing, and workforce, patient, and organizational outcomes
To this day, the Magnet Recognition Program evaluates hospitals' performance according to each of these five areas and will only give the Magnet status to the elite tier of hospitals who work hard to achieve it. Currently, only 10 percent of the hospitals in the United States have earned this designation.
Acute Nursing Care Models Re-imagined
Innovative ideas are being used to improve the patient experience. In order to achieve such a profound impact on the delivery of healthcare, nurses and physicians need to achieve optimal performance to promote better outcomes.Relatively few hospitals achieve Magnet recognition because it typically requires a substantial investment in order to achieve it. On average, it takes a hospital somewhere between three to five years to meet the parameters needed to attain the designation. This costs the hospital an average of $500,000 annually, which comes out to an investment of approximately $2 million. While these initial costs are incredibly hefty for even top-performing healthcare systems and hospitals, the investments have shown to pay off within a few years because of the lowered personnel costs and improved patient outcomes.
Outcomes Demonstrate Correlation Between Excellent Nursing Care and Physician Performance
The Harvard study looked directly at the association between superior nursing care (as indicated by the hospital's Magnet status), the patient's satisfaction with nursing performance evaluation comments, the overall hospital scores on the national Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey, and the evaluation of the hospital within the Press Ganey's database of more than 2,000 healthcare organizations.HCAHPS is a standardized survey that collects feedback from patients on many different aspects of their care, includingnursing performance evaluation comments, hospital environment perception, food quality, and how responsive the staff is with them, including how well the nurses and doctors communicate with patients (Are they respectful? Do they offer good explanations? Do they take time and listen to concerns? Etc.)In addition to specific questions about the care received, the patients are also asked to give an overall rating to the hospital. These ratings are referred to as "top box" score - or the percentage of patients who scored the hospital superior in a specific measure. According to the Harvard Business Review:
"We found that Magnet hospitals outperformed the non-magnet hospitals on patients’ 'likelihood to recommend' top box scores (75.7 compared to 70.8) and we saw a similar spread on the 'overall rating score' (76.0 vs. 72.8). We also saw a smaller but significant difference on patient assessment of physician concern about the patient’s questions or worries, which gauges courtesy and respect, listening, and explaining."
Magnet Status Associated with Higher Patient Ratings of Physician's Skill in Another Survey
A meaningful associated was also made between the Magnet status and the patients' ratings of physicians in terms of their skills, responsiveness to concerns, time spent with the patient, courtesy, friendliness, and other measures according to results from the Press Ganey’s proprietary survey.On average, the Magnet facilities fell into a range from 84.6 percent for“time physician spent with you” to 93.2 for “skill of the physician” - conversely - the non-Magnet facilities ranged from 83.6 to 92.1 for the exact same questions. While the differences may seem to be subtle - they are, in fact, significant. Even a slight difference in the points of the overall score can have a dramatic effect on the percentile rank because there is a tight compression of the national scores. To put this into perspective, an increase of only a couple of points on a mean score (from perhaps 86 to 88), can mean the difference between a hospital being in the 50th percentile versus the 75th.Furthermore, the Harvard data analysis revealed that out of the 123 Press Ganey client hospitals in the United States, 45 percent of those in the top quartile for physician engagement were designated Magnets, while only 16 percent in the bottom quartile were Magnet designated facilities.
Excellence in Nursing Care Models Does Not Require Magnet Designation
Even though the Magnet designation is indicative of a hospital's commitment to excellence, it does not mean a hospital or healthcare organization needs this status to achieve excellence in nursing care models. Culture of acute nursing care as an outline of Magnet has an emphasis on autonomy, quality, leadership, and relationship - but these core values should expand beyond the nursing staff and into the climate of care provided throughout the organization.This type of devotion requires a commitment to transformational change in order to drive workforce engagement, safety, clinical excellence, and positive patient experiences.
