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Nursing at Michigan

Nursing at Michigan. Institutional Assessment for Magnet Designation Margaret M. Calarco, PhD, RN Health System Clinical Quality Committee January 10, 2012. Sharon Smith, PhD, RN Leah Shever , PhD, RN Kathleen Moore, MBA Denise Kotsones , MSN, RN Benchmarking Partners:

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Nursing at Michigan

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  1. Nursing at Michigan Institutional Assessment for Magnet Designation Margaret M. Calarco, PhD, RN Health System Clinical Quality Committee January 10, 2012

  2. 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: Acknowledgements

  3. 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: Strategic Goals

  4. Magnet represents top 5% of country’s hospitals (391 hospitals are currently designated) Promotes quality in a milieu that supports professional practice and identifies excellence in the delivery of nursing services to patients and families Provides a mechanism for the dissemination of “best practices” in nursing services Reflects the presence of both organizational, as well as nursing, excellence Criteria is based on evidence of a professional practice environment Institutional Assessment for Magnet Designation: The Value of Magnet Criteria

  5. 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: The Value of Magnet Criteria

  6. 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: Potential “Benefits”

  7. 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 The overwhelming majority of hospitals (85.4%) reported a vacancy rate less than 7.5%. Sixty-one percent have a vacancy rate of less than 5% (National Healthcare & RN Retention Report, 2011) Institutional Assessment for Magnet Designation: UMHS Vacancy Rates

  8. UMHS Termination (Turnover) Rate FY 2012 Q1 - 2% Voluntary Termination = 1.9% Termination minus retirement = 1.6% FY 2012 Q2 -1.4% Voluntary Termination 1.3% Termination minus retirement = 1.1% FY 2011 - 6.9% Voluntary Termination 6.4% Termination minus retirement = 5.5% Institutional Assessment for Magnet Designation: UMHS Turnover rates

  9. National Turnover Rate 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) Magnet Hospitals Turnover rate – 11.4% vs non-Magnet Hospitals – 15 - 18% (UMHS – 6.9%) (Drenkard , et al., 2010) Institutional Assessment for Magnet Designation: UMHS Vacancy and Turnover rates

  10. 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”

  11. 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”

  12. 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”

  13. Quality  Decreased Falls (NDNQI, Dunton, et al, 2009) Patient Safety – improved communication (Hughes, Chang & Mark) (2009 American Nurses Credentialing Center) Institutional Assessment for Magnet Designation: Potential “Benefits”

  14. 19 Magnet hospitals were compared to 35 non-Magnet hospitals in the University Health System Consortium using the 2005 UHC operational and clinical database Total HPPD and RN mix were compared along with outcomes which included : 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)

  15. 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 Statistically better outcomes for postoperative sepsis, hospital-acquired infections, and postoperative metabolic derangement were demonstrated by non-Magnet hospitals The Impact of Magnet Status on Patient Outcomes (Goode, et. al. (2011) , JONA)

  16. 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 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 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)

  17. 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) Few studies compare Magnet and non-Magnet hospitals on patient outcomes and findings have been mixed The authors of this study while surprised by the results, in the end believe that this study adds to the evidence that “staffing matters” The Impact of Magnet Status on Patient Outcomes (Goode, et. al. (2011) , JONA)

  18. US News and World Report Rating Leapfrog Institutional Assessment for Magnet Designation: Potential “Benefits”

  19. US News and World Report Rating • Johns Hopkins • MGH • Mayo • Cleveland Clinic • UCLA • NY Presbyterian - No • UCSF - No • Brigham & Women’s - No • Duke • U. of Pennsylvania • Barnes Jewish • UPMC (Shadyside & St. Margaret) • U of Washington

  20. 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”

  21. US News and World Report Rating (Mott) The weighted points by specialty for magnet status are as follows: 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”

  22. 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 ) Institutional Assessment for Magnet Designation: Potential “Benefits”

  23. Implement critical components of a well-designed nursing workforce that mutually reinforce patient safeguards, including the following: 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. Senior administrative nursing leaders, such as a Chief Nursing Officer, as part of the hospital senior management team. 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. Provision of budgetary resources to support nursing staff in the ongoing acquisition and maintenance of professional knowledge and skills. Leapfrog Designation:NQF Safe Practice 9: Nursing Workforce

  24. 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 Magnet Designated Hospitals in Michigan

  25. 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 to Excellence

  26. Additional NDNQI participation 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

  27. Direct Magnet Expenses Magnet application fee and manuals– $4,200 Appraisal fee (based on bed size) – $57,850 Appraiser fees (4 day survey with 4 surveyors) - $29,600 Travel costs of appraisers (hotel + airfare) – $10,000 (estimated) Document review fees: Team leader and three reviewers – $8,500 Estimated Direct Magnet Expenses - $110, 150 The Magnet Journey: Requirements

  28. Three year journey - July 2012 – June 2015 Timing related to Nursing negotiations is required Magnet requirements have significantly shifted from process measures to outcome measures NDNQI and other nationally benchmarked comparisons are required in all categories Most indicators require submission of two years of data Unfair labor Practices (ULPs) need to be monitored and may impact evaluation and/or designation * Requires significant focus across entire organization The Magnet Journey: UMHS Overview

  29. Three year journey - July 2012 – June 2015 Must integrate the Magnet measures with the final Michart and centricity planned abstraction of the final list for meaningful use and other required data Must align any activities required for Magnet preparation with the work being done in our professional practice model development The Magnet Journey: UMHS Overview

  30. 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

  31. 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

  32. 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

  33. Ongoing annual expenses $568,944 Recertification required every four years Annual expenses plus full certification expenses The Magnet Journey: UMHS Estimated Expenses

  34. Comments & Questions

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