Monday, October 27, 2014

Magnetic forces

A blog post I wrote in 2012 about the quality assertions of the Magnet recognition program developed by the American Nurses Credentialing Center raised the hackles of some close friends and colleagues.  My point, back then, was this:

So, here's the question:  With all that it takes to receive Magnet® status, and with all the assertions by the ANCC about the superior nature of Magnetized institutions, what peer-reviewed data exist that support the assertion that such hospitals do in fact deliver higher quality patient care than the non-Magnetic hospitals?

What prompts me to raise the issue again is a double-full-page ad in the Sunday New York Times. The prominent quote:

Health care organizations that receive the prestigious accolade have proven that they excel at providing high-quality nursing. Magnet-recognized hospitals have improved patient outcomes and satisfaction and attract highly talent nurses, physicians and other health care providers. The designation is widely considered the gold standard of patient care.

Here's the underlying issue, concisely summarized back in 2012 by a commenter, Dr. James O'Brien:

In addition to the financial costs of completing the application and review process for this and other such awards, there is a tremendous opportunity cost. I have assisted some of the nursing committees who spend considerably time completing the application and review process. I wonder what the results might have been had this time been devoted to direct quality improvement. Additionally, if an institutions chooses to prioritize these applications and yet does not appear to provide the same resources and time to direct quality improvement, it sends a clear message to its employees about the true priorities of the organization.

Regarding the issues of the predominant association between such designations and outcome - this would be an easier inference to make if there was a transparent reporting of the data. Ultimately, the costs of these applications must be paid for by health care dollars - therefore, they should have some semblance of cost-effectiveness - with an assessment that includes the man-hour costs of the application and review process.

I almost hesitate to say so, but the kind of claims placed in the Magnet ad remind me of other New York Times ads, those promoting robotic surgery.  There, too, assertions about the relative benefit of that surgical approach have no documented support and appear to be designed mainly to serve as marketing vehicles for the hospitals mentioned.


nonlocal MD said...

One wonders why the Magnet people feel the need to advertise their program in a newspaper at all. Who is their desired audience and why?

Coupled with the recent revelation (to me, anyway) that the departing Partners Health Care CEO is making $2 million a year, it becomes very discouraging. As the cynics say, follow the money.

e-Patient Dave said...

And this is the same as the US News hospital rankings, right?

Anonymous said...

We failed to get Magnet designation in our hospital because they couldn't tolerate the nurse/doctor leadership teams that were pervasive in our organization. They were all about separate structure and hierarchy. We were all about patients and outcomes. They said no. We walked away and have never looked backed.

Somehow we have managed to struggle forward!

nonlocal MD said...

Anon 10:08, your comment is VERY illuminating. I have to be careful here, as when I had surgery years ago the nurse who came to give me my pain shot at 0300 was an angel in white.
However, I do think nurses often have a victim complex that leads to the sort of tunnel thinking that you describe. It would be very ironic if the larger power/voice which they seek is right there in front of them in the form of these egalitarian teams, only to be ignored because it doesn't fit their vision for themselves.

Disillusioned Nurse said...

As a nurse employed in the ICU of a tertiary care hospital in Asheville, NC, I can attest that the decade long investment in the pursuit of Magnet Status has resulted in the LOWER quality nursing care over this time. Finances that might have been used to provide adequate staff compensation have been diverted to pay for all that it takes to achieve Magnet Recognition. Employee wages are stagnant. PTO had been reduced, resulting in nurses and other staff working sick or without vacations. Employer Retirement Contributions have been reduced, causing increased stress and distraction amongst hospital staff. Employer provided health benefits are abysmal. Perhaps if resources were directed toward the nursing staff themselves, a healthy productive workforce would provide the very care they wish to claim to have. Then again, I have yet to see a hospital market “We treat our Nurses well”.

Of note, the hospital I work for has yet to obtain Magnet Status.