Thursday, June 18, 2015

What do Magnets draw?

Over three years ago, I wrote this piece on Magnet hospitals and took a lot of flak from people who said I was too harsh when I asserted that the Magnet organization was overstating things when it implied that Magnet hospitals had better clinical outcomes.  I noted:

Currently, there are 391 Magnet hospitals.  As I look through the list of those from my own state of Massachusetts, I don't see any that offer sufficient public, real-time data about clinical quality to prove the case of higher quality.  And given the dearth of transparency with regard to clinical outcomes nationwide, it is hard to believe that one could do so in any other state.

I did a Google search on the topic of "quality of care at Magnet hospitals" and found very little.  There was a 2010 thesis by Kelly Scott, a nursing student at the University of Kansas, entitled "Magnet Status: Implications for Quality of Patient Care," which said: 

In summary, this study did not find evidence to support the expectation that Magnet accreditation directly correlates to lower rates of hospital‐acquired infections. There was evidence to support existing research indicating that nursing workforce characteristics are better in Magnet hospitals. While Magnet accreditation remains the gold standard for nursing work environments, this status does not automatically lead to better patient outcomes.

So now look at this article by Jennifer Thew in HealthLeaders Media, which makes a similar point: 

A study in the June issue of Health Affairs supports the idea that the Magnet Recognition Program is, in fact, excellent at identifying excellence. But while researchers found the program to be an accurate tool in identifying high-performing hospitals, they also uncovered some surprising nuances about Magnet facilities' surgical outcomes—namely, Magnet recognition alone does not improve surgical patient outcomes.

"Many of us in the nursing community know that Magnet recognition confers a great deal of benefit to the staff nurses and the nursing leadership that are in those institutions," says Christopher R. Friese, PhD, RN, AOCN, FAAN, assistant professor at the University of Michigan School of Nursing in Ann Arbor.

But "there's been a question as to whether Magnet recognition was also associated with improved patient outcomes."

Friese says through the study, titled "Hospitals In 'Magnet' Program Show Better Patient Outcomes on Mortality Measures Compared to Non-'Magnet' Hospitals," he hoped to delve into how Magnet recognition was related to surgical patient outcomes.

For the published paper, he and his colleagues looked at 13 years-worth of national Medicare data for 1.9 million surgical patients hospitalized from 1998 to 2010 for coronary artery bypass graft surgery, colectomy, or lower extremity bypass. The anonymous data came from 1,000 hospitals across the country and the study was funded by the National Institute of Nursing Research.

According to the study findings, surgical patients treated in Magnet hospitals were "7.7% less likely to die within 30 days of their operation, and 8.6% less likely to die after a post-operative complication, compared with patients in non-Magnet hospitals."

"From the patient point of view, if I have to pick a place to go, I want to pick a Magnet," Friese says.

The Big But
"In this study… what we find is yes, Magnets are better," he says, "but Magnets were better to begin with. They were better many years before they were a Magnet and then during and after their Magnet recognition their [surgical] outcomes don't change."

In short, there is no doubt that Magnet status is good for many things, but let's not sell it as something it isn't.

"If the goal is to improve engagement, satisfaction, and staff retention, Magnet is a very well-established way to do that," Friese says. "If your motivation is, 'We have a problem with our patient outcomes [or] with our care delivery,' pursuing Magnet recognition… may not be the best use of your resources."


Brad F said...

I get your point.

However, if we take two baseball teams, both striving to become "magnet teams," and each has a team batting avg of 240. One works hard and picks their avg up to 275, and the other does not change. Is it not likelier the former will win more games, or even win a division or more?

Now granted, if you are a 275 team and you go magnet, and then hit 290, you still breathe rarefied air. However, in the examples above, there is something to say for picking your game up. Not causal, but whatever it takes to get that avg up will be pretty close. Just a hunch.


Anonymous said...

Ours touts it but they still leave patients high and dry if a surgeon makes a mistake.