Does a hospital's "nurse magnet" recognition matter for patient outcomes?

New findings from University of Michigan researchers in the June Health Affairs confirm enhanced outcomes for patients before and after recognition—to a point

Ann Arbor, MI – Around the nation, hospitals work to gain or keep “nurse magnet” recognition as part of their strategy to attract patients and high-quality nurses, and to do well in rankings. Now a new national study looks at how the recognition, designed as a standard of excellence for nursing, affects the care patients receive. 

“We wanted to see if the Magnet program successfully identified high-performing hospitals, and it does—yet we also found that Magnet hospitals did not improve after they were recognized,” says lead author Christopher R. Friese, PhD, RN, an assistant professor at the University of MichiganSchool of Nursing and member of U-M’s Comprehensive Cancer Center, Center for Health Outcomes and Policy andInstitute for Healthcare Policy and Innovation. The findings appear in the June issue of Health Affairs.

“Understandably, patients are confused about where they should receive their health care,” Friese notes. “Every hospital has a billboard or sign touting them as ranked highly by one organization or another.”

The Magnet Recognition Program was established in 1994 by the American Nurses Credentialing Center as means of recognition for health care organizations with high-quality patient care, nursing excellence, and innovations in professional nursing practice. The process to achieve Magnet recognition includes rigorous documentation and site visits with specific emphases on transformational leadership, staff empowerment, an established nursing practice model, support for knowledge generation and application, and quality-improvement mechanisms. Putting these processes in place can take many years before the hospital starts its actual application for Magnet recognition, which itself is a multi-year process. Magnet recognition is part of the U.S. News and World Report hospital rankings.

Funded by the National Institute of Nursing Research (NINR), Friese and colleagues used national Medicare data to study over 1.9 million surgical patients during a 13-year period. The anonymous records came from nearly 1,000 hospitals across the United States. Friese and colleagues compared outcomes in Magnet hospitals with outcomes achieved by hospitals that were matched on similar characteristics, like size and geography. The results also accounted for the underlying severity of the patients’ conditions.

The findings show that surgical patients treated in Magnet hospitals were 7.7 percent less likely to die within 30 days of their operation, and 8.6 percent less likely to die after a post-operative complication, compared with patients in non-Magnet hospitals. However, patient outcomes did not improve for the threRead the complete article.e years after they received Magnet recognition. This suggests that while the Magnet program does recognize established excellence, it does not correlate with continued improvements in outcomes. 

The work supports previous findings of overall quality in Magnet hospitals because they have “improved organizational hierarchy, nurse empowerment, measure and benchmark quality indicators and have a more satisfied nursing staff,” the authors write.

“A second motivation for the research was from the hospital executive perspective,” says Friese. “If a hospital leader wants to improve patient outcomes, how should they pursue these activities? Magnet hospitals were better to begin with and did not improve after they were recognized. We still need to investigate how high-performing hospitals achieve the results we observe. We need to get 'under the hood' of excellent hospitals and share those lessons with others.”

Hospital performance is becoming an increasingly important area of research as health care reform continues. Dr. Friese points to the rapid shift in changes from a traditional fee-for-service system to pay-for-performance as one incentive for hospitals to improve outcomes.

Friese and co-authors Amir A. Ghaferi, MD, MS, of the Medical School’s Department of Surgery and Mousumi Banerjee, PhD, of the School of Public Health’s Department of Biostatistics, are already at work as part of a U-M team researching why high and low-performing hospitals achieve the results they do. “We hope these lessons will prove useful to hospital leaders as they prioritize steps to improve care in their facilities,” says Friese.

Manuscript Information

Reference: Health Affairs, June 2015 vol. 34 no. 6986-992, doi: 10.1377/hlthaff.2014.0793 

• Christopher R. Friese, PhD, RN, AOCN, FAAN, School of Nursing, University of Michigan; Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation, University of Michigan
• Rong Xia, MS, Department of Biostatistics, School of Public Health, University of Michigan
• Amir A. Ghaferi, MD, MS, Department of Surgery, University of Michigan Medical School and Ross School of Business; Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation, University of Michigan
• John D. Birkmeyer, MD, Dartmouth-Hitchcock Medical Center
• Mousumi Banerjee, PhD, Department of Biostatistics, School of Public Health, University of Michigan; Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation, University of Michigan