1
Magnet Recognition Program
Clinical Excellence in Action
Overview
• Explain importance of a strong, supportive Professional
Practice Model (PPM)
• State role of Magnet Recognition...
Description of Magnet ®
• Promotes quality in a milieu that supports
professional practice
• Identifies excellence in the ...
Magnet Recognition
• Magnet Recognition is the highest recognition
the American Nurses Credentialing Center
grants to heal...
The
Journey
MagnetMagnet
QualityofLeadership
OrganizationalStructure
ManagementStyle
PersonnelPolicies&Procedures
Professi...
Magnet Designated Facility Information
Update for January 2013
• The Commission on Magnet Recognition Program currently re...
Benefits of Magnet Designation
For patients…
• Multiple studies have shown that patient outcomes are more
favorable in Mag...
A New Model for
ANCC’s Magnet Recognition Program ®
Empirical
Outcomes
Structural
Empowerment
Transformational
Leadership
...
© American Nurses Credentialing Center
Theoretical Underpinning
Donabedian, 1966; 1990
Transformational Leadership
• Organizations can no longer just try to solve
problems, fix broken systems, and empower staf...
Transformational Leadership:
In the Evidence...
• Alignment of Partners, MGH, Patient Care
Services and Nursing’s strategi...
Transformational Leadership:
In the Evidence...
• Example of how Chief Nurse leads organizational-
wide change, e.g., desi...
Transformational Leadership:
In the Evidence...
• How nurse leaders use input from direct care nurses
to improve the work ...
Structural Empowerment
• Solid structures and processes developed by leadership
provide an environment where strong profes...
Structural Empowerment:
In the Evidence…
• Structure and processes that support nurse involvement
in organizational decisi...
Structural Empowerment:
In the Evidence…
• Affiliations with schools of nursing, consortiums or
community outreach program...
Structural Empowerment:
In the Evidence…
• Recognition of Nursing
•Publications (Nursing at 200), featured in MGH
publicat...
Exemplary Professional Practice
• This component entails a comprehensive understanding of
the role of nursing; the applica...
Professional Practice Model
• Provides a comprehensive view of the components of
professional practice and the contributio...
Massachusetts General Hospital
Professional Practice Model
© MGH Patient Care Services 1996, 2006, 2012
Massachusetts General Hospital
Patient Care Delivery Model
© MGH Patient Care Services 1996, 2006, 2012
Interdisciplinary,...
Exemplary Professional Practice
In the Evidence…
• Evaluation of Professional Practice Environment
•Internal: Staff Percep...
Exemplary Professional Practice
In the Evidence…
• Interdisciplinary collaboration across multiple settings
to ensure the ...
Exemplary Professional Practice
In the Evidence…
• Organizational structures and processes that are in place to
identify a...
New Knowledge, Innovation
& Improvements
• This is the nursing research component of Magnet.
• Healthcare organizations, w...
New Knowledge, Innovation
& Improvements
In the Evidence…
• Consistent involvement of nursing in Institutional
Review Boar...
New Knowledge, Innovation
& Improvements
In the Evidence…
•Structures and processes to:
•Evaluate nursing care
•Translate ...
Empirical Quality Results
The question the ANCC poses to organizations seeking
Magnet status is not “What do you do?” or “...
Quality: Indicator Definitions
• Nursing-sensitive indicator
“Measures and indicators that reflect the
impact of nursing c...
What We Measure
• Pressure Ulcers
• Falls
• Physical Restraints
• Pediatric Peripheral Infiltrations
• Central Line Blood ...
Falls:Trends
HAPU:Trends
Restraints: Trends
CLABSI: Trends
• HCAHPS is an acronym for “Hospital Consumer
Assessment of Healthcare Providers & Systems”
• Random sampling of adult inp...
• ED and Pediatrics: specialized surveys administered by QDM
• Radiation Oncology and Infusion center: Press Ganey
• Outpa...
Nurse Listening – Indicator Results
During this hospital stay how often did nurses listen
carefully to you?
Adult Inpatien...
Nurse Explaining– Indicator Results
During this hospital stay, how often did nurses explain
things in a way you could unde...
Nurse Courtesy and Respect
During this hospital stay, how often did nurses treat you
with courtesy and respect?
Adult Inpa...
Response to Pain– Indicator Results
During this hospital stay, how often did the hospital staff do
everything they could t...
Nurse Satisfaction Surveys
• Staff Perceptions of Professional Practice Environment Survey
– Measures: autonomy, control o...
SPPPE 2011: Population Size
by Department
Department Population Surveys Overall Response
Size Completed
Rate
_____________...
43
PCS Mean Scores on 8 Professional
Practice Environment
Characteristics
C h a r a c t e r is t ic
2008
Mean
Scores
N = 1...
44
2011 SPPPE: Overall Work Satisfaction
2008 2010 2011
N** Satisfied* N**
Satisfied
*
N**
Satisfied
*
Total Patient Care
...
NDNQI Nurse Survey –
Nursing Participation in Hospital Affairs
Best Practices: Transformative Leadership, Collaborative Go...
Massachusetts General Hospital - June 2012 Survey
Nurse Satisfaction - Practice Environment Scale of the Nursing Work Inde...
NDNQI Nurse Survey – Nurse Manager
Ability, Leadership, and Support of Nurses
Best Practices: Safety Reporting system; Lea...
NDNQI Nurse Survey –
Staffing and Resource AdequacyMassachusetts General Hospital - June 2012 Survey
Nurse Satisfaction - ...
NDNQI Nurse Survey –
Collegial Nurse-Physician Relations
Massachusetts General Hospital - June 2012 Survey
Nurse Satisfact...
 April 2010 – October 2012 Evidence collection and writing
 October 1, 2012 Submitted evidence to ANCC
 October 1, 2012...
Purpose of Site Visit
• A site visit occurs if the scores for the
sources of evidence fall within a range of
excellence.
•...
Site Visit – March 4-7, 2013
Appraisal Team
• Mary G. Nash, PhD, FAAN, FACHE - Team Leader
Chief Nursing Officer and Assoc...
Staff and Public Notices:
Before 1/23/13
Staff Notices:
- All-user message
- Mailing to MGH employees not on e-mail
- Have...
Site Visit – Agenda
• Visits to patient care settings (units, clinics, health centers)
• Numerous meetings with MGH Staff ...
Champions
• Staff nurse representatives from each practice area
along with all members of the Hospital community
• Role:
...
Communications & Education Plan
Each week, 1 topic is covered by the 5 strategies below,
and repeated as time allows
• Mag...
Magnet Portal Page
http://www.mghpcs.org/magnet
Characteristics of Magnet Hospitals Include:
• Concern for patients and families is our #1 priority
• Nurses identify the ...
Discount! Discount! Discount!
• We are happy to announce our services at
discounted rates during this nursing week.
• The ...
011-25464531, 011-41425180, 011-66217387
+91-9818308353,+91-9818569476
othermotherindia@gmail.com
www.other-mother.in
http...
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  • In 1993, the American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association, introduced a new Magnet Hospital certification process modeled after the 1980s study.
    The program is based upon quality indicators and standards of nursing practice as defined in the American Nurses Association’s Scope & Standards for Nurse Administrators.
    The Magnet designation process involves submission of written evidence addressing each of the Forces of Magnetism and an on-site review by Magnet appraisers.
  • Approximately 4.45% of all health care organizations in the US have achieved Magnet designation by the ANCC.
  • Patients, nurses and the entire hospital community benefit from Magnet designation. Some of the most visible examples are… (review points highlighted for each group).
  • (Source: Executive Summary)
    1-4 LIKERT SCALE…MEAN SCORES
  • (Source: Executive Summary)
  • This timeline highlights key activities that have been completed to date as well as planning and preparation that will take place in the beginning of 2008.
  • Nursing week

    1. 1. 1 Magnet Recognition Program Clinical Excellence in Action
    2. 2. Overview • Explain importance of a strong, supportive Professional Practice Model (PPM) • State role of Magnet Recognition Program as “evaluation” of PPM • Describe the five Magnet Model components • Share examples of evidence to illustrate Magnet Model components • Outline components of Magnet Site Visit
    3. 3. Description of Magnet ® • Promotes quality in a milieu that supports professional practice • 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 • Demonstrates criteria-based evidence of a professional practice environment © American Nurses Credentialing Center
    4. 4. Magnet Recognition • Magnet Recognition is the highest recognition the American Nurses Credentialing Center grants to healthcare organizations for excellence in nursing practice. • It is a hospital award.
    5. 5. The Journey MagnetMagnet QualityofLeadership OrganizationalStructure ManagementStyle PersonnelPolicies&Procedures ProfessionalModelsof Care QualityofCare QualityImprovement Consultation& Resources Autono my Community&the Hospital Nursesas Teachers Imageof Nursing Interdisciplinary Relationships Professional Development Grounded in Research
    6. 6. Magnet Designated Facility Information Update for January 2013 • The Commission on Magnet Recognition Program currently recognizes 395 healthcare organizations, as well as three in Australia, one in Singapore and one in Lebanon for their excellence in nursing service. • Massachusetts General Hospital received Magnet designation in 2003 by the ANCC, the first in Massachusetts; Redesignated in 2008.
    7. 7. Benefits of Magnet Designation For patients… • Multiple studies have shown that patient outcomes are more favorable in Magnet hospitals. They experience fewer complications, lower mortality rates & higher patient satisfaction scores. For nurses… • Professional nurses consider Magnet designation as the Gold Standard when looking for a practice environment where autonomy, control over practice & professional development are emphasized. For the hospital… • Magnet signifies high quality care to consumers. Many Magnet hospitals advertise through media, newspaper announcements, billboards, radio & TV commercials. The improved attraction & retention of nurses results in significant cost savings. Of note, 8 of the top ten hospitals ranked by US News & World Report are Magnet Hospitals.
    8. 8. A New Model for ANCC’s Magnet Recognition Program ® Empirical Outcomes Structural Empowerment Transformational Leadership Exemplary Professional Practice New Knowledge Innovations & Improvement © American Nurses Credentialing Center
    9. 9. © American Nurses Credentialing Center Theoretical Underpinning Donabedian, 1966; 1990
    10. 10. Transformational Leadership • Organizations can no longer just try to solve problems, fix broken systems, and empower staff – they must actually transform the organization to meet the future. • This requires vision, influence, clinical knowledge, and strong expertise relating to professional nursing practice. “It is relatively easy to lead people where they want to go; the transformational leader must lead people where they need to meet the demands of the future.” - ANCC
    11. 11. Transformational Leadership: In the Evidence... • Alignment of Partners, MGH, Patient Care Services and Nursing’s strategic and quality plans • How nurses at every level advocate for resources to support goals, e.g., new units (Bigelow 7 Short Stay, Blake 12 ICU); additional staff (Lunder 9 Oncology, MGH North Shore Surgical Center); and equipment (Dolphin mats to prevent pressure ulcers or Biopatch dressing to prevent central line infections) • Patient Care Services’ Strategic Plan: key focus on patient experience, efficiency and effectiveness of care and ensuring staff have a strong voice in care delivery
    12. 12. Transformational Leadership: In the Evidence... • Example of how Chief Nurse leads organizational- wide change, e.g., design and implementation of Innovation Unit • How nurses lead during planned and unplanned change •Planned: Innovation Units, Lunder Building •Unplanned: Pediatric ICU evacuation • How leaders value, encourage, recognize/reward and implement innovation: clinical recognition program, awards, Innovation Units
    13. 13. Transformational Leadership: In the Evidence... • How nurse leaders use input from direct care nurses to improve the work environment and patient care Examples include: Staff Perceptions of the Professional Practice Environment Survey, PLEN Survey (educational learning needs assessment), Collaborative Governance Committees and Ambulatory Practice Committee •Additional examples in the evidence included: •Newborn Family Quiet Time •Family presence during resuscitation in CICU •lntracranial Neuroendovascular care redesign
    14. 14. Structural Empowerment • Solid structures and processes developed by leadership provide an environment where strong professional practice flourishes. • It is an organization where the mission, vision and values come to life to achieve the outcomes important for the organization. • Strong relationships and partnerships are developed with all kinds of community organizations to improve patient outcomes. • This is accomplished through the organization’s strategic plan, structure, systems, policies and programs.
    15. 15. Structural Empowerment: In the Evidence… • Structure and processes that support nurse involvement in organizational decision-making, e.g., Collaborative Governance, Innovation Unit Attending Nurse role, interdisciplinary post-op care processes team, Lunder Building planning teams •Structure and processes that support nurse involvement in professional organizations and pursuit of formal education, continuing education and certification, e.g., tuition reimbursement, scholarships, flexible scheduling, paid time off, certification exam reimbursement, on-site certification exam preparation programs, Norman Knight Nursing Center, HealthStream on-line learning programs and simulation programs
    16. 16. Structural Empowerment: In the Evidence… • Affiliations with schools of nursing, consortiums or community outreach programs, e.g., Institute for Patient Care, Dedicated Education Unit, Clinical Leadership Collaborative for Diversity in Nursing, ED and ICU Consortiums, MGH Center for Community Health, MGH/James P. Timilty Middle School Partnership, Bicentennial Scholars, International Twinning Programs (Huashan Hospital in Shanghai, King Edward VII Memorial Hospital in Bermuda) •Community partnership to address healthcare needs, e.g., MGH Center for Community Health Improvement, Student Health Center at Chelsea High School, Boys and Girls & Boys Club of Boston, Charlestown Substance Abuse Coalition, Revere CARES
    17. 17. Structural Empowerment: In the Evidence… • Recognition of Nursing •Publications (Nursing at 200), featured in MGH publications (Hotline, Caring, MGH Magazine) •Nurse Recognition Week •Leadership positions in professional organizations (MARN, New England Regional Black Nurses Association) •Grant funding (Ethics Residency and AgeWISE) •Hosted national conference regarding professional practice
    18. 18. Exemplary Professional Practice • This component entails a comprehensive understanding of the role of nursing; the application of that role with patients, families, communities and the interdisciplinary team; and the application of new knowledge and evidence. • The goal is more than the establishment of strong professional practice; it is what that professional practice can achieve. • Nurses are accountable for safe, ethical, evidence- based care.
    19. 19. Professional Practice Model • Provides a comprehensive view of the components of professional practice and the contributions of all disciplines engaged in patient care. The model reflects an organizational commitment to teamwork in an effort to facilitate optimal patient care. MGH Patient Care Services • Creates a practice setting that best supports professional nursing practice and allows nurses to practice to their full potential. American Association of Colleges of Nursing, 2010
    20. 20. Massachusetts General Hospital Professional Practice Model © MGH Patient Care Services 1996, 2006, 2012
    21. 21. Massachusetts General Hospital Patient Care Delivery Model © MGH Patient Care Services 1996, 2006, 2012 Interdisciplinary, patient- and family-focused care A philosophy of relationship-based care guides our practice, emphasizing basic tenets of the caregiver’s relationship with: • Self (self-awareness) • Team/Colleagues • Patient and Family • Environment of Care
    22. 22. Exemplary Professional Practice In the Evidence… • Evaluation of Professional Practice Environment •Internal: Staff Perceptions Survey •External: Magnet Recognition •Promotion of patient and family involvement in plan of care •Engagement of internal and external consultants to improve care in practice setting, e.g., Visiting Scholars, Clinical Nurse Specialists •How staff participate in scheduling and staffing processes •How nursing plays leadership role in interdisciplinary collaboration
    23. 23. Exemplary Professional Practice In the Evidence… • Interdisciplinary collaboration across multiple settings to ensure the continuum of care, e.g, case management, access nurse coordinators, clinical nursing supervisors, interdisciplinary rounds • Annual performance appraisals include: self-evaluation, peer evaluation, manager evaluation and goal-setting •Use of ANA Code of Ethics for Nurses to address complex ethical issues •How nurses use resources to meet unique and individual needs of patients and families, e.g., consults, nurse orders, Blum Patient and Family Learning Center
    24. 24. Exemplary Professional Practice In the Evidence… • Organizational structures and processes that are in place to identify and manage problems related to incompetent, unsafe or unprofessional conduct, e.g., Compliance Hotline, safety reporting system, MGH Workplace Violence initiative, MGH Credo and Boundary Statement •Organization's workplace advocacy initiatives for caregiver stress, diversity, staff rights and confidentiality, e.g., Benson- Henry Institute for Mind Body Medicine, Employee Assistance Program, Office of Patient Advocacy, Policies on Staff Rights, Privacy Office, Diversity Steering Committee •Structures and Processes to promote staff safety, e.g, Be Well, Work Well Program, Occupational Health, Quality Initiatives, Infection Control
    25. 25. New Knowledge, Innovation & Improvements • This is the nursing research component of Magnet. • Healthcare organizations, which earn the Magnet designation, must show they are open to, and even developing new models of care, applying existing evidence, building new evidence, and making visible contributions to the science of nursing.
    26. 26. New Knowledge, Innovation & Improvements In the Evidence… • Consistent involvement of nursing in Institutional Review Board •Structure and processes to develop, expand and/or advance nursing research, e.g., Yvonne L. Munn Center for Nursing Research, Research and Evidence Based Practice Committee, Munn awards, Post-doctoral Fellowships, Nursing Research EXPO
    27. 27. New Knowledge, Innovation & Improvements In the Evidence… •Structures and processes to: •Evaluate nursing care •Translate new knowledge into nursing practice •Participate in Innovation •Involvement in evaluation and allocation of technology and information systems to support practice •Participation in architecture and space design to support practice
    28. 28. Empirical Quality Results The question the ANCC poses to organizations seeking Magnet status is not “What do you do?” or “How do you do it?” but rather a focus on “What difference have you made?” A shift from structure and process to outcomes. • Healthcare organizations are expected to become pioneers of the future and to demonstrate solutions to numerous problems inherent in the health care systems today. • Outcomes need to be categorized in terms of clinical outcomes related to nursing; workforce outcomes; patient outcomes; and organizational outcomes. Key indicators that paint a picture of the organization.
    29. 29. Quality: Indicator Definitions • Nursing-sensitive indicator “Measures and indicators that reflect the impact of nursing care on outcomes.” (ANA 2004) • Clinically-relevant indicator Indicators for specialty areas and ambulatory nursing practices that may not have a national benchmark but are clinically relevant
    30. 30. What We Measure • Pressure Ulcers • Falls • Physical Restraints • Pediatric Peripheral Infiltrations • Central Line Blood Stream Infections • Catheter-Associated Urinary Tract Infections • Ventilator-Associated Pneumonia • Time in Therapeutic Range • Completion of INRs in 28 days • Administration of Prophylactic Antibiotics before Surgical Incision • Universal Protocol • Administration of Prophylactic Antibiotic before Cardiovascular Electronic Device Implementation • DVT Prophylaxis +/- 24 hours before Surgery • Administration of Prophylactic Antibiotics before Cesarean Section • Administration of Appropriate DVT Prophylaxis before Cesarean Section • Human Papillomavirus Vaccine • Influenza Vaccine with Asthma • Diabetes Self Management • Informed Consent • Completion of RN Machine Safety Check Prior to Initiation of Dialysis • Pre-operative Fall Risk Assessment • Successful First Attempts at Peripheral Intravenous Insertions • Occlusion Rates in ICC Lines • Proportion of Infants in 22 to 29 Weeks Gestation Treated with Surfactant within 2 hours of birth • Proportion of Infants in 22 to 29 Weeks Gestation Screened for Retinopathy of Prematurity (ROP) • Managing Post-operative Care Correct Tray Set-up Protocol • Vascular Access Time-Out • Door to IV rt-PA in 60 Minutes • Door to CT Scan (median time) • Acute Myocardial Infarction (AMI): Primary PCI within 90 minutes of Arrival
    31. 31. Falls:Trends
    32. 32. HAPU:Trends
    33. 33. Restraints: Trends
    34. 34. CLABSI: Trends
    35. 35. • HCAHPS is an acronym for “Hospital Consumer Assessment of Healthcare Providers & Systems” • Random sampling of adult inpatient discharges • Excludes psychiatry, rehabilitation, and pediatric discharges • Separate survey is done for inpatient pediatrics • MGH administers through vendor (QDM) by phone Patient Satisfaction: HCAHPS Survey Basics
    36. 36. • ED and Pediatrics: specialized surveys administered by QDM • Radiation Oncology and Infusion center: Press Ganey • Outpatient: CG-CAHPS “Clinician and Group Consumer Assessment of Healthcare Providers & Systems” Survey • currently voluntary but CMS moving towards making it publicly reported • MGH is exploring ways of incorporating nursing specific questions into this survey. • All of these surveys measure patients’ perceptions of “how often” they felt they received high quality clinical and customer service Other Patient Experience Surveys
    37. 37. Nurse Listening – Indicator Results During this hospital stay how often did nurses listen carefully to you? Adult Inpatient HCAHPS Item Level Top-Box Scores Nurses Listen vs. QDM 50th Percentile 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Quarter Top-Box% Nurses Listen 76.5% 75.6% 76.3% 74.9% 77.6% 77.2% 76.7% 77.9% QDM 50th %ile 74.3% 74.3% 74.3% 74.3% 74.3% 74.3% 74.3% 74.3% Oct - Dec 2010 Jan - Mar 2011 Apr-Jun 2011 Jul - Sep 2011 Oct - Dec 2011 Jan - Mar 2012 Apr - Jun 2012 Jul - Sep 2012
    38. 38. Nurse Explaining– Indicator Results During this hospital stay, how often did nurses explain things in a way you could understand? Adult Inpatient HCAHPS Item Level Top-Box Scores Nurses Explain vs. QDM 50th Percentile 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Quarter Top-Box% Nurses Explain 72.3% 74.1% 76.4% 75.0% 77.2% 77.8% 76.2% 77.4% QDM 50th %ile 71.6% 71.6% 71.6% 71.6% 71.6% 71.6% 71.6% 71.6% Oct - Dec 2010 Jan - Mar 2011 Apr-Jun 2011 Jul - Sep 2011 Oct - Dec 2011 Jan - Mar 2012 Apr - Jun 2012 Jul - Sep 2012
    39. 39. Nurse Courtesy and Respect During this hospital stay, how often did nurses treat you with courtesy and respect? Adult Inpatient HCAHPS Item Level Top-Box Scores Nurses Respect vs. QDM 50th Percentile 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Quarter Top-Box% Nurses Respect 87.2% 86.7% 85.6% 86.2% 87.1% 87.0% 87.2% 89.0% QDM 50th %ile 84.7% 84.7% 84.7% 84.7% 84.7% 84.7% 84.7% 84.7% Oct - Dec 2010 Jan - Mar 2011 Apr-Jun 2011 Jul - Sep 2011 Oct - Dec 2011 Jan - Mar 2012 Apr - Jun 2012 Jul - Sep 2012
    40. 40. Response to Pain– Indicator Results During this hospital stay, how often did the hospital staff do everything they could to help you with your pain? Adult Inpatient HCAHPS Item Level Top-Box Scores Help with Pain vs. QDM 50th Percentile 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Quarter Top-Box% Help with Pain 78.5% 78.2% 77.1% 78.6% 78.5% 79.9% 79.1% 79.3% QDM 50th %ile 77.2% 77.2% 77.2% 77.2% 77.2% 77.2% 77.2% 77.2% Oct - Dec 2010 Jan - Mar 2011 Apr-Jun 2011 Jul - Sep 2011 Oct - Dec 2011 Jan - Mar 2012 Apr - Jun 2012 Jul - Sep 2012
    41. 41. Nurse Satisfaction Surveys • Staff Perceptions of Professional Practice Environment Survey – Measures: autonomy, control over practice, clinician- physician relationships, communication, teamwork, conflict management, internal work motivation, cultural sensitivity • NDNQI Nurse Survey with Practice Environment Scale Subscales) – Nurse Participation in Hospital Affairs – Nursing Foundations for Quality of Care – Nurse Manager Ability, Leadership, and Support of Nurses – Staffing and Resource Adequacy – Collegial Nurse-Physician Relations
    42. 42. SPPPE 2011: Population Size by Department Department Population Surveys Overall Response Size Completed Rate _______________________________________________________________ Ambulatory Care 476 217 46% Chaplaincy 18 12 67% Child Health Specialists 10 7 70% Nursing 3052 1481 49% Occupational Therapy 35 22 63% Physical Therapy 128 70 55% Respiratory Therapy 84 44 52% Social Services 152 87 57% Speech/Lang. Pathology 33 17 52% TOTAL 3,988 1,957 49% 42
    43. 43. 43 PCS Mean Scores on 8 Professional Practice Environment Characteristics C h a r a c t e r is t ic 2008 Mean Scores N = 1,941 2010 Mean Scores N = 1,664 2011 Mean Scores N = 1,957 A u to n o m y /L e a d e r s h ip 3.0 3.0 2.8 C lin ic ia n /M D R e la tio n s h ip s 3.0 2.9 2.9 C o n tr o l O v e r P r a c tic e 2.9 2.9 3.0 C o m m u n ic a tio n 3.1 3.0 3.0 T e a m w o r k 2.9 2.8 2.9 C o n flic t M a n a g e m e n t 2.7 2.6 2.7 In te r n a l W o r k M o tiv a tio n 3.4 3.4 3.4 C u ltu r a l S e n s itiv it y 3.2 3.2 3.2
    44. 44. 44 2011 SPPPE: Overall Work Satisfaction 2008 2010 2011 N** Satisfied* N** Satisfied * N** Satisfied * Total Patient Care Services 1934 85% 1638 87% 1919 86% Ambulatory Care = = = = 214 85% Chaplaincy 13 92% 13 92% 12 67% Child Health Specialists = = = = 7 100% Nursing 1675 85% 1383 86% 1454 84 Occupational Therapy 26 100% 21 100% 22 86% Physical Therapy 83 96% 85 94% 70 93% Respiratory Therapy 58 95% 54 85% 44 93% Social Services 59 66% 59 66% 80 81% Speech/Language Pathology 20 100% 22 96% 16 94% * Includes satisfied and very satisfied; ** N changed due to missing data = not measured
    45. 45. NDNQI Nurse Survey – Nursing Participation in Hospital Affairs Best Practices: Transformative Leadership, Collaborative Governance Committees, Clinical Recognition Programs, Access to CNO, Input into selection process for hiring new staff at all levels, Care Redesign Teams Strategies for Improvement: Committee participation, Clinical Recognition Program Massachusetts General Hospital - June 2012 Survey Nurse Satisfaction - Practice Environment Scale of the Nursing Work Index (PES-NWI) NDNQI Database - Academic Medical Centers Benchmark 2.93 2.87 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 MeanScore MGH Mean NDNQI Academic Medical Center Mean MGH Mean 2.93 NDNQI Academic Medical Center Mean 2.87 Nursing Participation in Hospital Affairs
    46. 46. Massachusetts General Hospital - June 2012 Survey Nurse Satisfaction - Practice Environment Scale of the Nursing Work Index (PES-NWI) NDNQI Database - Academic Medical Centers Benchmark 3.12 3.09 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 MeanScore MGH Mean NDNQI Academic Medical Center Mean MGH Mean 3.12 NDNQI Academic Medical Center Mean 3.09 Nursing Foundations for Quality of Care NDNQI Nurse Survey – Nursing Foundations for Quality of Care Best Practices: Continuing Education; MGH Mission, Credo, Boundaries; Nursing Sensitive Indicators; Unit-based Clinical Nurse Specialists; Learning bundles; Culture of Safety Survey; Excellence Every Day Portal; Toolkits; ethics resources Strategies for Improvement: Monitoring of resources; sharing best practices
    47. 47. NDNQI Nurse Survey – Nurse Manager Ability, Leadership, and Support of Nurses Best Practices: Safety Reporting system; Leadership Participation in Professional Organizations and Professional Development; Awards and Recognition Programs; Excellence in Action; unit-based staff meetings; unit-based orientation programs Strategies for Improvement: Recognizing Opportunities for Improvement Massachusetts General Hospital - June 2012 Survey Nurse Satisfaction - Practice Environment Scale of the Nursing Work Index (PES-NWI) NDNQI Database - Academic Medical Centers Benchmark 3.00 2.97 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 MeanScore MGH Mean NDNQI Academic Medical Center Mean MGH Mean 3.00 NDNQI Academic Medical Center Mean 2.97 RN Manager Ability, Leadership, & Support of RNs
    48. 48. NDNQI Nurse Survey – Staffing and Resource AdequacyMassachusetts General Hospital - June 2012 Survey Nurse Satisfaction - Practice Environment Scale of the Nursing Work Index (PES-NWI) NDNQI Database - Academic Medical Centers Benchmark 2.92 2.79 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 MeanScore MGH Mean NDNQI Academic Medical Center Mean MGH Mean 2.92 NDNQI Academic Medical Center Mean 2.79 Staffing and Resource Adequacy Best Practices: Quadramed workload activity measurement system; Exempt status; self- scheduling; budget Strategies for Improvement: Leave of absence, capacity management
    49. 49. NDNQI Nurse Survey – Collegial Nurse-Physician Relations Massachusetts General Hospital - June 2012 Survey Nurse Satisfaction - Practice Environment Scale of the Nursing Work Index (PES-NWI) NDNQI Database - Academic Medical Centers Benchmark 3.09 3.07 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 MeanScore MGH Mean NDNQI Academic Medical Center Mean MGH Mean 3.09 NDNQI Academic Medical Center Mean 3.07 Collegial RN-MD Relations Best Practices: Conflict resolution courses; nurse practitioner expansion; interdisciplinary rounds; care redesign teams; attending nurse role; safety reports Strategies for Improvement: Monitoring impact of care redesign initiatives; care providers; roll-out of Attending Nurse role; addressing disruptive behavior
    50. 50.  April 2010 – October 2012 Evidence collection and writing  October 1, 2012 Submitted evidence to ANCC  October 1, 2012 – Prepare for site visit Site visit 2013  March 4-7, 2013 Site Visit  Approx. 2 months post site visit Magnet Commission Vote Magnet Re-designation Timeline
    51. 51. Purpose of Site Visit • A site visit occurs if the scores for the sources of evidence fall within a range of excellence. • The purpose of the site visit is to verify, clarify, and amplify the content of the written documentation and evaluate the organizational setting in which nursing is practiced.
    52. 52. Site Visit – March 4-7, 2013 Appraisal Team • Mary G. Nash, PhD, FAAN, FACHE - Team Leader Chief Nursing Officer and Associate Vice President for Health Sciences, Ohio State University Health System, Columbus, OH • Carol “Sue” Johnson, PhD, RN, NE-BC – Team Member Director, Nursing Clinical Excellence & Research, Parkview Health, Fort Wayne, IN • Linda C. Lewis, RN, MSA, NEA-BC, FACHE – Team Member Chief Nursing Officer and Vice President for Patient Care Services, Forsyth Medical Center, Winston-Salem, NC • Linda Lawson, MS, RN, NEA-BC – Team Member Chief Nursing Officer, Sierra Medical Center, El Paso, TX
    53. 53. Staff and Public Notices: Before 1/23/13 Staff Notices: - All-user message - Mailing to MGH employees not on e-mail - Have 24/7 access to Magnet evidence (Magnet Portal Page: http://www.mghpcs.org/magnet or in Nursing Supervisor Office on Bigelow 1406D, phone 617-726- 6718, pager 617-726-2000 #2-5101 Public Notices: - Hospital signage (English & Spanish) - Newspaper ads: Boston Metro, Beacon Hill Times, Charlestown Patriot, Revere Journal, Chelsea Record, Waltham News Tribune, Danvers Herald, El Mundo Boston Other: - MGH website - Caring Headlines, Fruit Street Physician, Hotline
    54. 54. Site Visit – Agenda • Visits to patient care settings (units, clinics, health centers) • Numerous meetings with MGH Staff Nurses • Breakfast and luncheon meetings (randomly-selected nurses) • Health Centers nurses • Nursing and Organizational meetings: • Hospital Senior Leadership plus representatives from MGH Board of Trustees • Nursing Executive Leadership • Nursing Directors • Physicians • Collaborative Governance committees (Ethics, Research/EBP, Informatics, all CG committees in aggregate) • Champions (e.g. Magnet, Pain, etc.) • Ancillary and Support Service Departments (Departments that support nursing care delivery) • Additional meetings: Interdisciplinary Committees, Community, Schools of Nursing, Human Resources, Nursing Education, Patient Satisfaction, Staff Satisfaction, Peer Review and Clinical Advancement) • Document review: performance evaluations for all levels of nurses, IRB minutes, staff and patient complaints, requested information about selected sources of evidence
    55. 55. Champions • Staff nurse representatives from each practice area along with all members of the Hospital community • Role: To influence To communicate To educate • Operationalized through Collaborative Governance structure and key linkages with off-site locations
    56. 56. Communications & Education Plan Each week, 1 topic is covered by the 5 strategies below, and repeated as time allows • Magnet Monday → electronic and web portal • Weekly Luncheon → content is covered “live” in Lunder 234 allowing for Q&A and other dialogue • Tool Box → material is provided to the ND/CNS/CG Champion to use (posted on portal page) • Leadership → materials are reviewed with the ND and CNS groups by a member of the subcommittee • Unit-Based → tool box contents are covered at the local level
    57. 57. Magnet Portal Page http://www.mghpcs.org/magnet
    58. 58. Characteristics of Magnet Hospitals Include: • Concern for patients and families is our #1 priority • Nurses identify the hospital as a supportive place to work • Nursing leadership is visible and accessible • Autonomous and empowered clinicians • Delivery of high quality nursing care as rated by patients and staff • Strong and collegial nurse-physician relationships, teamwork and communication • Delivery of interdisciplinary patient- and family- centered care
    59. 59. Discount! Discount! Discount! • We are happy to announce our services at discounted rates during this nursing week. • The offer valid till 21st may 2014.
    60. 60. 011-25464531, 011-41425180, 011-66217387 +91-9818308353,+91-9818569476 othermotherindia@gmail.com www.other-mother.in https://www.facebook.com/pages/Other-Mother-Nursing-Crusade/224235031114989?ref=hl http://www.linkedin.com/profile/view?id=326103341&trk=nav_responsive_tab_profile https://twitter.com/othermotherindi https://cparveen.wix.com/other-mother A WORLDWIDE MISSION Contact Us:- JOIN US
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