Magnet Recognition Program Clinical Excellence in Action

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 Provide illustrations of Magnet Model components

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

Massachusetts General Hospital Professional Practice Model © MGH Patient Care Services 1996, 2006

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

Benefits of Magnet Recognition People  Increased RN retention and lower nurse burnout Decreased RN vacancy rate turnover rate Cost  Reduction in RN agency rates Reduction in staff needle stick rates Improved operating margin Improved bond rating Marketing ROI – publication in lieu of ads Service Increased patient satisfaction Quality  Decreased mortality rates Decreased pressure ulcers Decreased ALOS Decreased falls Patient Safety US News and World Report rating © American Nurses Credentialing Center 6

Grounded in Research Magnet Standards of Professional Performance The Journey Magnet Quality of Leadership Organizational Structure Management Style Personnel Policies & Procedures Professional Models of Care Quality of Care Quality Improvement Consultation & Resources Autonomy Community & the Hospital Nurses as Teachers Image of Nursing Interdisciplinary Relationships Professional Development Standards of Practice for Nurse Administrators Standards of Professional Performance for Nurse Administrators 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.

Theoretical Underpinning Structure Outcome Process Donabedian, 1966; 1990 © American Nurses Credentialing Center © 2008 American Nurses Credentialing Center. All Rights Reserved. 8

Structure + Process = Outcome Outcomes Plans Roles Resources Equipment Systems Supports Communication Development Recognition Discipline Education Relationships Productivity Satisfaction Accomplishments Contributions © American Nurses Credentialing Center

A New Model for ANCC’s Magnet Recognition Program ® Structural Empowerment Exemplary Professional Practice Transformational Leadership Empirical Outcomes New Knowledge Innovations & Improvement © American Nurses Credentialing Center

Transformational Leadership Leaders are: Visionary Inspiring Strategic Engaging Respectful Trusting Demonstrated by nurse leaders at all levels

Transformational Leadership: Rationale Need for dramatic change To transform, not reform Call for a new way of thinking Leading people where they need to be Transcending self-interests Sharing vision and sense of belonging Dealing with ambiguity

Transformational Leadership Examples: Excellence Every Day philosophy Quality and safety strategy to guide the outcome Adequate resources to support nursing practice Creating a culture of safety Clear strategic direction Nursing strategic plan and quality plan aligned with Hospital’s mission and strategic plan Fiscal support for nursing education, conference attendance, certification and research Award & Recognition Programs Robust communication structure (e-mail, website, newsletters) Advocate for support for innovative programs New Graduate Residency Program Innovation Units Short-stay unit Force 2 focuses on a organizational dynamics that supports proactive decision-making & responsiveness to change. Nurses are in decision-making roles throughout the organization. Key forums include: Patient Care Services Executive Committee (PCSEC) – comprised of the Directors of each of the PCS departments and the Associate Chief Nurses. Charges of the committee include evaluation & adoption of policies relating to patient care, education for nursing & health professions, and/or other matters affecting the optimal operation of PCS. Combined Leadership – provides an opportunity for nursing leadership & triad teams to discuss & review departmental and/or hospital-wide initiatives, policies & procedures that will be implemented on the patient care units. Unit-based staff meetings – provide an opportunity for the Nursing Director & staff to discuss issues that have a direct impact on the day-to-day operations of the unit. The Institute for Patient Care is the new interdisciplinary structure within Patient Care Services that provides a “think and do tank” for work to unite multiple organizational efforts designed to advance high quality, cost-effective, safe care. The Institute is comprised of the following Centers: The Norman Knight Center for Clinical & Professional Development, The Yvonne L. Munn Center for Nursing Research, The Blum Patient & Family Learning Center and The Center for Innovations in Care Delivery. The Collaborative Governance model is the core mechanism within the Professional Practice Model used to support nursing practice by bringing decision-making to the bedside. The seven committees are: Diversity, Ethics in Clinical Practice, Nursing Practice, Nursing Research, Patient Education, Quality & Staff Nurse Advisory. The unit-based leadership triad is comprised of the Nursing Director, Clinical Nurse Specialist and Operations Coordinator. Together, they oversee the clinical operations of the unit and supporting unit-based decision-making.

Structural Empowerment Transformational leaders create structures that ensure access to: Information Resources Support And opportunity to take advantage of them

Structure Empowerment: Rationale The mission, vision and values of the organization “come to life” in the structure. The structure needs to acknowledge, value, support, and develop strong professional practice.

Structural Empowerment Examples: Organizational structure (flat organizational chart) Interdisciplinary collaborative governance communication & decision-making structure Clinical Recognition Program – promotes advancement at the bedside Institute for Patient Care Norman Knight Center for Clinical & Professional Development Yvonne L. Munn Center for Nursing Research Eleanor & Maxwell Blum Patient & Family Learning Center Center for Innovations in Care Delivery Force 2 focuses on a organizational dynamics that supports proactive decision-making & responsiveness to change. Nurses are in decision-making roles throughout the organization. Key forums include: Patient Care Services Executive Committee (PCSEC) – comprised of the Directors of each of the PCS departments and the Associate Chief Nurses. Charges of the committee include evaluation & adoption of policies relating to patient care, education for nursing & health professions, and/or other matters affecting the optimal operation of PCS. Combined Leadership – provides an opportunity for nursing leadership & triad teams to discuss & review departmental and/or hospital-wide initiatives, policies & procedures that will be implemented on the patient care units. Unit-based staff meetings – provide an opportunity for the Nursing Director & staff to discuss issues that have a direct impact on the day-to-day operations of the unit. The Institute for Patient Care is the new interdisciplinary structure within Patient Care Services that provides a “think and do tank” for work to unite multiple organizational efforts designed to advance high quality, cost-effective, safe care. The Institute is comprised of the following Centers: The Norman Knight Center for Clinical & Professional Development, The Yvonne L. Munn Center for Nursing Research, The Blum Patient & Family Learning Center and The Center for Innovations in Care Delivery. The Collaborative Governance model is the core mechanism within the Professional Practice Model used to support nursing practice by bringing decision-making to the bedside. The seven committees are: Diversity, Ethics in Clinical Practice, Nursing Practice, Nursing Research, Patient Education, Quality & Staff Nurse Advisory. The unit-based leadership triad is comprised of the Nursing Director, Clinical Nurse Specialist and Operations Coordinator. Together, they oversee the clinical operations of the unit and supporting unit-based decision-making.

Exemplary Professional Practice • A professional practice model depicts a nursing philosophy and links it an organization’s mission. • The model frames and directs nursing practice according to legal and ethical professional standards. • Nurses are accountable for safe, ethical, evidence- based care.

Exemplary Professional Practice: Rationale Nursing practice in Magnet organizations actualizes ideals and believes of the profession. A professional practice model depicts a nursing philosophy and links it to the organization’s mission. The professional practice model frames and directs nursing practice according to legal and ethical professional standards. Nurses are accountable for safe, ethical and evidence-based care.

Exemplary Professional Practice Examples: Care Delivery Model: Interdisciplinary, Patient- and Family-Focused Relationship-Based Care Autonomous practice Provide educational programs and coaching to develop nurses’ critical independent thinking skills Nurses as teachers Nurses are preceptors, mentors, instructors (for nurses, students, patients, families and the community) Rounds: Safety Rounds Interdisciplinary rounds Force 2 focuses on a organizational dynamics that supports proactive decision-making & responsiveness to change. Nurses are in decision-making roles throughout the organization. Key forums include: Patient Care Services Executive Committee (PCSEC) – comprised of the Directors of each of the PCS departments and the Associate Chief Nurses. Charges of the committee include evaluation & adoption of policies relating to patient care, education for nursing & health professions, and/or other matters affecting the optimal operation of PCS. Combined Leadership – provides an opportunity for nursing leadership & triad teams to discuss & review departmental and/or hospital-wide initiatives, policies & procedures that will be implemented on the patient care units. Unit-based staff meetings – provide an opportunity for the Nursing Director & staff to discuss issues that have a direct impact on the day-to-day operations of the unit. The Institute for Patient Care is the new interdisciplinary structure within Patient Care Services that provides a “think and do tank” for work to unite multiple organizational efforts designed to advance high quality, cost-effective, safe care. The Institute is comprised of the following Centers: The Norman Knight Center for Clinical & Professional Development, The Yvonne L. Munn Center for Nursing Research, The Blum Patient & Family Learning Center and The Center for Innovations in Care Delivery. The Collaborative Governance model is the core mechanism within the Professional Practice Model used to support nursing practice by bringing decision-making to the bedside. The seven committees are: Diversity, Ethics in Clinical Practice, Nursing Practice, Nursing Research, Patient Education, Quality & Staff Nurse Advisory. The unit-based leadership triad is comprised of the Nursing Director, Clinical Nurse Specialist and Operations Coordinator. Together, they oversee the clinical operations of the unit and supporting unit-based decision-making.

New Knowledge, Innovation & Improvements • Establishing new ways to achieve new heights of quality, efficiency, and effectiveness. • Magnet organizations are in a key position to advance nursing science, learning, and discovery.

New Knowledge, Innovations and Improvement: Rationale As exemplary professionals, nurses are accountable for using and expanding nursing knowledge. Magnet nurses should be the pioneers of our future. Innovations in nursing care, care delivery, and the practice environment are the hallmark of Magnet organizations. Create new designs, models of care, evidence and standards.

New Knowledge, Innovation and Improvement Examples: Nurses actively participate in many initiatives that improve the quality of patient care (research, evidence-based practice (EBP) and process improvement). Munn research awards and fellowships EBP-driven practice, e.g. temporal thermometers Process improvement projected guided by Plan-Do-Check-Act (PDCA) framework Innovation in service delivery is a novel set of behaviors, routines, and ways working that are directed at improving health outcomes, administrative efficiency, cost effectiveness or users’ experience and that are implemented by planned and coordinated actions. (Greenhalgh, 2004). Innovation Units, e.g., Attending nurse role, patient- and family notebooks, enabling technology Force 2 focuses on a organizational dynamics that supports proactive decision-making & responsiveness to change. Nurses are in decision-making roles throughout the organization. Key forums include: Patient Care Services Executive Committee (PCSEC) – comprised of the Directors of each of the PCS departments and the Associate Chief Nurses. Charges of the committee include evaluation & adoption of policies relating to patient care, education for nursing & health professions, and/or other matters affecting the optimal operation of PCS. Combined Leadership – provides an opportunity for nursing leadership & triad teams to discuss & review departmental and/or hospital-wide initiatives, policies & procedures that will be implemented on the patient care units. Unit-based staff meetings – provide an opportunity for the Nursing Director & staff to discuss issues that have a direct impact on the day-to-day operations of the unit. The Institute for Patient Care is the new interdisciplinary structure within Patient Care Services that provides a “think and do tank” for work to unite multiple organizational efforts designed to advance high quality, cost-effective, safe care. The Institute is comprised of the following Centers: The Norman Knight Center for Clinical & Professional Development, The Yvonne L. Munn Center for Nursing Research, The Blum Patient & Family Learning Center and The Center for Innovations in Care Delivery. The Collaborative Governance model is the core mechanism within the Professional Practice Model used to support nursing practice by bringing decision-making to the bedside. The seven committees are: Diversity, Ethics in Clinical Practice, Nursing Practice, Nursing Research, Patient Education, Quality & Staff Nurse Advisory. The unit-based leadership triad is comprised of the Nursing Director, Clinical Nurse Specialist and Operations Coordinator. Together, they oversee the clinical operations of the unit and supporting unit-based decision-making.

Empirical Quality Results • Focus on “What difference have you made?” • Shift from structure and process to outcomes. • Key indicators that paint a picture of the organization.

Empirical Outcomes Examples: Regulatory Readiness Robust Quality and Safety Committee Structure Safety reporting system (root cause analysis) Measurement and tracking of nursing sensitive indicators: clinical quality indicators, patient satisfaction and staff satisfaction Staff safety programs (e.g. needle stick injuries, flu vaccines) Promotion of safety in environment of care (e.g., equipment, supplies, construction) Force 2 focuses on a organizational dynamics that supports proactive decision-making & responsiveness to change. Nurses are in decision-making roles throughout the organization. Key forums include: Patient Care Services Executive Committee (PCSEC) – comprised of the Directors of each of the PCS departments and the Associate Chief Nurses. Charges of the committee include evaluation & adoption of policies relating to patient care, education for nursing & health professions, and/or other matters affecting the optimal operation of PCS. Combined Leadership – provides an opportunity for nursing leadership & triad teams to discuss & review departmental and/or hospital-wide initiatives, policies & procedures that will be implemented on the patient care units. Unit-based staff meetings – provide an opportunity for the Nursing Director & staff to discuss issues that have a direct impact on the day-to-day operations of the unit. The Institute for Patient Care is the new interdisciplinary structure within Patient Care Services that provides a “think and do tank” for work to unite multiple organizational efforts designed to advance high quality, cost-effective, safe care. The Institute is comprised of the following Centers: The Norman Knight Center for Clinical & Professional Development, The Yvonne L. Munn Center for Nursing Research, The Blum Patient & Family Learning Center and The Center for Innovations in Care Delivery. The Collaborative Governance model is the core mechanism within the Professional Practice Model used to support nursing practice by bringing decision-making to the bedside. The seven committees are: Diversity, Ethics in Clinical Practice, Nursing Practice, Nursing Research, Patient Education, Quality & Staff Nurse Advisory. The unit-based leadership triad is comprised of the Nursing Director, Clinical Nurse Specialist and Operations Coordinator. Together, they oversee the clinical operations of the unit and supporting unit-based decision-making.

When you add it all together… So what happens when you put the concepts of transformational leadership, structural empowerment, exemplary professional practice, new knowledge, innovations and improvement, and empirical outcomes together? Here’s where I remind you that I promised you a one-sentence summary…..

A New Model for ANCC’s Magnet Recognition Program ® © American Nurses Credentialing Center

ANCC 5 Model Components & 14 Forces of Magnetism Model Elements Rationale Forces of Magnetism Transformational Leadership Pivotal driving factor which should spread over time. F1: Quality of Nursing Leadership F3: Management Style Structured Empowerment Initially critical for Magnet work to occur; should become hardwired over time. F2: Organizational Structure F4: Personnel Policies & Programs F10: Community F14: Professional Development F12: Image of Nursing Exemplary Professional Nursing Practice The key driver of Magnet outcomes. Should drive better outcomes over time as it becomes hardwired. F5: Models of Care F9: Autonomy F11: Nurses as Teachers F13: Interdisciplinary Relations F8: Resources & Consultation New Knowledge, Innovation & Improvement Drives the model; should become stronger over time. F7: Quality Improvement (research & EBP) Empirical Quality Results Use for dashboard; should improve over time. F6: Quality of Care

Champions Staff nurse representatives from each practice area along with all members of the Hospital community Role: To discover To communicate To motivate Operationalized through Collaborative Governance structure

Magnet Re-designation Timeline 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 TBD in 2013 Site Visit TBD Magnet Commission Vote 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.

Site Visit – Foci Numerous meetings with MGH Staff Nurses Visits to patient care units Meetings with department of nursing committees Organizational meetings: Hospital Senior Leadership plus representatives from MGH Board of Trustees Leadership of Quality & Safety Initiatives Physicians Nursing Directors and other nursing leaders Case Managers Support services Nursing Executive Operations Group Patient Care Services Executive Committee Additional groups: Patients, Families and Volunteers, Interdisciplinary Committees, Community and educational institution representatives, Critical Care Committee, and Human Resources) Document review

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 Conference → content is covered live in O’Keeffe allowing for Q&A and other dialogue Tool Box → material is provided to the ND/CNS/CG Champion to use 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

Topics 11/12 Introduction to Magnet Components of the model, why Magnet is important to MGH 11/19 Preparing for the Survey What to expect during survey, bios of the survey team, how to interact with them 11/26 Professional Practice Model and Patient Care Delivery Model Differentiate between the two; What Magnet is evaluating – detailed for leadership, general for staff 12/3 Outcomes 101 How do our interventions make a difference? How did we measure outcomes? Why is it important? 12/10 Nursing Sensitive Indicators Which are measured on their unit, which were used in the submission; RN and Patient Satisfaction; scenarios 12/17 Support of Staff to pursue formal education & certification 12/24 Professional Development Educational needs assessment and continuing education 12/31 Performance Evaluation Self-assessment, peer review, assessment of competencies > how you develop your goals 1/7 Differentiating between evidence-based practice, research, and process improvement 1/14 Internal/External resources to promote EBP research and ethical decision-making (unit-based CNSs with specific areas of expertise, visiting scholars) 1/21 through site visit Mock Surveys and recycle through information above

Critical Success Factors Interdisciplinary teamwork that supports patient- and family-centered care delivery model. Nurses are expected to practice with autonomy and control over practice. Collaborative clinician-physician relationships. Compliance with documentation standards. Voice in decisions regarding practice and quality of work-life. Integration of quality initiatives across the entire organization; strong empirical outcomes. Nurses and patients receive a high level of support from hospital and nursing administration.