A decade ago, the management team at Middlesex Hospital launched a bold experiment designed to turn the traditional hospital structure on its head in pursuit of improved patient and employee satisfaction levels.
Today, the 297-bed Middletown hospital is reaping the rewards:
• An unprecedented third “Magnet” recognition from the American Nurses Credentialing Center;
• Improved employee retention and an enviable position as a place where newly graduated nurses want to begin their careers;
• And patient satisfaction feedback that tells management the long journey has been worthwhile.
Middlesex Hospital President and CEO Robert Kiely said from a business perspective, everything is about satisfying the customer and delivering a great product.
“I think the fundamental premise is, if a hospital is not about quality and patient satisfaction, what should it be about?” he said.
That led Kiely and his team to examine a shared governance model, professional practice standards and ultimately to the Magnet Recognition Program, which set out a path that promised the results Middlesex wanted through empowering nurses.
Under the Magnet umbrella, Middlesex Hospital set out to increase nurse satisfaction; strengthen interdisciplinary relationships between nurses and other staff, and create innovations in professional nursing practice.
“Our decision to begin the Magnet journey is a reflection of our desire to have the highest quality and patient satisfaction. By embracing what (the Magnet Recognition Program) puts forward, you’re committing to a level of nursing practice that is the best possible nursing care available.”
Now more than a decade down the Magnet path, Middlesex remains a pioneer. It is one of just two of the state’s 31 hospitals to ever receive the Magnet designation. Nationally, 15 of the top 21 medical centers in U.S. News & World Report’s 2009 ranking of “America’s Best Hospitals” were Magnet facilities. While more than 300 hospitals have now earned the recognition, there are more than 4,000 other hospitals which have not.
“The Magnet Recognition Program is all about using standards to create a professional practice climate of excellence in nursing,” said Colleen Smith, the hospital’s vice president of nursing. “While it is about nursing, it’s a designation that is conferred on the entire organization because it’s well recognized that without the support of the Board of Directors, the CEO and all the departments that support patient care, it wouldn’t be possible.”
Smith said the hospital has worked to increase nurse satisfaction by allowing them more opportunities to see their own ideas and suggestions put into practice at the hospital. The hospital’s shared governance model uses participative management, where decisions that are about the practice of nursing are made by clinical nurses practicing at the bedside.
Middlesex Hospital’s shared governance model includes committees consisting of staff nurses in every area of practice and on every nursing unit in the facility.
Kristin Andrews, R.N., a Middlesex Hospital employee for nearly four years, serves on both the wound and skin and emergency management committees at the hospital. Andrews said the increased role of staff nurses in management decisions helps boost morale.
“We’re the ones living with the decisions, so we’re the ones helping to make the decisions,” Andrews said. “It affects our day to day roles, and provides better care for the patients. I think happier nurses make happier caregivers.”
Lindsey Gustafson, R.N., a staff nurse at Middlesex for almost three years, agreed. “Our nursing staff is valued and respected, which in turn provides confidence in giving the best patient care that we can,” Gustafson said.
Middlesex is working to strengthen interdisciplinary relationships among staff by creating a work environment that allows staff nurses easy access to everyone from physicians to upper level hospital management. Managers maintain an open-door policy, and staff nurses report feeling welcome to approach management with ideas or concerns.
“When I round with the CEO and the COO, we regularly visit the patients and certainly employees,” Smith said. “Family members, patients and staff are pleased that we’re taking the time to come up to their units and connect with them. They have no problem at all telling us what might be a barrier to good care.”
The Magnet Recognition Program turns the typical hierarchical system of a hospital on its head, so to speak, according to Judith Kunisch, co-interim director of the Yale School of Nursing and consultant to healthcare providers and insurers. She compares a hospital’s staff structure to that of the military.
“Staff nurses are sort of like the privates doing the work, and privates generally don’t get to talk to four-star generals,” she said. “The Magnet program says, we have to listen to the people in the trenches — it’s all about patient care and best practices. The Magnet designation shows they have their priorities in the right place.”
Middlesex Hospital has created professional nursing practice innovations by forming its own professional nursing practice model, to incorporate input from staff nurses. While many hospitals adopt a professional nursing practice model based on research or another established model, Middlesex created its own.
Through the use of focus groups, nurses were questioned about their own ideas to improve patient care. “It’s specific to Middlesex Hospital, and it empowers our nurses,” said Gustafson. “It was originated by our hospital and more importantly, the nurses giving direct patient care.”
“This is kind of the gold standard,” Kiely said. “I would expect over time there would be more and more hospitals that would say this is a very worthy endeavor.”
The distinction is not going unnoticed among nurses — those just out of college and those who have been working at the hospital for some time. According to Smith, the hospital’s turnover rate is lower than the national benchmark. The average tenure of the hospital’s R.N.s is 11 years, and job vacancy rates tend to be very low.
New grads are also finding the hospital a coveted place to work. Kiely said recently graduated student nurses have said they see a different, better climate of nursing practice at Middlesex than the other hospitals they’ve worked in. The hospital’s 13 nurse residency positions have already been filled.
Kunisch said the triple Magnet designation for Middlesex is impressive. “It’s a long-term strategy for an organization,” she said. “They’re saying, ‘We need to commit the resources and our strategic direction to it’.”
Kunisch cites the recent Robert Wood Johnson Foundation’s initiative focusing on the critical role nurses play in patient care. “When people are hospitalized, they’re there for the nursing,” Kunisch said. “The people at the bedside need to feel empowered.”
While the Magnet Recognition Program specifically addresses nursing quality, Kiely said it was really a hospital-wide initiative that resonated with everyone, from nurses to physicians and from housekeeping staff to security.
“I was personally pleased when we received the initial designation to receive the across-the-board enthusiasm and excitement,’’ she said, “and I think people took a step back and smiled and said we did this as a team.”
