Patients' experience with healthcare has become the focal point for quality improvement among hospitals and care providers. The Affordable Care Act incentivizes hospitals to improve patient satisfaction by paying a financial incentive to hospitals that achieve high ratings from patients.
A new study published in the prestigious scientific journal Health Services Research shows that Magnet hospitals nationally accredited for nursing excellence have higher patient ratings of care than other hospitals. The study led by Dr. Witkoski-Stimpfel at NYUCN and the University of Pennsylvania School of Nursing's Center for Health Outcomes and Policy Research suggests that hospitals seeking to improve patient satisfaction, and qualify for new financial incentives, would be well advised to consider investing in nursing excellence.
"One straightforward strategy to improve patients' experience, and thus improve the performance scores, involves registered nurses," says Amy Witkoski-Stimpfel, PhD, RN, assistant professor at the New York University College of Nursing (NYUCN). "Research has shown that patients' experience with hospital care is significantly related to whether or not hospitals are well-resourced with respect to nursing, as nurses are the ones providing the most direct patient care in hospitals."
For hospital management and policy makers, despite the evidence showing that patient outcomes are better in hospitals with good nurse work environments, it is not always clear how to translate this evidence into practice and to reform work environments. Dr. Witkoski-Stimpfel points to the Magnet recognition program as a method to implement improvements in nurse work environments.
"Magnet recognized hospitals have consistently been associated with superior patient outcomes, including lower patient mortality and higher nurse job satisfaction," she says. "And, with an estimated pool of over $1 billion for performance incentives in 2014 fiscal year alone and increases in subsequent years, there is good reason for hospital leaders to be motivated to improve their patients' experience."
The study evaluated the performance of 212 Magnet hospitals in comparison to that of 212 matched non-Magnet hospitals, by assessing their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Designed to evaluate patients' short-term hospital care experience, the HCAHPS survey constitutes thirty percent of a hospital's total performance score for reimbursement by the Centers for Medicare & Medicaid Services.
"Our study is one of the most comprehensive studies to date to demonstrate an association between Magnet recognition and patients' satisfaction with their hospital care using the HCAHPS survey," said Linda H Aiken, Director of Penn's Center for Health Outcomes and Policy Research. "Patients who received care in Magnet hospitals reported signi?cantly greater satisfaction with their care."
"The Magnet recognition process emphasizes innovation; evidence-based, patient-centered care; and a collaborative culture, making these likely contributors to the more favorable patient care experience demonstrated in our results," said co-investigator, Matthew D McHugh from Penn Nursing's Center for Health Outcomes and Policy Research. "For example, when nurses work in an environment that is well resourced and management is supportive of nurses, nurses are able to spend time assessing and educating patients and families, which may explain the better communication, pain control, and medication explanation scores that we observed."
The evidence suggests that nursing excellence is key to achieving good hospital ratings from patients, says Dr. Witkoski-Stimpfel.
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Joint Acknowledgment/Disclosure Statement: This research was supported by the National Institute of Nursing Research grant T32-NR-007104 (Aiken, PI) and the American Nurses Foundation Margretta Madden Styles Award in Credentialing Research (Witkoski Stimpfel, PI).
Researcher Affiliations: Amy Witkoski Stimpfel, PhD, RN1; Douglas M Sloane, PhD2; Matthew D. McHugh, PhD, JD, MPH, RN, CRNP, FAAN2, and Linda H. Aiken, PhD, FAAN, FRCN, RN2.
1. New York University College of Nursing
2. University of Pennsylvania School of Nursing
About New York University College of Nursing
NYU College of Nursing is a global leader in nursing education, research, and practice. It offers a Bachelor of Science in Nursing, a Master of Science and Post-Master's Certificate Programs, a Doctor of Philosophy in Research Theory and Development, and a Doctor of Nursing Practice degree. For more information, visit https://nursing.nyu.edu/
The Center for Health Outcomes and Policy Research (CHOPR) at the University of Pennsylvania School of Nursing is a leading research and research training enterprise focusing on the outcomes of health care and health workforce policy. With collaborators from around the world, Center researchers study health system reorganization and policy changes and aim to produce research evidence to improve health care quality. For more information, visit http://www.nursing.upenn.edu/chopr
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Health Services Research