Best quality patient care: a historical perspective on Magnet hospitals

Abstract

Donabedian's Structure-Process-Outcome paradigm is used to analyze the evolution and research on the concept of magnetism through 4 phases. The identifying foci of the original 1983 study were 4 outcomes. A large number and array of structural features were derived from the identified Magnet hospitals. The quest for excellence in nursing care continued with the Gold Standard of Magnetism case studies utilizing all identified Magnet structures, processes, and outcomes. The advent of the American Nurses Credentialing Center Magnet Recognition Program stimulated much valuable and insightful research related to outcomes associated with the large group of magnetic structures. Magnet hospital staff nurses (SNs) identification of processes/functions most essential to quality patient care highlights the Process phase. Many of the vast array of structural features attributed to Magnet hospital in 1983 are outdated and differentially defined and have not been tested for their relationship to either processes or outcomes. Identification of magnetism from an SN perspective has lagged. Recommendations include updating and clarifying structural criteria; increasing focus on the SN perspective of magnetism by continuing identification of processes; and challenging leadership in Magnet hospitals to initiate multisite evidence-based practice initiatives to link structures with process-enabling outcomes. Now may well be the time for nursing to exert leadership in expanding the Magnet concept to the total patient-care operation in a hospital.