Magnet facility credits communication for success

Designation result of sharing of best practices

Baptist Health System of Jacksonville, FL, has become one of only 13 health care systems nationwide to achieve recognition from the American Nurses Credentialing Center (ANCC) as a Magnet health care system, an international quality designation considered the "gold standard" for nursing and clinical care. According to researchers, Magnet facilities have lower mortality rates and higher patient satisfaction, and also outperform other facilities in recruiting and retaining nurses.

The application and appraisal process extended over a four-year period and included reviews of Baptist Medical Centers (Downtown, South, Beaches, and Nassau), Wolfson Children's Hospital, and Baptist Home Health Care.

Baptist Health leaders believe their unique communications strategies were a key to successfully implementing QI processes across the system. "Over and above our meeting their standards, [the appraisers'] comments focused on the engagement of the entire organization and the innovation around communication," says Diane Raines, RN, MSN, senior vice president and chief nursing officer.

"One of the things that makes this award unique is that we applied as a health system — so we had to have the same [quality] across all five hospitals, including home health," adds Kristin Vondrak, MSN, ARNP-BC, AOCN, CNA, system director of clinical quality and Magnet program coordinator. "We acculturated quality into the system and we were able to demonstrate that."

This approach is not something that was just developed for the Magnet process, adds Keith Stein, MD, FCCM, FCCP, senior vice president and chief medical officer. "It's not like we had to start from a blank slate; this honor recognizes a 50-year-plus history of our culture characterized by excellent communications and inter-disciplinary cooperation for which we have been recognized in other ways," he says.

Dashboards: A vital tool

In addition to the historic culture of quality, however, Baptist Health did introduce some important innovations during the four-year period. "Three years ago we called together a clinical quality and technology committee formed by representatives from each of the facilities," recalls John Wilbanks, FACHE, chief operating officer. "One of the first bits of work sanctioned and authorized by that committee was quality dashboards for each hospital, which we use as a method for evaluating parameters the committee deems significant." The committee recommended the most pertinent and valuable parameters, and reports to each hospital board on a quarterly basis.

"The dashboards look like Excel spread sheets presented in tabular form," explains Stein. "Color coding reflects how close we are to achieving targets or benchmarks."

Stein says that of a total of 800 parameters used by the system, two dozen of the more "overarching" parameters have been selected for board review. "Most recently we have talked about putting them on our internal portal for staff and physicians," he adds.

The dashboards are used on multiple levels, adds Vondrak. "In addition to system-wide reports that go to the board, they are also facility-specific and unit-specific," she explains.

Numerous vehicles developed

Through the Magnet process, Vondrak says, an internal infrastructure was developed, made up of several high-level committees — system and facilities, education, research, process improvement, community and family partnership, and clinical practice. "We developed a bi-directional approach to reporting — up to the executive level and down to the bedside," she says. "We communicate quickly and often, through our CNO Newsletter, [see excerpted sample, below] 'Care Connection,' 'Vital Signs,' the 'Baptist Health Blitz', and the 'Pharmacy Tablet' — many tools to communicate to many disciplines."

Critical Success Factor of Quality

As the dashboards are facility-specific, the process improvement council can readily learn the different hospitals' internal best practices and then share them with the rest of the system, adds Vondrak. "In the context of the PI council, we have issues in common across all facilities, so we benchmark internally and externally," she explains. "So, we move not only knowledge but processes around the system, by moving internal process experts to places that need their help."

"Within the five hospitals there will be someone who exhibits best practices, and they become our internal expert," adds Raines. "Their expertise can also be shared in writing, or put on-line. Or, they could become the faculty for the next education session."

This works on a team level as well, says Raines. "Take fast-track [units] in the ED," she says. "We have a team that perfected that approach, and this internal team moves around to help us refine the approach, measure the impact, and continue to improve."

Clinical Measures

"One of the key things is that the information is driven down," adds Vondrak. "Since all councils are interdisciplinary, they communicate to the ancillary departments as well."

Raines explains how specific QI initiatives unfold at Baptist Health. "One of our quality goals is the prevention of pressure ulcers," she shares. "So, we bring together our nursing leadership and conduct an extensive review of best practices (both internal and external) around that goal, and the tools needed to audit their own work units. So, each of them learns the best practices, takes that back and works with their staff. In addition to that, we have specific programs for staff members on the topic; they can go on-line and access information relative to best practices."

The leaders agree the Magnet process itself actually led to further innovation. "I think the Magnet process allowed us to make great strides, and sometimes forced us to have conversations about where we needed to go,"says Wilbanks.

"The connection here was that striving for Magnet designation as a system gave us a platform, and helped create the vehicles to improve communication," adds Raines.

[For more information, contact:

Keith Stein, MD, FCCM, FCCP, Senior Vice President and Chief Medical Officer; Kristin Vondrak, MSN, ARNP-BC, AOCN, CNA, System Director of Clinical Quality and Magnet Program Coordinator; John Wilbanks, FACHE, Chief Operating Officer. Baptist Health, 1325 San Marco Boulevard, Suite 601, Jacksonville, FL 32207. Phone: (904) 202.2294. Web site: www.e-baptisthealth.com.]