Tai Teresa Wai Chi, Bame Sherry I
Teresa Wai Chi Tai, PhD, associate professor, Department of Health Management and Organizational Leadership, School of Business, Quinnipiac University, Hamden, Connecticut, and Sherry I. Bame, PhD, BSN, professor, Urban Planning Program, Texas A&M University, College Station, Texas.
J Healthc Manag. 2017 Jan/Feb;62(1):62-76.
The Magnet Recognition Program for healthcare organizations promotes excellence in nursing services and professional practices. However, organizational and community characteristics that contribute to the adoption of Magnet status remain unexplained. Investigating organizational and community factors will help determine systematic structural and contextual dimensions of Magnet hospitals previously shown to be more cost-effective in comparison with non-Magnet hospitals. Using the baseline 2005 database of all Magnet hospitals in the United States, the authors selected a matched sample to determine key organizational and community characteristics associated with Magnet adoption while controlling for regional and local factors. Four tertiary databases were merged to identify measures of organizational and community characteristics of 132 Magnet hospitals and 264 non-Magnet pairs matched in closest proximity. The authors used bivariate tests and logistic regression to analyze the data. The findings show that Magnet adoption was positively associated with teaching affiliation, hospital size, nonprofit ownership, admission rates, and registered nurse (RN) staffing rates, but was negatively associated with licensed practical nurse (LPN) staffing rates. In the logit model, key organizational factors associated with the likelihood of Magnet adoption were larger hospitals, higher RN staffing rates, and lower LPN staffing rates. Key community factors were location in less densely populated counties and higher emergency department visit rates. The study findings reinforce previously established hypotheses that better RN staffing of Magnet hospitals is associated with higher cost-effectiveness. The study also adds key organizational and community factors that differentiate Magnet adoption. The Magnet concept as an innovative strategic choice assists healthcare leaders in better managing their resources to improve the cost-effectiveness of hospital care.
医疗机构的磁石认可计划促进护理服务和专业实践的卓越性。然而，促成磁石地位采用的组织和社区特征仍未得到解释。调查组织和社区因素将有助于确定磁石医院的系统结构和背景维度，此前已表明与非磁石医院相比，磁石医院更具成本效益。作者利用美国所有磁石医院的2005年基线数据库，选取了一个匹配样本，以确定与磁石采用相关的关键组织和社区特征，同时控制区域和地方因素。合并了四个三级数据库，以确定132家磁石医院和264对最接近匹配的非磁石医院的组织和社区特征指标。作者使用双变量检验和逻辑回归分析数据。研究结果表明，采用磁石地位与教学附属关系、医院规模、非营利性所有权、入院率和注册护士（RN）人员配备率呈正相关，但与执业护士（LPN）人员配备率呈负相关。在逻辑模型中，与采用磁石地位可能性相关的关键组织因素是较大的医院、较高的RN人员配备率和较低的LPN人员配备率。关键社区因素是位于人口密度较低的县以及较高的急诊科就诊率。研究结果强化了先前确立的假设，即磁石医院更好的RN人员配备与更高的成本效益相关。该研究还增加了区分磁石采用的关键组织和社区因素。磁石概念作为一种创新的战略选择，有助于医疗保健领导者更好地管理其资源，以提高医院护理的成本效益。
