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From Magnet-Hospital to the Hospital of the Future


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In the United States the Magnet Recognition Program® is an established nursing-oriented organizational model. Accredited Magnet hospitals succeeded in attract and retention of qualified nurses. This demonstrated the future potential of this model. However, a direct transfer of the model to European conditions seemed to be limited. It raised the question concerning a European model that could give hints to organize the hospital of the future. This exploratory and descriptive study attempted to create a European framework in order to made recommendations for the hospital of the future. Following recommendations were made: 1. Designation of nursing as connecting health profession, 2. In-depth structural integration of nursing into the hospital organization, 3. Lived professionalism and quality. URL:
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Nursing and Health 1(4): 78-87, 2013
DOI: 10.13189/nh.2013.010403
From Magnet-Hospital to the Hospital of the Future
André Heitmann1,*, Rosana Svetić Čišić2, Iris Meyenburg-Altwarg1
1Medical School (MHH), Department of Nursing, Carl-Neuberg-Str.1, 30625 Hannover, Germany
2St Catherine specialist hospital, Bracak 8a, 49210 Zabok, Croatia
*Corresponding Author:
Copyright © 2013 Horizon Research Publishing All rights reserved.
Abstract In the United States the Magnet Recognition
Program® is an established nursing-oriented organizational
model. Accredited Magnet hospitals succeeded in attract and
retention of qualified nurses. This demonstrated the future
potential of this model. However, a direct transfer of the
model to European conditions seemed to be limited. It raised
the question concerning a European model that could give
hints to organize the hospital of the future. This exploratory
and descriptive study attempted to create a European
framework in order to made recommendations for the
hospital of the future. Following recommendations were
made: 1. Designation of nursing as connecting health
profession, 2. In-depth structural integration of nursing into
the hospital organization, 3. Lived professionalism and
Keywords Magnet Hospital, Exploratory Study,
European Framework, Hospital of the Future, Croatia,
1. Introduction
During essential changes in the US health care system in
the eighties of the last century [1] some hospitals mastered
this change despite the financial pressure through the
implementation of DRGs [1]. They were successful in
attracting and retaining nurses [2] despite the shifted focus
from a goal-driven concept in direction of a resource-driven
model [1], which affected the resource situation of the
hospitals. Since them the Magnet Model became an
exceptional framework to promote this change to build an
agile and dynamic nursing work force [3]. These
characteristics referred to the fact that the self-image and
image of the US nursing staff differed significantly from
those in Europe. A direct copy of the so-called concept of
success was therefore limited and reasonable. On this
background the Magnet model was the subject of this
explorative study. Questions aroused concerning the
transferability and adaptability of this Model which affected
the efforts of nurse managers to create a Hospital of the
future. This study tried to identify elements of this Model
which were set in relationship to US and European
To achieve this subject a Literature review and analysis of
empirical studies concerning Magnet hospitals were
conducted. In a further literature search the US context
conditions were identified and sketched to an US framework
model. The findings were interpreted with the
extra-organizational US context conditions and combined to
a conceptional framework. It was applied on two European
countries (Croatia, Germany) to create a basis for further
interpretations aiming to create a matched model. Data
concerning the exemplary (extra-organizational) European
health care systems were also collected via literature search
according the US framework. In a next step the results were
matched to form a European conceptional framework
“Characteristics Hospital of the Future”. This framework
was applied on the Hannover Medical School (MHH)
(Germany) and the St Catherine Hospital (Croatia) as
exploratory examples. In conclusion some recommendations
for nurse managers were given.
2. Methods
Following methods were used in this exploratory and
descriptive study: literature research and analysis of relevant
literature, interpretation of the findings and creation of
conceptional models.
1st Step: Literature search, analysis and clustered
categories: A literature search was conducted in several data
bases: PubMed-NCBI, MEDPILOT and Scopus. The search
strategy in PubMed and Scopus included the use of
following combinations of keywords corresponding to
specific search operators: “magnet hospitals” AND USA,
Nursing AND Magnet AND USA, retention AND strategies
AND hospitals AND USA, “Nursing magnet” AND USA,
“nursing staff retention” AND USA, “retentions strategies
hospitals” AND USA, magnet hospitals AND USA,
“retention nursing hospitals” AND USA, nursing AND staff
AND retention AND USA. In MEDPILOT a parallel
unspecific literature search was conducted (keywords:
“Magnetkrankenhaus”, “Magnet-hospitals. Empirical
studies (quantitative and qualitative studies) and
Nursing and Health 1(4): 78-87, 2013 79
retrospective studies as also systematic reviews were
included into the analysis: 12 relevant papers were able to be
used in the literature analysis. Clustered categories were
interpreted on the basis of the findings.
2nd Step: Literature analysis and interpretation with
clustered categories: A second literature search in PubMed,
Scopus, MEDPILOT and the university library of the
Hannover Medical School was conducted to describe
relevant issues of the US health care system. The search
strategy comprised the keywords “health care system
comparison” AND United States and “health care delivery”
AND United States, and “US Health Care” AND system.
The results were set in relationship to the clustered
categories of the first literature analysis. This step aimed to
create comprised characteristics of the US system as a base
for further interpretations.
3rd Step: Literature search and analysis on the base of the
US conceptional framework model: To adapt the US
conceptional framework a third literature search in PubMed,
Scopus, MEDPILOT and local resources was conducted.
The search strategy comprised the keywords “health care
system comparison” AND Croatia (resp. Germany) and
“health care delivery” AND Croatia (resp. Germany), and
“Croatia/ German Health Care” AND system. It aimed to
draw a sketched view on both European health care systems.
4th Step Creation of a matched model called “European
conceptional framework”: In this stepthe results were
matched into a conceptional framework regarding the
European context.
5th Step: In this step the European conceptional framework
was applied in an exploratory manner on two European
hospitals (St Catherine Hospital, Hannover Medical School).
The objective was to prove the applicability of the
framework aspects. Lead by this framework both
organizations were reviewed and set in an interpretative
relationship to the frameworks’ aspects.
6th Step: In this step recommendations concerning the
hospital of the future were formulated.
3. Results
a) Results of the First Literature Analysis
Following pre-categories were identified from the
analyzed literature (see table 1). These pre-categories gave
an impression about the implementation of the Magnetism in
American hospitals. They were compared with the ANCC
Magnet Recognition Program® Model. The results showed
the relativistic character of the Magnet concept:
Progressive structure-supported quality-oriented
financially-backed leadership style: The Magnet
concept had a meaning about leadership and
organization. A progressive leadership style was
strong connected with an organizational structure
committed to transformation. This included
outcome-orientation and an idea of quality, also
continuity on the management level and financial
Relative degree of autonomy and improved
working conditions: The Magnet concept aimed to
ensure structural empowerment framed by
progressive leadership and organized
transformational processes. A relative degree of
autonomy and relative improved working conditions
constituted an objective.
Quality comes first: Quality Improvement was a
very important model component. It needed the
existence of a so called “quality comes first”
Primary focus nursing: Professional practice in
Magnet hospitals was noticeable by a relative degree
of Nurses’ autonomy. The focus lied primary on the
Nursing profession.
Selective quality: The Magnet concept should
ensure overall high quality, but the implementation
resulted in higher quality in selective fields of
nursing practice compared to
Selection bias of Magnet studies: The studies
which examined Magnet and Non-Magnet hospitals
showed selection bias. No possible Magnet effects
on other professions were investigated.
Fragility of Magnet status: Studies results
indicated that the Magnet status was fragile:
Structural inconsistencies which affected working
conditions remained after Magnet recognition.
Tab le 1. Results of the literature analysis
Pre-categories Characteristics Reference
Pre-category I Facilitators
outcome-orientation, quality comes first, commitment of proactive leadership, structural
[4], [5]
Pre-category II Barriers personnel discontinuity in management, financial restrictions [4]
Pre-category III - Relative
visible organizational structures, self control, qualification levels
[6], [7], [8],
Pre-category IV - Working
relative differences with non-magnet hospitals, dependence of working conditions on
composition of qualification
[10], [11]
Pre-category V - Selective high
quality of health care
selective high quality in elements of nursing, intra-professional better communication and
cooperation, probably higher patient safety
[12], [13]
Category VI - Limitations to
Magnet Characteristics
selection bias on magnet studies, fragile state of magnet hospitals, structural differences
within magnet hospitals affect magnet outcomes, Organization produces outcomes
[14], [15]
80 From Magnet-Hospital to the Hospital of the Future
b) Results of the Second Literature Analysis
Following the literature analysis concerning the US
context some categories were able to set out the
extra-organizational conditions which affected hospitals:
variability of the health care system, possibilities for health
care providers, reform in health care systems.
Variability of the health care system [16], [17], [18]:
There was only a partial coherent public health care
system, which was primarily focused on special population
groups. The public influence on the design of supply and
financing of health care settings differed significant between
the states. There were also differences in the amount of pay
depended on the financiers (e.g. Health Maintenance
Organizations, Medicaid program). Employers acted partly
as self-insurer of their employees. Also insurances (e.g.
Health Maintenance Organizations) were a social benefit
from the employers.
Possibilities for health care providers [19], [20]:
The health care providers had many ways to create their
offer on the U.S. health care market. This included the
connection with the gatekeeper by purchasing general
practitioner practices or the provision of hospital equipment
for them in the hospitals’ owned health care centers. They
reduced costs by creation of new professional groups as
substitutes for established professions (e.g. license
Anesthesia Assistants vs. Anesthesia Nurses). In individual
segments there was a high attractiveness for students in
established professional groups.
Reform in health care system [20], [21]:
The shortcomings of the system were modified by the
reforms in context of "Obama Care." This included the
elimination of maladministration that a large number of the
US-citizens have no health insurance coverage. By the
reforms supply gaps should be filled, spending on
government programs should be reduced and the quality of
care should be improved. For the health care providers the
reforms caused a requirement for action.
c) Creation and Interpretation of a Conceptual
Framework USA
The used framework (see fig. 1) divided the conditions in
conditions outside the hospital organization (=
extra-organizational conditions) and within the organization
(= hospital). The extra-organizational conditions were the
categories identified in the second literature analysis.. In this
model they produced an innovative pressure, caused by the
variability of the health system. This VARIABILITY
initiated an increased need for reform(s) in order to cancel
problems caused by this VARIABILITY. The variability
was related to the allocation of monetary resources to the
hospitals. Especially against the background of different
accounting systems to allocate resources the VARIABILITY
triggered in this way the innovative pressure. Also
POSSIBILITIES which were affected by the condition
REFORM contributed the innovative pressure.
POSSIBILITIES existed for hospitals, e.g. in the
construction or expansion of hospital buildings or in buying
facilities downtown commercial areas. In the same direction
POSSIBILITIES potentially exacerbated the
VARIABILITY in this model.
The organization HOSPITAL had to make a respond on
this innovative pressure. A HOSPITAL could focus on the
nursing profession (i.e. mono-disciplinary focus) or it could
focus the entire organization (i.e. multidisciplinary focus).
The results of the literature review indicated that either little
difference between the magnet- and non-hospitals exist (see
[3], [10]) or accredited magnet hospitals had also internal
organizational differences that affected the magnet status. It
could therefore assume that there are existing different
manifestations of the response to the innovative pressure
with respect to the chosen focus. This fact was illustrated by
the reciprocal overlap of the two foci. Reciprocally because
structural changes in a department affected other
organizational structures. A reciprocal interface in this case
related to be a mixed response to the innovative pressure.
The reflection on the basis of the clustered categories and
the comparison with the Magnet Recognition Progra
Model illustrated the dependence on structural (legal, policy
and intra-organizational) aspects. With this viewpoint a
framework model was designed as an exploratory approach.
It visualized on the one side extra-organizational conditions
and on the other side the intra-organizational foci. The first
one comprised the terms “Variability”, “Possibilities” and
“Reform”; the last one was designed according the
components of the Magnet Recognition Program® Model.
This exploratory framework was used in further reflections
as an interpretation basis on the Croatian and German
framework conditions. The results of these interpretations
were part of the matching of the country-specific
d) Results of the Matching of the Conceptual Framework
US A on European Examples
Matching of extra-organizational conditions (see table 2)
The frameworks in both European countries showed a
distinctive consistency. This consistency was in straight
opposition to the variability of the US-Health care system.
Certainly the conditions in the European Union would also
lead to the impression of a great range of variability
concerning each health care system of the member states,
because of country specific driving forces [44]. But all
systems shared similarities like the universal or
near-universal coverage of health care costs e.g. for hospital
care [45]. For the European matching model we could
assume that the term “Consistency” visualized a very
important condition which influenced the nursing service in
hospitals. Seen through the lens of this framework all
hospitals including the nursing profession had to face the
same innovative pressure. This pressure emerged from the
“trinity” “Consistency, Reform and Possibilities”.
Consistency was the key element regarding the regulation of
resources on the basis of the health care insurance system. It
influenced the term “reform” which included the actions to
accommodate the “consistency” to the respective
Nursing and Health 1(4): 78-87, 2013 81
Figure 1. Conceptual Framework USA
Tab le 2. Matching of extra-organizational conditions
“Reform” became a common condition as a result of the
analysis of the circumstances of the three exemplary
countries. In opposition to the US reform which focused on
the elimination of the maladministration in form of an
expansion of the population coverage [46], Europe’s
direction focused on cost reduction, cost containment and
improvement of quality and efficiency. Hospitals in Europe
dealt with a need for investments in their provision of health
care services (quality + efficiency) and paradoxically to cut
their costs.
Concerning the condition “Possibilities” to match the
innovative pressure and focusing on European conditions
Hospitals had to invest in job opportunities due to the
shortage of Health professionals (especially nurses)
connected with the fulfillment of high professional standards
and the enhancement of clinic facilities. These actions
should be done instead of the above mentioned paradoxical
direction of the innovative pressure.
The dominance of the medical profession in Germany was
not part of the matched model because the independence of
82 From Magnet-Hospital to the Hospital of the Future
the medical profession as a requirement for this dominance
eroded gradually [36].
Matching of intra organizational conditions (see table 3)
Many sub segments of the intra-organizational conditions
which effects nursing were related to the Magnet model
concept. In the matched model “Mutual Respect” was a
component of the magnetic force “Management Style” and
the Model component “Transformational Leadership” which
was represented by the term “Nursing centered
Management”. This could be justified because mutual
respect should be set as an organizational norm to provide
structure and direction in patient care as also in
organizational functions [47]. The Magnet model component
“Structural Empowerment” was related via the magnetic
force “Personnel policies and programs” with efforts for
“Increasing the number of nurses”, the “Involvement in
organizational changes” and the “Provision of
work-home-balance”. These sub segments importance was
justifiable because some studies (although some limited on
the German context) gave hints: As an example the
introduction of the DRG in Germany possible worsened
adequate staffing and supportive management [48]. As well
Management should address the work-home interface which
influences leaving intentions [49]. Also the magnetic force
“Professional Development” was similarly to the sub
segment “Research and professional development”. In
conclusion the best term to summarize this sub segments was
“Nursing integrating structure” which included Personnel
Policies and Programs with emphasis on increasing the
Number of Nurses, competence development, research as
also significant involvement in organizational changes and
provision of Work-home Balance. Quality improvement as a
magnetic force was interpreted as a result of the other sub
segments which also characterized the European matched
model. But to take emphasize into the nursing focus it should
be noted as “Improvement of Quality in Nursing”. An
approach could be the enhancement of working conditions
which maintains the work force, able to ensure a high level of
quality [49]. The Magnet model component “Exemplary
Professional Practice” contained the magnetic force
“Professional Models of Care” which was related to the
(European) sub segment “Fulfillment of professional
standards and Quality of Care”. This point had for example
in Germany a great Importance corresponding to the
increased valuation of the evidence based nursing principle
through the jurisprudence [50]. Especially service provider
should integrate professional standards in their processes to
prevent liability cases [51]. Also the magnetic force
“Interdisciplinary Relationships” was related to “Mutual
respect”. Concerning “Mutual respect” a longstanding
emotion work should be addressed to enable nurses for
collaboration with other professionals [52], although of the
existence of a fragmented and transient collaboration in
practice [53]. In the matched model the term “Lived
professional practice” denoted both sub segments in the best
manner. The magnetic force “Quality of Care” respectively
the Magnet model component “Empirical Quality Results”
were also related with the “Fulfillment of professional
standards”. This relationship was justified because “lived”
professional standards ensured empirical quality results. In
consequence this aspect was integrated into the segment
“Lived Professional Standards”
Tab le 3. Matching of intra-organizational conditions
Nursing and Health 1(4): 78-87, 2013 83
e) European Conceptual Framework Characteristics
“Hospital of the Future”
At first this conceptional framework focused on
intra-organizational aspects. This approach could be
reasonable because extra-organizational conditions could not
be influenced by a single hospital. Regarding this aspect the
extra-organizational conditions were concluded into the
keyword of “Innovative Pressure” which visualized the
influence of these conditions without dominating the
framework: consistency (= all hospitals have
country-specific same starting positions), reform (=
rationalization as target) and possibilities (= requirement for
self-investment). These facts needed innovative measures to
cope it and to gave the nursing profession a responsible role
as a “Connecting Health Profession” including effective
self-competences. That was the reason why this framework
should be an integrative part of the Nursing management as
also on the general hospital management level. It gave an
impression concerning quality in nursing in the hospital of
the future derived from current understandings and
requirements. Nursing should be part of a holistic strategy
referring to the multi-professional character of hospitals.
They should emphasize improved nursing quality in the
context of a multi-professional institution. From our view
this approach was justified referring to the “interface
character” of nursing. Nursing should be considered as a
“connecting health profession” because Nurses act on a field
with many reciprocal interfaces (e.g. Nurses and Physicians
or Nurses and Physiotherapists). The accentuation of Quality
improvement in Nursing seemed to be a promising approach
to address the innovative pressure and to correspond with the
sub segments in relation to the magnetic forces. As a
consequence investments in Nursing could support to meet
other demands and pressures in the future.
This framework was constructed by these aspects: Nursing
centered management, nursing integrating structure, lived
professional standards and lived quality. Aspect 1 “Nursing
Centered Management” meant a culture of mutual respect
between the nursing management level and nurse
professionals at the bedside. Also it meant a culture of
mutual respect on the management level of the different
professions which affected the cooperation between health
professionals on the lower hierarchical levels [6], [7]. From
our view this was a very essential issue, because it gave nurse
managers a wide radius of action to establish and maintain
the following aspects of the conceptual framework. Another
essential reason was that institutional mutual respect support
high quality patient care [54]. From our view mission
statements indicated the scope and profoundness of mutual
Aspect 2 “Nursing Integrating Structure” meant a strong
institutional emphasis on efforts for increasing personnel
resources. In this direction professional competences should
be developed to gain benefits from a sound and empowered
staff. The provision of competences with a sound staffing
made it easier to conduct organizational changes in a
multi-professional expert organization [55]. As a possible
result e.g. business processes could be defined from a
bedside perspective. Another issue of this structure was a
main focus on staff retention the provision of
work-home-balance. It reflected the coming requirements
concerning the demographic change which could affect the
workforce structure [56], [57], [58].
Aspect 3 “Lived Professional Standards and Quality of
Care” could be defined as a commitment for fulfillment of
the own professional standards and quality of care. This
meant e.g. a stronger appreciation of the specific role
accountability as a nurse [59]. Also a professional model
could affect the patient safety more favorable than a
functional model [60]. The professional model was
characterized by managers who recognized nursing as a
profession exercised by skilled professionals [60]. A
functional model which regarded nursing as a broad resp.
unspecific set of tasks [60] should be removed by nurse
managers. In case of this aspect respectful interdisciplinary
relationships would be essential [44]. Also this aspect
focused on the operational level regarding working groups,
structures and proceedings.
Tab le 4. Efforts in direction of the Conceptional Framework Europe Characteristics “Hospital of the Future”
Medical School Hannover (MHH) St Caterine Hospital
Nursing Centered Management:
Mission Statements (= Mutual Respect)
Nursing Integrating Structure:
Re-entry and trainee programs (= Increasing Number of Nurses)
Advanced Professional Training/ Future Oriented Development
Program ZEP (= Development of Nursing Competencies)
Research Office (= Investment in Nursing Research)
Participation in Corporate Development Programs (= Significant
Involvement in Organizational Changes)
Service Agreements/ Reconciliation Family/Work (= Provision of
Nursing Integrating Structure:
Coping of Nursing Shortage (= Increasing Number of Nurses)
Education measures in a new established institution (=
Development of Nursing Competencies)
Publications on nursing management research (= Investment in
Nursing Research)
Planning and organization of equipment and services (=
Significant Involvement in Organizational Changes)
Lived Professional Standards and Quality of Care:
Commitment in Mission Statements/ Quality Management
System/ Working Group on Nursing Standards
Commitment in Mission Statements/ Certification ISO
84 From Magnet-Hospital to the Hospital of the Future
Figure 2. Conceptional Framework Europe Characteristics “Hospital of the Future”
f) Application of the European Conceptional Framework
Hannover Medial School (GER) Sveta Katarina
In this chapter the European conceptional framework was
applied in an exploratory manner. The objective was to prove
the applicability of the framework aspects. Lead by this
framework both organizations were reviewed and set in an
interpretative relationship to the frameworks’ aspects.
Regarding the MHH the application of the matched model
led so some suggestions about the congruence of institutional
efforts with the matched model: Concerning the sub-segment
“Mutual respect” this sub-segment was stated as a core value
of all nursing relevant mission statements. The “Nursing
Integrating Structure” comprised the sub-segment
“Increasing number of Nurses” which was embodied by the
re-entry and trainee programs. Especially the re-entry
program was an effort to increase nursing staff with a strong
reference to the gender topic, because it was targeted on the
empowerment of women to enhance their career chances.
Concerning the next sub-segment “Development of nursing
competence” the MHH applied a micro- and macro-level
approach. Possibilities for advanced professional training
focused on the point of care on the micro-level; the future
oriented development program (ZEP) faced the macro-level
to enable coming nurse managers. The sub-segment
“Investment in nursing research” was embodied by the
institution of a research office of the nursing department.
This indicated efforts to establish and maintain applied
nursing research activities. “Significant involvement in
organizational changes” was represented by the participation
of the nursing department in corporate development projects.
Referring the sub-segment “Provision of work-home balance”
the context of the MHH as a governmental institution was
evident, because efforts for reconciling family and work and
the service agreement were fostered by this institutional
status. The sub-segment “Fulfillment of professional
standards” in the segment “Lived Professional Standards and
Quality of Care” and “Mutual respect” were embodied by the
mission statements. It was also (focused on quality of care)
embodied by the certified quality management system and
the working group on nursing standards wherein nurses
combined evidence based knowledge with practice
requirements. This indicated that the fulfillment of
professional standards in the nursing department was a key
objective which was pursued by the management. All these
efforts indicated a growing consciousness about the
importance and responsibility of nursing in a maximum care
setting. This could reflect the future requirements concerning
hospitals to integrate nursing into a general management
The Croatian example showed that the establishment of a
new hospital enabled the nursing profession to make
significant contributions in direction of institutional
structuring and development. Compared with the MHH St
Catherine Hospital was a small hospital in a specific
therapeutic field. But it was interesting that this “small”
institution reflected many aspects of the theoretical
framework like the MHH as a “bigger” institution. In the first
segment “Nursing Centered Management” Mutual Respect
was also addressed in the mission statement. The “Nursing
Integrating Structure” comprised the sub-segments
“Increasing number of nurses” and the “Development of
nursing competences” as imperative conditions of a new
hospital within a countrywide shortage of skilled health
professionals. Noticeable were the efforts in the sub-segment
“Investment in nursing research”. Similar to the MHH the St
Nursing and Health 1(4): 78-87, 2013 85
Catherine Hospital invested in research activities which
resulted in two papers. From our view the involvement in
the institutional building as part of the establishment process
was strong connected with the “Significant involvement in
organizational changes”. The sub-segment “Provision of
Work-home-Balance” was not addressed. We found possible
reasons were in the situation of a newly established hospital
and in the employment law, which did reflect the shortage of
skilled health professionals. The segments “Lived
Professional Standards and Quality of Care” were also
addressed by the St Catherine Hospital in the same manner
like the MHH.
g).Recommendations for the Hospital of the Future
This exploratory study showed the meaning of structural
aspects which determined the efforts of nurse managers to
keep and attract nurses (in the sense of Magnet Hospitals) as
also the efforts to address a paradoxical systemic pressure on
From this view we could formulate three
recommendations which should be considered as key points
for the hospital of the future by nurse managers and the
hospitals’ executive committees:
Designation of nursing as connecting health
In-depth structural integration of nursing into the
hospital organization
Lived professionalism and quality
Designation of nursing as connecting health profession:
Nurses and their profession should be designated as
connectors in the multidisciplinary hospital setting. The term
connecting health profession implied that the focus should be
placed on the interfaces between other health professions.
Nurse Managers should advocate and promote mission
statements which take emphasis on mutual respect as a
pre-requisite to act in interface areas. This could create a
climate which attract and retain nurse employees. We think
that a lot of innovation impeding gaps could be filled with
the engagement by these interface professionals.
In-depth structural integration of nursing into the
hospital organization:
From our view in-depth structural integration was an
aspect which will gain more and more importance for the
nursing profession. This finding meant that in term of a
nursing integrating structure and with consideration of the
site-specific situation nurse managers should amplify
conditions for a sound staffing situation. This could include
measures which deal with the staffing shortage in the best
way. In either situation some points could be the
development of nursing competences (e.g. strengthening the
core and interface competences) and the investment in
research actions on practical issues (e.g. quality research).
Significant involvement in organizational changes should be
advocated by nursing managers but needed a broad
institutional commitment of each hospital’s executive
committee. Measures to provide a work-home balance
should be installed in accordance with the hospitals’
economic situation. As a possible consequence nurses could
act as active colleagues with their counterpart from other
Lived Professionalism and Quality:
To foster a nurse attracting and retaining hospital structure
a culture of lived professionalism and quality should be
promoted by nurse managers. The third segment of the
European framework (“Lived Professional Standards and
Quality of Care) addressed this issue: Standards were an
embodiment of professionalism. They based on developed
competences and results of research projects from an
integrated nursing profession. This also included the
reference on mutual respect, because it was not sufficient
that nurses believed in their own professionalism alone.
Nurse professionalism needed to be acknowledged by other
professions (e.g. physicians). Also the fulfillment of
standards indicated Quality of Care.
This exceeded the level of professional standards in
direction of a general thinking about quality in the hospital.
A concrete measure to promote both aspects could be the
generation of experience- and research-based nursing
databases. Other measures could be sharing and spreading of
professional knowledge (visualized by professional
standards) with other institutions.
4. Limitations
This study did not claim completeness on the topics
magnetism and future requirements for hospitals. As an
exploratory study it aimed to sketch and visualize possible
aspects with meaning for the future which should be
considered by nursing managers. Also the framework was
sketched in a comprised way. The application of the
framework could include some bias because the authors
explored their own institutions. As a consequence further
empirical research could be needed to fill this framework
with evidence for refinement of its’ theoretical approach.
From the authors view this framework should be a basis for
further discussions concerning the hospital of the future.
5. Discussion
Both examples show that nurse managers undertook
activities according the European framework for hospitals of
the future. In opposition to the Magnet Recognition
Program® Model as a nursing centered staff attracting and
retaining approach, this concept focused on the coping of the
external innovative pressure which needed a more integrated
nursing profession into the hospitals’ structures. As a
possible by-product the implementation of this framework
could attract and retain nurses because their meaning as
interface-experts resp. connectors in high-complex settings
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... The goal of this initiative is to define and build a healthcare facility equipped with modern technologies, using up-to-date standards to efficiently distribute and utilize hospital resources, ultimately providing cost effective and state-of-the-art healthcare to everyone. The HoF concept also includes home or remote healthcare facilities [6,7], allowing realtime monitoring of patients [8], remote control of robots 1 3 [9], implants or actuators, etc. Truly connected healthcare can only be achieved if every stakeholder of the HoF is connected to a communication highway where the hulk of information between patients, equipment and healthcare personnel is efficiently and timely delivered [10,11]. ...
Full-text available
In this conceptual paper, we discuss the concept of hospital of the future (HoF) and the requirements for its wireless connectivity. The HoF will be mostly wireless, connecting patients, healthcare professionals, sensors, computers and medical devices. Spaces of the HoF are first characterized in terms of communicational performance requirements. In order to fulfil the stringent requirements of future healthcare scenarios, such as enhanced performance, security, safety, privacy, and spectrum usage, we propose a flexible hybrid optical-radio wireless network to provide efficient, high-performance wireless connectivity for the HoF. We introduce the concept of connected HoF exploiting reconfigurable hybrid optical-radio networks. Such a network can be dynamically reconfigured to transmit and receive optical, radio or both signals, depending on the requirements of the application. We envisage that HoF will consist of numerous communication devices and hybrid optical-radio access points to transmit data using radio waves and visible light. Light-based communications exploit the idea of visible light communications (VLC), where solid-state luminaries, white light-emitting diodes (LEDs) provide both room illumination as well as optical wireless communications (OWC). The hybrid radio-optical communication system can be used in principle in every scenario of the HoF. In addition to the hybrid access, we also propose a reconfigurable optical-radio communications wireless body area network (WBAN), extending the conventional WBAN to more generic and highly flexible solution. As the radio spectrum is becoming more and more congested, hybrid wireless network approach is an attractive solution to use the spectrum more efficiently. The concept of HoF aims at enhancing healthcare while using hospital resources efficiently. The enormous surge in novel communication technologies such as internet of things (IoT) sensors and wireless medical communications devices could be undermined by spectral congestion, security, safety and privacy issues of radio networks. The considered solution, combining optical and radio transmission network could increase spectral efficiency, enhancing privacy while reducing patient exposure to radio frequency (RF). Parallel radio-optical communications can enhance reliability and security. We also discuss possible operation scenarios and applications that can be introduced in HoF as well as outline potential challenges.
The theoretical professional foundations of the nursing discipline, nurses' professional status and their interpretation are explored in this chapter. It's important to differentiate between nursing and organizational models of care, as one has a professional theoretical foundation, the other is about work distribution. Traditional models of care are described and evaluated. The many factors influencing choices regarding the model of care adopted are identified and described. This includes the recognition of professional status, social and working conditions. Nurses make use of a problem based scientific method to assess, plan, implement and evaluate care. Nursing care plans serve as a guide for allocating care activities. The efficacy of nursing resource management at the point of care directly influences the quality of care received by patients as well as staff satisfaction and productivity. Linking electronic care plans and nursing documentation with electronic health/medical records can facilitate data analytics, improve efficiency and the effectiveness of services delivered. This chapter provides detailed instructions regarding the adoption of teamwork, a shift routine example and a method to evaluate the success of small team nursing. It concludes with a discussion of interdisciplinary and multidisciplinary teamwork and associated success factors.
Full-text available
This paper reviews current issues in health care policy and re-form in Croatia. It analyses the microeconomic foundations of health care (characteristics of health as an essential good, market and govern-ment failures in allocation of health care services); the role of health care in the process of European Union accession; the status of health care in Croatia (health status of the population, demographic trends, health care resources); microeconomic and macroeconomic aspects of health care financing; and recent reform proposals for the health care sector. On this basis a number of recommendations for health care re-form in Croatia are formulated. The proposals refer to financial sustain-ability of health care in the medium and long term; the mix of general taxes and mandatory health insurance contributions as sources of pub-lic funding; the mix of public and private funding; the impact of differ-ent financing instruments on the operations of health care providers; labour market effects of different financing methods; and the political economy of health care reform.
Full-text available
Objective: To examine the associations of four distinct nursing care organizational models with patient safety outcomes. Design: Cross-sectional correlational study. Using a standardized protocol, patients' records were screened retrospectively to detect occurrences of patient safety-related events. Binary logistic regression was used to assess the associations of those events with four nursing care organizational models. Setting: Twenty-two medical units in 11 hospitals in Quebec, Canada, were clustered into 4 nursing care organizational models: 2 professional models and 2 functional models. Participants: Two thousand six hundred and ninety-nine were patients hospitalized for at least 48 h on the selected units. Main outcome measure: Composite of six safety-related events widely-considered sensitive to nursing care: medication administration errors, falls, pneumonia, urinary tract infection, unjustified restraints and pressure ulcers. Events were ultimately sorted into two categories: events 'without major' consequences for patients and events 'with' consequences. Results: After controlling for patient characteristics, patient risk of experiencing one or more events (of any severity) and of experiencing an event with consequences was significantly lower, by factors of 25-52%, in both professional models than in the functional models. Event rates for both functional models were statistically indistinguishable from each other. Conclusions: Data suggest that nursing care organizational models characterized by contrasting staffing, work environment and innovation characteristics may be associated with differential risk for hospitalized patients. The two professional models, which draw mainly on registered nurses (RNs) to deliver nursing services and reflect stronger support for nurses' professional practice, were associated with lower risks than are the two functional models.
Managed Care ist keine in sich geschlossene Theorie, sondern vielmehr ein Bündel ganz unterschiedlicher Organisationsmodelle und Management-Instrumente, die in vielfältigen Kombinationen eingesetzt werden. Genau aus diesem Grund ist es auch nicht möglich, „für“ oder „gegen“ Managed Care zu sein. Dies kann ausschließlich auf der Ebene der einzelnen Organisationsformen oder Management-Instrumente stimmen. Managed Care hat sich in den letzten Jahren deutlich weiter entwickelt und neue Themen sind hinzugekommen. Diesen Entwicklungen hat der Autor in dieser Auflage Rechnung getragen. Neu aufgenommen hat beispielsweise Kapitel zu Consumer Driven Health Plans (CDHP), Accountable Care Organizations (ACO), Medical Homes, Pharmaceutical Benefit Management, Bundled Payments, Pay-for-Performance, Public Reporting und Patienten Coaching sowie eine Vielzahl neuer Fallstudien. Der Inhalt: -Grundideen von Managed Care -Managed Care-Organisationen und -Produkte -Managed Care-Instrumente -Bewertung von Managed Care
American health care reformers face a number of ethical issues, including familiar debates over the merits of a single-payer system and publicly provided universal health insurance. No matter how these debates are resolved, a further ethical question must be addressed. Both universal coverage and a single-payer system are compatible with permitting some patients to pay more for faster, better, or more health care choices. Should the United States continue to have a two-tier health care system in which wealth grants some patients access to medical services that others with the same needs cannot obtain? Critical evaluation of both principled objections to inequalities and practical objections to anticipated social and medical consequences of a two-tier health care system are needed.
Health care is a daunting field to understand, with rapidly advancing medical sciences, a complex array of institutions, heavy government regulation, and numerous highly engaged stakeholders. The sheer complexity of the field has led to widely different opinions about the problems in health care and the many ill-advised “solutions” to these issues. Despite the many voices speaking about the German health care system, the challenge is clear: the system is in need of reform. While Germany has achieved much over the course of the last 65 years in providing health care to citizens, the nation is on an unsustainable path. There is a toxic combination of rising costs, unsustainable financing, divergent quality of care, shortages of skilled personnel, and a confrontational atmosphere among entrenched stakeholders.
National health system reform in Germany, as well as in many other countries, has historically been approached on an issue-byissue basis. Each reform has focused on solving individual problems such as rising costs, risk selection by insurance plans, or skewed reimbursement incentives. While many of these efforts involve desirable steps, an overall strategic framework has been lacking.
Begriff, Ziele und Aufgaben des Marketings gewinnen in der medizinischen Versorgung an Bedeutung. Wir haben untersucht, wie sich dies in deutschen Universitätskliniken auswirkt. Dazu haben wir die Marketingaktivitäten der Kliniken mittels öffentlich zugänglicher Quellen und mit einem Fragebogen untersucht. Dabei zeigt sich, dass Ziele, Aufgaben und Organisation je nach Klinik sehr unterschiedlich ausgeprägt sind. Insbesondere verstehen manche Kliniken Marketing als Teil der strategischen Unternehmensführung, andere hingegen als eine unter anderen Unternehmensfunktionen mit dem Schwerpunkt Öffentlichkeitsarbeit; entsprechend unterschiedlich sind Gewichtung, Aufgaben und Ressourceneinsatz der Marketingabteilungen bzw. der Abteilungen, die Marketingfunktionen übernehmen. Vor dem Hintergrund der Änderungen im Gesundheitssystem scheint die Zunahme betrieblicher Steuerung in Universitätskliniken zu einem grundlegenden Veränderungsprozess im Marketing zu führen.
It is important to project a clear image of the professional registered nurse (RN) role to increase awareness of the value of nursing practice. A clear image will show the role authority, responsibility, accountability, and autonomy of the RN in a manner that demonstrates the impact on generating positive outcomes for patients. Numerous recommendations have been made as to how best to create models that structure and organize our work within a professional practice framework, each having its own focus of attention. 1–3