Sustaining the pivotal organizational outcome: magnet recognition

The components of strategic leadership competencies of chief nurse executives in private hospitals in Thailand

AIM

To determine the components of the strategic leadership competencies of chief nurse executives.

BACKGROUND

The nursing executives are currently required to have strategic competencies including a strategic vision, a capability to inspire nursing staff to use their maximal potentials for the highest benefits of the organisation.

METHODS

This research was mixed methods with phenomenology qualitative design and factor analysis. The samples consisted of 253 nurse executives from 65 private hospitals in Thailand. The content validity test was at 0.91, and the reliability was at 0.91. The data were analysed using content analysis and confirmatory factor analysis.

RESULTS

There were 7 components of the strategic leadership with 75 competencies with factor loadings as follows: strategic-innovative thinking and planning (0.89), developing today's and tomorrow's leaders (0.89), relating the parts to the whole (0.82), building partnership (0.78), making it happen (0.78), corporate spirit (0.73) and giving direction (0.66).

CONCLUSION

The new knowledge was 7 components with 75 competencies particularly the top 3 components for developing nurse executives in strategic thinking and innovation of nursing management to become strong leaders of today and tomorrow.

IMPLICATIONS FOR NURSING MANAGEMENT

These findings contribute to leadership development for chief nurse executives in possessing the administrative capability and leadership attributes.

Creating a Culture of Success: Using the Magnet Recognition Program® as a Framework to Engage Nurses in an Australian Healthcare Facility

An organizational culture that reflects distrust, fear of reprisal, reluctance to challenge the status quo, acceptance of poor practice, denial, and lack of accountability creates significant issues in healthcare in relation to employee retention, burnout, organizational commitment, and patient safety. Changing culture is one of the most challenging endeavors an organization will encounter. We highlight that the Magnet Recognition Program® can be implemented as an organizational intervention to positively impact on nursing workplace culture in an international healthcare facility.

Changing the Publication Culture From "Nice to Do" to "Need to Do": Implications for Nurse Leaders in Acute Care Settings

PROBLEM

Nurses in clinical settings often generate innovative practice ideas to inform their practice and improve patient outcomes. Yet, few publish and share these innovations with a wider audience. Barriers impeding clinical nurses from writing for publication include discomfort with writing, lack of time, and scarce resources.

METHODS

A qualitative study was designed to determine obstacles and facilitators to writing for publication. Interviews were conducted with five clinical nurses who had recently published in peer-reviewed journals.

FINDINGS

Three themes emerged from the data: culture of "nice to do," personal motivation, and writing experiences. Findings from the study offer implications for nurse leaders to help increase publication efforts by clinical nurses in acute care settings.

CONCLUSION

Nurse leaders can promote publication by clinical nurses through three main strategies: create a culture that supports publication, offer incentives to motivate nurses to publish and reward those who do publish, and provide writing experiences that facilitate writing for publication.

The Center for Nursing Excellence: A Health System Model for Intentional Improvement and Innovation

An innovative Center for Nursing Excellence model that supports structural empowerment and the achievement of exemplary nursing, patient, and organizational outcomes was implemented in 2 separate health systems in the western United States. Formal leadership roles for nursing practice, research, professional education, and Magnet® continual readiness are aligned to ensure that Magnet designation is attained and maintained in system hospitals.

Physician Perceptions of Magnet Nurses and Magnet Designation

This exploratory study uses focus group methodology to examine physician perceptions of Magnet nurses and Magnet designation. No studies have explored physicians' insights, which are becoming increasingly important to implementing and sustaining a Magnet culture. Qualitative content analysis demonstrated that physicians highly regard Magnet nurses and benefit from Magnet status. Key themes emerged related to Magnet nurse characteristics, relationships with physicians, nursing leadership, shared governance, and Magnet as a marketing tool. "Magnet marginalization" emerged as a new concept.

Sustaining organizational culture change in health systems

Purpose

– The questions addressed by this review are: first, what are the guiding principles underlying efforts to stimulate sustained cultural change; second, what are the mechanisms by which these principles operate; and, finally, what are the contextual factors that influence the likelihood of these principles being effective? The paper aims to discuss these issues.

Design/methodology/approach

– The authors conducted a literature review informed by rapid realist review methodology that examined how interventions interact with contexts and mechanisms to influence the sustainability of cultural change. Reference and expert panelists assisted in refining the research questions, systematically searching published and grey literature, and helping to identify interactions between interventions, mechanisms and contexts.

Findings

– Six guiding principles were identified: align vision and action; make incremental changes within a comprehensive transformation strategy; foster distributed leadership; promote staff engagement; create collaborative relationships; and continuously assess and learn from change. These principles interact with contextual elements such as local power distributions, pre-existing values and beliefs and readiness to engage. Mechanisms influencing how these principles sustain cultural change include activation of a shared sense of urgency and fostering flexible levels of engagement.

Practical implications

– The principles identified in this review, along with the contexts and mechanisms that influence their effectiveness, are useful domains for policy and practice leaders to explore when grappling with cultural change. These principles are sufficiently broad to allow local flexibilities in adoption and application.

Originality/value

– This is the first study to adopt a realist approach for understanding how changes in organizational culture may be sustained. Through doing so, this review highlights the broad principles by which organizational action may be organized within enabling contextual settings.

An organizational perspective on the long-term sustainability of a nursing best practice guidelines program: a case study

BACKGROUND

Many healthcare innovations are not sustained over the long term, wasting costly implementation efforts and often desperately-needed initial improvements. Although there have been advances in knowledge about innovation implementation, there has been considerably less attention focused on understanding what happens following the early stages of change. Research is needed to determine how to improve the 'staying power' of healthcare innovations. As almost no empirical knowledge exists about innovation sustainability in nursing, the purpose of our study was to understand how a nursing best practice guidelines (BPG) program was sustained over a long-term period in an acute healthcare centre.

METHODS

We conducted a qualitative descriptive case study to examine the program's sustainability at the nursing department level of the organization. The organization was a large, urban, multi-site acute care centre in Canada. The patient safety-oriented BPG program, initiated in 2004, consisted of an organization-wide implementation of three BPGs: falls prevention, pressure ulcer prevention, and pain management. Data were collected eight years following program initiation through 14 key informant interviews, document reviews, and observations. We developed a framework for the sustainability of healthcare innovations to guide data collection and content analysis.

RESULTS

Program sustainability entailed a combination of three essential characteristics: benefits, institutionalization, and development. A constellation of 11 factors most influenced the long-term sustainability of the program. These factors were innovation-, context-, leadership-, and process-related. Three key interactions between factors influencing program sustainability and characteristics of program sustainability accounted for how the program had been sustained. These interactions were between: leadership commitment and benefits; complementarity of leadership actions and both institutionalization and development; and a reflection-and-course-correction strategy and development.

CONCLUSIONS

Study findings indicate that the successful initial implementation of an organizational program does not automatically lead to longer-term program sustainability. The persistent, complementary, and aligned actions of committed leaders, in a variety of roles across a health centre department, seem necessary. Organizational leaders should consider a broad conceptualization of sustainability that extends beyond program institutionalization and/or program benefits. The development of an organizational program may be necessary for its long-term survival.

High performing hospitals: a qualitative systematic review of associated factors and practical strategies for improvement

BACKGROUND

High performing hospitals attain excellence across multiple measures of performance and multiple departments. Studying high performing hospitals can be valuable if factors associated with high performance can be identified and applied. Factors leading to high performance are complex and an exclusive quantitative approach may fail to identify richly descriptive or relevant contextual factors. The objective of this study was to undertake a systematic review of qualitative literature to identify methods used to identify high performing hospitals, the factors associated with high performers, and practical strategies for improvement.

METHODS

Methods used to collect and summarise the evidence contributing to this review followed the 'enhancing transparency in reporting the synthesis of qualitative research' protocol. Peer reviewed studies were identified through Medline, Embase and Cinahl (Jan 2000-Feb 2014) using specified key words, subject terms, and medical subject headings. Eligible studies required the use of a quantitative method to identify high performing hospitals, and qualitative methods or tools to identify factors associated with high performing hospitals or hospital departments. Title, abstract, and full text screening was undertaken by four reviewers, and inter-rater reliability statistics were calculated for each review phase. Risk of bias was assessed. Following data extraction, thematic syntheses identified contextual factors important for explaining success. Practical strategies for achieving high performance were then mapped against the identified themes.

RESULTS

A total of 19 studies from a possible 11,428 were included in the review. A range of process, output, outcome and other indicators were used to identify high performing hospitals. Seven themes representing factors associated with high performance (and 25 sub-themes) emerged from the thematic syntheses: positive organisational culture, senior management support, effective performance monitoring, building and maintaining a proficient workforce, effective leaders across the organisation, expertise-driven practice, and interdisciplinary teamwork. Fifty six practical strategies for achieving high performance were catalogued.

CONCLUSIONS

This review provides insights into methods used to identify high performing hospitals, and yields ideas about the factors important for success. It highlights the need to advance approaches for understanding what constitutes high performance and how to harness factors associated with high performance.

The sustainability of healthcare innovations: a concept analysis

AIM

To report on an analysis of the concept of the sustainability of healthcare innovations.

BACKGROUND

While there have been significant empirical, theoretical and practical contributions made towards the development and implementation of healthcare innovations, there has been less attention paid to their sustainability. Yet many desired healthcare innovations are not sustained over the long term. There is a need to increase clarity around the concept of innovation sustainability to guide the advancement of knowledge on this topic.

DESIGN

Concept analysis.

DATA SOURCES

We included literature reviews, theoretical and empirical articles, books and grey literature obtained through database searching (ABI/INFORM, Academic Search Complete, Business Source Complete, CINAHL, Embase, MEDLINE and Web of Science) from 1996-May 2014, reference harvesting and citation searching.

METHODS

We examined sources according to terms and definitions, characteristics, preconditions, outcomes and boundaries to evaluate the maturity of the concept.

RESULTS

This concept is partially mature. Healthcare innovation sustainability remains a multi-dimensional, multi-factorial notion that is used inconsistently or ambiguously and takes on different meanings at different times in different contexts. We propose a broad conceptualization that consists of three characteristics: benefits, routinization or institutionalization, and development. We also suggest that sustained innovations are influenced by a variety of preconditions or factors, which are innovation-, context-, leadership- and process-related.

CONCLUSION

Further conceptual development is essential to continue advancing our understanding of the sustainability of healthcare innovations, especially in nursing where this topic remains largely unexplored.

Nurses' perceptions of sustainability of Magnet® efforts

Magnet® designation and redesignation efforts are time and resource intensive. The results of a survey of nurses' perceptions about 4 components of sustainability indicate differences between Magnet and non-Magnet hospitals. Evaluating nurses' perception of the sustainability of Magnet efforts will help nurse executives determine where to commit financial, time, and human resources.