Building Research Infrastructure in Magnet® Hospitals: Current Status and Future Directions.

OBJECTIVE: The aim of this study was to describe the infrastructures supporting research in Magnet® hospitals. BACKGROUND: Hospitals undertaking the journey toward Magnet designation must build research and evidence-based practice (EBP) infrastructures that support the infusion of research and EBP into clinical practice. METHODS: An electronic survey was developed and distributed to the chief nursing officer or Magnet coordinator of all Magnet hospitals between June 10, 2015, and July 8, 2015. RESULTS: Of the 418 Magnet hospitals invited, 249 responses (60%) were received. Resources dedicated to nursing research were difficult to isolate from those for EBP. Supporting clinical nurses' time away from the bedside remains a challenge. Nearly half (44%) indicated that research is conducted within the nurses' usual clinical hours, and 40% indicated that nurses participate on their own time. CONCLUSIONS: Hospitals use a variety of resources and mentor arrangements to support research and EBP, often the same resources. More targeted resources are needed to fully integrate research into clinical practice.

Credentialing: the need for a national research agenda.

A national research agenda is needed to promote inquiry into the impact of credentialing on health care outcomes for nurses, patients, and organizations. Credentialing is used here to refer to individual credentialing, such as certification for nurses, and organizational credentialing, such as American Nurses Credentialing Center Magnet recognition for health care organizations or accreditation of providers of continuing education in nursing. Although it is hypothesized that credentialing leads to a higher quality of care, more uniform practice, and better patient outcomes, the research evidence to validate these views is limited. This article proposes a conceptual model in which both credentials and standards are posited to affect outcomes in health care. Potential research questions as well as issues in research design, measurement, data collection, and analysis are discussed. Credentialing in nursing has implications for the health care professions and national policy. A growing body of independent research that clarifies the relationship of credentialing in nursing to outcomes can make important contributions to the improvement of health care quality.

A mile in their shoes: interdisciplinary education at the Johns Hopkins University School of Medicine.

An elective course exposing medical students to nonphysician hospital providers and staff was conceived and implemented. Goals and objectives identified were to (1) increase students' understanding of the roles of nonphysician professionals in hospital care, (2) demonstrate how the services offered by these professionals complement those offered by physicians, (3) improve students' skill in communicating with nonphysician professionals, (4) develop students' comfort approaching these professionals about patient care issues, (5) show students "what it is like" to be each of these providers, and (6) demonstrate the common challenges they face. A 2-week elective rotation paired students with experienced preceptors in several nonphysician hospital care disciplines. Quantitative and qualitative data indicate that this experience empowered students to collaborate more actively with the nonphysician colleagues, whom they would encounter in their careers, to provide coordinated patient care.

Paying the piper: investing in infrastructure for patient safety.

BACKGROUND: Although the best allocation of resources is unknown, there is general agreement that improvements in safety require an organization-level safety culture, in which leadership humbly acknowledges safety shortcomings and allocates resources at the patient care and unit levels to identify and mitigate risks. Since 2001, the Johns Hopkins Hospital has increased its investment in human capital at the patient care, unit/team, and organization levels to improve patient safety. PATIENT CARE LEVEL: An inadequate infrastructure, both technical and human, has prompted health care organizations to rely on nurses to help implement new safety programs and to enforce new policies because hospital leaders often have limited ability to disseminate or enforce such changes with the medical staff. UNIT OR TEAM LEVEL: At the team or nursing unit level, there is little or no infrastructure to develop, implement, and monitor safety projects. There is limited unit-level support for safety projects, and the resources that are allocated come from overtaxed department budgets. ORGANIZATION LEVEL: HOSPITAL LEVEL AND HEALTH SYSTEM: Infrastructure is needed to design, implement, and evaluate the following domains of work-measuring progress in patient safety, translating evidence into practice, identifying and mitigating hazards, improving culture and communication, and identifying an infrastructure in the organization for patient safety efforts. REFLECTIONS: Fulfilling a commitment to safe and high-quality care will not be possible without significant investment in patient safety infrastructure. Health care organizations will need to determine the cost-benefit ratio of various investments in patient safety. Yet, predicating safety efforts on the mistaken belief in a short-term return on investments will stall patient safety efforts.

Senior executive adopt-a-work unit: a model for safety improvement.

BACKGROUND: At The Johns Hopkins Hospital (JHH), the patient safety committee created a safety program that focused on encouraging staff in selected units to identify and eliminate potential errors in the patient care environment. As part of this program, senior hospital executives each adopted an intensive care unit and worked with the unit staff to identify issues and to empower staff to address safety issues. JHH PATIENT SAFETY PROGRAM: The program consisted of eight steps, which together require six months for implementation: (1) conduct a culture survey; (2) educate staff on the science of safety; (3) identify staff safety concerns through a staff safety survey; (4) implement the senior executive adopt-a-work unit program; (5) implement improvements; (6-7) document results, share stories, and disseminate results; and (8) resurvey staff. RESULTS: The senior executive adopt-a-work unit program was successful in identifying and eliminating hazards to patient safety and in creating a culture of safety. DISCUSSION: The program can be broadly implemented. The keys to program success are the active role of an executive advocate and staff's willingness to openly discuss safety issues on the units. Regular meetings between the advocates and the units have provided a forum for enhancing executive awareness, increasing staff confidence and trust in executive involvement, and swiftly and effectively addressing areas of potential patient harm.