Magnet Hospital: A model of excellence for attracting and retaining talent and ensuring quality of care

The concept of the magnet hospital has established itself since the 1980s as a model of a high-performing healthcare facility, capable of attracting and retaining qualified and motivated personnel, while ensuring optimal quality and safety of care. Faced with the "human resources crisis" that health and medico-social organizations are experiencing, the concept of the magnet hospital offers avenues for reflection and concrete action for a managerial transformation. The objective of this article is to explore this model in depth, its foundations, its implications, and its relevance in the current context, particularly in France.

What is a Magnet hospital? (definition and origins)

The term "Magnet Hospital" first emerged in the early 1980s following a qualitative study conducted with caregivers in 41 American hospitals. At a time marked by a shortage of caregivers in North America, this research focused on hospitals known for their attractiveness and ability to retain competent staff. The scientific team of Margaret McClure, a professor of nursing, identified healthcare organizations that functioned as "magnets" for the nursing profession.

The innovative approach of this study was to focus on the reasons why caregivers choose to join and remain in a hospital, rather than on the factors that cause them to leave. This shift in perspective has highlighted the positive capacities of work environments and organizations and their impact on the quality of work life (QWL) and, consequently, on the attitudes and behaviors of professionals.

In the early 1990s, the Magnet Hospital concept evolved into a label awarded by the American Nurses Credentialing Center (ANCC) to hospitals meeting a set of rigorous criteria evaluating human resources, organizational, and managerial practices aimed at optimizing the professional practice of caregivers. Used as a criterion of excellence to designate the best American hospitals, this label is now held by more than five hundred hospitals, mainly in the United States, but also in Australia, New Zealand, and Canada. The Magnet Recognition Program® is regularly cited in the literature as the "gold standard" for the quality of nursing practices and could be considered an employer brand.

Beyond its initial definition focused on attracting and retaining caregivers, the Magnet hospital is now seen as an organizational context that promotes the best performance of each healthcare professional. According to Yvon Brunelle, it is a "hospital where it is good to work and good to be cared for". This definition highlights the reconciliation between quality of work life and quality of care as a fundamental characteristic of the Magnet hospital.

The eight essential dimensions of hospital magnetism

For over thirty years, numerous academic studies have sought to identify and categorize "magnetic forces". Although the inventory may vary depending on the authors, the list of eight essential dimensions proposed by Kramer and Schmalenberg is the most frequently cited in the literature. These dimensions define the attributes of a magnetic context:

• A culture of care centered on patient needs: The entire organization is oriented towards meeting the needs of patients and providing quality care.
• Healthcare professionals who are experts in their field: The hospital values and supports the development of skills and expertise of healthcare professionals.
• Strong institutional support for staff training: The hospital invests in continuing education and professional development of its employees.
• Transformational nursing leadership: Nursing leadership is visionary, inspiring, mobilizing, and focused on team development.
• A participatory management style favorable to the empowerment of caregivers: Caregivers are involved in decision-making processes and feel they can control their work.
• A collegial relational climate between physicians and caregivers: Interprofessional relationships are based on open communication, mutual respect, trust, and reciprocal esteem. This relational mode is statistically the most determining factor in characterizing "caring" management.
• Autonomy of caregivers in their sphere of clinical decision-making: Healthcare professionals have leeway in their clinical decisions, in compliance with professional standards.
• Adequate staffing, adapted to the workload and patient needs: The organization ensures that it has a sufficient number of qualified personnel to ensure the quality and safety of care.

These eight dimensions are interdependent and contribute to creating a positive and stimulating work environment for healthcare professionals. Validated assessment tools, such as the Nursing Work Index or the Essentials Of Magnetism Tool, can be used to measure caregivers' perceptions of these "magnetic" organizational and managerial characteristics.

The fundamental values of the Magnet hospital

Beyond its structural and managerial dimensions, the Magnet hospital is based on a foundation of fundamental values that guide practices and behaviors within the hospital:

• Kindness or "care" towards both patients and staff: The organization is driven by a pursuit of well-being for all, recognizing the personal expectations of individuals beyond their work.
• Autonomy within a framework organized by professional standards: The Magnet hospital promotes professional autonomy as a necessary condition for the fulfillment of their roles, while respecting practice standards. Interdisciplinarity and shared decision-making are key elements.
• The complementarity of actions by administrative, medical, and caregiving authorities aimed at accountability and cooperation: The Magnet hospital promotes a flat and decentralized decision-making structure to ensure the sharing of power and the professional autonomy of each individual. This approach encourages a "nurturing" and "integrative" power.

These ethical and organizational values contribute to creating a positive and collaborative culture within the hospital, promoting engagement and satisfaction among professionals.

Expected effects of the Magnet hospital model

The implementation of the principles of the Magnet hospital has significant positive effects on several aspects:

• Improved care performance: This results in increased quality and safety of care, greater patient satisfaction, fewer complaints, and fewer care-related errors and accidents. Studies have even shown lower mortality rates in magnet hospitals.
• Greater mobilization of caregivers: Healthcare professionals report higher job satisfaction, increased professional involvement, and greater productive effort. The feeling of collective efficacy is also strengthened.
• Better physical and mental health: The magnet model is associated with a decrease in workplace accidents, blood exposure incidents, burnout, and a better work-life balance.
• Greater attractiveness and loyalty to the organization: Magnet hospitals experience fewer vacancies, reduced absenteeism, a stronger intention to stay, and lower turnover.

These results, based on numerous studies comparing the performance of labeled and non-labeled hospitals, highlight the positive impact of the magnetic hospital model on the quality of care, the well-being of professionals, and the overall performance of the hospital.

The cause-and-effect model of the Magnet hospital

The compilation of empirical research results has led to the development of a conceptual "cause-consequence" model that relates the eight essential dimensions of magnetism to empirically observed results.

This synthetic model illustrates how the eight dimensions (healthcare professional expertise, training support, transformational leadership, empowerment/participative management, collegial physician/caregiver climate, clinical autonomy, patient-centered culture, adequate staffing) positively influence the attitudes and behaviors of healthcare professionals (mobilization, satisfaction, involvement, intention to stay) and organizational performance (quality and safety of care, patient satisfaction, workplace health, attractiveness/loyalty).

The model suggests that creating a magnetic work environment, characterized by the eight essential dimensions, leads to greater mobilization and satisfaction of professionals, which in turn results in better quality of care and greater staff retention. This virtuous circle contributes to the overall performance of the hospital.

Transferability of the concept to the French context

Although the Magnet hospital model was initially developed and validated in the North American context, many authors believe that it has elements transferable to the French and European context. While certain structural characteristics related to human resource management policies may be specific to the American hospital system, the qualitative management that underlies the concept appears more universally applicable.

This "loving" management is primarily based on three pillars:

• Transformational leadership of front-line management: A department head or care manager who is stimulating, mobilizing, visionary, charismatic, and attentive to their employees.
• Perceived empowerment: The feeling for professionals of being able to act and control their work.
• Collegiality in the climate of interprofessional relations: Relations based on open communication for dialogue, mutual respect, trust, and reciprocal esteem between physicians and caregivers.

A survey of healthcare professionals in French hospitals confirmed the importance of these three elements, and in particular of collegial relations, in characterizing "loving" management and fostering positive attitudes at work. The study also highlighted the high expectations of French healthcare professionals with regard to teamwork, and the need to break down traditional barriers between professions.

Although no French hospital has yet embarked on the Magnet Recognition Program® labeling process, some hospitals are undertaking initiatives inspired by this model. The idea of developing qualitative management, focused on well-being at work and the valorization of personnel, is gaining ground in the French context.

Practical implications in HRM

The Magnet hospital model offers numerous inspirations for updating human resources (HR) management policies in French healthcare facilities. The goal is to strategically subordinate the quality of care to the improvement of the quality of work life and the development of "human capital". Here are some concrete ideas:

• A careful recruitment policy: Select qualified professionals in sufficient numbers, in line with the workload, specializations, and patient needs. Limit the use of temporary staff and promote team stability. Alignment with international best practices in terms of nurse-to-patient ratios could be considered.
• A successful integration policy: Implement tailor-made support for new staff, based on an initial assessment of skills and a mentoring system with experienced professionals.
• A strengthened training policy: Actively support qualification needs by providing resources (funding, leave), organizing seminars, and interacting with the research community. Ring-fencing training budgets is a practice of magnet hospitals.
• An incentive-based remuneration policy: Advocate recognition measures that encourage innovation (awards, grants, special leave) and reward the acquisition of skills through career advancement.
• A policy of improving benevolent working conditions: Paying particular attention to the well-being of professionals, in particular by promoting work/life balance (relaxation areas, flexible hours, concierge services, etc.).
• A policy of empowerment and skills development for managers: Develop management training for department heads, health executives and physicians, and implement collective skills management systems, such as discussion forums on work.

The implementation of these policies, adapted to the French context, could contribute to overcoming the hospital human resources crisis by acting on the attractiveness and retention of staff.

The Magnet Hospital: Towards an Exemplary Hospital?

In conclusion, the concept of the magnet hospital offers a "salutogenic" perspective for rethinking the management of healthcare facilities. It encourages moving beyond an approach solely focused on preventing constraints and suffering at work to actively promote health at work.

The Magnet Hospital lays the foundation for an "exemplary" hospital in accordance with the values displayed in the Trust Pact for the Hospital: humanism and professional competence, respect for the person receiving care, solidarity and respect for others in professional relationships, pride, commitment, and recognition of staff.

This approach encourages leaders and managers to build on existing positive organizational and managerial capabilities, which ensure the fulfillment of hospital missions while caring for both their patients and their staff. Although some recommendations may seem simple, they are based on solid research and deserve to be implemented with dedicated training programs. The Magnet hospital thus constitutes a fertile ground for fostering experimentation and the development of positive social relationships within healthcare facilities.

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