Scott Webb (Host): Magnet designation is the highest distinction a hospital can receive for nursing excellence and quality patient care. And today, we're going to learn about the rigorous evaluation process that Montefiore St. Luke's Cornwall underwent on the road to achieving Magnet designation.

Joining me today is Margaret Allers. She's a Senior Vice president, Chief Operating Officer and Chief Nursing Officer. And I'm also joined by Matthew Agazzi-Cowton. He's the Director of Clinical Practice at Magnet .

 This is Doc Talk presented by Montefiore St. Luke's Cornwall. I'm Scott Webb. It's nice to have you both here. Today we're going to talk about Montefiore St. Luke Cornwall's Magnet designation, and what does that mean, right, Margaret? So, I'm going to start with you. What does it mean to be a Magnet-designated hospital?

Margaret Allers: To be a Magnet-designated hospital, one, it was incredibly important to our organization and really exciting for our nursing team. It is the highest national honor for professional nursing practice. It does set us apart from other organization and recognition, that we have a number of standards that we must achieve in order to be able to obtain Magnet. It says that we demonstrate excellence in patient care. It fosters a philosophy of shared decision-making. So, it empowers our nurses to be vocal at the bedside, to work with management and bedside nurses together to ensure that patients get the best care, evidence-based care. We're striving to make sure that we are providing the best care for our patients.

Host: Yeah, I like some of the words you used there. It's exciting, it's empowering, And Matthew, I just wanted to find out and get a sense from you, like what's the process of the survey?

Matthew Agazzi-Cowton: Sure. So, the journey to Magnet is actually a process that takes place over the course of four years. So during that four-year timeframe, we are in the process of not just doing staff outreach and education and involvement with the councils and committees that we do, but a large part of what myself and Sue Curry do is we write to all the processes and the standards that Magnet asks us to meet. So, there's nearly 100 different standards that a Magnet organization has to meet or exceed in order to be considered even eligible. So, there's a very large document that we write. Each one of those standard gets a personal individualized story that really exemplifies or highlights the work of not just the nurses, but really the interprofessional team here at the organization. That document is then submitted to the Magnet Commission for a full review in which they read through everything and the evidence and the outcomes that we've supplied them as evidence of all of the wonderful work that we've been doing.

If it's approved, then we move to what they call the site visit, which is when they actually have a number of surveyors come in and they are all professionals and experts in their fields, all in the nursing realm of things. Some are nurse scientists. Some are leaders at other organizations and they actually come on site. And it's basically a "is-your-money-where-your-mouth-is?" They come in and they say, "Okay, great. You've met all these wonderful standards. We want to see if it's truly enculturated and make sure that this is the work that's really being done.

So over the course of three to four days, they're typically on site in the facility and they take time to meet with all of the different Magnet councils and the nurses that are involved in those councils in addition to meeting with patients, providers and community members to really just see not just the nursing perspective, but what is the perception of the community of the work that the hospital is doing as well. So once that site visit is concluded, a report is written and it's sent again back to the Magnet Commission who makes the final determination. And then, they'll notify us, which they have, and award us with a Magnet designation.

Host: Yeah. So as you say, Matthew, it's a long process, very comprehensive that they come on site, all of that. So Margaret, then, how did MSLC achieve this? Like, how does it work and how did you all get this designation?

Margaret Allers: First, I want to say that it is a recognition. There's only 8% of the hospitals in the country that have been able to achieve Magnet. So, it doesn't just come because we say we want to apply. There's a lot that we have to do in order to be able to achieve it. And it's really about changing the culture within the organization. There's a recognition that the bedside nurses and management together need to work together in order to be able to achieve these standards and achieve these outcomes. And so, it's sort of a recognition that the nurses at the bedside have an important voice, because they're closest to the patients, so they know what's working and what's not working in terms of process. And it means that we need to be able to work very closely together in order to be able to change processes and change what we do in order to be able to continuously improve outcomes.

To me, this recognition, it does validate that our organization met those rigorous national standards for nursing leadership, for patient-centered care, for innovation, in order to be able to achieve the outcomes. There's been proven that nurses in Magnet Hospitals, they enjoy the greater autonomy that they're given, that they recognize, again, that strong voice in decision-making that they have increased access to opportunities to grow to become leaders as well.

And when you talk about the improved outcomes, over and over again as research has demonstrated, comparing non-Magnet hospitals to Magnet hospitals, they have demonstrated that Magnet hospitals consistently achieve lower mortality rates, reduce hospital-acquired infections, fewer falls, just better overall quality outcomes. And again, it has a lot to do with that empowering of everybody's voice in order to be able to speak up and make changes in order to be able to improve outcomes.

This has been an incredibly, you know, I say important, but a very exciting award for us to have received. And we went on this journey, you know, we signed the application in December of 2017. From my perspective, at that time, the culture was here, we continue to keep growing. And it's not a given that you achieve Magnet because you apply for it. The survey was very rigorous, and you have to show and demonstrate those improved outcomes and beat the benchmarks.

Host: Yeah. As you say, it's long, rigorous, certainly exciting. I want to bring Matthew back here at the end. And Matthew, just have you talk about the exemplars this time around. What were they?

Matthew Agazzi-Cowton: Sure. So, we were really proud and pleased that we had a total of nine exemplars. And what an exemplar means is that basically we have outperformed even the Magnet standards as it relates to patient outcomes or excellence in our programs and patient care. So, the magnet standards already exceed most of the current regulatory body or state regulations as far as benchmarks go. It really holds you to a higher standard too.

So to exceed even the Magnet standard for that, it is something to be very proud of. So like I mentioned, we had a total of nine. And when it comes to quality metrics, it means that you have to have eight consecutive quarters of performing at 100%. So within that, we had outperformed in falls with injury, hospital-acquired pressure injuries, catheter-associated urinary tract infections, central line-associated bloodstream infections, patient burns, surgical errors, courtesy and respect as far as communication and treatment with patient ,perception and our no-wait emergency room department model, with special highlights to a couple of the programs that we have down in the ED, including a substance abuse and PRx program, which has really been tremendous for our community.

Kathy Sheehen, who is our AVP of Patient Care Services here at the hospital, she did some tremendous work down in the ED along with the leadership and nurses down there. And what it does is it takes patients who are suffering from substance abuse disorder, and it matches them with a community partner. And it's really a program surrounding the concept of meeting them where they're at. So, we can actually take somebody, look at what particular type of substance abuse they're facing and match them almost with a community level sponsor, but someone who has talked to talk and walked the walk, if you will, someone who has had a similar journey with substance abuse. We can make matches based on gender, race, other commonalities. And it really just helps the longevity of success and really gives somebody the relatable support that they're looking for to help them on a recovery journey. And since rolling out that program, our community has seen a 19.5% decrease in our fatal overdoses. So, really, really impactful for our local community and really just has made such a wonderful difference that we've seen with our substance abuse population.

Host: Yeah.

Matthew Agazzi-Cowton: And if I could just circle back to our no-wait ED model we actually rolled this out a number of years ago, we do not utilize our waiting room in our emergency department. We bring you immediately back into the care areas. You may not have your own personal bay. Sometimes it is a stretcher or a chair near the nurses station, but the concept behind it is reducing patient risk. At least this way, you are in front of a variety of different practitioners, whether they be nurses, providers who can have eyes on you who can do a faster triage and so that the patients themselves can see the work that's going on around them. They can see that they don't feel forgotten. There's people tangible there. They're not wondering what's happening behind a door. And they feel a little more seen. So, not only is it reducing the patient risk for harm by having a faster evaluation, but it's also actually improving the patient's experience and their satisfaction because they have a better appreciation of what's going on around them and being kept in the loop as far as their care journey progresses.

Host: Right. Yeah. Everybody seems like they come up winners in this Magnet designation, patients, families, providers. No-wait ED, that's music to my ears, of course, for any of us patients out here, you know? So, it's really all good stuff. I appreciate you both being here today. Thank you so much.

Matthew Agazzi-Cowton: Thank you so much for having us.

Host: And to learn more about MSLC's services, visit montefioreslc.org. And if you found this podcast to be helpful, please be sure to share it on your social channels and be sure to check out all the other Doc Talk episodes. This has been Doc Talk, the podcast from Montefiore St. Luke's Cornwall Hospital. I'm Scott Webb. Stay well.