Establishing Global Partnerships - University of Pennsylvania ...

The Center for Health
Outcomes and Policy Research
began a series of studies more
than a decade ago that together have
made a substantial impact on public and
private actions to improve the quality of
hospital care within the United States
and internationally.
The Center’s landmark research
showed those hospitals attracting and
retaining nurses, since designation as
“magnet hospitals” by the American
Academy of Nursing, also had lower
risk-adjusted mortality.The next study
of innovation in hospital AIDS care
showed that “magnet hospitals” achieved
excellent outcomes by having lower
patient-to-nurse ratios and providing
nurses with greater autonomy, providing
good support from administration, and
facilitating positive doctor-nurse relationships.
Further, they showed that
dedicated AIDS units had many of the
same organizational features of magnet
hospitals. Patient-care outcomes were
better than those achieved in conventionally
organized hospitals.
As a result, these findings prompted
the Center to direct an international
study of hospital outcomes, funded by
the National Institutes of Health, which
encompassed more than 700 hospitals,
45,000 nurses, and hundreds of thousands
of patients in the United States,
Canada, England, Scotland, Germany,
and New Zealand.
Now the Center, partnering with
the Institute of Nursing Science at the
University of Basel, is replicating this
hospital outcomes study in Switzerland.
The collaboration followed a nursing
policy research paper given by Linda H.
Aiken, PhD, FAAN, FRCN, RN, Claire
M. Fagin Leadership Professor in
Nursing, Professor of Sociology, and
Director of the Center for Health
Outcomes and Policy Research, at the
University of Leuven, Belgium, persuading
the health minister there to add one
additional nurse per shift to improve
patient outcomes and increase retention
of nurses.The results of the Center’s
international research validate
nurses’ claims that reasonable
patient-to-nurse ratios and organizational
features that promote
professional nursing practice lead to
better outcomes for patients and the
opportunity to retain more nurses in
hospital practice.
Evaluating the applicability of
American Nurses Credentialing Center’s
(ANCC) magnet-hospital standards in
the United Kingdom, the ANCC
launched a successful pilot program,
evaluated by the Center, at the
Rochdale National Health Service Trust
in England that became the first magnet
hospital recognized outside the United
States.The Center’s research on magnet
hospitals has created the evidence base
showing that professional nurse practice
models have better patient and nurse
outcomes (as summarized in “Magnet
Hospitals Revisited”) and contributed
substantially to domestic and international
interest in magnet hospitals (as
evidenced by the establishment of the
ANCC International Advisory Board).
Dr.Aiken is a founding member.
In Armenia, Penn launches the Magnet Project Yerevan with Dr. Aiken (center) and the ANCC team.
The American International Health
Alliance, with funding from the United
States Agency for International
Development, is now conducting a
four-hospital demonstration in Russia
and Armenia that represents the first
application of magnet-hospital standards
in a developing world context. Led by
the Center, the demonstration includes a
before-and-after study of nurses and
In the first study of its kind,
researchers from the Center for
Health Outcomes and Policy
Research found that patients
undergoing common surgeries
have up to a 31 percent
increased chance of
dying when four patients
are added to the responsibilities
of a nurse already caring for four.
The research team, led by Linda H. Aiken,
PhD, FAAN, FRCN, RN, Claire M. Fagin
Leadership Professor in Nursing, Professor
of Sociology, and Director of the Center for
Health Outcomes and Policy Research,
published its findings in The Journal of the
American Medical Association in October
to headlines around the world.
The Penn researchers found that every
additional patient in an average hospital
nurse’s workload increased the risk of
death in surgical patients by 7 percent.
The findings were also related to increases
in patient complications, failure by the
hospital to rescue patients in trouble, and
greater job stress for nurses.
“Nurses report greater job dissatisfaction
and emotional exhaustion when they’re
responsible for more patients than they
can safely care for. Hospitals’ failure to
retain nurses contributes to avoidable
patient deaths,” Dr. Aiken said.
patients to determine whether the
introduction of magnet standards
strengthens professional nursing and
improves patient outcomes. If successful
there, the magnet concept is likely to be
replicated elsewhere internationally, particularly
in the developing world, where
nursing is the key to improving quality
of care.
Cover reproduced with permission of The
Journal of The American Medical Association.
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