What’s More Dispensable: Magnet or Baldrige?

Posted by Dawn Marie Bailey

Faced with limited resources, many health care administrators ask themselves whether to invest in Magnet or in the Baldrige Health Care Criteria for Performance Excellence. Is one more dispensable than the other?

Magnet designation, now operated by the American Nurses Credentialing Center, was approved for creation by the American Nurses Association in 1990. Today, Magnet is used as a way of recognizing hospitals that offer both excellent nursing care and an environment supportive of nurses–based on the characteristics of health care organizations that excel in recruitment and retention of registered nurses.

In 1998, Congress authorized the participation of health care organizations in the Malcolm Baldrige National Quality Awards, the nation’s highest Presidential honor for organizational excellence. With funding originally from the Veterans Administration, the Health Care Criteria were published to provide a framework for organizations to examine all parts of their management systems and improve processes and results, from results related to leadership and the workforce to customers, operations, and strategies. The Health Care Criteria were based on the best practices and ideas learned from business organizations that had contributed to the Baldrige Award since 1987.

I asked Donna Poduska, chief nursing officer of Poudre Valley Health System, who is speaking at the 26th Annual Quest for Excellence Conference, and Priscilla Nuwash, system director for performance excellence of University of Colorado Health, about their presentation that focuses on using Baldrige and Magnet together.

What are three reasons that a hospital might find value in implementing both Baldrige and Magnet principles?

  1. Baldrige and Magnet complement each other in creating a successful organization. Both are based on quality, innovation, and the pursuit of areas for improvement, and Magnet has components that integrate with the areas to address in the Baldrige Criteria. Although they complement and integrate with the other, each also addresses areas that the other does not. Together, they can create an exceptional organization.
  2. At times, different parts of the organization may not work together as a system; the value of using the Baldrige Criteria and Magnet together is that you are able to identify the best approach from each and deploy that throughout the organization.
  3. The Baldrige Criteria and Magnet succeed through engaging the workforce. Differing segments of the workforce have differing key elements that engage them. The value of using Magnet and the Baldrige Criteria together is that they produce professional work environments that address key elements for engaging everyone in the workforce.

 What are some tips for using them together?

  1. Emphasize that both are grounded in what is best for the patient, which creates purpose and pride in the workforce.
  2. Focus on the concept that both the Baldrige Criteria and Magnet are based on evidence-based practice; they learn from each other.
  3. Both the Baldrige Criteria and Magnet are based on a foundation of having structure, process, and outcomes. Those three premises work together for both the Baldrige Criteria and Magnet. When developing committee structure, capitalize on your existing committees.
  4. Use one process improvement methodology when making improvements identified by the Baldrige Criteria and by Magnet. Then involve nursing and non-nursing staff in both to get the benefit of differing perspectives.
  5. Crosswalk your responses in applications for both Magnet and the Baldrige Award. Crosswalks are cost effective and are an additional way to identify best practices.

What else might folks learn at your Quest for Excellence session?

Donna will present a crosswalk visual of Magnet and the Baldrige Criteria and show how the components of Magnet and the Criteria are indispensable for an organization’s performance excellence journey.

For more information, attend Poudre Valley Health System’s special presentation, “How Baldrige and Magnet Are Successful Together,” at the Baldrige Program’s Quest for Excellence® Conference in Baltimore, Maryland.

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4 Responses to What’s More Dispensable: Magnet or Baldrige?

  1. Carole Bergeron says:

    Often it is the nursing department or patient care services that initially champions the decision to embark on a journey of excellence. Acknowledging the complexity of patient-centered care, the institution is best served by an integration of Baldrige and Magnet to create a powerful organization-wide force for aspiring to and achieving excellence in care and services. This combination identifies the important roles played by all departments and staff in achieving and maintaining a consistently high standard of excellence in a rapidly evolving healthcare environment. It is ‘both/and’ at its best!

  2. Analyst says:

    Wondering if the presentation or any articles will address the question; What’s more dispensable? Resources can be constraining .. which one would be the best choice to impact overall facility excellence? Inquiring minds want to know!

  3. Barry Johnson says:

    What’s More Dispensable: Magnet or Baldrige?

    See if this helps answer your question.

    Almost all, if not all, of the 17 Baldrige recipients to date also have achieved Magnet designation. So, on this level, it appears to be a tough choice. It is not. There is no correlation, covariance, or causality in this database.

    The first rule for any market is that your offerings will not produce a profit (what economists call an “economic” rent) if other competitors offer the same products or services as you do. That is called perfect competition. To be successful in a market (to earn what economists call a “Ricardian” rent), you need to offer a higher value, a clear advantage that customers can perceive. Something you THINK is a competitive advantage confers no advantage when many competitors can obtain the same capability. To be a competitive advantage, customers must PERCEIVE that your offerings are RELATIVELY more Valuable, Rare, Inimitable, and have No Substitutes or “VRIN.” All competitive advantages are relative. They are VRIN only to the relative degree of how many of your competitors have the same “advantage.”

    Let’s compare the VRIN of these two healthcare “excellence” designations — Magnet and Baldrige. I propose this simple test to help you decide.

    Write down the names of the competitors in your service area. Now as these two questions. (1) How many of your competitors have Magnet designation? (2) How many have Baldrige designation?

    There is very high probability (close to 100%) that MANY of your competitors will have Magnet designations and NONE or only one will have Baldrige designations.

    Although, Magnet is a worthy designation to achieve, this designation is achieved by about 50 TIMES MORE (17 v 800) hospitals than Baldrige. As such does not pass “The VRIN test.” Although Magnet may be arguably Valuable, it is not comparatively Rare, Inimitable, or has No substitutes. Baldrige meets all 4 VRIN criteria. The Truven Top 100 Hospitals designation also passes the VRIN test. That’s why Truven found a high correlation between Baldrige and their Top 100 Hospitals in their research (2012.) There is no similar correlation between Magnet hospitals and Truven Top 100 hospitals.

    Magnet does not create a sustainable competitive advantage.

    Every leadership team should consider this distinction when calculating ROI on pursuing excellence designations.

    • Jan C. says:

      Barry,

      your analysis is over simplistic and flawed. Obviously your background is not nursing, and thus explains why your reasoning lead you to that conclusion.

      While your argument is sound, it is a fact that neither of these two accreditation bodies affects reimbursement. Neither Magnet nor Baldrige can enhance financial value directly because it is not a criteria required by payors. In fact going by your reasoning, since The Joint Commission is achieved by almost all organizations, it is less valuable. Of course it is not so, the TJC accreditation is a requirement by most payors. The fact is Baldrige does not add directly “a higher value, a clear advantage that customers can perceive.” Unfortunately, the customers are not the same as the payers in most cases. In addition, the customer does not base decision on where to go based on the kind of accreditation that the hospital has. If you looked more into research about what satisfy the customers you would find out that this is heavily influenced by the level of nursing care of the organization (aside from the medical staff care). Evidence of this can be found in the HCAHPS dimensions of evaluation. In this regard, where the level of nursing care is important, Magnet® plays a bigger role. Magnet influence Nurse satisfaction which has shown to directly translate to patient/customer satisfaction. Baldrige may improve organizational efficiency but does not necessarily change the nursing care process, which is the Magnet focus.

      It is unfortunate that you don’t think Magnet® will not offer any advantage to your organization. You may not opt to get it, but the evidence is against you (Magnet vs non-Magnet facilities) when it comes to organizational excellence.

      Jan

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