A MAGNET FOR SUCCESS

As the NHS tentatively starts to emerge from the COVID-19 pandemic, hospitals across England are taking part in a much-needed Europe-wide project to improve nurses’ working environments and reduce stress levels.

The Magnet4Europe study, funded by a €4 million grant from the EU’s Horizon 2020 programme, will implement the principles of the Magnet programme, a US accreditation scheme that recognises excellence in nursing. The project is a collaboration between some of the world’s leading universities and is being led by Katholieke Universiteit Leuven in Belgium and the University of Pennsylvania School of Nursing.

“Burnout, anxiety, sleep disorders, and depression are far too common among healthcare workers. Patient safety depends on vigilance, quick thinking, and attention to detail by health professionals; this is made more difficult by stressful work settings,” explained Jane Ball, Professor of Nursing Workforce Policy and Principal Investigator on the study at Southampton. “Nurses in the UK have one of the highest levels of burnout in any country in Europe, it’s high time we took a long hard look at how we organise the delivery of healthcare in the NHS, and find ways of reducing stress and improving staff wellbeing.”

How it works Studies have shown that Magnet-recognised hospitals in the US have lower health professional burnout and safer patient care. There are currently 502 Magnet-recognised hospitals in eight countries, with most located in the US. Very few hospitals in Europe have ever achieved Magnet recognition: notable examples are Nottingham City Hospital and the Antwerp University Hospital.

Magnet is based on research showing that creating positive work environments for nurses leads to happier and healthier staff and the delivery of safer patient care, in turn improving recruitment and retention. Among the key pillars of Magnet are transformational leadership, shared governance and staff empowerment, exemplary professional practice within nursing, strong interdisciplinary relationships and a focus on innovation.

Magnet4Europe will test the feasibility and sustainability of the Magnet Model® for organisational redesign in the context of healthcare in Europe.

“Over 60 hospitals in the six European countries of Belgium, Norway, England, Germany, Ireland, and Sweden are being supported by one-to-one twinning with an experienced Magnet-recognised US hospital and an annual learning collaborative to redesign their ways of working, staffing and systems,” explained Jane. “Magnet4Europe uses a mixed method design to determine individual and collective health outcomes and cost effectiveness; it will examine whether redesigning clinical work environments can improve staff health and wellbeing.”

The COVID effect

The study began in January 2020 and researchers were initially concerned that trusts’ interest in taking part may have faded, in light of the immense challenges posed by the pandemic.

Professor Jane Ball

In fact the opposite was true, with organisations keen to explore new ways to support staff.

“We’ve been blown away by trusts’ enthusiasm and interest,” said Jane. “Many say they wanted to take part because of COVID-19. The study provides a real collaboration between each European hospital and its US based ‘twin’; they are able to share ideas and inspiration and I think that’s been a major draw for participating hospitals following such a tough year.”

Building blocks

Magnet4Europe is a follow up to the landmark RN4Cast study, which involved many of the same academics and was also funded by the EU. In what became the biggest nursing workforce study of its kind, RN4Cast involved 500 hospitals across 12 European countries, and was carried out between 2009 and 2011.

Jane explained: “The RN4Cast study was believed to have been one of the first to find links between the quality of the practice environment and not only patient mortality and satisfaction, but also nurse outcomes.

“It found high levels of nurse burnout, intention to quit and dissatisfaction with their job in England. This finding, with the benefit of hindsight, should have been the writing on the wall for the nurse staffing crisis we are now facing.”

Measuring impact

One of the key ways the project research team will measure the impact of any changes made is through surveys of front-line nursing and medical staff, repeated at different points during the study.

Jane believes this feedback is crucial: “The ideal from my point of view is that the research will help us to understand, not ‘should everybody do Magnet?’, but more ‘When you’re going on a journey of quality improvement and when your goal is improved nursing care and to improve nurse staffing wellbeing, which are the really critically important bits? Which are the bits that are worth putting most energy and effort into, which are the bits which are really going to pay off in terms of achieving that big goal?’.”

The effect the intervention and its outcomes have on staff other than nurses will also be key in tracing impact. Magnet has elements relating how staff work and interact together, so as things improve for nurses, that should in turn improve aspects for doctors and other staff.

Jane concluded: “The study is only 18 months in but already it’s been hugely rewarding to be part of it – just to see the enthusiasm and commitment of NHS colleagues to trial a new way of doing things, which we hope will make things better for staff, and ultimately for patients too.”

MAGNET4EUROPE PROJECT OBJECTIVES

• To implement an evidence-based and stakeholder co-created intervention (Magnet4Europe) to achieve better clinical work environments as a strategy to improve worker mental health and wellbeing.

• To evaluate the effectiveness of the intervention on mental health and wellbeing of health professionals.

• To evaluate the effectiveness of the intervention on productivity and patient outcomes.

• To evaluate the cost-effectiveness of the Magnet4Europe intervention, balancing intervention costs, productivity gains from improved mental health and wellbeing, and improved patient outcomes.

• To identify barriers and enablers for the successful implementation of the Magnet4Europe model of organistional intervention in hospitals.

• To foster stakeholder buy-in for spreading and scaling to a larger set of hospitals, other health care settings, and the wider health sector throughout Europe.