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Magnet4Europe: Improving Mental Health and Wellbeing in the Health Care Workplace

Periodic Reporting for period 1 - Magnet4Europe (Magnet4Europe: Improving Mental Health and Wellbeing in the Health Care Workplace)

Reporting period: 2020-01-01 to 2020-12-31

Mental health and wellbeing are among the highest priorities of the public health agenda in the European Union (EU). Mental health conditions account for 22% of the EU’s burden of disability as measured in Years Lived with Disability, imposing a significant burden on individuals, society and the economy. The prevalence of job-related burnout and other mental health morbidities is greater in the healthcare workforce than among workers in other settings. Burnout in the healthcare workforce inherently impacts on workers’ own mental health, leading to high rates of depression, substance abuse and even suicide among physicians, but has also been associated with poorer patient outcomes, lower patient satisfaction, medical errors, reduced quality and safety and avoidable costs and inefficiencies in hospitals. Additionally, lost productivity from healthcare workforce burnout by means of absenteeism, presenteeism, turnover, premature departure from healthcare workforce combined with current recruitment challenges, further undermines already stretched and scarce healthcare resources, compounding the gap between available health services and population needs. The coronavirus disease 2019 (COVID-19) may aggravate workplace conditions that impact healthcare workers’ mental health.

Magnet4Europe aims to redesign the clinical work environment, particularly of nurses and physicians by applying the Magnet® concept and to evaluate its transferability to the European context. The Magnet concept originally derived from the American healthcare context where it has been shown to successfully improve well-being of staff including lower burnout and improved clinical outcomes. However, despite the large body of evidence, Magnet© organizational redesign initiatives have not yet taken hold in Europe. Magnet4Europe follows a multi-country, hospital-based, matched-pairs wait-list cluster randomized controlled trial (RCT), with a nested qualitative process evaluation. An innovative multi-methodological approach is applied to facilitate organizational redesign to 69 hospitals in six European countries (Belgium, Germany, Ireland, Norway, Sweden, and United Kingdom). By doing so, each hospital participates in a twinning relationship with a Magnet® recognized hospital promoting the successful implementation of the original Magnet® Recognition Manual blueprint. The intervention is complemented by annual Europe-based learning collaborative and critical mass creation maximizing network exchanges, knowledge sharing, and opportunities for feedback. The primary aim of Magnet4Europe is to evaluate the effect of organizational redesign in general acute care hospitals on nurses’ and physicians’ wellbeing that will be measured by survey among nurses and physicians. The main outcome measure is burnout measured at the individual level. The implementation of the intervention is evaluated using a nested mixed-methods process evaluation, based on focus groups and individual interviews with a selection of hospitals in the participating countries. The secondary aims are to analyze patient outcome data and the cost-effectiveness of the intervention.

Disclaimer: Intervention Hospital Magnet® is a trademark of ANCC registered in the United States of America and other jurisdictions, and is being used under license from ANCC. All rights are reserved by ANCC. ANCC’s consent to the use of the Intervention Hospital Magnet® mark shall not be construed as ANCC sponsoring, participating, or endorsing the Magnet4Europe intervention.
In year 1, all participating hospitals in Magnet4Europe (n=69) have been allocated to either the intervention group or the control group. All hospitals allocated to the immediate intervention group (i.e. Group 1) have been successfully twinned with a US Magnet hospital. All twinning activity is performed by means of virtual conferencing. Despite this virtual approach, Group 1 hospitals are actively working on completing their first GAP-analysis as originally intended in close collaboration with their twinning partner, allowing them to co-design action plans and shape the Magnet4Europe intervention within their hospital. The support of hospitals in Group 1 to implement their intervention is provided on multiple levels. The first level is that of the interactive Learning Collaboratives. In addition, country leads have organized different virtual network meetings giving hospitals the opportunity to discuss operational issues related to Magnet4Europe. The training and preparation for hospitals in relation to the Learning Collaboratives has taken place but has significantly changed due to the COVID-19 pandemic. In brief, the two-day Learning Collaborative event, where all participating hospitals, stakeholders and academic partners meet, has now been changed into the following multiple events: (1) a general Magnet4Europe kick-off event for all participating hospitals in Magnet4Europe (both European and US Magnet hospitals) followed by (2) six consecutive online interactive Learning Collaboratives (from December 2020 to May 2021) specifically designed for and only accessible to Group 1 hospitals. The Learning Collaboratives are attended by clinicians in European and US Magnet hospitals, academics, researchers and relevant stakeholders. The Learning Collaboratives are highly effective in transferring knowledge and building relationships. Attendance rates for both EU hospitals as well as US Magnet hospitals are very high.
The cost of health care is about 10.1% of GDP internationally and growing fast. Expenditure on labor is one of the major costs in health care. Moreover, health care is facing serious staff shortages now and in the near future, which is leading to health care workers becoming a scarce resource that needs to be managed. The WHO is referring to a changing narrative to describe the health workforce: 1) not a ‘cost’ but an investment; and 2) the ‘human capital’ for ‘human security’. Given the human capital dimension, it is important that work environments are designed so that health professionals can practice in line with their talents and competences. We expect that improving work environments would lead to reduced absence from work, decreased intention-to-leave and turnover. The direct impact on increasing the available capacity of staff would lead to higher productivity and more patients being treated.

By focusing our work in hospitals, we have the potential for “double-impact” whereby worker mental health can be improved and translated into better outcomes for patients. There is ample evidence that unsafe care is highly influenced by the work environment and the clinical staff. A recent EU report on the cost of unsafe care estimated that - in general - about 4–17 percent of patients experience adverse events, whereby 44–50 percent of these events are preventable. In addition, a potential “Triple Impact” was reported by the All-Party Parliamentary Group on Global Health (APPG) in 2016. The triple impact means that the focus on health care will not only improve health, support economic growth but will also contribute to gender equality as it allows all health professionals (the vast majority in all health professions are women) to work to their full potential. Developing and investing in health professionals will help empower them economically and as community leaders. Improving health and empowering women will in turn strengthen local economies.
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