Periodic Reporting for period 4 - Magnet4Europe (Magnet4Europe: Improving Mental Health and Wellbeing in the Health Care Workplace)
Reporting period: 2024-01-01 to 2024-06-30
Health workers experience greater levels of job-related burnout and other mental health disorders than those in other sectors.
Burnout in the healthcare workforce impacts those experiencing it, but is also associated with worse patient outcomes and reduced efficiency of hospitals.
The resulting lost productivity, combined with current recruitment challenges, threatens the already overstretched health workforce, widening the gap between provision of health services and population needs.
This situation has been exacerbated by the COVID-19 pandemic.
Effective, affordable and sustainable interventions to improve health professionals’ mental health and wellbeing are essential to interrupt the vicious cycle of high burnout, worsening mental health, lost productivity and unsafe care.
There is substantial research pointing to organisational redesign as a promising approach.
The finding that the causes underlying burnout in nurses and physicians are similar and are rooted within the work environment provides a compelling rationale for prioritising the redesign of hospital environments to address this issue.
The overall objective of Magnet4Europe is to evaluate the effectiveness of organisational redesign of acute care hospitals, guided by the Magnet® blueprint of organisational redesign, on nurses’ and physicians’ wellbeing using a multicomponent and innovative implementation strategy.
Conclusion action
We demonstrated that organisational redesign in acute care hospitals in Europe using the Magnet model of organisation redesign is feasible.
o Comparing the change in organisational design before and after the intervention, using the GAP-analysis tool, we showed that implementation of the magnet model varied from 20% up to 90%, with an average implementation of 50% on the level of the hospital. Main progress was seen on transformation
leadership, exemplary professional practice, adapting new knowledge and innovations, organisational overview and structural empowerment. Less progress has been seen on the level of providing and using empirical outcomes to guide practice.
o Significant improvements in nurse wellbeing (burn-out, intention-to-leave, job satisfaction) and staff perceptions on patient safety and quality of care are seen in hospitals with high improvements in gap items completed (as a proxy for the extent of implementation of the intervention).
o Based on the current findings, we estimate that, when all Magnet4Europe hospitals would reach at least 80% implementation of the Magnet Blueprint, it would lead to significant and major reductions in the percentage of nurses with high burnout, intention-to-leave and job dissatisfaction.
Burnout in the healthcare workforce impacts those experiencing it, but is also associated with worse patient outcomes and reduced efficiency of hospitals.
The resulting lost productivity, combined with current recruitment challenges, threatens the already overstretched health workforce, widening the gap between provision of health services and population needs.
This situation has been exacerbated by the COVID-19 pandemic.
Effective, affordable and sustainable interventions to improve health professionals’ mental health and wellbeing are essential to interrupt the vicious cycle of high burnout, worsening mental health, lost productivity and unsafe care.
There is substantial research pointing to organisational redesign as a promising approach.
The finding that the causes underlying burnout in nurses and physicians are similar and are rooted within the work environment provides a compelling rationale for prioritising the redesign of hospital environments to address this issue.
The overall objective of Magnet4Europe is to evaluate the effectiveness of organisational redesign of acute care hospitals, guided by the Magnet® blueprint of organisational redesign, on nurses’ and physicians’ wellbeing using a multicomponent and innovative implementation strategy.
Conclusion action
We demonstrated that organisational redesign in acute care hospitals in Europe using the Magnet model of organisation redesign is feasible.
o Comparing the change in organisational design before and after the intervention, using the GAP-analysis tool, we showed that implementation of the magnet model varied from 20% up to 90%, with an average implementation of 50% on the level of the hospital. Main progress was seen on transformation
leadership, exemplary professional practice, adapting new knowledge and innovations, organisational overview and structural empowerment. Less progress has been seen on the level of providing and using empirical outcomes to guide practice.
o Significant improvements in nurse wellbeing (burn-out, intention-to-leave, job satisfaction) and staff perceptions on patient safety and quality of care are seen in hospitals with high improvements in gap items completed (as a proxy for the extent of implementation of the intervention).
o Based on the current findings, we estimate that, when all Magnet4Europe hospitals would reach at least 80% implementation of the Magnet Blueprint, it would lead to significant and major reductions in the percentage of nurses with high burnout, intention-to-leave and job dissatisfaction.
Specific activities in the first six months involved 1) recruitment hospitals, 2) preparation ethics applications 3) development of scientific study protocol, and 4) the establishment of an effective project management structure. A 2-days kick-off meeting was held, attended by all consortium members.
Hospitals were allocated to either the intervention group or the control group. All European hospitals allocated to the immediate intervention group (i.e. Group 1) were successfully twinned with a US Magnet hospital.
After the international Magnet4Europe Launch Event in October 2020, all hospitals (EU and US) received the administrative contact details of their twinning partner from their country PI. Group 1 hospitals received the intervention related materials.
At month 18, all Group 1 hospitals in Europe have successfully started the Magnet4Europe intervention together with their US Magnet twin partner.
Within RP2 the consortium focused on 1) collection of quantitative and qualitative data (WP3 & WP4) and 2) the intervention (WP2).
Country teams started the preparation for the process evaluation, i.e. the assessment of change commitment using the ORIC questionnaire (M18 (Group 1) and M26 (Group 2)).
The second activity was conducting semi-structured interviews between M23 and M25. In the second half of RP2, preparations for the second staff survey took place (T1), launched in M29.
Hospitals submitted their completed Gap Analysis (Group 1 in M18 and Group 2 in M24) and started to develop their action plans. A particular highlight in RP2 was the first in-person Learning Collaborative in M29 which brought together participants from the twinned hospitals across the US and Europe.
Within RP3, the consortium focused on 1) continuing and finalizing the collection of quantitative and qualitative data, 2) the intervention and 3) focusing and working on the topics around sustainability, transferability, and dissemination. The consortium and country teams worked on joint publication resulting in a first cross-country publication in the open access journal BMJ Open. A highlight was the second in-person Learning Collaborative in Oslo (Norway) which brought together nearly 200 participants from the twinned hospitals across the US and Europe, as well as the Magnet4Europe research teams.
Within RP4 all available data was processed to evaluate the effect of the Magnet4Europe intervention as comprehensively as possible. Dissemination of these results to a wider audience and also translating those findings into a policy brief and policy recommendations was the second priority. During the closing conference in Leuven we were able to disseminate the results to a wide audience (300+). Policy makers from across Europe (from WHO, OECD, European Observatory and EUHA) were brought together to have a policy dialogue.
Hospitals were allocated to either the intervention group or the control group. All European hospitals allocated to the immediate intervention group (i.e. Group 1) were successfully twinned with a US Magnet hospital.
After the international Magnet4Europe Launch Event in October 2020, all hospitals (EU and US) received the administrative contact details of their twinning partner from their country PI. Group 1 hospitals received the intervention related materials.
At month 18, all Group 1 hospitals in Europe have successfully started the Magnet4Europe intervention together with their US Magnet twin partner.
Within RP2 the consortium focused on 1) collection of quantitative and qualitative data (WP3 & WP4) and 2) the intervention (WP2).
Country teams started the preparation for the process evaluation, i.e. the assessment of change commitment using the ORIC questionnaire (M18 (Group 1) and M26 (Group 2)).
The second activity was conducting semi-structured interviews between M23 and M25. In the second half of RP2, preparations for the second staff survey took place (T1), launched in M29.
Hospitals submitted their completed Gap Analysis (Group 1 in M18 and Group 2 in M24) and started to develop their action plans. A particular highlight in RP2 was the first in-person Learning Collaborative in M29 which brought together participants from the twinned hospitals across the US and Europe.
Within RP3, the consortium focused on 1) continuing and finalizing the collection of quantitative and qualitative data, 2) the intervention and 3) focusing and working on the topics around sustainability, transferability, and dissemination. The consortium and country teams worked on joint publication resulting in a first cross-country publication in the open access journal BMJ Open. A highlight was the second in-person Learning Collaborative in Oslo (Norway) which brought together nearly 200 participants from the twinned hospitals across the US and Europe, as well as the Magnet4Europe research teams.
Within RP4 all available data was processed to evaluate the effect of the Magnet4Europe intervention as comprehensively as possible. Dissemination of these results to a wider audience and also translating those findings into a policy brief and policy recommendations was the second priority. During the closing conference in Leuven we were able to disseminate the results to a wide audience (300+). Policy makers from across Europe (from WHO, OECD, European Observatory and EUHA) were brought together to have a policy dialogue.
The challenges of nurse retention in Europe are complex and multifaceted, involving personal, organizational, and societal factors. The COVID-19 pandemic has exacerbated existing challenges, highlighting the need for resilient health systems that prioritise retention. Many nurses have reassessed their professional goals and work-life balance and left the workforce. This study highlights the need for comprehensive strategies to address the critical issues at hand, improving burnout and wellbeing to increase retention, highlighting that while there is no single solution, targeted, evidence-based interventions can help to mitigate the crisis.The first priority is to take retention seriously. Too many responses to the health workforce crisis focus on training new staff. Yet unless those in post can be encouraged to stay, this is like pouring water into a bucket that has a hole in it. The second is to focus on the organisation. The best functioning health organisations have shown that they can attract and retain nurses and the Magnet principles offer guidance as to what is needed. This includes sustained efforts to improve the conditions in which nurses work and to provide them with the rewards that are commensurate with their training and skills. It also includes ensuring that nurses are adequately supported, working in teams that have enough staff. This study shows that the short term fix of creating new occupational groups as substitutes for nurses is not a solution and is seen by many health providers as dangerous. Then, the nursing workforce is ageing. A health system designed for nurses in their 20s and 30s will struggle to adapt to those who are now in their 60s. And none of this will be fixed without strong and effective nursing leadership.