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Magnetic Hospital, Excellent Hospital

Sergio R. López Alonso
Ldo. Enfermería. Master en Salud Pública y Gestión Sanitaria. Coordinación Regional de Desarrollo e Innovación en Cuidados. Dirección General de Asistencia Sanitaria. Servicio Andaluz de Salud, Sevilla, Spain

Index de Enfermería [Index Enferm] 2004; 44-45: 7-8 (original version in Spanish, printed issue)








How to cite this document



López Alonso SR. Magnetic Hospital, Excellent Hospital. Index de Enfermería [Index Enferm] (digital edition) 2004; 44-45. In </index-enfermeria/44revista/44e7-8.php> Consulted









     The programs of certification for the health institutions involve a warranty of excellence not only in terms of professional satisfaction but also in terms of quality of the health cares. At the moment, an increasing number of researches that link the high rate of absenteeism from work to the syndrome of "the burnout" among the Spanish nurses1,2 exist, being the hospital the predominant environment. Such a high rate of absenteeism points to be a determinant answer faced with the work dissatisfaction.  This phenomenon, particularly the work dissatisfaction in this professional area, is reproduced accurately in the rest of the countries of the world as it can be EEUU, United Kingdom, France, Italy or Portugal. Nevertheless the answer to this dissatisfaction is very different as it is characterized by a high index of staff turnovers among the health institutions, and a high index of professional desertions that produces an alarming shortage of human resources in those countries4.  Therefore it would be interesting to find out the possible solutions that those countries have developed to face this problem. Such solutions should at the same time be compatible with a policy of excellence and total quality in the health services.
     Most of the European countries have chosen to incorporate nurses coming from developing countries such as The Philippines, Pakistan or India, and from other occidental countries among which Spain is found. This solution demands a double reconsideration.  From one side, an ethical dilemma appears when thinking about the consequences of subtracting qualified human resources from countries where those resources are the most needed ones for their own national development. On the other side, we find Spain. Our country appears as an atypical one in the European context.  Even if in the year 2000 Spain had 372 nurses per each one hundred thousand inhabitants while the European average was 755, the policy practiced was to train professionals for other countries to enjoy their services
6. On the other hand, EEUU, a place where the shortage of professionals is not a new issue, faces the difficulty for attracting nurses coming from other countries by developing formulas that make the profession attractive. Among those, it must be underlined the effort made by the managers to achieve the certification of  "Magnetic Hospital" by means of the program elaborated by the American Nurses Credentialing Center7.
     But, what is that issue of the "Magnetic Hospital"? This question has a difficult answer without mentioning its origin. Well, as early as in the 70's the EE.UU suffered from a big shortage of nurses that came to reach the 14% in some of its member states according to a report elaborated by the Department of Health and Human Services in 1.981
1.  In the face of such a discouraging circumstance, the same year of the report publication the American Academy of Nursery elaborated a study on a nationwide basis whose aim was to analyze all the organizational characteristics that made the nursing practice easy or difficult in those hospitals where there was not vacancies without covering9. That was the way the term "Magnetic Hospital " was born.
     The criteria followed to select the hospitals subjected to analysis as good places to work, were three:  a hospital with a low rate of rotations towards other institutions and vacancies without covering, a hospital introduced in a competitive market, and a hospital fulfilling the condition of not being the only source of employment for the nurses of the area10. The characteristics examined in these hospitals were the personal and professional satisfaction, the status, the role of the nurse in the quality of the care for the patient, the ratio nurse-patient, the recruitment and maintenance of the nurses, the relationship doctor-nurse, the decentralization of the decision-making, the clinical leadership, the autonomy and responsibility in the care for the patient, and the flexibility in the timetables, among others
     The research alluded, therefore, to environments favouring the practical implementation of the knowledge and clinical experience of the nurses. At first, as it was mentioned before, such qualities were related to work satisfaction, being it also reflected in the rate of rotation and abandonment
12. Afterwards and until now, the research line centred in the work satisfaction started to shift towards the linking between organizational features and clinical results, looking for the excellence in the cares. It is not surprising that the conclusions of these surveys pointed out rates of death up to a 4,6% lower13, a lower rate of death 30 days after the admission, a higher patient satisfaction about the nursery cares14,15, and even a more secure environment in terms of work accidents16 in these hospitals. Everything exposed until now seems to indicate that the philosopher's stone for the organization of the health services has been found. An evidence of this is the fact that this program of certification for the excellence in the quality of the cares is able to supply empirical evidences of its effectiveness. In this way, at the present time they already exist 196 organizations certified, one of which, recently incorporated, is located in the United Kingdom.
     This model of magnetic hospital is being object of attentions in different disciplines such as medicine of work, social health services, psychology, nursery and management among others. Besides, this attention is not exclusive of the EE.UU.  On the contrary, it is gradually expanding worldwide. A clear example would be the magnetic hospital located in the United Kingdom. Nevertheless, the impact of this model has not only taken on in the Anglo-Saxon world. It is also reflected already in a certain number of Spanish publications: Aiken & Mullin
17, Marcos18, Havens et al19, and even in PhD thesis like the one of Manzano García2.
     There is no doubt that the achievement of changes inside such a big and complex system, as it is the National Health System, requires a lot of work and effort coming from the health policies and the management of the health services. It would demand the fulfilment of minimum but radical changes assuming all the responsibility concerning them. It would be necessary to bind the strategies of intervention basing them on an organizational model that could guarantee the achievement of a unique aim: the excellence. This guarantee of excellence is marked by the best knowledge available nowadays, in its case a model of magnetic hospital, being this equivalent to say a model of excellent hospital.


1. Atance Martínez JC. Aspectos epidemiológicos del síndrome de Burnout en personal sanitario. Revista Española de Salud Pública. 1997. 71(3):293-303.
2. Manzano García G. Estrés en personal de enfermería. Universidad de Deusto. 1997. Tesis doctoral sin publicar.
3. Carrillo de Albornoz G. Análisis comparativo del absentismo entre la asistencia especializada (hospitalaria) y la asistencia primaria, para la misma área asistencial. Enferm Integral. 1997. 41: 28-31.
4. World Health Organization. Country profiles. 2001. www.who.org. [Visitada el 01-03-2003].
5. World Health Organization. Health For All Database. 2000. www.who.org. [Visitada el 01-03-2003].
6. Consejo General de Enfermería. El Consejo General de Enfermería impulsa una guía europea para la contratación de enfermeras. 24 de noviembre de 2000. www.ocenf.org [Visitada el 01-03-2003].
7. American Center Credentialing Center. http://www.nursingworld.org/ancc/ index.htm. [Visitada el 01-03-2003].
8. U. S. Department of Health and Human Services. The recurrent shortage of registered nurses: A new look at the issues. Rockville, MD: Author. 1981.
9. McClure M, Poulin M, Sovie M, Wandelt M. Magnet Hospitals: Attraction Retention of Professional Nurses. Kansas City: American Academy of Nursing. 1983.
10. Bucham J. Still attractive alter all these years? Magnet hospitals in a changing health care environment. Journal of Advanced Nursing. 1999. 30(1): 100-108.
11. Lake ET. Development of the Practice Environment Scale of the Nursing Work Index. Research in Nursing & Health. 2002. 25: 176-188.
12. Kramer M, Hafner LP. Shared values: impact on staff nurse job satisfaction and perceived productivity. Nursing Research. 1989. 38(3): 172-177.
13. Aiken LH, Smith H, Lake E. Lower Medicare mortality among a set of hospital known for good nursing care. Medical Care. 1994. 32(8): 771-787.
14. Aiken LH, Sloane D, Lake ET, Sochalski J &Weber AL. Organization and outcomes of inpatient AIDS care. Medical Care. 1999. 37(8): 760-772.
15. Aiken LH, Sloane D, Lake ET. Satisfaction with inpatient acquired immunodeficiency syndrome care: A national comparison of dedicated and scattered-bed units. Medical Care. 1997. 35(9): 948-962.
16. Aiken LH, Sloane D, Klocinski J. Hospital nurses risk of occupational exposure to blood: Prospective, retrospective, and institutional reports. American Journal of Public Health. 1997.87: 103-107.
17. Aiken LH, Mullin M. Hospitales con magnetismo: un modelo de organización para mejorar los resultados de los pacientes.  Enfermería Clínica. 1995. 5(6): 259-62.
18. Marcos MM. Are hospitals changing? Revista de Enfermería. 1997. 20(230): 59-61.
19. Havens DS, Labov TG, Faura T, Aiken LH. The clinical environment of hospital nursing. Enfermería Clínica. 2002. 12(1):13-21.





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