Badges of Honor

When Le Bonheur celebrated the hard-earned honor of achieving ANCC Magnet designation this spring, they reveled in more than just a badge they could hang on the wall.

The real win for Le Bonheur and its families: increased use of evidence-based practices, more highly trained and educated nurses and a more deliberate approach to quality improvement that improved outcomes for patients. Leaders say the designation was proof of a cultural shift that has permeated across physician faculty and clinical staff in the past several years – proof that this once community children’s hospital is set on becoming a regional and national leader in pediatric care.

In the past seven years, Le Bonheur has added more than one badge to its hallways. It has been named a Best Children’s Hospital by U.S. News & World Report for six consecutive years, ranked in seven specialties for 2016-2017.

Last year, the hospital was re-designated as the region’s only American College of Surgeons Level 1 Pediatric Trauma Center. And this past spring, the American Nursing Credentialing Center designated Le Bonheur a Magnet hospital – a designation only 7 percent of hospitals in the country hold.

 “We use these processes as a way to improve the care we offer children,” said hospital President and CEO Meri Armour. “It is our responsibility as health experts to give our children every opportunity to grow up healthy and strong. We are committed to excellent clinical care, investigating the causes of our region’s most pressing health problems and teaching the next generation of health professionals.”

A Best Practice

Chief Nursing Officer Nikki Polis, PhD, RN, says the hospital’s Magnet designation is an “ultimate credential for high-quality care” that families rely on. More than that, it is proof the staff is committed to a higher level of care.

“The steps we have taken on our Magnet journey have pushed us to be even better versions of ourselves,” she said.

Nursing Administrative Director Paula Dycus, DNP, RN, CPHQ, NEA-BC, can churn off a list of improvements that hospital staff has made as a result of the Magnet process: improved safety measures like lower Catheter-Associated Urinary Tract Infection and Central Line-Associated Bloodstream Infection rates, as well as decreasing device-related injuries in critical care units.

The level of nursing education and national board certification rates – along with nursing satisfaction -- has also dramatically increased in the past six years, along result of the push to become a Magnet-certified facility.

“Nurses are using evidence-based practice to improve patient outcomes and the nurse work environment,” Dycus said.

Le Bonheur Quality Director Donna Vickery also believes that work toward national designations created higher engagement related to quality among nurses.

“We already had strong quality initiatives, but this added more awareness for front-line nurses of what they do – and how it is related to quality,” Vickery said.

Similarly, in Le Bonheur’s Heart Institute, registration in a handful of national quality and safety collaboratives – like The Society of Thoracic Surgeons and Children’s Hospitals’ Solutions for Patient Safety National Children’s Network (a hospital-wide initiative) – has helped clinicians benchmark themselves against other hospitals and join a larger discussion about making pediatric medicine safer.

The Heart Institute is also active in specific collaboratives that study conditions like Hypoplastic Left Heart Syndrome or even cardiac intensive care medicine. Membership in registries and collaboratives like these have helped establish practices that Le Bonheur didn’t have before, leaders say.

A push to raise the game in the hospital’s trauma care has also had unexpected benefits, said Trey Eubanks, MD, medical director of Trauma Services and surgeon in chief at Le Bonheur. In 2011, Le Bonheur began pursued and later obtained American College of Surgeons (ACS) Level 1 Pediatric Trauma Verification.

“Not only did it set up on par with every other pediatric trauma center, it made us raise our game,” Eubanks said.

Today, thanks to the pursuit of the ACS designation, anesthesiology is in house 24/7 and the Emergency Department and operating rooms have specialized refrigerators that provide immediate access to blood products. Efforts are better coordinated throughout the hospital from the moment the patient arrives in the ED, to CT scan, to OR, to inpatient room.

Outside the hospital, Le Bonheur educators work with 28 adult facilities in the region to provide mock codes, following up with training after a patient has been transferred – and serving as a 24-hour resource to that adult facility.

Culture Shift

Hospital CEO and President Armour says that since the hospital’s first national U.S. News ranking six years as a “Best Children’s Hospital” hospital employees are prouder and sense the they are doing something extraordinarily different and important.

As a result of the Magnet journey, nurses have adopted a shared governance culture among themselves and are much more involved about decisions involving their work. In turn, nurse satisfaction is dramatically higher, Dycus said.

The clout of staying on the list has also helped all Le Bonheur clinical and physician leaders recruit and retain top talent. In the past six years, Le Bonheur has recruited more than 100 new physicians – including a pediatrician-in-chief who also serves as the chair of the Department of Pediatrics at the University of Tennessee Health Science Center and sought-after experts in fields like pediatric heart failure, pediatric cardiovascular surgery, tuberous sclerosis and pediatric obesity medicine.

Heart Institute Executive Co-Director Jeffrey Towbin, MD, joined Le Bonheur in 2015 because he wanted to help build “nationally recognized destination program with world-class expertise,” he said. He saw the chance to expand his growing field and develop new areas of care – based on a foundation that had already been established.

The ability to recruit and keep talent – both among physicians and clinical staff, is just another benefit to the badges on the wall.