Leading Change in Critical Access Hospitals: A Case Study of the Journey to Magnet®

Abstract

Nurses have been called to lead change in transforming health care systems to provide safe, high quality care. This is an especially challenging goal for nurses in rural critical access hospitals (CAHs) with limited resources. The Magnet®-designated hospital is a universal symbol for high quality nursing care and superior outcomes. Yet, little is known about how nurses, in collaboration with others, lead organizational change to achieve Magnet® standards. The purpose of this qualitative, index case study was to understand how nurses in one Midwestern 25-bed hospital led change to become the first independent CAH to achieve Magnet® designation. A case study design was used to gain a holistic understanding of how nurses at all levels of the organization individually and collectively led change. A conceptual model of leading change was developed from a concept analysis and subsequently used as the conceptual framework for the study. Twenty-seven individuals, including staff nurses, nurse managers, interprofessional care providers, nursing administrative leaders, hospital Board of Directors, and the Magnet® consultant participated in the study. Data collection included in-depth semi-structured individual interviews, focus groups, unstructured observation, documents and artifacts. Qualitative thematic analysis and the triangulation of data sources were used to analyze and interpret the data. Nine themes emerged to support a refined conceptual model of leading change: driving forces, organizational readiness, individual and collective leadership, organizational learning, operational support, fostering relationships, balance, improved performance and outcomes, and new organizational culture and values. The journey to Magnet® leads to improved nurse and patient outcomes, and a new organizational culture centered on shared governance, evidence-based practice, and higher education. Rural nurse executives may use the journey to Magnet® as a blueprint for leading change to advance CAH outcomes. Efforts should focus on: securing administrative support; strategically planning for small, incremental change; building shared governance, quality improvement, research, and education; harnessing collective power; and believing and staying committed to the purpose of improving staff and patient outcomes. This study adds to the body of organizational systems and nursing leadership knowledge through a greater understanding of the phenomenon of leading change to advance rural CAHs.