Date of Award

Spring 2020

Document Type

Open Access Dissertation


Health Services and Policy Management

First Advisor

M. Mahmud Khan


The American Nurse Credentialing Center (ANCC) introduced Magnet Recognition (MR) in the U.S.A in 1994. Magnet Recognition was adopted based on the findings of a comprehensive study (conducted in 1983) that tried to identify factors explaining high rates of nurses’ retention in 41 hospitals in the U.S.A.

The objective is to compare MHs with the hospitals not recognized as “Magnet” (non-MHs) in terms of important outcomes of the health system and to examine whether the MHs themselves vary significantly in terms of the outcomes.

All the general specialty of MHs (367 hospitals) and their matched of non-MHs (380 hospitals) in 2017 were included in the analyses. Hospital characteristics were obtained from the 2017 American Hospital Association dataset. Hospital outcome and structure measures were obtained from the Center for Medicare & Medicaid Services. Forty-five measures from seven domains of hospital quality and Overall Hospital Quality Star Ratings were used in the analysis. Descriptive statistics and regression models were used to examine the differences between MHs and non-MHs and the variability within the MHs group.

The analysis showed that MHs were significantly different from the non-MHs in terms of hospital characteristics. It was an indication that not all hospital types in the U.S.A are interested in applying for Magnet Recognition. For example, Two-third of MHs was nongovernment-not-for-profit while 50% of the non-MHs were governmentnonfederal and investor. After matching the non-MHs to the MHs, the analyses

confirmed that Magnet Recognition significantly improved three out of seven outcomes domains: “mortality, readmission, and patient experience.” Within the group of MHs analyses, the results indicate significant variability among MHs. For example, the coefficient of variation of seven domain scores varied from 7.4% to 16%. The “overall hospital quality star ratings” also varied among MHs with 3.54%, 24.2%, and 20.7% in 1- star, 3-star, and 5-star categories, respectively. The variability of star rating among MHs was explained by hospital characteristics.

Our analysis found that it is possible that the flexibility of Magnet Recognition requirements, such as giving hospitals the option to choose national benchmark(s) to compete with for the required empirical-outcomes, may have created significant variability.


© 2020, Abdulmalik Alhammad