Shared Governance FAQ
Shared governance is a leadership model used to promote empowerment of those closest to the work, shared leadership, and accountability. Developing shared governance gives those at the point of care or service a voice to become more involved in the decision-making process.
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Shared governance is not leaders asking for input on decisions while leaders retain the decision-making authority. Rather, leaders partner with councils or teams to share guardrails for determining solutions to issues that impact their work. It aims to distribute power and authority more evenly and create a sense of ownership and accountability among all participants.
Shared governance in healthcare and governing boards in colleges and universities share some similarities in terms of their collaborative decision-making processes. However, there are also significant differences in their objectives, stakeholders involved, and decision-making structures.
In healthcare organizations, shared governance aims to improve patient care, enhance the quality and safety of healthcare services, and empower healthcare professionals to have a voice in decision-making. It focuses on clinical and operational matters, such as developing and implementing policies and procedures, quality improvement initiatives, and interdisciplinary collaboration. The focus is on engaging frontline staff and clinicians who directly provide patient care.
Governing boards in higher education institutions have a broader scope of responsibilities and often consist of external individuals who bring diverse expertise and perspectives, such as business leaders, community representatives, alumni, and sometimes faculty or student representatives.
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They are responsible for overseeing the strategic direction of the institution, ensuring its financial sustainability, and safeguarding its mission and values.They address issues related to academic programs, faculty appointments and promotions, financial management, campus infrastructure, and long-term planning.
While both healthcare organizations and colleges/universities aim to involve stakeholders in decision-making, the context and specific objectives of shared governance and governing boards differ significantly. Governing boards in higher education institutions have a hierarchical decision-making structure. They have ultimate decision-making authority and set policies and strategic directions for the institution. Where shared governance in healthcare organizations involves decentralized decision-making structures, where various councils are formed to address specific clinical or operational areas.
Organizations who practice shared governance recognize that nurses have valuable insights and expertise gained from their direct patient care experience. Involving nurses in decision-making leads to better outcomes for patients, improves job satisfaction among nurses, and promotes a culture of continuous quality improvement.
Shared governance is not nurse leaders and managers asking for input on decisions while they retain their decision-making authority. It is nurse leaders partnering with councils and giving them guardrails for determining solutions to issues that impact direct care employees and the services that they provide. This is an important approach to enhance the quality of nursing practice and ultimately improve the overall delivery of patient care.
Shared governance empowers nurses by giving council members autonomy or accountability to take action and share in the decision-making process within the organization. It allows those closest to the issues of caring for patients the autonomy to share their ground level knowledge and make changes to how they perform their daily work.
Shared governance is a venue for clinical nurses to be at the table, along with management/organizational leaders and interprofessional partners to contribute ideas and participate in decisions affecting their practice. This process allows point of service decision making and is built on a strong collaboration between clinical nurses, those supporting clinical nurses, and others providing care/contact with the patient.
In hospitals, shared governance plays a crucial role in fostering collaboration, improving patient care outcomes, and creating a positive work environment. Shared governance promotes collaboration, enhances patient care, improves staff engagement and job satisfaction, supports professional development, encourages interdisciplinary collaboration, and fosters a culture of continuous improvement and innovation. It contributes to the overall effectiveness, quality, and patient-centeredness of care provided in hospitals.
Shared governance can be implemented at various levels within health care facilities, from unit-specific practices to organization-wide initiatives, with the goal of engaging healthcare professionals in decision-making and promoting a culture of collaboration, ownership, and continuous improvement.
Administrators ensure that shared governance aligns with the strategic goals and objectives of the healthcare organization, and they allocate budgetary resources for educational opportunities, professional development, research, and quality improvement initiatives. Administrators also ensure that staff members have protected time to participate in shared governance activities without compromising their workload. This support helps to create a culture of collaboration, engagement, and continuous improvement, ultimately leading to improved patient care outcomes and a positive work environment.
The team’s voice needs to be heard because they have first hand experience. They have a deep understanding of the challenges, opportunities, and complexities of their work environment. By hearing the team’s voice, shared governance can tap into this expertise and ensure that decisions are grounded in the realities of clinical practice.
When team members have a voice in decision-making, they develop a sense of ownership and accountability and they are more likely to be invested in the implementation and outcomes. Having a voice in decision making also increases engagement and job satisfaction. By valuing and incorporating the team’s voice, shared governance can effectively address challenges, optimize care delivery, and ultimately benefit both the healthcare team and the patients they serve.
Shared governance recognizes the value of involving multiple stakeholders in decision-making to leverage diverse perspectives, empower employees, improve outcomes, foster trust and transparency, and promote continuous improvement. By not relying solely on administration for decision-making, shared governance harnesses the collective wisdom and engagement of the entire healthcare team, leading to more effective decision-making processes.
Evidence-based practices in shared governance refer to the use of research evidence, best practices, and quality improvement data to inform decision-making, policy development, and practice improvements within the shared governance framework. By incorporating evidence-based practices, shared governance ensures that decision-making and policy development are rooted in reliable and relevant evidence. It promotes the use of research, best practices, quality improvement data, and benchmarking to drive informed decision-making, improve patient care outcomes, and enhance organizational performance. Evidence-based practices in shared governance contribute to the delivery of high-quality, patient-centered care within healthcare organizations.
The pitfalls of not practicing shared governance include decreased staff engagement and empowerment, limited perspectives and expertise, reduced innovation and creativity, inefficient decision-making, lack of ownership and accountability, missed opportunities for quality improvement, and decreased staff retention and satisfaction. Implementing shared governance can help mitigate these pitfalls and create a more collaborative, patient-centered, and effective healthcare environment.
Structural empowerment is one of five Magnet model components, and organizations applying need to provide evidence that shared decision making is enculturated in the organization. Foundational organizational documents must address nurses’ involvement in shared decision making at the unit and at the organizational level.
As a principle of shared governance, nurses must participate in decision making concerning practice, the practice environment, and opportunities for improvement. Shared governance is a venue for clinical nurses to be at the table, along with management/organizational leaders and interprofessional partners to contribute ideas and participate in decisions affecting their practice. This process allows point of service decision making and is built on a strong collaboration between clinical nurses, those supporting clinical nurses, and others providing care/contact with the patient.
In a journey to excellence, shared governance addresses the professional practice tenet of control of the work environment. Shared governance is an essential step on the journey to staff empowerment, ownership of practice and important for all organizations as they pursue excellence as externally measured by receipt of Pathway to Excellence® designation.
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Shared decision making is one of the six standards of the Pathway to Excellence framework.The principles of shared decision-making and nurse engagement align with the goals of the program, and many organizations pursuing Pathway designation incorporate shared governance as a means to support nursing excellence and create a positive work environment.
Shared governance is essential for all organizations that are concerned with providing optimal care for patients, families, and health care providers. It provides a venue for those providing care to have a voice to make decisions regarding the care. Those closest to the care often are able to outline what will work, how to make it work, and are more engaged in the processes. Shared governance is a way for clinical staff and leadership to discuss issues that ultimately can improve patient care, and workplace outcomes.
Shared governance is not a “thing” organizations do. It is a method of empowering staff, and when fully embraced, a deep, unstoppable culture and way of being is developed. Shared governance improves nurse satisfaction by empowering nurses, providing opportunities for professional growth, creating a positive work environment, increasing engagement and motivation, offering recognition and appreciation, and supporting work-life balance. By involving nurses in decision-making processes and valuing their contributions, shared governance enhances nurse satisfaction and contributes to a positive and fulfilling work experience.
Not if shared governance council members have dedicated, protected time to attend council meetings. If council members are struggling to juggle council attendance and patient care responsibilities, it will likely discourage others from participating. Council members should also be paid for their time spent in council meetings.
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This additional involvement may seem like it adds more work to a bedside nurse. However, it’s important to note that shared governance is designed to empower nurses and improve their work environment, rather than overwhelm them with additional tasks. With effective time management, support, skill development, and alignment with professional goals, shared governance can enhance job satisfaction and contribute to the professional growth of bedside nurses.
The time required to implement shared governance in a healthcare organization can vary depending on several factors, including the size of the organization, its existing structures and processes, the level of staff engagement, and the organization’s readiness for change. Implementing shared governance is not a one-time improvement project or a one-size fits all program. It needs to be addressed and improved continually. It is important to recognize that shared governance is a cultural shift rather than a quick fix, and it can take time to fully establish and integrate into the organization.
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The timeline for implementing shared governance can range from several months to a few years and can vary based on the organization’s unique circumstances. It requires strong leadership support, staff engagement, and a commitment to ongoing learning and adaptation. A gradual and phased approach to implementation is often recommended to allow for learning, adjustments, and the cultivation of a supportive culture. Overall, the implementation of shared governance is a journey rather than a specific timeframe.
Shared governance can play a valuable role in succession planning within healthcare organizations. Succession planning involves identifying and developing future leaders to ensure continuity and smooth transitions in leadership positions. Being a shared governance council chair is an excellent way to develop professionally. Many organizations look to their shared governance chairs when leadership positions become available. This helps with succession planning because the skills needed in management (leading meetings, dealing with differing opinions, addressing changes in practice) have been practiced and developed by the chairperson.
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By integrating shared governance into the organizational culture, health care organizations can build a pipeline of capable leaders who are prepared to take on future leadership roles, ensuring continuity and effective leadership transitions. Shared governance has also been proven to improve with employee retention.
By involving firstline staff in policy development, review, and adherence, shared governance helps ensure that policies and procedures reflect the needs and realities of the clinical practice setting. This involvement contributes to a sense of ownership, accountability, and commitment to delivering high-quality care in accordance with established policies and procedures.
A shared governance council is a formal group or committee that serves as a platform for staff members to participate in decision-making processes, collaborate, and contribute to the functioning of the health care organization. The council represents the collective voice of the staff and plays a vital role in shaping policies, improving patient care, and promoting a positive work environment.
No, not all nurses are necessarily members of a shared governance council in every healthcare organization. The specific composition and structure of shared governance councils can vary depending on the organization’s size, structure, and the scope of shared governance implementation. While shared governance often includes nurses as key stakeholders, the composition of the council may also include representatives from other disciplines and departments.
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The selection process for council membership can vary. It may involve nominations, elections, or appointment by leadership or unit managers. The specific criteria for council membership can be based on factors such as experience, expertise, interest, and willingness to actively participate in shared governance activities.
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It’s important to note that even if a nurse is not a direct member of a shared governance council, they can still participate and contribute to the shared governance process through other channels. This can include attending council meetings as observers, providing input and feedback during open forums or staff meetings, or actively engaging with council members to share their perspectives and ideas.
Shared governance brings healthcare providers together by fostering collaboration, shared decision-making, communication, team building, and alignment of goals, shared governance strengthens unity and fosters a culture of teamwork in healthcare organizations. This unity enhances patient care, promotes a positive work environment, and improves overall organizational performance.
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The selection process for council membership can vary. It may involve nominations, elections, or appointment by leadership or unit managers. The specific criteria for council membership can be based on factors such as experience, expertise, interest, and willingness to actively participate in shared governance activities.
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It’s important to note that even if a nurse is not a direct member of a shared governance council, they can still participate and contribute to the shared governance process through other channels. This can include attending council meetings as observers, providing input and feedback during open forums or staff meetings, or actively engaging with council members to share their perspectives and ideas.
An interprofessional shared governance structure is a framework that brings together healthcare professionals from different disciplines to collectively participate in decision-making and contribute to the functioning of a healthcare organization. In an interprofessional shared governance model, the focus is on collaboration and engagement among professionals from various healthcare disciplines, such as nursing, medicine, pharmacy, allied health, and others. The aim is to create a unified approach to decision-making, quality improvement, and patient care that reflects the expertise and perspectives of all involved disciplines. This structure facilitates a unified and collaborative approach to healthcare delivery, ultimately benefiting both healthcare professionals and patients.
Determining whether a nursing-specific shared governance structure or an interprofessional shared governance structure is best for a hospital depends on various factors, including the organization’s goals, culture, resources, and the needs of the healthcare professionals and patients. Ultimately, there is no one-size-fits-all answer. Some hospitals may find that a nursing-specific shared governance structure best meets their needs, while others may benefit from an interprofessional shared governance model. In some cases, a hybrid approach can be adopted, where nursing-specific and interprofessional structures coexist, with overlapping representation and collaboration between the two. The key is to align the chosen shared governance structure with the organization’s goals, culture, and commitment to interdisciplinary collaboration and patient-centered care.
These core principles of shared governance in nursing are:
Partnership: Shared governance is built on the principle of partnership, recognizing that nurses, as frontline caregivers, have valuable insights and expertise that can contribute to decision-making processes.
Collaboration and teamwork: Shared governance encourages collaboration and teamwork among nurses and other healthcare professionals. It promotes an environment where interdisciplinary communication and cooperation are fostered to improve patient care outcomes, enhance professional development, and address operational issues.
Accountability and autonomy: Shared governance emphasizes accountability and autonomy. It acknowledges that nurses are accountable for their professional practice and have the autonomy to make decisions related to patient care within their scope of practice. It supports nurses in having control over their practice and participating in decision-making processes that affect their work environment.
Evidence-based practice: Shared governance encourages nurses to utilize the best available evidence, along with their clinical expertise and patient preferences, to make informed decisions regarding patient care and nursing practice.
Professional development and empowerment: Shared governance supports ongoing education, training, and mentorship programs that empower nurses to take an active role in decision-making, quality improvement initiatives, and professional growth.
Continuous quality improvement: Shared governance promotes a culture of continuous quality improvement in nursing practice. It supports the implementation of evidence-based guidelines and fosters a culture of innovation and continuous learning.
Open communication and transparency: Shared governance emphasizes open communication and transparency among nurses, nursing leadership, and other stakeholders. It encourages an environment where all individuals feel comfortable expressing their ideas, concerns, and suggestions. It promotes transparent decision-making processes, information sharing, and effective communication channels to facilitate collaboration and trust.
Throughout its history, shared governance has undergone refinements and adaptations to suit the specific needs and contexts of different healthcare organizations. The focus has shifted from mere participation to creating meaningful structures and processes that enable healthcare professionals to actively contribute to decision-making, quality improvement, and patient-centered care.
Shared governance in healthcare is important because it promotes a collaborative, inclusive, and patient-centered approach to decision-making and care delivery. It enhances the work environment, improves patient outcomes, and contributes to the overall effectiveness and quality of healthcare organizations.
Various types of shared governance councils can be established to address different aspects of decision-making, collaboration, and quality improvement. The specific councils implemented may vary based on the hospital’s goals, organizational structure, and areas of focus. Some common types of shared governance councils are unit-based, clinical practice, quality improvement, education or professional development, research and evidence-based practice, and advisory councils.
Shared governance in hospital settings promotes collaboration, engagement, and a patient-centered approach to decision-making and care delivery. It improves the work environment, patient outcomes, and the overall effectiveness and quality of organizations.
Implementing shared governance in nursing is important as it empowers nurses, promotes collaboration and interdisciplinary teamwork, enhances the quality of care, and improves staff satisfaction and retention. It fosters a culture of excellence, accountability, and continuous improvement, leading to better patient outcomes and a positive work environment.
Creative Health Care Management (CHCM) is a consulting firm that specializes in supporting organizations in the implementation and development of shared governance. CHCM can help with shared governance in several ways:
Education and Training: CHCM provides education and training programs to healthcare organizations on shared governance. They offer workshops, seminars, and online courses to educate leaders, managers, and staff members about the principles, concepts, and implementation strategies of shared governance. This helps create a shared understanding of shared governance and prepares individuals for their roles in the shared governance structure.
Consulting and Implementation Support: CHCM offers consulting services to healthcare organizations seeking to implement shared governance. They work closely with organizations to assess their current structures, culture, and readiness for shared governance. CHCM consultants provide guidance and support in designing and implementing shared governance structures, developing policies and procedures, establishing councils and committees, and facilitating the engagement and participation of staff members.
Coaching and Mentoring: CHCM provides coaching and mentoring services to leaders and staff members involved in shared governance. They offer ongoing support and guidance to individuals in leadership roles, assisting them in understanding their responsibilities, developing their leadership skills, and effectively facilitating shared decision-making processes. This coaching and mentoring help strengthen the shared governance infrastructure and promote its sustainability.
Assessments and Evaluation: CHCM conducts assessments and evaluations to measure the readiness and effectiveness of shared governance within healthcare organizations. They use tools and methodologies to assess the level of engagement, collaboration, and empowerment among staff members. Based on the assessment results, CHCM provides recommendations for improvement and assists organizations in implementing changes to enhance the shared governance structure.
CHCM’s support helps organizations establish and sustain effective shared governance structures, foster collaboration and engagement among staff members, and promote a culture of empowerment and shared decision-making. Ultimately, this contributes to improved patient outcomes, staff satisfaction, and organizational effectiveness.
MAGNET®, Magnet Recognition Program®, ANCC Magnet Recognition®, Journey to Magnet Excellence®, Pathway to Excellence® Program, Pathway to Excellence in Long Term Care®, Demographic Data Collection Tool®, DDCT®, Practice Transition Accreditation Program® (PTAP) are registered trademarks of the American Nurses Credentialing Center (ANCC). The products and services of Creative Health Care Management are neither sponsored nor endorsed by ANCC. All rights reserved. The content presented in here is the expressed opinion of the author/presenter and not that of the American Nurses Credentialing Center (ANCC).
