Shared governance is a leadership model that uses structure and process for partnership, equity, accountability, and ownership. It puts the responsibility, authority, and accountability for practice related decisions into the hands of the individuals who will operationalize the decision. Shared governance allows managers and staff to come together in the decision-making process. We define shared governance as “a leadership model in which positional leaders partner with staff in decision making processes while creating ownership for improvement in practice” (Guanci & Medeiros).
In a shared governance framework, leadership continues to have responsibility for regulatory requirements, immediate safety concerns, performance management and operations decision such as hiring and staffing. However, decisions relating to practice are the ones that are decided in partnership in a shared decision-making model. To learn more about Shared Governance see our FAQ Page.
Facing a competitive environment and potential staffing shortages, hospitals have a vested interest in promoting a culture of engagement among nurses and interprofessional partners, who comprise the largest share of the hospital workforce.
There is a significant amount of research on the patient outcomes that result from implementing shared governance in nursing practice. In addition, organizations that foster employee engagement through shared decision-making outperform their counterparts in terms of job satisfaction and retention, profitability, and performance.
Facing a competitive environment and potential staffing shortages, hospitals have a vested interest in promoting a culture of engagement among nurses and interprofessional partners, who comprise the largest share of the hospital workforce.
Nursing leadership and nursing practice within the shared governance model is foundational to professional practice and a pillar of the ANCC Magnet® culture. Utilizing this approach in the hospital and ambulatory settings allows for better nurse satisfaction, patient care, and improved outcomes. The process of building nursing excellence through this type of structure and the related processes can be challenging among nurse administrators, nurse leaders at all levels, and bedside nurses.
For many healthcare organizations their biggest challenges currently are nurse retention and recruitment. Today’s workforce demands empowerment, and ownership of their practice and using council-based shared governance structures, enhances nurse autonomy and strengthens employee engagement. With the help of companies like Creative Health Care Management (CHCM), you can implement shared governance within any healthcare setting, and you will see positive outcomes.
We provide education, structures, processes and ongoing support that enhances staff members’ ability to make the best decisions for your organization, while developing a greater sense and new level of ownership for their work. We not only support staff members as they embark on increased ownership; we also support the leaders who often have to change the way they make decisions and lead.
The key work in shared governance involves the shared decision making authority of councils comprised of nursing administration, nursing leaders, registered nurses, point of care and frontline nurses and health care providers.
Developing shared governance supports evidenced based practices, problem solving, quality care measures, process improvements, and improves the patient experience and outcomes within the health care organization. Shared governance councils can collect data to drive their practice and improve the metrics the desire; for example nursing sensitive indicators, nurse engagement, quality care or patient experience.
Shared governance will influence decisions as a structured model in which health care organizations empower nurse leaders, nursing staff and interdisciplinary teams with leadership support in organized decision-making.
Remember, the role of nurse leaders in shared governance is just as important as it is in any other decision-making structure. The nurse leaders role simply changes to one of making space for the interprofessional team, particularly those closest to the work like frontline nurses, to determine their own priorities and design their own work process improvements.
The most common shared governance model is the Councilor Model. the Councilor Model is made up of a coordinating council, central councils like professional development or education councils, quality council, practice council, leadership council, and unit councils.
Shared governance structure can greatly enhance the success of your shared governance council work. Consider including a diverse group of people from all aspects of patient care to ensure that everyone’s voice is heard. Whenever practical, invite interprofessional team members to take part in the planning and creation phase of nursing councils.
Bylaws are an important part of shared governance model. At a minimum, one set of bylaws outlines the purpose of shared governance, the purpose of each council, and the function of the councils. Bylaws provide the structure the shared governance model works from and guides council operations.
Make sure you have an effective communication tool to communicate what happened at the shared governance council meeting. All stakeholders need to be communicated with. For unit councils this means everyone on the unit must know how to find out what happened at the shared governance meeting.
Shared Governance is a model of partnership of leaders and staff in which decisions regarding practice are made by the people who will be carrying out the work. Leadership enhances these decisions by sharing the guardrails for successful decisions. Our experts offer structures, processes, education and evidence-based practices to support your vision.
This type of shared governance process allows for active engagement throughout the healthcare team to promote positive patient outcomes and also creates a culture of positivity and inclusion, which benefits job satisfaction. Shared governance leads to greater autonomy due to engaged and empowered staff, and leads to professional growth along with better working conditions and quality work environment.
Creative Health Care Management has a long-standing history of implementing shared governance and transforming cultures to help ensure employees feel heard and respected, knowing that their contributions matter and they are making a positive difference to help the organization thrive.
Creative Health Care Management has a long-standing history of implementing shared governance and transforming cultures to help ensure employees feel heard and respected, knowing that their contributions matter and they are making a positive difference to help the organization thrive.
In a shared governance culture, staff members are empowered to design their own work, which leads to a high degree of ownership for achieving results! It’s also a cornerstone of the ANCC Magnet Recognition Program®, the highest international distinction a healthcare organization can receive for nursing excellence and quality of care.
Shared Governance is a tenant of professional practice that promotes nursing empowerment and decision making by giving nurses the responsibility, authority and accountability for decisions that impact practice, policies, procedures, and outcomes at the point of care. There is no question that this is an effective technique for creating a positive culture and improving patient safety.
Through the incorporation of shared governance in healthcare organizations, increases in nurse engagement helps improve both staff and patient outcomes, such as increased RN satisfaction, job and patient satisfaction.
CHCM offers a continuum of solutions to cultivate a culture of empathy, compassion, and trust in individuals, teams, and patients and families. Our expertise includes sustainable cultural change methods, open communication, leadership development, engagement of staff and providers to deliver exceptional patient care and collegial relationships, and the advancement of an overall culture of quality, excellence, and Wellbeing.
Creative Health Care Management has partnered with healthcare organizations of all sized on five continents on everything from one-day presentations to organizational and system-wide assessments, workshops, shared governance, and multi-year Relationship-Based Care® implementations and Magnet® or Pathway® journeys.
CHCM provides thought leadership not only through consultation, but through the publication of numerous award winning and bestselling books and journal articles in a variety of publications.
The benefits of a shared governance structure has been cited for years in stronger staff partnerships, ownership of data and outcomes, healthier work environments, increased employee satisfaction and retention, better patient experience, and of course the financial benefits tied to all of these improvements.
Staff members participating also exhibit increased autonomy and a stronger sense of meaning and purpose in their work. It is gratifying for staff and leaders to see the accomplishments and outcomes of council work, and the ownership of the data by councils and committees ensures that data drives practice.
By implementing shared governance, decision making assists nursing management by creating measurable patient care and improved positive patient outcomes. Having shared governance councils and a shared governance structure also improves nursing care which leads to job satisfaction.
Implementing shared governance is a leadership model and a key expression of an organization’s culture. Shared governance is not the replacement or elimination of positional leadership, a strategy to support downsizing leadership, or self-governance. Instead by implementing shared governance clinical nurses, and interprofessional staff, as well as their leaders become more involved with the process and structure of the practice or organization in which they work.
Many organizations start off with strong structures in place and lose steam over the years. Councils and committees are still meeting, yet it seems as though nothing is happening. Meeting time is costly in financial, human, and time resources.
A best practice is to make sure councils and committees have a strong purpose and set goals that align with the organization’s strategic plan and priorities. As a way to remind members of their purpose, state that goal at the top of your meeting agenda. When building your agenda keep in mind the goals of the group and attach times to each agenda item. This will help the group stay on task and know what topics will be covered during each council meeting.
To evaluate the effectiveness of unit councils, have each council review its purpose/aim on an annual basis. If the purpose is no longer relevant or it needs to be revised, update as necessary and make the purpose of the meeting clear to all members. State the purpose on the top of the agenda so it is front and center every meeting.
To keep meetings on track, have a purposeful agenda with times attached to each agenda item. Designate one person to keep track of the time and make suggestions if it is time to wrap up and move on. “Parking lot” ideas that come up that are not on the agenda and suggest additional time on next agenda and/or form a subcommittee or task force for items that need more attention.
Keep accurate and meaningful minutes. You can refer back to the minutes to see what has been done, and what still needs to be done. Assignments for next meetings should be recorded in the minutes along with person responsible for assignment. Decisions that were made at the meeting should be recorded in the minutes.
Set goals for your council/committee that are SMART.
Specific
Measurable
Achievable
Relevant
Time related
Track goals and outcomes quarterly, and by year’s end track outcomes and goal attainment.
Strategic planning is an important part of shared governance. High-functioning cultures engage in routine planning, typically on an annual basis, during a facilitated retreat that includes people from all levels of the organization.
Some healthcare organizations only take into account the opinions of nursing administration instead of clinical nurses. This often leaves staff nurses feeling disconnected from the plan and less motivated by it. More importantly, the knowledge and experience of front line nurses is highly valuable.
A shared governance council can serve as a way to refine and validate the strategic plan. By doing this front nurses will feel heard as they’re able to contribute to the future of the organization, increasing staff engagement.
Shared Governance aims to promote quality care and build a healty relationships between teams, leaders and staff. Decisions regarding professional autonomy in a specific practice will go to those who will perform the work and decide on their own. Leadership support will increase and the effectiveness of optimize efficiency will be seen in patient and nurse outcomes.
A simple shared governance definition includes – increased communication, understanding of core values and objectives by all staff, staff input in decision-making, transparency in communication, possibilities for influencing the decision-making process.
Imagine a world where all patient physician communication and health care providers work together as partners, making and screening decisions based on organizational values, healthcare research and quality of care
In August of this year, an inspiring episode of the “Compassion and Courage” podcast, hosted Donna Wright from Creative Health Care Management as a guest. This post is an overview
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