Shared Governance: What it Is and Is Not

by Gen Guanci M.Ed., RN, NPD-BC, CCRN-K, CEO, Consultant

Shared governance pioneer, Tim Porter-O’Grady, defines shared governance as “a structural model though which nurses can express and manage their practice with a higher level of professional autonomy.” (Porter-O’Grady, 2003). While originally introduced in the 1970s and 1980s, shared governance waxed and waned in its popularity. Today, it has become the preferred leadership model for transformational leaders throughout healthcare. Despite its rise in popularity, challenges still remain regarding what it is, and more importantly, what it is not.

Shared governance is a structure and process for partnership, equity, accountability, and ownership. It puts the responsibility, authority, and accountability for practice related decisions into hands of the individuals who will operationalize the decision.

I often hear people say they have shared governance. They then go on to share an example, that for me, is clearly participatory leadership. There is no doubt clarity about the difference between participatory management and shared governance is needed as organizations implement or strengthen their shared governance culture. Let’s take a closer look at the difference through the following example.

A group of staff is asked to trial several versions of the same product for an upcoming purchase . They complete this trial by comparing the various products and then shared their feedback of what they liked, and didn’t like of the various products, to leadership. Leadership reviews the staff feedback and makes the final decision on what will be purchased. Leadership may or may not take into account staff feedback yet, the staff did have the opportunity to participate in the product decision. This is clearly participatory management.

Using a shared governance approach, let’s re-run the same scenario. A group of staff is asked to trial several versions of the same product and select the product to be purchased. Leadership articulates the parameters and/or criteria that must be met by the product for it to be purchased. These parameters often include things such as budget amount, vendors in the organization’s buying group, quantity needed, etc. Upon completion of the trial, staff forwards their feedback to leadership of what they liked and didn’t like of the various products as well as which one they want purchased. In addition to this feedback, they inform leadership that the product they have chosen is meet all the articulated parameters/criteria shared with them. Upon receiving all this information leadership thanks the group and proceeds to order the product identified by the shared decision-making staff group. Because of the articulated parameters and/or criteria the response from leadership in a shared governance culture would be “thank you” and the purchase is processed through the system. This is true shared governance… leadership shared the parameters and/or criteria and staff made the decision.

So just what IS shared governance?

Shared governance IS:
➢ a model that ensure that decisions are made by the people working at the point of care,
➢ a leadership development strategy,
➢ a way to identify future positional leaders,
➢ a tenant of professional practice; and
➢ a key expression of organizational culture.

Shared governance IS NOT:
➢ the replacement or elimination of positional leadership;
➢ a strategy to support downsizing of leadership;
➢ self-governance; or
➢ abdication of leadership responsibilities. (adapted from Guanci and Medeiros, 2018)

All involved in shared governance must have clarity that there are structures, processes and outcomes that leadership will continue to have responsibility for such as regulatory requirements, immediate safety concerns, performance management, and operations decisions such as hiring, salary, staffing, etc. Decisions related to practice are the ones that should be decided in a shared decision-making model.
Time spent implementing, strengthening and/or deepening a shared governance culture is time well spent. The ROI will be seen in the outcomes of shared governance work including improved patient experience, clinical outcomes, and staff engagement.