Shared Governance

Prepared by-:1 -Ahmed Mohammed Zinhom

2 -Rady Mubarak

Under supervision of:prof. Magda El Mola

Outlines1-Introduction2-Definition of -Share -Governance -Shared governance3-Aims of shared governance4-Governance styles5-World without shared

governance

6-World with shared governance7-Benefit from shared governance8-How can I help make shared

governance work on my unit?9-Shared governance models10-Shared governance at the unit

level11-Barriers to implementation of

shared governance.

Introduction

First introduced by Christman in1976

•Asserted the idea that nurses should have decision making power within their scope of practice equal to that of physicians within theirs .

• that was developed as an alternative to the traditional bureaucratic organizational structure.

• In shared governance, the organization's governance is shared among board members, nurses, physicians, and management. (Kovner, Hendrckson, &Finkler, 1993).

cont.Decision making and

communication channels are altered.

Group structures, in the form of joint practice committees, are developed to assume the power and accountability for decision making and professional communication takes an equalitarian structure.

(Gessner,1990; Boeglin,1993)

Shared Governance

Share: participate, partake, implies having or taking part in an undertaking or activity

Governance: Exertion of a determining or guiding influence over; government; direct control; having the authority to determine basic policyThe action or manner of governing.

Definitions of Shared GovernanceIt is a partnership between staff and

management working together to promote shared decision making and accountability to provide an improved work environment

Shared governance is an organizational framework grounded in a philosophy of decentralized leadership that fosters autonomous decision making and

professional nursing practice .

cont. In shared governance, a nursing

organization's management assume the responsibility for organizational structure and resources.

In turn, staff nurses accept the responsibility and accountability for their professional practice

cont.Shared governance is collaboration, whether

in scheduling staff, educating new staff, or implementing evidence-based practice.

It involves teamwork, problem-solving, and accountability, with the goals of improved staff satisfaction, productivity, and patient outcomes.

It is working together to make decisions that affect nursing practice and patient care.

It is working with other disciplines for the good of the patient. It is collaborating to improve nursing practice. 

Aims of Shared governance

Empowerment of individuals within the decision making system, this empowerment is directed at increasing nurse's authority & control over their nursing practice.

Shared governance improves staff nurses' perception of their job & practice environment.

(Jones, & Lucas,1993; Ludemann, & Brown,1989).

Governance Styles

Shared Governance

ParticipatoryManagement

Self Governance

Staff are given the responsibility, authority and accountability for

decisions

Leaders request input from staff. Use of input is

optional

Staff determine goals without input from leaders

Goals

Leadership and staff activities are interdependent

Leader is not required to use

staff input

Can foster a “they…we” attitude

Use of Input

Leaders clearly articulate the guidelines for

decisions

Final decision lies with leadership, who may accept or reject staff

input

All decisions made by work team with no external input

of guidance

How Decisions Are Made

Servant leader

Hierarchical leader

Absent leader Presence of Leader

DecentralizedDecision-

making

Centralized decision-making

Decentralized decision making

Where Decisions are Made

A World without Shared Governance

Managers make the decisionsNurses are powerless, self-focused

& see a narrow scopeFew people do the work, while

others don’t follow the new rules because they don’t know why or how they were established

A World with Shared Governance

Nurses are empowered They have a voiceAutonomy is valuedNurses have control over their practice

Happier work environment

Impact

Nurse satisfaction improvesNurses turnover decreasesQuality of care improves

benefit from Shared Governance

Possibility to make changesDecisions made by bedside

cliniciansPromotes healthy work

environmentImproves employee satisfaction,

patient outcomes and employee turnover

How can I help make Shared Governance work on my unit?EngageCommit Collaborate DeliverEncourage

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Shared Governance

Communication Channels

Shared governance model:Organizational Shared governance

structures are usually council models that have evolved from preexisting nursing or institutional committees.

In a council structure, clearly defined accountabilities for specific elements of professional practice have been delegated to five main areas of accountability:

cont. 1. Clinical practice2. Quality3. Education4. Research5. Management

A typical model of shared governance is a committee structure (congressional model) where representative staff nurses belong to nursing committees that are assigned specific management or clinical functions.

cont.The committees composed of a staff nurse

( administrative chair) and representatives of staff & administration. The nursing committee chairs & nursing administrators compose the nursing council that make the final decisions on recommendations from the committees.

In Porter-O, Grady's model(councilor model),

issues related to nursing practice are the responsibility of nurses, not managers, and nursing councils elected at the organization & unit levels are used to organize governance using a congressional format organized like a representative form of government.

cont.

Coordinating council

Clinical practice

Manageme

nt

Researc

hEducatio

n

Quality

A Shared Governance Model

Shared Governance

Each Shared governance model:

1- Clinical Practice Council: The purpose is to establish the practice

standards, job description, care delivery system for the work group.

This council or committee is a unit -level committee that work in conjunction with the organizational committee accountable for determining policy & procedures related to clinical practice.

2- Quality Council: The purpose is to credential staff & to

oversee the unit quality management initiatives, peer review, evaluation criteria, evaluation process.

Quality Councilcont.In the role of credentialing staff, this

committee is responsible for: 1. Interviewing potential staff . 2. Reviewing their qualifications or credentials.3. Make recommendations regarding their

hiring.4. Review staff credentials on an ongoing basis

& make recommendations regarding promotion.

Quality management responsibilities of this council can include review of indicators of the unit overall clinical performance, such as medication errors, pt. falls, family & pt. satisfaction.

3- Education Council: The purpose is to assess the learning

needs of the unit staff and develop and implement programs to meet these needs.

This council usually works closely with organizational education & training departments.

4- Research Council: At the unit level, this council

advances research utilization with the intent of incorporating research-based findings into the clinical standards of unit practice.

cont.5- Management Council: This council ensures that the

standards of practice and governance agreed upon by unit staff are upheld and that there are adequate resources to deliver patient care.

Members of this council are the first-line pt. care manager (a standing member), the assistant nurse managers, & the charge or resource nurses from each shift.

cont.6- Coordinating Council:The purpose of this council is to

facilitate and integrate the activities of the other councils.

This council usually facilitates the annual review of the unit mission & vision, and develops the annual operational plan. (Sellers,1996).

This council is usually composed of the first-line pt. care manager and the chair-people of the other councils.

Shared Governance at the unit level

Unit-based shared governance structures may be less diverse:Some of the councils are combined into one

council e.g. education & research.A council may contain subcommittees whose

purposes are to perform very specific tasks e.g. credential & promote staff or recruit & retain staff.

Unit-based structures are varied, with the primary purpose being to empower staff by fostering professional practice while meeting the needs of the work unit.

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Shared Governance

Unit shared governance

Barriers to implementation of Shared Governance 1- The resistance of nurse managers to

change their roles from autocratic decision makers to consultants, teachers, collaborators, & facilitators of shared decision making.

This new role is foreign to many managers & difficult to accept, In addition, consensus decision making takes time more than autocratic decision making ,

not all nurses want to share decisions and accountability.

cont.

3- Shared governance requires a considerable & long term commitment on the part of the workers and the organization.

Question????