This presentation is uploaded for information purposes and as a partial requirement of Philippine Women's University in Ph.D. class; Subject: Governance in Health Care Practice.
2. Disclosure
The author of this presentation disclosed no relevant
relationships with any commercial organization to
influence the content of this learning material.
3. Learning Outcomes
At the end of this presentation, the
readers will be able to:
ï Define Shared Governance and
Shared Governance in Nursing.
ï Identify the principles of shared
governance, its advantages and
disadvantages.
ï Understand the implementation of
shared governance in a nursing
organization.
4. Introduction
âGood leaders make people feel that
theyâre at the very heart of things, not
at the periphery. Everyone feels that
he or she makes a difference to the
success of the organization. When
that happens, people feel centered and
that gives their work meaningâ
- Warren G. Bennis
5. What is Shared
Governance?
ï” It is a shared decision-making based on
the principles of partnership, equity,
accountability and ownership at the point
of service.
ï” It involves empowerment of all members
of the healthcare workforce to have a
voice in decision-making, which
encourages diverse and creative input
that will help advance the business and
healthcare missions of the organization.
ï” In this type of management process
model, the employee feels like he/she is
a âpart managerâ who has a personal
stake in the organization's success
6. Shared Governance in Nursing
Nurse
Leaders
Bedside
Nurses
Shared Decision-Making
Resources
Nursing Research
Evidence-Based
Practice Projects
Equipment
Staffing
7. Shared Governance
in Nursing
ï” It is a pillar of the ANCC Magnet
culture.
ï” This encourages active engagement
among the members of the
healthcare team to promote positive
patient outcomes.
ï” It creates a culture of positivity and
active involvement that leads to
staffâs satisfaction.
ï” It shifts the governance from a top-
down management style to a
collaborative focus from the
administration to the nurses who are
providing direct patient care at the
bedside.
8. History of Shared
Governance
ï” In 470 â 399 B.C., Socrates integrated shared
governance concepts in his education
philosophies. The Socratic Method lets the
teacher facilitate the studentâs autonomous
learning and the students are encouraged to
use reason instead of making an appeal to
authority.
ï” In 1863, the US government model was
established on the concepts of shared
governance, wherein the citizens are directly
responsible for the government on both state
and federal levels. As what Abraham Lincoln
said in his Gettysburg Address in 1863, âof the
people, for the people, for the peopleâ
ï” Shared Governance eventually found its way
into business and management as
organizations start to create formal structures
and relationships among leaders and
employees.
ï” In 1970s â 1980s, as part of participative
management, shared governance found its
way in healthcare and nursing due to nursesâ
dissatisfaction from the institutions.
9. Contributing Factors
Towards Shared Governance
ï” In the era of organizational theories, Herzberg (1966)
and McGregor (1960) considered employees as the
most important asset of an organization, hence, must
invest in their motivation and growth. This lead to
advocacy of autonomy, empowerment, involvement
and participation. (Bolman and Deal, 1997)
ï” In 1986, Deming introduced the concepts of quality
management and proposed that organizations value
quality and must empower workers to be more
productive and emphasized the importance of
leadership and team building.
ï” Kanterâs Theory on structural power suggest that
formal and informal power give access to work
empowerment structures which include opportunity,
resources, support and information.
ï” In nursing, shared governance was introduced to
improve nursesâ work environment, satisfaction and
staff retention.
10. ï” In the increasing complexity of nursesâ
struggle in patient care delivery,
workplace partnership between nurses
and employing organizations is vital for
the successful delivery of healthcare.
ï” Shared governance provides
organizational support for nurses who
provide direct patient care and enables
them to become committed to quality
nursing practice.
ï” It empowers both workers and
workplaces and has been linked to
nursing job satisfaction, quality care and
fiscal viability.
ï” Shared decision-making works best in a
in decentralized structure wherein staff at
the point of service make their own
decisions and determine whether they
are appropriate (Koloroutis, 2004)
Why is there a need
for Nursing Shared
Governance?
11. Essential Actions
Towards Shared
Governance
1. Be clear about what shared governance is.
2. Assist and guide staff members understand
the importance of shared governance.
3. Give orientation to council chairpersons
about the basics of planning and facilitating
meetings.
4. Cultivate a sense of ownership.
5. Encourage a continuous focus on mission
and vision.
6. Council members must be provided with
protected time to conduct meetings.
7. Involve staff in council development or
redesign
8. Coach and mentor chairpersons.
9. Recognize excellence.
10.Study the successes and struggles of others
13. Partnership
ï” This is vital in building relationships,
as all staff members are involved in
decision-making and other
processes.
ï” It emphasizes that each member
plays a key role in fulfilling the
organizationâs purpose and mission,
which is critical to the healthcare
systemâs effectiveness
(Porter-OâGrady and Hinshaw 2005;
Batson 2004)
14. Equity
ï” This principle maintains a focus on
services, patients and staff and is the
foundation of measure and value.
ï” It emphasizes that âno one role is
more important that any otherâ; each
team member is essential to providing
safe and effective care.
(Porter-OâGrady and Hinshaw 2005; Batson
2004; Porter-OâGrady, Hawkins and Parker
1997)
15. Accountability
ï” The core of shared governance
that supports partnership.
ï” It is the willingness to invest in
making decisions and demonstrate
ownership in those decisions.
ï” This term is often used
interchangeably with responsibility.
(Porter-OâGrady and Hinshaw 2005;
Batson 2004)
16. Accountability vs. Responsibility
Accountability Responsibility
Defined by outcomes Defined by functions
Self-described Delegated
Embedded in roles Dictated by specific tasks/routines
Partnership-dependent Isolative
Evaluation is shared Supervisor evaluation
Contributions-driven value Tasks-driven value
Adapted from T. Porter-OâGrady and K.S. Hinshaw, 2005
17. Ownership
ï” Shared governance requires staff
members to have commitment in
contributing something, to own
what they contribute and to
participate in devising purposes
for the work.
(Porter-OâGrady and Hinshaw 2005;
Batson 2004; Koloroutis 2004; Page
2004)
18. Governance
Models
The Whole-Systems Governance
ï” It creates a transitional model for ownership
across all levels of the organization.
Accountability is also reflected at each level
and creates a seamless structure directed
towards he delivery of health service to its
community.
ï” The nursesâ role in whole-systems
governance is multifaceted, occurring within
the multiple levels of the organization.
ï” This model emphasizes that all employees
have their roles in the organization,
participating as part of the organization in
the directions, policies, decisions and
objectives that set the future of an
organization.
19. Governance
Models
Nurse-Shared Governance
ï” The critical concept of this type of
governance is shared decision-making
between the nurse leaders and bedside
nurses.
ï” This type of governance promotes
collaboration and open communication
among the administrative leaders and
bedside nurses.
ï” Although it promotes nurse satisfaction
and positive patient outcomes, the
process of building this type of
governance and the related processes
can be challenging for both leaders and
frontline nurses.
20. Governance
Models
Professional-Shared Governance
ï” It focuses on the creation of a structural
framework that is consistent with
different professions.
ï” Professional governance distinguishes
itself from management functions with
its exclusive control over the professionâs
own practice. It works as a partner with
the organizations instead of being
controlled or managed by them.
ï” Professional shared governance brings
every professional stakeholder to the
table to create a team, having the focus
of realizing goals, enhancing
professionalism and improving the
delivery of services.
21. Advantages of
Shared Governance
ï” Improved patient outcomes
ï” Improved job satisfaction
ï” Promotes sense of belongingness and
loyalty to staff and also increases morale
and performance
ï” Increased engagement among staff
members
ï” Decreased staff turnover
ï” It assists succession planning for
organizations
ï” Lower burnout rates
ï” Improved nurse-physician relationships
22. Disadvantages of
Shared Governance
ï” Inefficient â consultation with members and
consideration of alternatives requires a lot of
time and it also considerably lengthens
implementation of policies.
ï” Divisive â discussions may create diverse idea
that may lead to conflicts
ï” Undercuts privacy and secrecy â issues
amongst personnel and negotiation about
policies may be prematurely revealed during
discussions
ï” Chaotic â unexpected issues that may alter
plans and procedures can arise at anytime
ï” Arbitrary â everyone cannot be included all the
time. Sometimes, debates need to end to make
a decision, that could make other members feel
left out or ignored.
23. Implementation of
Shared Governance
ï” The implementation may take at least 3-5
years because of the extended preparation
period necessary for both management and
staff for each phase of the process.
ï” There is a remarkable relocation of decision
making in shared governance and the nurse
executive must be comfortable with this in
order to be successful.
ï” Both nursing and general administrative
leadership must be committed to the
anticipated changes. According to Wilson
(1989), there must be a consensus about the
meaning of shared governance because each
position in the organization will experience a
different role change.
24. Implementation of
Shared Governance
ï” A steering committee which includes staff and
management must be available to oversee the
process of shared governance.
ï” The philosophy and purpose of the organization
must be determined, specific and applicable to
the department. It may focus on development of
nurse-patient relationship, nursingâs participation
in supporting the goal and how the work will be
organized to support the practice environment
and standards for evaluation of results.
ï” It must be emphasized that shared governance
will not happen without management support, so
they must be present at the implementation
process.
25. Implementation of
Shared Governance
ï” A decision-making group must be
established, commonly called a unit-
based council, wherein chairpersons
and members must be selected who will
serve as the decision-making body
group.
ï” Education and training must be provided
to all council members regarding their
new roles and responsibilities.
ï” A timetable must be established to
ensure efficiency and to monitor
progress.
26. âThe best executive is the one
who has sense enough to pick
good men to do what he wants
done, and self-restraint to keep
them from meddling with them
while they do itâ.
- Theodore Roosevelt
27. References:
ï” McKnight H. and Moore S. (2019). Nursing shared governance. StatPearls. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK549862/
ï” Hess, R. (2004). From bedside to boardroom â nursing shared governance. The Online Journal for Issues in Nursing. Retrieved from
http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No1Jan04/FromBedsidetoBoa
rdroom.html
ï” VijayaNarayanan, R. (2014). Shared governance: reality or sham? In nursing profession. International Journal of Nursing Care, 2(1), 32-26. Retrieved
from https://search.proquest.com/docview/1515962943/fulltext/B746FA8CF99B43BFPQ/8?accountid=38643
ï” History and development of shared governance. (2019). Nurse Leader Insider. Retrieved from http://www.hcpro.com/NRS-266847-975/From-the-
staff-development-bookshelf-History-and-development-of-shared-governance.html
ï” Green, A. and Jordan, C. (2004). Common denominators: shared governance and workplace advocacy â strategies for nurses to gain control over their
practice. Online Journal of Issues in Nursing, Vol. 9, No. 1, Manuscript 6. Retrieved from
http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No1Jan04/SharedGoverna
nceandWorkPlaceAdvocacy.html
ï” Anthony, M. (2004). Shared governance models: the theory, practice and evidence. The Online Journal of Issues in Nursing. Retrieved from
https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No1Jan04/SharedGovern
anceModels.aspx#:~:text=Shared%20governance%20is%20a%20model,environment%2C%20satisfaction%2C%20and%20retention.
ï” Taylor, K. (2016). Using shared governance to empower nurses. Nursing Times; 112: Âœ, 20-23. Retrieved from
https://www.nursingtimes.net/clinical-archive/leadership/using-shared-governance-to-empower-nurses-11-01-2016/
28. Note:
These slides are uploaded for information
purposes and as a partial requirement of
Philippine Women's University in Ph.D.
class; Subject: Governance in Health Care
Practice.
