Shared Governance: What it Is and Is Not

Gen Guanci MEd, RN-BC, CCRN-K is a consultant at Creative Health Care Management.

Shared governance pioneer Tim Porter-O’Grady defines shared governance as “a structural model through which nurses can express and manage their practice with a higher level of professional autonomy.” (2003). When 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 shared governance 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 the 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 that 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. The group completes this trial by comparing the various products, and then they forward their feedback 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 identify the product to be purchased. Leadership articulates the parameters or criteria that must be met by the product for it to be purchased. These parameters often include things such as 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. In addition to this feedback, staff informs leadership that the product they have chosen meets all the articulated parameters/criteria. Upon receiving 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/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/criteria, and staff made the decision.

Participatory Management

Shared Governance

Goals

Leaders request input from staff to determine goals; use of input is optional.

Goals

Staff are given the responsibility, authority, and accountability to determine what goals to pursue.

Use of input

Leader is not required to use staff input.

Use of input

Staff obtains input from colleagues and others.

How decisions are made

Final decision lies with leader, who may accept or reject staff input.

How decisions are made

Leaders clearly articulate the guidelines for the decision (e.g., “We have $10,000 to spend on xx”) and staff make autonomous decisions that stay within the guidelines.

Leadership style

Hierarchical leader

Leadership style

Servant leader

Level at which decisions are made

Centralized decision making

Level at which decisions are made

Decentralized decision making

 

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 leader,
  • a tenant of professional practice; or
  • 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.

What has been your experience with shared governance?

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