Shared Governance

1. SHARING IS CARING
Rustan P. Geronimo
Reviewed by: Dr. David Hali De Jesus

2. Objectives
A
B
C
D
Todiscuss the meaning of shared governance
Todiscuss the background on the emergence of shared governance, as well as
the different typesof models
Toidentify theadvantages and disadvantages of shared governance
Todiscuss the ways on how toimplement shared governance

3. Shared Governance
Governance is about power, control,
authority, and influence.
An organizational strategy through
which nurses can express and mange
their practice with a higher level of
professional autonomy
Focus on the micro-level

4. Shared Governance
Shared decision making between the
bedside nurses and nurse leaders
Pillar of the ANCC Magnet culture
COLLABORATION
working together to make decisions that affect nursing
practice and patient care.

5. FourPrinciples
EQUITY OWNERSHIP
PARTNERSHIP ACCOUNTABILITY
Shared
Governance

6. PARTNERSHIP
- COLLABORATIVE
RELATIONSHIP AMONG ALL
STAKEHOLDERS.
- EACH MEMBER HAS A KEY
ROLE IN FULFILLING THE
MISSION AND PURPOSE OF
THE ORGANIZATION

7. EQUITY
- Maintains focus on services,
patients and staff
- Foundation and measure
value
- No one role is more
important than any other
- Each member is essential to
providing safe and effective
care

8. ACCOUNTABILITY
- Willingness to invest in
decision-making and express
ownership in those decision
- Core of shared governance
- Supports partnership

9. OWNERSHIP
- Recognition and acceptance
of importance of everyone’s
work
- Designates where work is
done and by whom

10. SHAREDGOVERNANCE
CONCEPTS
WHO SHARED?
Board members,
nurses, physician
and management WHO GOVERNS?
WHO BENEFITS?
Health care
team,
organization
and patients
Board members,
nurses, physician
and management

11. SHAREDGOVERNANCE
EMERGENCE
Shared governance
found its way into
business and
management
literature (Human
resource era)
19xx
First introduced by
Christman: asserted
idea that nurses
should have decision
making skills
1976
Porter O’Grady’s work
brought the concepts
into the nursing
practice
1978
Decrease in
popularity of shared
governance. Self
managing work teams
emerge
1990s
According to AONE and
AACN: professional
practice environment of
nursing care has shifted
dramatically due to rapid
advances
2000
1 2 3 4 5
START
MILESTONE

12. HUMAN RESOURCEERA
• Earliest foundation for shared governance arose in this era.. This era represented the first departure
from the traditions of scientific management.
• Business and management philosophies influenced the development of shared governance models.
KANTER’STHEORY
• Theory on structural power has been instrumental in the development and formation of shared
governance models.
• Influenced broader redesign initiatives that emphasize work empowerment
SOCIOLOGYOF PROFESSIONS
• Greatly influenced shared governance
• Professional autonomy is the basis for managing care environment
• Shared governance, as an organizational form, has potential to bridge differences between the
traditional bureaucratic models, characterized by centralized decision making, with professional
models that are distinguished by independent authority for decision making
SHAREDGOVERNANCE
CONTRIBUTING FACTORS

13. ACTIONS TOWARDS SHARED GOVERANANCE
THE EVOLUTION
• Conceptual models depicting shared governance
evolved from linear, reductionistic
representation to dynamic, integrated circular
representation.
• This represents multidimensionality.
• Evolution reflect transition from first generation
models aligned with bureaucratic traditions to
second generation reflecting broader multilevel
involvement.

14. SHARED GOVERNANCE
G R O W I N G N E E D S
Achieve quality care
RetentionJob satisfaction
Improve nurse’s work
environment
Integrate core values
and beliefs
SHARED GOVERNANCE

15. GOVERNANCE MODELS

16. SHARED GOVERNANCE
MODELS
COUNCILOR MODEL
Integrates decisions made by
managers and staff in
subcommittees
Clearly defined accountabilities
delegated to 5 main areas: clinical
practice, quality, education,
research and management
CONGRESSIONAL MODEL
Relies on democratic
component to empower
nurses to vote on issues as a
group
Representative staff nurses are
assigned specific management
or clinical functions.
ADMINISTRATIVE MODEL
Resembles traditional
bureaucratic structure. Splits
organizational chart into two
tracks: management or clinical
focus

17. WHOLESYSTEMGOVERNANCE
01
Reflects accountability
at every level
02
Creates seamless
structure directed
towards providing health
service to its community
03
Recognizes multiple
stakeholders
04
Highlights coordination
and collaboration
05
Highlights the need to
build capacity

18. NURSE-SHAREDGOVERNANCE
01
Managerial innovation
that legitimizes nurses’
control over practice
02
Nurses extends their
influence into
administrative areas
previously controlled only
by managers
03
Focus on nurses
controlling their
professional practice
04
Ability to exercise control
over personnel in such
areas as hiring, transferring,
promoting, and firing
personnel;
05
Nurses feel that they
have access to the
information
necessary to make
effective governance
decisions

19. PROFESSIONAL-SHAREDGOVERNANCE
01
Modernized term for
shared governance.
02
Is not a management
strategy, model, tactic,
approach, or operational
component
03
Mechanism for professions
to not be controlled or
managed by organizations
or those outside the
profession.
04
Definition: The accountability, professional
obligation, collateral relationships, and decision-
making of a professional, fundamental to
autonomous practice and the achievement of
empirical outcomes

20. SHAREDGOVERNANCE
ADVANTAGES AND DISADVANTAGES
PROS CONS
Empowers nurses to use
their clinical knowledge and
expertise to develop, direct
and sustain our own
professional practice.
.
Allows nurses to network
with colleagues and to
collaborate among units and
departments.
Encourages linear career
development
Job satisfaction
Nurse retention
Involving of nurses who work
off shifts such as nights and
weekends
Increase level of work and time
commitment
Increased upfront cost

21. SHAREDGOVERNANCE
ADVANTAGES AND OBSTACLES
PROS OBSTACLES
Improved patient outcomes
Greater patient satisfaction
Decrease in medical errors
Increase long-term cost
effectiveness
Poor communication
Overenthusiasm
Resistance to change
Lack of interest and concern
Poor planning

22. Is there a best
way to implement
shared
governance?
NO ONE RIGHT
WAY

23. POSSIBLE WAY FOR SHARED GOVERNANCE
DETERMINETHE TYPEOF
GOVERNANCETO BEUSED
SETGROUND
RULES/FOUNDATIONFOR
SHAREDGOVERNANCE
DETERMINETHE ISSUES
DETERMINENURSE’SPREFERRED
LEVELOF INVOLVEMENTIN
DECISIONMAKING

24. SHAREDGOVERNANCE
EXAMPLES
UNITCOUNCILS THEMED COUNCILSHOSPITAL COUNCILS
- Organized and
implemented by
direct care nurses
- Staff nurses share
opinion, suggest
ways to improve and
make decisions.
- Nurses from many
units come together
to discuss issues.
- Members of nursing
leadership should be
present to act as
intermediate
- Address broader
issues such as
quality and safety,
professional
development or the
healing environment

25. References
◦ HCPro. 2006. Shared governance: A practical approach to reshaping professional nursing practice. Retrieved from: http://www.strategiesfornursemanagers.com/supplemental/4428_book.pdf
◦ Taylor K (2016) Using shared governance to empower nurses. Nursing Times; 112: 1/2, 20-23. Retrieved from: https://www.nursingtimes.net/clinical-archive/leadership/using-shared-governance-to-empower-
nurses-11-01-2016/
◦ McKnight H, Moore SM. Nursing Shared Governance. [Updated 2019 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK549862/
◦ Lippincott solutions. 2019. How shared governance in nursing works. Retrieved from: http://lippincottsolutions.lww.com/blog.entry.html/2019/02/27/how_shared_governanc-oiGj.html
◦ Anthony, M. 2004. Shared governance models: Theory, practice and evidence. OIJN. Retrieved from:
https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No1Jan04/SharedGovernanceModels.aspx
◦ Warren, S. Nursing shared governance. Retrieved from: https://www.slideserve.com/donkor/nursing-shared-governance
◦ Zinhom, A., Mubarak, R. Shared governance. Retrieved from: https://www.slideshare.net/AHMEDZINHOM/shared-governance-52677290
◦ Vail, K, Collins, A., Coyle G. et.al. Shared governance in nursing. Retrieved from: https://prezi.com/ajwlomftwz9v/shared-governance-in-nursing/
◦ Hess, R., 2004. From Bedside to Boardroom – Nursing Shared Governance. Online Journal of Issues in Nursing. Vol. 9 No.1, Manuscript 1. Retrieved from:
www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No1Jan04/FromBedsidetoBoardroom.aspx
◦ Porter-O’Grady, T. 2017. A response to the questions of professional governance versus shared governance. JONA. 27 (2). Retrieved from:
https://www.nursingcenter.com/journalarticle?Article_ID=3959486&Journal_ID=54024&Issue_ID=3959485
◦ Porter-O'Grady, T. 2019. Pinciples for sustaining shared/professional governance in nursing, Nursing Management (Springhouse). 50 (1): 36-41 doi: 10.1097/01.NUMA.0000550448.17375.28. Retrieved from:
https://journals.lww.com/nursingmanagement/Fulltext/2019/01000/Principles_for_sustaining_shared_professional.8.aspx
◦ Fawcett, G. 2018. Professionalization leads to better governance and public financial management. Retrieved from: https://slideplayer.com/slide/14542935/
Slides is uploaded for information purposes and as partial requirement of Philippine Women's University in
PhD class; Subject: Governance in Health Care Practice.