By Sitti Nihar

1. SHARED
GOVERNANCE
Sitti Nihar Adil Jaafar, MAN, RN

2. Before it can be solved, a problem must be clearly defined.
—William Feather

3.  Shared governance is a working model of participatory decision
making in which nurses are organized to make decisions about
clinical practice standards, quality improvement, staff and
professional development, and research.
 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
(Bonsall, 2011).
What is Shared Governance

4. Shared governance requires strategic change in organizational culture and leadership. It
demands a significant realignment in how leaders, employees, and systems transition into
new relationships and responsibilities. It begins with the definitions and objectives and
flows from the design.
According to Porter O’Grady, Hawkins, and Parker (1997), when an organization
embraces professional governance concepts, the culture shifts toward work that supports
the following principles:
 Partnership is centered on building relationships. It links healthcare providers and patients
along all points in the system.
 Equity is based on the belief that every role is important, and no role or perspective holds
more influence than another; it is the foundation of measure and value.
 Accountability is shared, and individuals involved in the change feel valued and appreciated
for their contributions. It is the core of shared governance.
 Ownership is recognition and acceptance of the importance of everyone’s work and that an
organization’s success is bound to how well individual staff members perform their jobs.
1.1 Concepts of shared
governance in nursing.

5. WHO SHARED
ORGANIZATIONS - HEALTHCARE
PROFESSIONALS - PATIENTSAND
FAMILY

6. Nurses, managers, interprofessional partners (i.e.,
physicians, professional nurses, pharmacists), and
organizational leaders must be prepared for new roles,
new relationships, and new ways of managing. Shared
governance is about moving from a traditional
hierarchical model to a relational partnership model of
nursing practice.
1.3 Who Governs

7.  Greater satisfaction
 Improved patient care outcomes
 Shorter hospital stay
1.4 Who Benefits
Organizations
Healthcare Professionals
 Increases respect, improves problem solving, and directly
affects the quality of care.
 Encourage collaboration among units and departments.
 Better financial status due to cost savings and cost reductions
 Coordinated group of employees and management
 Increased nurse job satisfaction with shared decision-making related to increased
responsibility combined with appropriate authority and accountability.
 Increased professional autonomy with higher staff and nurse manager retention
 Participate in determining goals and priorities and in making decisions in other aspects
of professional practice.
Patients and Family

8. The concepts of shared governance and shared decision-making are not
new ones. Philosophy, education, religion, politics, business and
management, and healthcare have all benefited from a variety of shared
governance process models implemented in many diverse and creative
ways across generations and cultures (Swihart, 2011).
Socrates (470–399 BC), an ancient Greek philosopher, integrated
shared governance concepts into his philosophies of education . The
Socratic Method encourages students to use reason rather than appeal
to authority.
The government model for the United States was established on the
concepts of shared governance— “of the people, by the people, for the
people” (from Lincoln’s Gettysburg Address, 1863)—wherein the very
citizenry is directly responsible for the government on both state and
federal levels.
2. Brief background of shared
governance.

9.  Eventually, shared governance found its way into the business
and management literature (Laschinger, 1996; O’May & Buchan,
1999). Organizations began to design formal structures and
relationships around their leaders and employees. Positive
outcomes emphasized movement from point of service outward.
 In the late 1970s and early ‘80s, shared governance found its
way into the healthcare and nursing arenas as a form of
participative management. It engaged self-managed work teams
and grew out of the dissatisfaction nurses were experiencing with
the institutions in which they practiced (McDonagh,Rhodes,
Sharkey, & Goodroe, 1989; O’May & Buchan, 1999; Porter-O’Grady,
1995).

10.  Shared governance has a decentered structure of power and
decision making.
 Shared governance is a major departure from traditional
management-drive systems. It requires commitment and investment
from all of nursing.
 Moving to shared governance affects the way in which nurses work
and relate to the organization.
 Governance structures of educational institutions directly influence
the faculty members and the staff and their occupational satisfaction .
 One challenge is how to engage and then supporting more junior
nurses in joining teams.
2.1Contributing factors towards
shared governance

11.  Understand what is shared government.
 Help employees appreciate the importance of shared governance.
 Have a regular scheduled education sessions.
 Develop a good judgment of ownership
 Promote a constant attention on the vision and mission of the
organization.
 Provide members with protective time to meet.
 Involve staff in planning and implementation.
 Train and guide chairpersons.
 Recognize merit and achievements.
 Learn the success and struggles of members.
2.2 Action towards shared
governance

12.  Improved job satisfaction among nurses is also a positive clinical impact for
those implementing a shared governance structure. Nurses are more engaged
in policy development and revision.
 Interprofessional involvement enhances a healthcare organization’s shared
governance structure.
 Successfully shared governance programs and structures assist healthcare
organizations with internal succession planning.
 Completing pulse checks to determine the current state of the shared
governance structure is key to success and continued improvement and
evolution.
 Clear and consistent communication is necessary within the healthcare
setting for promoting collegiality, patient safety, and building trust.
2.3 Growing needs in shared governance for
collaboration, engagement in healthcare practices.

13. 3. GOVERNANCE
MODELS

14. Whole systems shared governance creates a
transitional model for ownership at all levels of
the organization. It reflects accountability at every
level and creates a seamless structure directed
towards providing health service to its community.
3.1 The whole – system
governance

15. The critical concept of nursing shared
governance is shared decision making
between the bedside nurses and
nurse leaders. Utilizing this approach
in the hospital setting allows for better
nurse satisfaction and improved
patient outcomes.
3.2 Nurse - shared
governance

16. Professional governance is a multidimensional
organizational characteristic that encompasses the
structure and processes by which professionals
direct, control, and regulate goal-oriented efforts of
one another.
3.3 Professional - shared
governance

17. 4. APPRECIATE
SHARED
GOVERNANCE
4.2 The disadvantages of
shared governance
4.1 The advantages of
shared governance

18.  Serve as a foundation for the implementation of nursing strategy.
 Increased staff engagement, staff satisfaction and professional
accountability.
 Provides a unique opportunity for clinical nurses to develop leadership skills.
 Improved patient care outcomes.
 Helps an organization achieve high-quality, patient-centered care.
 Better financial states due to cost savings and cost reductions.
 It empowers nurses to use their clinical knowledge and expertise to develop,
direct and sustain our own professional practice.
 It allows nurses to network with colleagues and to collaborate among units
and departments.
4.1 The advantages of
shared governance

19.  Personal and organizational stress caused by the
change to shared governance for both staff and mangers
alike seem to increase.
 No protection against group ganging up on others,
pushing through a change not accepted by all.
 May reveal unexpected issues that may alter plans and
process.
 Divisive discussions may reveal widely divergent ideas,
and may cause conflict.
4.2 The disadvantages of
shared governance

20. 5. IMPLEMENTATION
OF SHARED
GOVERNANCE

21.  A very important part of the implementation of shared governance, is to increase
the visibility and expand the influence of nursing.
 There is no question that shared governance is an effective technique for
empowering nurses and improving patient outcomes.
 It helps front line healthcare workers to participate in decision-making about
issues that impact on them and the services delivered.
 Support for personal and professional development which centered on evidence
based patient outcomes.
 Communication strategy is key in involving nurses in the shared governance work.
 It is essential to find ways to determine the benefits of shared governance.
 Understand how shared governance impacts and influences staff, patient, and
financial outcomes.
5.1 Is there a BEST way?

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25. Note: These slides is uploaded for information
purposes and as partial requirement of Philippine
Women’s University in PhD class; Subject:
Governance in Health Care Practice