Shared governance is a model that promotes shared decision making between management and staff in a healthcare organization. It is based on four key principles: partnership, equity, accountability, and ownership. There are several models of shared governance including congressional, councilor, and unit-based models. Implementation occurs over three phases starting with staff representatives and evolving to councils with authority. Barriers to adoption include resistance to changing roles and lack of communication. Governing boards are responsible for strategic planning, budget approval, and oversight of quality assurance. Federal requirements specify board composition for health centers.

1. By / Mahmoud Shaqria
‫شقريه‬‫محمد‬ ‫محمود‬

2. Out lines
OIntroduction
Oshared governance
ODefinition of Shared Governance
OPrinciples of Shared governance

3. O Benefit From Shared Governance
O Shared governance models
O Three Developmental Phases of Shared
Governance in Nursing
O Barriers to implementation of Shared
Governance
Governing boards:
O What is a Governing Body
O Governing Board Responsibilities
O The functions of hospital governing board
O Health center board …( Federal Requirements)
Out lines

4. O First introduced by Christman in1976
O Asserted the idea that nurses should have decision
making power within their scope of practice equal to
that of physicians within theirs.
O that was developed as an alternative to the
traditional bureaucratic organizational structure
O In shared governance, the organization's
governance is shared among board members,
nurses, physicians, and management
Introduction

5. Shared governance
OShare:
O participate, partake, implies having or taking part in
an undertaking or activity
O Governance:
O having the authority to determine basic policy
O The action or manner of governing

6. Definition of Shared Governance

7. O It is a partnership between staff and management
working together to promote shared decision making
and accountability to provide an improved work
environment
O It is working together to make decisions that affect
nursing practice and patient care.
O It is working with other disciplines for the good of the
patient.
Definition of Shared Governance

8. principles of shared
governance
OFour principles of shared
governance
Partnership
Equity
Accountability
Ownership

9. Partnership
 Developing collaboration and healthy partnerships among the
healthcare team is essential to teambuilding, relationship
development, and strengthening professional practice.
 Each team member’s role is important in helping the organization
to meet its overall goals.
 This importance is further demonstrated when staff are included
in practice decisions and process changes.
O Partnerships development can occur both internally and externally in
an organization
principles of shared governance

10. O Equity
 Equity within a shared governance structure focuses on all members of the
team having an equal stake in the outcomes of the care and quality that they
provide
 No one role is more important than the other in providing safe and efficient
care.
 Each member has specific knowledge and skills that, when combined with
those of the entire healthcare team, deliver quality to patients in the most
efficient way.
 Collaboration and team effort are essential for healthcare members to
achieve optimal outcomes.
 Equity is achieved when team members come prepared to work within their
scope of practice and role within the organization to achieve an overall goal
principles of shared governance

11. Accountability
when all staff members achieve a clear
understanding of their role and expectations, and
take responsibility for their actions and decisions;
this is the core of shared governance.
In order to operationalize professional
accountability there must be autonomy, authority,
and control of practice.
principles of shared
governance

12. O Ownership
O Ownership is based on the fact that success of an
organization depends on how well each member of the
healthcare team performs their jobs.
O Ownership is being responsible for the end product or
outcome, whether good or bad.
O In ownership, the individual goals become team goals,
because the goal of the team cannot be achieved
without each person skillfully performing his roles and
integrating his efforts .
principles of shared governance

13. Benefit From Shared Governance
O Possibility to make changes
O Promotes healthy and Happier work environment
O Improves employee satisfaction and patient
outcomes
O Nurses are empowered
O They have a voice
O Autonomy is valued
O Nurse satisfaction improves
O Nurses turnover decreases
O Quality of care improves

14. Shared governance models
O A congressional model,
O which is structured similarly to that of the federal government, all
nursing departments belong to the nursing congress.
O Members are elected into the cabinet or committees that represent the
areas of nursing accountability, which typically include: practice, quality,
professional development and education, research, and management.
In this model, work is submitted to the committees for action.
O The various committees of the congress are delegated decision making
power in their area of accountability and report back to the cabinet or
senate their activities

15. O The councilor model
O uses councils that act on behalf of staff to make
decisions.
O Councils are given authority and accountability to
make decisions in their area of oversight
O Like the congressional model, the councilor model
divides nursing accountability into five key areas:
practice, quality, education, research, and resource
management
Shared governance models

16. O The accountability is dispersed between staff and
management.
O Typically there is a central council that coordinates the
activities of the different councils.
O Nurse accountability is divided in the same categories as
in the congressional and councilor models.
O The main difference is that this model has two separate
tracks, one for clinical practice and one for management
O The structure allows for work to be completed by
committees and then reported to the responsible
committees for accountability
Shared governance models

17. The unit-based model
O Is the last model discussed in the literature and is rarely
used.
O Accountability is defined by the unit and decisions made
on the unit typically do not affect the organization outside
of the unit.
O In a unit based model, each unit can establish its own
individual system; the downfall is that there may be
different models within an organization.
O Unit-based councils are not recommended by literature
because they do not integrate with the organization or the
nursing executive level ‫للتمريض‬ ‫التنفيذي‬ ‫المستوى‬ .
Shared governance models

19. O Phase 1
OStaff nurse representatives
‫مندوب‬
OManagers
OExecutive committee ‫اللجنة‬
‫التنفيذية‬
OChief nurse executive
Three Developmental Phases of
Shared Governance in Nursing

20. O Phase 2
O Staff nurse representatives ‫-ممثلو‬ members of
nursing committees that are designated for specific -
management and/or clinical functions.
O Managers - serve on same committees with staff
nurses.
O Committee chairs ‫اللجان‬ ‫-رؤساء‬ appointed by chief
nurse executive.
O Nursing cabinet ‫التمريض‬ ‫مجلس‬ - composed of
multiple committee chairs that make final decisions
on recommendations from the committees.
Three Developmental Phases of
Shared Governance in Nursing

21. OPhase 3
OStaff nurse representatives - belong to
councils with authority for specific functions.
OCouncil chairs - make up management
committee charged with making all final
operational -decisions
Three Developmental Phases of
Shared Governance in Nursing

22. Barriers to implementation of
Shared Governance
O The resistance of nurse managers to change their
roles from autocratic decision makers to consultants,
O Not all nurses want to share decisions and
accountability
O Poor communication
O Lack of interest
O Lack of concern
O Poor planning

23. Governing boards ‫اإلدارة‬ ‫مجالس‬ :
OThe organization using authority to direct and
control provided by the owners and the legal
act of formation.
OThey set initial direction and have the full
authority to act in the owners’ best interests.
OGoverning boards function at arm’s length
from ‫عن‬ ‫بعيدا‬ the operational organization.
OThey focus on the big picture, future-oriented
and act as a single entity ‫واحد‬ ‫كيان‬

24. What is a Governing Body
OIs the highest governing authority
within the organizational and
governance structures of the
institution

25. Governing Board Responsibilities
• Assess and Monitor Needs of Target
Population
• Approve Health Center Program Grant
Application
• Approve and Monitor Annual Budget .
• Establish a Quality Assurance/Quality
Improvement (QA/QI) Program
• Select Services provided and Hours of
Operation.
• Engage in Long-Term Strategic Planning

26. The functions of hospital
governing board:
(1) It ensures the quality of care provided by the
individuals who have been granted privileges at the
hospital.
(2)To fulfill that responsibility, the board oversees the
quality of the credentialing, privileging, and peer
review processes
(3) The board hires a CEO who forms an administrative
team that is capable of making smart strategic and
financial decisions.

27. Required knowledge and skills
of individual board members:
O Understanding of the concept and operation of a
health center
O Ability to read and understand standard financial
statements
O Ability to work with others on the board and in a
community setting
O Training and/or experience in one or more of the
following areas is desirable: (management - health care
delivery marketing/public relations - employee relations-
Community affairs - financial management - personnel
management - law)

28. Health center board …( Federal
Requirements)
1 .The board must have at least 9, but no more than 25 members.
2 .At least 51 percent of the board‘s members must be users of
the health center.
3 .Half of the remaining members of the board cannot earn more
than 10 percent of their income from the health care industry.

29. Health center board …( Federal
Requirements)
4.The remaining members of the board must represent the
area served by the center and have expertise in
community affairs; Federal, State, and local government;
accounting; health administration; health professions;
business; finance; banking; legal affairs; trade unions;
insurance; and personnel management as well as social
services such as religion, education, and welfare.
5. Employees of the center and their spouses, children,
parents, or brothers or sisters (blood or marriage) cannot
be members of the board.