Shared governance in health care: How can nurses help shape and manage their own workplaces?
As part of our ongoing series on the topic of shared governance in health care, we’re taking a look at how this emerging health care management model helps empower nurses, improve health care efficiency and reduce health care costs all at the same time. Under shared governance models, nurses have far greater potential to shape and manage their own workplaces, while also providing direct input at all levels of managerial decisionmaking and patient care.
Kathryn J. McDonagh, RN, PhD, is Vice President of Executive Relations at Hospira Inc., and her work in shared governance dates back to its origins in the early 1980s under University of Phoenix alum and shared-governance pioneer Tim Porter O’Grady (DM, School of Advanced Studies, 2007) at Saint Joseph’s Hospital of Atlanta (SJHA). “I started at SJHA in 1983 because the philosophy of shared governance and how congruent it was with my participative and collaborative leadership style,” says McDonagh. “As a nurse I understood the frustration of working within bureaucratic hospital structures which often thwarted the sound judgment of clinicians. Shared governance empowered our clinicians to utilize their skills and knowledge to create policies and care processes that were more conducive to safe, evidence-based care for patients. Shared governance is very patient-focused and customer-centric, which makes it a very successful model in our health care delivery system.”
McDonagh has helped develop shared governance systems at SJHA and elsewhere. Her 1990 book "Nursing Shared Governance: Restructuring for the Future" detailed her work at SJHA and also included contributions from shared governance administrators at Henry Ford Hospital in Detroit and MacNeal Hospital in Chicago. “These models are still relevant today,” she says. “Many organizations have advanced themselves tremendously with shared-governance models, and yet many more health care institutions still remain very bureaucratic and in need of redesign to fit into today’s flatter, more agile world.”
McDonagh consulted with many health care delivery systems on implementing shared governance throughout her career, and it still impacts her current job. “Shared governance has been a foundation to my career and success as a leader and health care executive,” she says. Furthermore, she believes that a shift toward shared governance across more and more health care systems until it becomes a universal standard is inevitable. “I think as hospitals move to more high-reliability organizational models (HROs), similar to those used in high-risk industries like airlines and nuclear and chemical engineering, there will continue to be more recognition that clinical expertise should be the driving force in decisionmaking about patients, versus old-style bureaucratic policies,” she says.
In shared governance, health care administration structure is more horizontal versus top-down, with nurses and other stakeholders working collaboratively with management via committees and parallel group decisionmaking to help shape policies. In this way, nurses can participate directly in the clinical and administrative decisionmaking that impacts their daily work and the care they provide to patients, while also fostering greater respect among the various health care disciplines. According to McDonagh, nurses have tremendous potential to shape and manage their own workplace under shared governance. “Nurses can benefit from shared governance because in this complex age of sophisticated care delivery, it is vital to have collaboration between clinicians to verify high-stakes decisions that support safe and effective patient care,” she says. “Collaboration is vital for professionals who have to exercise professional judgments in complex settings. The patient benefits as well because the team is delivering care that is continuous and not fragmented.”
Not only that, when nurses collaborate with their colleagues in other disciplines, even non-nursing care improves, according to McDonagh. “When nurses collaborate with physicians, pharmacists, and other clinicians, care improves,” she says.
And as shared governance models become more widespread, and with more and more nurses participating directly in management and decisionmaking, the ranks of high-level nurse executives are also increasing. “Shared governance is a means to support more equitable approaches to the health care delivery system,” McDonagh says. “As more health care administrators come from the ranks of clinicians, such as the rising numbers of nurse CEOs and COOs as well as physician executives, I think this also benefits a more equitable approach.”
And perhaps most important of all, shared governance has the potential to transform the whole nursing profession for the better, according to McDonagh. “One of the most rewarding aspects of shared governance in action is to witness the growth and transformation of nurses and clinicians as they assume greater accountability for their practice,” she says. “There is enthusiasm and passion for being a professional who advocates for their patients and for high-quality, safe care.”
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