Tim Porter-O'Grady sounds off: Shared governance and what it means to nursing

Nurse Manager Website, March 5, 2006

Learning objectives: After reading this article, you will be able to
1. indicate how a facility should begin its journey to shared governance
2. underline the four principles that must be understood and valued to support the strengthening of interdisciplinary relationships through shared governance

Shared governance is about putting decision-making power in the hands of those who are most closely affected by those decisions. In other words, organizations should allow the appropriate people to make decisions regarding their jobs (i.e., nurses should have a say in clinical practices), Dr. Tim Porter-O'Grady told the audience of a recent HCPro, Inc., audioconference.

"The right decision, the right person, the right place, for the right purpose," said Porter-O'Grady, senior partner of Tim Porter-O'Grady Associates, Inc., an international healthcare consulting firm in Atlanta, during the audioconference "Shared Governance: How to create and sustain a culture of nurse empowerment."

"This means looking past simple notions of empowerment and seriously looking at empowerment as a frame of reference for engaging the staff more fully in those decisions that affect what they do, how they do them, and the outcomes of their work," said Porter-O'Grady.

He believes a facility begins its journey to shared governance by structuring a sturdy framework based on accountability, equity, partnership, and ownership.

According to Porter-O'Grady, if an organization builds its shared governance practices on such a structure, it will create a basis for behavior that is accountable and sustainable and that reflects a commitment to patient care. Ultimately, working toward the same cause (i.e., patient care) will support the growth of relationships between professionals of other disciplines, he said.

To support the strengthening of relationships through shared governance, there are four principles that must be understood and valued, said Porter-O'Grady. These four principles are

1. accountability: The mutual commitment to positive patient-care outcomes.
2. equity: The valuing of every role in the organization.
3. partnership: Nurses' relationships with one another, the patient, or other disciplines.
4. ownership: Membership in the nursing profession, clinical practice, and the work that nurses do as individuals.

Shared governance and Magnet
According to the ANCC Magnet Recognition Program® standards, shared decision-making and shared governance are fundamental elements when organizations develop structures that support excellence.

The leadership team at Lehigh Valley Hospital and Health Network of Allentown, PA, couldn't agree more. The organization decided to restructure the language in its professional practice model documentation according to the 14 Forces of Magnetism, said audioconference cospeaker Kim S. Hitchings, RN, MSN, manager of the Center for Professional Excellence and Magnet Recognition Program® site director at the facility, during the audioconference.

As a designated facility, many of the practices surrounding shared governance were already in use, Hitchings said. Because of this, it seemed natural to structure Lehigh Valley's professional practice model around the Forces of Magnetism, she said.

Having a formal document is imperative for creating structure for the shared governance process. This clearly and officially outlines the organization's values and beliefs, said Hitchings.

Expert advice
To help facilities that newly implement shared governance models, Hitchings suggested the following:

  • Create a template that helps guide unit-based shared governance councils. Doing so will streamline the practices and structure of such councils.
  • Allow unit members to decide how they want to exercise shared governance; let them decide whether they want to form a practice or quality council.
  • Identify the key components that your organization believes its nurses are empowered to affect. For example, Lehigh Valley officially empowers nurses in the areas of professional accountability, clinical practice and quality, professional excellence, operations research, collegial review, and recognition.
  • Hold staff accountable through annual performance reviews. For example, Lehigh Valley practices a pay-for-performance model in which salary increases for performance are based on definitive goals and outcomes. One of those is including participation in the professional practice model.
  • Offer a facilitation workshop, if possible. By doing so, staff selected to act on unit councils will know what their roles are and how to use the council.

MAGNET(TM), MAGNET RECOGNITION PROGRAM®, and ANCC MAGNET RECOGNITION® are trademarks of the American Nurses Credentialing Center (ANCC). The products and services of HCPro, Inc. and The Greeley Company are neither sponsored nor endorsed by the ANCC.