Hospital Study Looks at Impact of Shared Governance

Shared governance has had success in its early years at Cleveland Clinic’s Hillcrest Hospital. This is great news because shared governance programs can take five to 10 years, or more, to become well-established and successful, says Tina Di Fiore, MSN, APRN, NNP-BC, principal investigator of a recent study looking at the program.

Six nurses at Hillcrest worked on a two-cohort study, which began in 2012 when the hospital had just started its shared governance structure. (Cleveland Clinic’s main campus shared governance program has been in place for 10 years.) At that time, clinical nurse specialist Molly Loney, MSN, RN, AOCN, wanted to see if Hillcrest Hospital’s one year-old shared governance program was making a difference in decision-making.

Shortly after writing the proposal, collecting data and completing a descriptive analysis, Loney passed away and her study results remained untouched for nearly three years.

“After Hillcrest achieved Magnet® status, we thought it was important to complete Molly’s study. We did so in her honor,” Di Fiore says. “We aimed to learn if structures, systems and processes that were put in place before the first data collection period were making a difference in shared decision-making three years later.”

Structures, systems and processes

The primary structure that advanced shared governance was the Cleveland Clinic Nursing Professional Practice Model. To “live” the model, a nursing congress was created to be a decision-making body for hospital nurses. One system that facilitated nurse participation in shared governance was to have all council meetings on the same day each month. Consistency in meeting dates and the one-day-per-month plans enabled more people to attend meetings and be prepared for team discussions, says Toni Zito, MSN, RN, CPAN, the study’s project manager.

Another process was to invite all nurses who joined shared governance monthly meetings to attend a boot camp. “The boot camp taught clinical nurses about the meaning of shared governance and the expectations that came with it,” Zito says. “They also learned decision-making skills, and how to make an agenda and lead an effective meeting, as we want clinical nurses to make decisions.”

Study details

In the research, clinical nurses, assistant nurse managers and nurse managers were invited to complete the 88-item Index of Professional Nursing Governance Questionnaire. The tool was developed and validated by Robert Hess, PhD, to assess shared governance efforts by looking at six dimensions of decision-making:

1. Professional control of nursing practice
2. Organizational influence: availability of nursing resources
3. Organizational recognition of personnel
4. Facilitating structures: nursing structure encourages nursing participation
5. Liaison: nursing personnel have the information necessary to control their practice and influence the allocation of resources
6. Alignment with institutional goals

When comparing the 2012 and 2015 cohorts, shared responsibility in decision-making improved for the total tool score, and for professional control, organization influence, organizational recognition and facilitating structures domains. Di Fiore said, “The structures, systems and processes we put in place made a difference.”

Success in shared decisions is important because quality and patient safety improve when nurses are empowered to make decisions. “In other research reports, investigators found that shared decision-making was associated with increased length of employment and employee satisfaction,” Di Fiore says.

Future goals

The team will develop a blueprint for future improvement. “Our shared governance meeting is the voice and decision-making body of nursing. One goal is to have more clinical nurses who plan and lead the meeting and participate in discussions, which optimizes our ability to meet clinical nurse needs,” Di Fiore says.

The team plans to share its findings widely, both internally and externally. “There are still skeptics who dismiss shared governance as just the latest buzzword. We want to let healthcare providers know that our research findings support our shared governance model,” Di Fiore says.

Working on the study with Di Fiore and Zito were Amy Berardinelli, DNP, RN, CPAN; Kathleen Kennedy, MSN, CCRN, CCNS; Ann Stibich, BSN, RN, CMSRN; and Diane (Dee) Keck, MSM, BSN, RN, CEN.

Cleveland Clinic’s 13th annual Nursing Research Conference is May 3 – May 4. Register now!
The Call for Abstracts is still open. Deadline for submissions is Feb. 1.