Problem Solving: Working Toward Shared Governance

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Problem Solving: Working Toward Shared Governance

You are the supervisor of a surgical services department in a nonunion hospital. The staff on your unit have become increasingly frustrated with hospital policies regarding staffing ratios, on-call pay, and verbal medical orders but feel that they have limited opportunities for providing feedback to change the current system. You would like to explore the possibility of moving toward a shared governance model of decision making to resolve the issue and others like it but are not quite sure where to start.


  1. Review Learning Exercise 12.6 – Problem Solving: Working Toward Shared Governance (located in Chapter 12 of the textbook)
  2. Answer the following questions:

Who do I need to involve in the discussion and at what point?

In the early planning phase, I would need to involve departmental staff members. Engaging them early enough would enable them to understand the need for change and hence, respond positively to the change process. In the next phase of determining the prospective impact of the shared governance model of decision making, I would involve other departmental staff members at managerial positions such as departmental managers, physicians, and medical assistants. These personnel would also help me in developing a communication strategy, providing effective training, and implementing a support structure. In the final stage of change implementation, I would involve executives and senior managers in the organization for them to authorize the model of decision making (French-Bravo, & Crow, 2015).

How might I determine if the overarching organizational structure supports shared governance?

How would I determine if external stakeholders would be impacted?

I would use various metrics to determine if the overarching organizational structure supports shared governance. These include measuring departmental performance (including patient care experiences), measuring individual performance, and the general working atmosphere at the surgical services department. By measuring departmental performance or productivity, we would be able to answer the question “is the new structure delivering what was expected?” Besides, measuring individual performance would indicate whether the staff impacted by the change are progressing (Terzioglu, Temel, & Uslu Sahan, 2016). Nonetheless, determining the general working atmosphere would say it all. It would indicate whether the staffs are happy, satisfied, and contended. It would tell a lot about their feelings towards their job duties and their relationships with superiors and colleagues (Ceylan, 2018).

How would I determine if organizational culture and subculture would support a shared governance model?

It will be easy to determine if the organizational subculture supports a shared governance model. Since the organizational subculture represents the shared ways of thinking, behavior, and feelings in a given unit, I would determine whether the shared governance model has any effect on these aspects (Huhtala, Tolvanen, Mauno, & Feldt, 2015). If for example, it affects behaviors of staff members negatively, then organizational subculture would be deemed unsupportive. If it changes their ways of thinking positively, then the subculture would be said to be supportive. In general, the employees’ response to the shared governance model will determine whether the organizational subculture is supporting it or not.

What types of nursing councils might be created to provide a framework for operation?

Various types of nursing councils might be created to provide a framework for operation. These include Nursing Unit-Based Councils, Nursing Practice Council, Nursing Operations Council, and the Nursing Coordinating Council (Stanford Health Care, 2019). Nursing Unit-Based Councils can function as a communication channel between Nursing Councils and department staff concerning decisions associated with the care provision and the care environment, accountability, and competency. Nursing Practice Council can make decisions regarding the revision and implementation of patient care and clinical practice care. This council would be tasked with ensuring patient care is in line with regulatory requirements, national specialty guidelines, and evidence-based practice. Nursing Operations Council can establish the premeditated nursing directions and resolutions associated with procedures and final policies. Nursing Coordinating Council can coordinate, integrate, monitor, and communicate the activities of other councils. Members on these nursing councils might include supervisors, nursing service managers, hospital matrons, hospital departmental managers, hospital CFO (chief financial officer) and clinic administrators.

Who would be the members on these nursing councils?

What support mechanisms would need to be in place to ensure success of this project?

What would be my role as a supervisor in identifying and resolving employee concerns in a shared governance model?