Professional Governance Models | Strengthening the Health Care Workforce | AHA (2024)

Section 4|Expanding the Reach

Professional Governance Models

Strong leadership is essential for informingand supporting professional sharedgovernance. Effective leaders use thestructures of professional governance to builda culture of excellence, where interprofessionalteams can exercise accountability for servicedelivery that advances patient outcomes.Traditionally,these models incorporate shareddecision-making between the bedside nursesand nurse leaders, but organizations arelooking at ways to expand these models toincorporate the full health care team. Successfulprofessional governance depends on clarityof accountability around practice, quality,competence and clinical knowledge. Cliniciansjoin with managers to inform access and use ofresources to support effective clinical practice.

Many of the challenges brought on by theworkforce shortages and impact of the pandemiccan be mitigated through models that encouragecommunication and shared accountability, suchas shared governance. While there are manyapproaches to professional governance acrossnursing, some organizations are using similarstructures to collaborate across disciplines tosolve problems, initiate innovations, and sustainpositive patient outcomes.

DOWNLOAD CHAPTER 10

• Considerations for Hospitals and Health System Leaders

  There are a number of structural elements andcharacteristics associated with effective professionalgovernance approaches. Below are three foundationalprinciples:

  1. Professional governance is grounded in clinician’sownership of their practice and their accountability forpositively impacting health;
  2. Professional governance provides the infrastructure ofclinical decisions and actions resulting in practices andbehaviors which impact and advance health care; and
  3. Professional governance provides the structuralframework for partnership across the clinicalcontinuum, with organizational leadership, and withthe clinical teams that collaborate to advance thehealth of individuals and communities.
     • ARTICLE
       Principles for sustaining shared/professional governance in nursing
       

  ‘Shared Governance: The critical concept of nursing shared governance is shared decision making between the bedside nurses and nurse leaders, which includes areas such as resources, nursing research/evidence-based practice projects, new equipment purchases, and staffing. This type of shared process allows for active engagement throughout the healthcare team to promote positive patient outcomes and also creates a culture of positivity and inclusion, which benefits job satisfaction.’

  McKnight H, Moore SM. Nursing Shared Governance. 2022 Sep 19. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31751052.

• Assessment

  As you consider your governance structure, think abouthow it can more inclusively engage clinical staff in clinical decision-making and whether there are opportunitiesto, in collaboration with the nursing teams, expand the structure to include additional, clinical team members.

  • CASE STUDY
    How to Keep your Nurse Governance System Effective and Dynamic
    The SkillBridge program allows HonorHealth to offer service members valuable civilian workexperience to acquire employment skills, knowledge and abilities to assist with job opportunities inthe civilian sector with the high probability of post-service employment being offered at the end ofthe internship.

  When everyone in the organization commits to investing in the governance process and acknowledging theirown contributions to the collective work through a shared governance model, organizational, patient safetyand satisfaction outcomes often improve.

  • ARTICLE
    Increasing Quality and Patient Outcomes with Staff Engagement and Shared Governance
    The SkillBridge program allows HonorHealth to offer service members valuable civilian workexperience to acquire employment skills, knowledge and abilities to assist with job opportunities inthe civilian sector with the high probability of post-service employment being offered at the end ofthe internship.
  • TOOLKIT
    University of Maryland: Nursing Professional Governance Organization Toolkit
  • CASE STUDY
    Professional Governance and Staff Engagement at Emory University Hospital

  • CONFERENCE
    AONL Professional Governance Leadership Conference
• Initiation and Growth

  It is beneficial in times of crisis to re-engage a professional governance structure. It can be the simple things — recognizing formally and informally thecontribution clinicians make, supporting them through time away from the bedside and counseling, and opportunities to bring clinicians together for shortperiods of time for peer support. One good way to do this is by maintaining unit councils to keep unit level staff engaged. It also means ensuring that clinicians are involved in a variety of problem-solving approaches at the point of service in the patient’s environment with professional peers, patients, and families who depend on nurses and the clinical team to facilitate, coordinate, and integrate their health journey.

  • PODCAST
    In Crisis and Beyond: Maximizing Nursing’s Impact through Professional Governance podcast
    An organization’s culture, the support of direct management and senior leadership, nursing’s autonomy and shared governance are key for providing nurses the opportunity to innovate.
  • PODCAST
    Innovation is at the Heart of Cardiac Nurse’s Practice
    Professional governance programs also provide an entry point for emerging leaders to engage in thegovernance process and learn essential skills to manage group dynamics and build consensus. It also offers aforum for continued engagement of patient and family advisors to provide feedback to the care team.
  • GUIDE
    Patient and Family Advisory Councils Blueprint: A Start-up Map and Strategy Guide
• Leadership

  As workforce shortages continue to challenge our organizations, a professional governance model can providea framework for innovating alternate service models to grow and retain the workforce beyond the COVID-19pandemic. This model encourages teamwork and prioritizes the voice of the bedside team, empoweringorganizations to usher in a culture shift that fundamentally improves trust and communication organizationwide.

  • CASE EXAMPLE
    Yale New Haven Hospital: Responding to Staffing Needs During a Crisis
    Professional governance provides a structure for supporting the ownership and accountability of practiceacross the system. It can be a turning point for interprofessional engagement and innovation.
  • ARTICLE
    Through the Looking Glass: Reimagining Nursing Professional Governance in the Age ofComplexity
• Sustainability

  A shared governance model promotes partnerships and collaboration between nurses and other health careprofessionals. One organization used LEAN principles in their professional governance structure, resulting inimproved efficiencies of processes allowing nurses more bedside time. How? Front-line staff are closest toeveryday challenges and can best identify how to improve productivity and remove inefficiencies.

  • PODCAST
    Shared Governance and Actionable Data Empower Nurses and Increase Patient Satisfaction