Using a shared governance approach in decision-making involves deploying an entity’s administration through stakeholders’ partnerships. In healthcare systems, service to clients forms the basis of most decisions. However, complete service delivery involves a long process that includes healthcare’s ‘outsiders’ and ‘insiders’. Shared governance in nursing settings is expected to lead to better patient care and higher productivity among professionals. In this scenario, a committee meeting in a healthcare organization is used as a case study for shared governance. The interactions between members and the meeting’s process are used to determine how the decision-making process incorporates shared governance.
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The committee meeting took place in the afternoon, where the chair was a hospital board member. The main agenda in the meeting was to re-evaluate employee morale, the rising cases of abuse of prescription procedures, and management hierarchy, among others. The committee members included representatives from the ethics department, physicians, nurses, and teaching staff. The committee was working under the umbrella of service stabilization with the view of moving the entire organization forward.
The committee was formed because of instances of high-employee turnover, criminal drug handling by employees, rising malpractice lawsuits, and a general lowering of the organization’s reputation. The chair started by outlining these issues and then opened the floor to contributors. The meeting started well with each member expressing the concerns of his/her represented-demographic. However, after twenty minutes or so, members eventually started trading accusations.
The board was accused of displaying outright favoritism by issuing differing verdicts on similar disputes. On the other hand, the board representative pointed out that there was a general lack of accountability among the nursing staff. According to the member, nurses have little concern about their job security, and they simply ‘mess up and change jobs’ before their mistakes become clear. In the same meeting, it became clear that physicians were using nurses as decoys when engaging in unethical practices. Although the meeting’s atmosphere calmed down eventually, the discussion of these issues was put off until the next meeting.
In the context of shared governance, the meeting failed in various ways. First, the allegation that board members were exercising favoritism indicates that there was an imbalance of power within the organization. Shared governance does not necessarily entail usage of power but its even distribution. Therefore, boards and other administrative members are only supposed to hold power on behalf of those below them but not to use it against them (Bogue, Joseph, & Sieloff, 2009).
Shared governance also consists of an element of strategy. If the meeting had happened in an environment of shared governance, the participants would have been able to identify the strategic issues without going on personal tangents.
The major issues facing a healthcare organization are likely to change from time to time, but this factor should be apparent where collaborative decision-making is utilized. The fact that roles between physicians and nurses were going into gray areas indicates that clearer governance guidelines are required.
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Eventually, the meeting recognized the need for laying out governance pathways. In most instances, “stakeholders who barrel ahead as if they own every process end up being burdens to decision-making processes and other individuals” (Baker, 2011, p. 491). Shared governance has the capacity to offer the organization a way forward. This decision-making approach will make sure that collective agendas are prioritized, whereby the benefits trickle down to all stakeholders.
Baker, J. (2011). Clinical governance: a Guide to implementation for healthcare professionals. Journal of Advanced Nursing, 53(4), 491-492.
Bogue, R. J., Joseph, M. L., & Sieloff, C. L. (2009). Shared governance as vertical alignment of nursing group power and nurse practice council effectiveness. Journal of Nursing Management, 17(1), 4-14.