Building Excellence through Shared Governance and Continuous Process Improvement

Abstract Background: Nursing shared governance in the hospital setting is a well-established structure for shared decision-making between staff nurses and nurse leaders to improve nursing practice, quality of care, and patient safety. Establishing effective, shared governance can take several years: new skills must be acquired, new behaviors accepted, and new professional commitments made. Newcomers to shared governance require support, education, and the opportunity to acquire requisite skills; otherwise, interest, commitment, and achievement of desired outcomes cannot be sustained. Local Problem: A large hospital in California established a shared governance structure in 2018. Performance gaps between two high-performing Nursing Unit Councils (NUC) and the other 11 NUCs indicated the need for education and skill-building in performance improvement. Context: The sustainability of shared decision-making, nursing ownership of the practice, and nurse engagement in the organization would be threatened without an environment that supports and generates performance improvement. Interventions: Two comprehensive learning sessions, and a toolkit, introduced shared governance foundational components and a performance improvement framework to engage nurses in process improvement. Outcome Measures: The outcome measures were greater understanding of the IHI Model of Improvement, increased use of performance improvement methodology, and improved perception of shared governance. Results: Knowledge of performance improvement methodology and perceptions of shared governance improved in all focus areas. Familiarity with the IHI Model for Improvement increased by 29%, knowledge of SMART goals by 5%, and utilization of outcome measures by 47%. Staff nurse participation in the development and evaluation of policies rose 18%, staff nurses providing professional and educational programs increased 60%, and staff nurses\u27 access to nursing department goals and objectives improved 17%. Conclusion: Intentional education and development of nurses in performance improvement and shared governance yields mature shared decision-making and effective problem-solving. Keywords: shared governance, decision-making, nursing, performance improvemen