Strengthening decision-making within shared governance : an action research study

This thesis presents an action research study concerned with strengthening decision-makingwithin a councillor model of shared governance in a UK hospital trust. Sharedgovernance seeks to flatten traditional hierarchies by empowering clinical staff to makedecisions affecting policy and practice.Chapter 1 sets the scene for this exploratory case study through identification of thenational and local health care context. The model of shared governance chosen forinvestigation is presented. An overview of the thesis is given.Chapter2 presents a literature review of shared governance framed by undertaking of aconcept analysis. Existing evidence concerning shared governance and decision-makingis examined.Chapter 3 considers methodology issues and justifies the selection of a qualitativeapproach that embraces action research as a means of promoting integration of findingsinto decision-making practice.Chapter4 sets out the methods used to collect data in response to the research questions.Issues around access to the research setting are discussed. Sampling decisions are madeexplicit and a description of the data collection process is given. Extensive use has beenmade of participant-observation as well as interview techniques.Chapter5 presents adetailed narrative of the approach to analysis centring on the use ofbasic and advanced data displays to aid qualitative data analysis.Chapter 6 details the study findings and culminates in the presentation of a conceptualmodel of shared governance decision-making.Chapter7 provides a substantive reflective narrative concerning my research practicesand experiences throughout the action research journey, and the impact of these on mypersonal development.Chapter8 discusses the study findings in light of a summative review of the literatureand evidence around shared governance and decision-making. Implications for practiceand policy are identified along with areas for future research