Those in health care know all too well that the patient experience is a top pain point for executives and therefore a top organizational priority. There is also no shortage of initiatives, programs and activities that focus on improving that experience. Committees and task forces are formed with participation from leaders across the entire organization. Education and action plans are developed and rolled out. Patient experience scores are closely watched for the anticipated improvement. Then, reality often sets it: There is no—or only minimal—improvement. How can that be? And what can be done about it?
What if you were to take the traditional approach to improving the patient experience—the approach where initiatives, programs and activities are developed by those outside the point of care and rolled out to those who must operationalize them—and flip it? Shared governance is a leadership model that does exactly that. In a shared governance culture, staff members are empowered to make decisions that meet a set of articulated expectations shared by leadership. Shared governance has proven to be a highly successful partner in crafting strategies that yield sustained improvements. Shared governance is built on a set of four overarching principles:
Staff and leaders work together to improve practice and achieve the best outcomes.
Everyone contributes within the scope of her or his role as part of the team to achieve desired outcomes.
Staff and leaders share ownership for the outcomes of work and are answerable to colleagues, the institution, and the community served.
Participants accept that success is largely dependent on how well they do their jobs.
Using shared governance, groups of staff members (councils) are charged with the development of the specifics of the plan to address the opportunities for improvement. Let’s take the desire to have purposeful rounding be a standard of care. While the desired outcome is purposeful rounding, it would be up to the individual councils, groups, departments, or units to determine how this could be best operationalized in their area. Here are some examples of what could happen when the people closest to the work in each department are empowered to make decisions about how to make rounding purposeful for their specific patient populations.
The Maternal-Child department determines that rounds will be done hourly between 6:00 a.m. and 11:00 p.m., then every two hours between 11:00 p.m. and 6:00 a.m. They have made this decision to meet the needs of their patients to have a period of uninterrupted sleep.
The Surgical unit decides rounds will be a shared responsibility between the RN and the Clinical Assistants (CA). RNs round on the even hours and CAs on the odd hours. For the same reasons as the Maternal-Child department, they too decide hourly rounding hourly will be done between 6:00 a.m. and 11:00 p.m., then every two hours between 11:00 p.m. and 6:00 a.m.
The Patient Experience council, made up of a mix of staff members from across the organization (i.e., environmental services, clinical, nutritional services, etc.) work together to develop a meaningful rounding experience for patients and staff members that includes addressing the best practices in rounding conversations.
The expectation for each of the above groups was to craft a meaningful rounding experience that worked for the patient as well as the specifics of the individual units/departments. The plans, developed by staff members, are supported by colleagues as peer developed and rolled out the plans. Peers create the accountability with each other, and this in turn lessens the need for leadership to “manage” the plan. It also moves organizations from “us” and “them” to “we.”
There is an ancient Chinese proverb that states “An owner in the business will not fight against it.” Using shared governance to craft a plan for sustainable improvement creates ownership at all levels of the organization.
Gen Guanci is a consultant with Creative Health Care Management where she works with organizations as they build a culture of excellence. Her work with Magnet® and Magnet® aspiring organizations focuses on improving the patient experience, work environment, clinical practice, and patient outcomes. Her expertise in shared governance has enable her to empower staff to generate outcomes that exceed national benchmarks.