Promising, but imposing, the sign announced, “Shared Governance Meeting – Everyone’s Attendance Mandatory.”

“Well, I’m not going. It’s not meant for me,” fumed bedside nurse Heather, her eyes popping and her feet firmly planted in victim. With rare commiseration, her manager agreed, “They shouldn’t involve staff in stuff like this. It’s obviously meant for managers.”

No one delays a journey like people who won’t get on board. Pulling against everyone else’s rosy expectations, these nurses tugged at the launch of their hospital’s shared governance program like ten-ton anchors. But petulance is not a virtue; participation is. Research with the Index of Professional Nursing Governance has shown that the opportunity to participate in governance decisions is present in every successful shared governance model. If you can make it to the table, you at least have a chance to help make decisions. And yet, when implementing governance innovations, every organization faces nonbelievers – staff reticent to participate, yet quick to demand to know what’s in it for them.

5 Essential Tips to Boost Participation

Here are a few essential tips for boosting participation – and maybe enthusiasm.

1) Pull everyone in through education

Make sure that main players as well as those on the sidelines know what shared governance is and what it can do for their practice. Don’t accept the excuse, “I didn’t sign on for this.” When health care professionals accept a professional license, they agree to professional responsibilities, such as an obligation to control their practice, another essential element of shared governance. Compile a short list of journal articles that describe shared governance, its purported outcomes, and implementation stories. Make the list mandatory reading. And find some internal and external speakers to periodically celebrate your launch and renewals. Structure opportunities for participation into the organization. Be certain that participation in shared governance permeates committee policies and job descriptions. Formal job responsibilities that encourage participation emphasize the importance an organization ascribes to its program and eliminates nonparticipation as an option.

2) Organize an involvement-friendly environment

Make it as easy as possible for staff to attend meetings. Don’t leave units short-staffed when people need to go off to committee meetings. Don’t expect people to participate on their own time. And don’t make it easier for some and harder for others to participate. You might be creating the next generation of resentful participants. Encourage everybody, and demonstrate effective, involved behaviors through role-modeling and coaching. Shift focus from the individual to the group. Praise the enthusiasm of cheerleaders, but also recognize subtle shifts in people’s commitment. People change, and sometimes even the most willful detractors stumble on epiphanies.

3) Understand that not everyone can make the journey

Shared governance is not appropriate for every health care organization and not right for every nurse. True nonbelievers can go in one of two directions – they can refuse to participate, but take orders from the group (they took orders from managers, didn’t they?), or they can move on. Let them slowly slide off the ship (at the dock, not at sea).

4) Teach some more

Make sure that everyone knows what job- and role-appropriate skills they need for shared governance and how to acquire them. Don’t confuse expertise with office. Staff, middle managers, and even executives will need new skill sets. Pull in advice and aid from organizations with mature models through networking.

5) Set a realistic time-frame for achieving goals

Don’t expect everyone to join in at the same rate or time. And as changes are made, benchmark the journey from beginning to end to chart your progress.

Robert Hess, Jr., PhD, RN, FAAN

Dr. Robert Hess is the founder & CEO of the Forum for Shared Governance and webmaster for www.sharedgovernance.org. He is the author of the only instruments for measuring governance in healthcare organizations, used globally in 300 healthcare systems, and translated into 10 languages, and coauthor with Dr. Swihart of a new instrument, Council Health, which measures shared governance councils’ effectiveness.

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