Accountability and ownership are important principles Children’s Hospital Colorado (CHC) is a 500-bed pediatric Developing shared-governance structures at the divisional Of course, developing new councils alone doesn’t The CNPC is a staff-nurse council with members representing Cost of the CNPC. The council has 56 members; The NGB formed in 2011 as the central oversight Cost of the NGB. This council has 49 members; During our journey to strengthen shared governance, Three strategies can be used to track expenses and Cost of the organization’s investment in shared governance ROI = gain from investment minus cost of the investment
how the work and decisions will be made.
nurse engagement, and nurse satisfaction.
of shared governance. Shared governance isn’t
a new concept in health care, but several misconceptions
exist about what it is and isn’t. One misconception
is that it adds expenses to already burdened
healthcare organizations. This article addresses this
misconception by sharing our organization’s experience
as well as several methods to demonstrate the
financial impact of shared governance.
hospital with a main campus in Aurora and 17
additional sites. It has a long history of shared governance.
Staff have participated in unit-based and hospital-
wide committees since the 1980s. However, CHC
had few division-level structures to support decisionmaking
across the nursing division. Creating these
structures was a priority for our new chief nursing
officer (CNO). In 2009, we began to revise the structures
and processes that support shared governance.
Shifting the culture
level wasn’t as simple as scheduling the time
and finding membership. We had to shift the organizational
culture. Although staff were engaged in
practice and decisions affecting their work, best
practices rarely were shared and aligned across units
and practice areas—mainly because we lacked the
structures for this. So we created new councils and
revised existing ones to meet our needs and provide
links among unit-based structures.
nursing directors, the CNO, and the associate
CNO, is strategically focused.
of nursing managers and directors, is operationally
practitioners, certified registered nurse anesthe –
tists, and physician assistants.
specialists and nurse educators to align practice
for staff education, training, and competency.
on research, evidence-based practice, and nursing
quality and safety.
venue that includes all clinical departments,
both within and outside the nursing division.
and Nursing Governance Board (NGB) are described
in the case studies below.
create a culture change. Individuals participating in
councils also must adopt the right attitude and behaviors.
Each council educated its members on the council’s function and
purpose, planning agendas and communicating with
staff. An experienced nurse leader acted as a mentor
for each council. Every council completed a charter to
further define its purpose, essential functions, decisionmaking
authority, membership and co-chair responsibilities,
and communication structures. Bylaws outlined
the overall structure of the entire division.
all areas of the organization, including inpatient
units, ambulatory clinics, procedural areas,
emergency department, urgent care, psychiatry, and
network-of-care sites. Although it existed before 2009,
it was mostly an advisory group that rarely got involved
in decision making. Slowly, through agenda
management and mentoring of staff co-chairs, it has
evolved into a decision-making body. Staff representatives
meet monthly to discuss clinical nursing practice
issues. Co-chairs can allot 8 to 10 hours of administrative
time each month for council activities.
55% are nonexempt employees. They hold 2-hour
meetings each month at a cost of $32,856 per year.
Co-chairs’ administrative time is $8,000 per year.
This brings the total cost to $40,856 per year.
body over all councils in the nursing division. Initial
membership included chairs of all practice-area
(unit-based) councils. The purpose of such wide
membership was to educate and train council chairs
on their role, effective meeting management, agenda
planning, communication, and conflict resolution.
To promote this training, a retreat was held
and relevant topics were discussed each month during
regularly scheduled NGB meetings. In fall 2012,
after 16 months of start-up, membership was cut to
18 to make the council more focused and efficient.
71% are nonexempt employees. They meet for 2
hours each month at a cost of $33,024 per year.
Co-chair administrative time is $6,144. This brings
the total cost to $39,168.
it became apparent that duplicate work was
occurring due to the large number of committees.
To streamline and steer discussions to the correct
council, CNPC absorbed the work of the laboratory/
nursing committee and safety device committee,
for a cost recovery of $13,804. Work continues on
evaluating all committees and councils to further
streamline and prevent duplication of work.
Tracking performance and outcomes
outcomes related to direct-care staff involvement in
shared governance. (See Tracking shared-governance
expenses and outcomes by clicking the PDf icon above.)
Return on investment
includes salary expenses for the hours that
direct-care providers allocate to shared-governance
work. Gain from the investment might be in the
form of savings related to equipment and supply decisions,
reduced lengths of stay for a certain patient
population, or other quantifiable outcomes. To calculate
return on investment (ROI), use this equation:
Accountability and ownership are important principles
Children’s Hospital Colorado (CHC) is a 500-bed pediatric
Developing shared-governance structures at the divisional
Of course, developing new councils alone doesn’t
The CNPC is a staff-nurse council with members representing
Cost of the CNPC. The council has 56 members;
The NGB formed in 2011 as the central oversight
Cost of the NGB. This council has 49 members;
During our journey to strengthen shared governance,
Three strategies can be used to track expenses and
Cost of the organization’s investment in shared governance
ROI = gain from investment minus cost of the investment