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Mhp Nursing Shared Governance Essay

What is Shared Decision Making
• Point of Service Decision Making – where staff who perform the work participate in decision making affecting their environment • A 30 year old decision making model meant to give equal voice to nurses • A decentralized style of management that creates an environment of empowerment

Shared Decision Making A Journey Not a Destination

We

TO

They

Why Shared Decision Making
• Essential to achieving the best patient outcomes by giving nurses control of their practice – they know best! • Recognizes the power already present in a role and allows that power to be expressed legitimately • Builds autonomy into the profession

Shared Decision Making – The Process
A dynamic process that is centered on 4 critical principles of fully empowered organizations: Partnership Accountability Equity Ownership

Operational Definitions
• Partnership – nursing staff and leadership work together at the unit and system level to move practice forward and achieve the best outcomes • Accountability – staff and managers share ownership for the outcomes of our work and are answerable to our colleagues, the institution and the community we serve

Operational Definitions
• Equity – Integrating roles to achieve outcomes; everyone contributes within
the scope of their role as part of the team • Ownership – Everyone must realize that success is linked to how well they do their jobs

Shared Decision Making Our Model
Professional Advancement Council Administrative Council
Safety First

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ina

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Quality & Safety Council

Cou

ncil

Unit
Patient Research & Evidence Based Nursing Practice Council

Great Place to Work

Professional Nurse Council

Family

Community

Clinical Excellence

Councils

Coo

Education Council

rdin

atin

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Cou

ncil

Think of yourself as a Patient

APN Council

Research Council

Financial Strength

CCHS Shared Decision Making Councils
• Quality & Safety Council • Research & Evidence Based Nursing Practice Council • Education Council • Professional Nurse Council • Coordinating Council

Education Council
 Collaborates with unit and system councils to identify educational needs, develop educational priorities with appropriate time lines and determine resources for all education impacting the Department of Patient Care Services  Disseminates approved educational strategies to unit leaders and support staff  Develops and maintains a communication network between unit
and systems councils

Research & Evidence Based Nursing Practice Council
 Promotes the spirit of inquiry in clinical nursing practice  Evaluates the literature in order to use best practices to transform clinical practice at the point-of-care

Quality & Safety Council
 Provides planned, systematic and collaborative approaches to oversee and direct quality and safety relating to the nursing process, functions and services provided.  The council’s scope includes performance improvement and safety measures throughout the Department of Patient Care Services

Professional Nurse Council
 Works to enhance the professional image of nursing within CCHS and the community  Supports the spirit of the professional advancement program  Identifies and supports implementation of recruitment and retention strategies

Coordinating Council
 Provides overall coordination of the systems councils.  Reviews the system strategic plan and adopts the plan for the Department of Patient Care Services and the nursing Shared Decision Making structure.  Serves as the portal for other departments or disciplines requiring assistance with the Shared Decision Making structure of nursing.

Problem Solving The Old Way
• Problem identified by staff and communicated to manager • Manager may or may not have asked for feedback about solutions • Manager made final decision or had final authority for approving a solution

Problem Solving The New Way
• Staff identify issues and communicate them to the unit council • Unit council formulates a response and communicates this to staff • Staff provide feedback via the comment form.

How Does The New Way Work • Unit Council:
 Collects Data  Develops a proposed plan using evidenced based practice  Develops a time line  Presents Plan for Feedback (Open Comment)  Revises Plan Based Upon Feedback  Forewards plan to system council, as needed

How Does The New Way Work

• Unit Council:
    Implements Plan Evaluates Outcome Report Results to Unit Staff Seeks staff feedback, formally and informally on council’s performance

How Does It Work – Problem Solving Methodology
• Identify an Issue or a Problem • Gather Data • Design a Solution • Obtain Feedback • Finalize a Proposal • Implement • Evaluate • Report

Increased Incidence of Pressure Sores
Problem

Unit Problem:

Unit Council
Problem Solving Model Results: Positive Outcomes

System Level
Practice Research

Problem

Coordinating

Operations

Education

Problem Solving Model

Results: Positive Outcomes

Nurse Manager’s Role
• Create a climate that is actively supportive and not just tolerant of shared decision making • Facilitate a leaning environment for staff growth and comfort with shared decision making • Support “release time” for staff to participate in shared decision making activities

Nurse Manager’s Role
• Share with staff your knowledge of leadership and help staff to minimize implementation barriers • Commit to the “New Way”

Role of Unit Based Council Chair
• • • • • • • • Set meetings Develop the agenda Move council to consensus Ensure members participate (per charter) Facilitate group assignments Ensure consensus for decision making Call emergency meetings, as needed Mentor Chair-elect

Benefits of Shared Decision Making
• Increased Staff Nurse Satisfaction (increased autonomy, increased control over practice, improved communication between nurses, physicians and administration) • Improved Nursing Retention ($90,000 to replace an RN – 2006 Advisory Board) • Improved Patient Safety Outcomes

Benefits of Shared Decision Making
• Improved collaboration and team Building • Improved quality of care and clinical effectiveness • Increased staff confidence, personal and professional growth • Development of new knowledge and skills • Increased professionalism and accountability

Requirements for success….
• Place the Patient First and focus on providing the best care possible • Trust and respect is essential • Communicate openly and honestly • Embrace
change and strive for improvement • Staff and managers hold each other accountable. • Organizational support of accountability in the performance appraisal process

Final Thought
Shared decision making is a journey, not an event. It is not achieved overnight, and there is no conclusion – no point when it is fully in place. It only provides a foundation for further growth.

Tim Porter-O’Grady


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