Shared governance consultants sometimes create confusion by substituting terms like shared decision-making or shared leadership. Here is guidance from the Forum on why terminology matters.
Advice From the Forum: Confusion Among Consultants
During the last nursing shortage, I witnessed a serious discussion among leaders about replacing the word “nurse.” They believed that its inherent gender bias discouraged men from swelling nursing’s ranks. I’ve been a guy all of my life and a nurse for more than 30 years; the idea of decoupling nurse from nursing left me cold. Thank God that notion never found traction.
A few years ago at an international nursing research conference, a grande dame of Magnet hospital research asked me if I could stop using the term—shared governance—and replace it with shared something else. I told her, in the face of more than 30 years’ tradition, why lose the term? Now it seems a cadre of misguided consultants promotes its own governance replacements.
Why Terminology Matters
Shared governance is an organizational innovation that gives professionals control over their practice as well as influence over resources that administrators and managers previously held in exclusive control. This multidimensional concept is a complex but essential characteristic of organizations. Importantly, it is not synonymous with shared decision-making or shared leadership, both of which are tangential to shared governance. As the fine, informed consultant, Vicki George, RN, PhD, FAAN, president of VMG Consulting and a Forum’s Advisory Board member, puts it, “Shared governance is the structure, shared decision-making is the process, and shared leadership between management and staff is the outcome.” To have a structure that facilitates shared decision-making and shared leadership is to have shared governance. Why call it anything else?
I remember visiting a major Magnet teaching hospital where staff admonished me not to use the term governance because it would not only “freak out” the physicians, but hospital board members as well. It is no coincidence that one of the finest shared governance hospitals in the United States, one that has remained firm and committed to the concept through 25 years of three major changes in leadership, has a chairman of the board who not only champions this model but brags about it all over the hospital’s community.
The Cost of Watered-Down Substitutes
Perhaps shared decision-making or shared leadership are softer, more sellable terms for nervous nursing executives and their bosses. However, shared governance is not a commodity. It is a revelatory, transforming experience for professionals that may produce profound effects on professional, organizational, and most importantly, clinical outcomes. In fact, one researcher believes she is close to linking shared governance to reductions in patient falls.
Anything that empowers healthcare professionals in their practice is good. Nevertheless, some consultants charge big bucks for muddying the waters and implementing watered-down substitutes for real shared governance. And if they get something as basic as this wrong, what else are they missing?