Hide Notes 

Slide 1: Course: Innovation and Change Content Area: Shared Governance Creating and Sustaining Nursing System Excellence: Utilizing a Triad Approach – Shared Governance, Expertise, Evidence Based Practice Patty Knecht 2009 PSU Grad Student
Slide 2: Audience MSN Administrative/Leadership Tract
Slide 3: AACN MSN Related Competencies  Communicate with other health care professionals; develop and work in collaborative relationships.  Assume the role of advocate for consumers and change agent within the health care system.  Effect change within the health care system, not merely react to changes brought on by others-monitor changes that are occurring within the health care system, through both internal and external forces, and make appropriate changes in order to improve the system, the delivery of health care, and health care outcomes  Understand the health care system in which they practice through the application of appropriate theories. www.aacn.nche.edu
Slide 4: EBP Skill Critical Thinking Communication  Information Literacy
Slide 5: Theory: Roger’s Theory 5 Main Attributes Influence Adoption Variance from 49 -87% (Rogers, 2003)  Relative advantage--which is whether it is seen as being better than the idea it supersedes, this can include economic and social prestige. Many healthcare studies now examine the economics of innovations when marketing it to the adopters.  Compatibility--the degree to which an innovation is perceived as consistent with the needs of the adopters.  Complexity--how difficult it is to use and understand.  Triability--degree to which it may be experimented with on a limited basis-those that can be "tried out" are generally more positively adopted  Observabilty--How visible the use of the innovation is to others.
Slide 6: Rogers, 2003 Theory of Diffusion Four Essential Areas For Adoption of EBP Innovation Communication Channels Time Social System
Slide 7: Roger’s Diffusion Of Innovation Theory Change is Difficult for Most!!
Slide 8: Iowa Model  Iowa Model Of Evidence Based Practice to Promote Quality of Care (Titler, 2008))  Organizational, collaborative model  Conduct research  Utilize research  Problem focused triggers  Evidence  confirm basis for practice  suggests need for clinical research  utilized to make decisions  If not enough evidence or clinical study is not possible, other types of evidence utilized (case studies, expert opinions etc)
Slide 9: Objectives 1. Access information about shared governance on professional web sites. (Information Literacy) 2. Discuss the pros and cons of a shared governance model. (Communication) 3. Describe the synergistic relationship between shared governance, EBP and expertise. (Critical Thinking) 4. Discuss the relationship of the triad (shared governance, EBP and expertise) in creating a culture of excellence. (Critical Thinking, Information Literacy) 5. Working with a small group, create an implementation strategy to employ shared governance on a clinical unit. (Critical Thinking, Information Literacy, Communication) 6. Discuss the key components of Roger's Diffusion of Innovation theory essential to effectively implementing sustained change in a health care setting. (Critical Thinking)
Slide 10: Required Resources (Student)  Saylor, D. (2007). Shared governance: Your opinion matters. Nursing Management 38(5): 14, 16.  Scott, L. & Caress, A. (2005). Shared governance and shared leadership: Meeting the challenges of implementation. Journal of Nursing Management 13, 4-12.  Zuzelo, P. et al (2006). Shared governance and EBP: A logical partnership? Nursing Management. 37 (6): 45-50.  www.sharedgovernance.org *Information Literacy, Critical Thinking
Slide 11: Suggested Resources (Student)  Dumpel, H. (2008). The true forces behind Magnetism: CNA/NNOC's position statement on hospital Magnet status. Registered Nurse: Journal of Patient Advocacy 104(4): 18-22.  Goode, C, (2005). The pull of Magnetism: A look at the standards and the experience of a Western Academic Medical Center in achieving and sustaining Magnet status. Nursing Administration Quarterly 29 (3): 202-13.  Johnson, K. et al (2006). A nurse-driven system for improving patient outcomes. Journal of Nursing Care Quality 21(2): 168-75.  Rogers, E. M. (2003). Diffusion of Innovations, Fifth Edition. New York: Free Press  www.nursecredentialing.org/Magnet  www.ahrq.gov *Information Literacy
Slide 12: Class Content  Excerpts follow from myplick presentation ( www.myplick.com/view/1X-g3jDfzQG/Triad2) of key class content concepts
Slide 13: You Have To Be Willing To Learn New Things Tim Porter O’Grady PhD Tim Porter O"Grady PhD
Slide 14: Nurses Control Over their Practice 1988 Sample of 3,500 nurses identified being "allowed" to exercise nursing judgment for patient care was one of the most important factors in their practice (Huey & Hartley, 1988). Research area for Magnet hospitals (Kramer & Schmalenberg, 2003) and nurse investigators (Weston, 2006). Reference Hess (2007)
Slide 15: Who Rules?? Governance relates to decisions that define expectations, grant power, or verify performance. (Wikipedia) Governance is about power, control, authority and influence (Hess, 2007)
Slide 16: History of Shared Governance  Christman (1976)  Introduced the autonomous nursing organization concept  Equal voice with physicians within hospitals  Cleland (1978)  Introduced label of shared governance  Model reconciled the interests of different organizational groups through the distribution of power to formulate policy  Soared in the 1980’s due to the infusion of humanizing models.  Original concepts morphed to fit institution
Slide 17: Three Models Councilor Model Coordinating council integrates decisions made by subcommittees Administrative Model More traditional bureaucratic model Congressional Model Democratic component
Slide 18: Key Points  Structure is Critical  Defined Set of Bylaws  Clinical Nurses have Control over their Practice  Decisions at the Unit Level  Clinical Nurses involved in Policy/Administrative Decisions (Nursing Councils)  Evidence Based Practice
Slide 19: Measure of Success of Shared Governance  Control of Practice leading to Better Patient Outcomes  Increased Nurse Retention/Job Satisfaction  Development of Enhanced Critical Thinking Skills  Development of Staff Conflict Resolution and Negotiating Skills  Tearing Down of Silos and Creating Enhanced Opportunities for Collaboration
Slide 20: Disadvantages/Concerns Cost ROI? Union/Labor Organization Concerns Staff concerns that they are burdened by management decisions
Slide 21: Key Steps to Implementing Shared Governance www.sharedgovernance.org  Assessing the Individual’s Perceptions  Assessing the Manager’s Perceptions  Assessing the Staff’s Perceptions  Beginning Implementation  The Index of Professional Nursing Governance (Hess, 1998)  Implementing the Governance Councils  Unit Based Shared Governance Activities  Implementing Changes Reference: Porter O'Grady, T (2004) Shared Governance Implementation M
Slide 22: Leaders should be looking ahead………. Tim Porter O’Grady PhD
Slide 23: Roger’s Diffusion Of Innovation Theory “Identify a Champion” Change is Difficult for Most!!
Slide 24: EBP and Shared Governance  EBP is at the core of Shared Governance  Councils utilize research to steer decisions related to policies, procedures and clinical pathways  “That’s the “way we always do it” no longer is acceptable  Efficient and reliable access to evidence
Slide 25: Expertise Expertise versus Experience Benner’s Novice to Expert
Slide 26: Magnet & Shared Governance Shared Governance is at the Core EBP Quality Outcomes www.ahrq.gov
Slide 27: Kitson, 2008  The final proposition attests that innovation is most effective in systems when it involves key stakeholders in personal development; control of the immediate physical resources and context; and increased autonomy over the external environment (Kitson, 2008)
Slide 28: Learner Activities
Slide 29: Learner Activities  Please read all required readings/resources.  2. Review the myplick presentation at  www.myplick.com/view/1X-g3jDfzQG/Triad2  3. Review the web site www.sharedgovernance.org  Review the site information.  Click on the link “overview” in the first paragraph – and read “From Bedside to Boardroom - Shared Governance”. Read the 2008-updated version. Hess, R. (2004). From the bedside to the boardroom – Nursing shared governance. Online Journal of Issues in Nursing 9 (1).  Review the link to related research  Note the link to Shared Governance Implementation Manual for future use.
Slide 30: Learning Activity Continued  Consider the following questions* as you review the materials:  How is the nursing shortage revitalizing the shared governance model?  What are the benefits to clinical nurses being involved in management (bureaucratic model) type decisions?  What groups might see shared governance model as negative or a threat?  How does EBP link to shared governance?  What is the relationship of nursing expertise to shared governance?  How does shared governance impact the needs of the nursing workforce?  How does shared governance impact patient quality outcomes?  5. Refer to recommended articles as needed.**  *Questions encourage critical thinking  **Develops information literacy
Slide 31: Consider the following scenario:  You are a relatively new administrator at a medium sized medical facility supervising two medical surgical units and one rehabilitation unit. During the interview process it is shared that the previous administrator was a long term, “respected by most” employee who micro-managed the front line charge and staff nurses.  In addition, the units were managed to meet budget and maintain status quo. In the last three years quality indicators had dropped but long-term staff still defend and believe in this most recent management approach.  A union environment has sustained employment of some long-term staff but relatively new staff have created a revolving door over the last two years. The units exist in silos and are virtually non-existent at administrative, decision making hospital wide meetings, leaving nursing often out of the loop.  At your third staff meeting, you mention the term shared governance and are met with bodies turned away from you and crossed arms. When you ask for the staff feelings, the room is silent. One new nurse finally speaks up and states, “What are the benefits of shared governance?” Another pipes in “There must also be negatives.”
Slide 32: Directions for Learning Activity      You have been assigned to teams of two. Jones and Murray Team A Bryant and Teny Team B Mathews and Albright Team C Gerrit and Susant Team D  1. Decide amongst yourselves who on your team will post the pros and who will post the cons in the discussion forum.  2. Prepare your individual bullet points as your response and post in the discussion forum by Wednesday at 5:00PM *Communication, Information Literacy, Critical Thinking
Slide 33: Learner Evaluation
Slide 34: Message to Students  Please note: Previous classes this semester have already introduced Diffusion of Innovation Theory and Evidence Based Practice. Please revisit this material as needed. This class will focus on the concept of Shared Governance and the interrelatedness of the triad in creating and sustaining nursing system excellence.
Slide 35: Assessment Activity Background Information  Some opposition still exists but several of the staff has demonstrated interest in the concept of shared governance. Some of the seasoned staff is skeptical of this concept and in fact some are fearful for their jobs, as they are AD graduates or LPNs and have heard through the grape line, shared governance is a precursor to magnet status. Rumor has it that shared governance and magnet status strongly endorse an all BSN staff.  One of the seasoned staff questions how these practices affect the quality of patient care. Another states, Why should we do management’s job? This is just more stress. Learner Evaluation  The decision has been made to implement a shared governance model.
Slide 36: Team Directions  Create a document describing your immediate response to the concerns listed above and implementation strategies over the next year. Include a timeline and resources. Be sure to consider Roger’s Diffusion of Innovation Theory, including the adoption curve and the ten critical dynamics of the Innovation of Diffusion Theory. Reflect on how EBP will influence your implementations. Don’t forget the key concepts of shared governance as the plan is created.  The article by Zuzelo et al (2005) Shared Governance and EBP: a logical partnership and the website www.sharedgovernance.org can be particularly helpful.  Think about the triad. How is the topic of expertise currently impacted by the state of the nursing workforce? Utilize all these thoughts to create your implementation plan strategies.  Work with the same team from the previous activty. With pros and cons in mind and all other material reviewed, create the document referenced above and as a team and post by Sunday at 5:00PM (Communication, Critical Thinking, Information Literacy)
Slide 37: Key Points for Faculty Grading of Learner Evaluation Evaluation is part of the 25% Course Participation Grade The following points should be referenced in the team’s implementation plan of shared governance.  Reinforces the fact that Shared Governance is a journey, not a destination (Hess, 2008).  Reinforces the relationship of Roger’s Diffusion of Innovation Theory to implementing change.  The concept of the adoption curve is noted in the team’s implementation plan  The relationship of the Triad is referenced in achieving nursing excellence  EBP is evident in the team’s Implementation plan.  Anticipated barriers and facilitators are communicated by team.  Team’s Implementation plan is clear and realistic.
Slide 38: Faculty/Course Evaluation  Recommend Course Evaluation at mid course and end of course.  If college/university does not have access to survey information electronically, you can utilize questionpro.com for no cost based on limited use.  Qualitative data can produce rich data in conjunction with quantitative data.
Slide 39: Course/Content/Faculty Evaluation Please complete this course/faculty survey and return by May 1, 2009. This data is critical to the ongoing quality improvement of the program. Your input is valued and utilized to initiate change. If you disagree or strongly disagree with any question, please provide a specific comment. Comments also are appreciated if you strongly agree with a question. Thanks for your time!! This survey is anonymous. Student Information Yes No Comments Are you a matriculated graduate student? Course evalua ted is Innovation and Change. Specific Content Area evaluated is Shared Governan ce Rate the following according to this scale: 1 = Strong Agree 2 = Agree 1 2 3 4 5 Comments 3 = Neutral 4 = Disagree 5 = Strongly Disagree Allobjectives were met as stated. Assignments supported your ability to meet objectives. Number of assignments was appropriate to the content delivered. Evaluation methods were appropriate in relat ionship to objectives and fairly implemented. Student feedback was given in a timely manner. Faculty was knowledgeable of content area. Content was current a nd transferable t o nursing practice. Learning strategies were innovative and engaging. Were there any articles or web sites that were particularly useful to understan ding and implementi ng shared governance? What should be changed to improve this learning experience? How could the scenario learning activity be improved to enhanc e student learning? Additional Comments:
Slide 40: Nursing Excellence = Quality Patient Outcomes Triad of Creating and Sustaining Nursing Excellence QuickTimeª and a decompressor are needed to see this picture. QuickTimeª and a decompressor are needed to see this picture. QuickTimeª and a decompressor are needed to see this picture.
Slide 41: In the 21st Century Do We Really Have a Choice If we Want to Thrive? Tim Porter O’Grady PhD
Slide 42: References for Teaching Plan  Dumpel, H. (2008). The true forces behind Magnetism: CNA/NNOC's position statement on hospital Magnet status. Registered Nurse: Journal of Patient Advocacy 104(4): 18-22.  Goode, C, (2005). The pull of Magnetism: A look at the standards and the experience of a Western Academic Medical Center in achieving and sustaining Magnet status. Nursing Administration Quarterly 29 (3): 202-13.  Hess, R. (2004). From the bedside to the boardroom – Nursing shared governance. Online Journal of Issues in Nursing 9 (1).  Johnson, K. et al (2006). A nurse-driven system for improving patient outcomes. Journal of Nursing Care Quality 21(2): 168-75.  Kitson, A (2008). The need for systems change: reflections on knowledge transition and organizational change. Journal of Advanced Nursing 10 (9): 1-12.  Rogers, E. M. (2003). Diffusion of Innovations, Fifth Edition. New York: Free Press
Slide 43: References for Teaching Plan  Saylor, D. (2007). Shared governance: Your opinion matters. Nursing Management 38(5): 14, 16.  Scott, L. & Caress, A. (2005). Shared governance and shared leadership: Meeting the challenges of implementation. Journal of Nursing Management 13, 4-12.  Titler, M. (2008). The Evidence for Evidence Based Implementation (Chapter 7) excerpt from Hughes, R. (2008) Patient Safety and Quality: An Evidence Based Handbook for Nurses. Agency for Health Care Research and Quality Publication No. 08-0043.  Zuzelo, P. et al (2006). Shared governance and EBP: A logical partnership? Nursing Management. 37 (6): 45-50.  The Essentials of Master's Education for Advanced Practice Nursing. Retrieved from www.accn.nche.edu  www.nursecredentialing.org/Magnet  www.sharedgovernance.org  www.ahrq.gov