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What is Shared Decision Making/Shared Governance? How does it look in practice?

Given you’re here reading this blog, it should mean you have some understanding of what the model entails already. There are many, many sources out there (as I link to below) that detail what Shared Decision Making & Shared Governance are, in more articulated ways. So instead of me rewriting those, I want to provide an outline and link to various sources, and then detail our UHL model to give you an idea of what could look like in practice. The term ‘Shared Decision Making’ comes from the ANCC (American Nurses Credentialing Centre) and their Pathway to Excellence ® framework, with the first of six standards being Shared Decision Making. The framework depicts six standards that are essential elements in developing a positive practice environment for nursing (and midwifery*) across a variety of healthcare settings. In their words, “Shared Decision-Making creates opportunities for direct care nurses to network, collaborate, share ideas, and be involved in decision-making.” (More info.) There are various ways to develop a culture of Shared Decision Making throughout nursing and midwifery teams. The Pathway to Excellence ® framework does not explicitly reference using a particular method to achieve this (if you are looking to designate with this accreditation, then you may wish to innovate and create this culture through other means). The way we have begun to do this however is through embedding the Shared Governance councillor model, which has proven highly successful and is widely praised by staff. Shared Governance also comes from the USA and has been popularised by the ANCC once again through their Magnet ® accreditation program, although not explicitly stated. Despite the different names we use for the (councillor) model in the UK, they are essentially the same. Nottingham University Hospitals, who started Shared Governance (first to do so significantly) in the NHS, use that term as they were going for Magnet ® designation (now designated). Northampton General Hospital and University Hospitals of Leicester decided to use the term Shared Decision Making instead, as they both are following the Pathway to Excellence ® framework. Below is a non-exhaustive list of SDM/SG resources to help improve your understanding. I strongly suggest you give the following a read, specifically the first link if you can get your hands on a not-to-expensive copy, it’s a brilliant resource for all things Shared Governance.

“Shared Governance: A Practical Approach to Transform Professional Nursing Practice” Paperback book, found on amazon: (Link here) “Overview: Shared Governance: Is It a Model for Nurses to Gain Control Over Their Practice?“ (Link here)

“Shared Governance: A Practical Approach to Transform Professional Nursing Practice” Paperback book, found on amazon: (Link here)

“Implementing Shared Governance” (Link here)

Shared Governance at Nottingham University Hospitals (Link here)

Using Shared Governance to Empower nurses (NUH): (Link here) Shared Decision Making at University Hospitals of Leicester At UHL we define Shared Decision Making to be: “ organic transformational leadership approach that: • Empowers all members of the healthcare workforce

• Gives staff a voice in the decision making process

• Encourages creativity and innovation to advance and improve healthcare practice

• Improves communication and collaborative relationships among stakeholders”

So how does it look in practice? At UHL we use a simple councillor model, with emphasis on the word ‘simple’. We form councils based on four principles: Responsibility and Accountability (Ownership), Authority and Equity. The councils are made up of approximately 4-6 members of staff from a mixture of roles up to band 6. We expect councillors to commit to 12 months (give or take) to sit on the council. They are given dedicated time per month, per member, to meet to discuss positive changes they would like to make in their areas around patient safety & experience, staff wellbeing, experience and development, or the environment. Improvements are staff led and are not imposed by management. The councils are each given a resource folder and access to a digital shared folder on the hospital network, enabling them to access digital resources (templates, dates, etc.) as well as accessing other councils’ work for inspiration. Every six weeks, we hold a ‘Leadership Council’ which is a relaxed meeting, running for approximately 1.5 hours, chaired by the Chief Nurse and supported by the senior nursing team. Here, the council chairs attend to feedback what they are working on, what is going well and if there are any barriers to their work. It is here they can share and collaborate with other councils, and we can facilitate board to ward communication.

We provide one day of training to our councils which they must attend prior to meeting for the first time. This covers Pathway to Excellence®, Shared Decision Making (what it is, their first meeting and the ‘how-to’ for improvements) and then we invite in our Hospital Charity, Health & Wellbeing and Patient Experience Teams to introduce themselves to the councils.

We have a full-time facilitator (myself) to support this process, from initially setting up councils to organising and providing training. We emphasise that each council’s journey is unique and their experiences will all be different depending on their areas. Additionally, what the councils choose to discuss and work on is their choice. We also do not set councils up for specific purposes/projects unless it is a staff led initiative (as opposed to being management led).

That is the core of it. Nothing unnecessarily fancy or complex. We keep it as simple as possible. Why? Frontline staff are currently under immense pressure in their daily roles, and we want them to engage in this process for the benefit of them and their patients. If we bog this process down with governance, or make it overly complicated, they will not engage. I hope this first post has helped to give an overview of SDM/SG and how it looks in practice. I'll be posting more on specific topics covering how to start SDM in your organisation, how to set up councils, what training I provide, etc.

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