The Value of Shared Governance

Partnership, equity, accountability and ownership

shared governance

By K. Kelly Hancock, DNP, RN, NE-BC, FAAN, Chief Caregiver Officer, Cleveland Clinic Health System


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The concept of shared governance and shared decision-making isn’t new to healthcare. It emerged decades ago as a form of participative management, altering the traditional model of top-down governance. Today, it’s a structure and process for partnership, equity, accountability and ownership and has become a preferred model for transformational leaders throughout healthcare.

What is shared governance?

Essentially, shared governance is a set of policies and regulations that allow staff members to participate in the decision-making process. Responsibility, authority and accountability for decisions are shared among team members. Each person is responsible for their actions, respects differences in opinions and contributes to the management of their work environment.

In healthcare, the roots of shared governance lie in nursing. Shared governance provides nurses a platform to share their voices, impact clinical practice, promote nursing excellence and bolster nurse loyalty, job satisfaction and leadership development. Revered shared governance expert Tim Porter-O’Grady, DM, EdD, ScD(h), defines nursing shared governance as “a structural model through which nurses can express and manage their practice with a higher level of professional autonomy.”

Cleveland Clinic’s nursing shared governance model is designed to empower clinical nurses at the unit level to step up, own their practice, contribute, lead and grow. Clinical nurses generate ideas and recommendations, which are communicated to shared governance councils. Local and system-wide councils are spearheaded by council chairs and co-chairs – who are clinical nurses – and include diverse groups of nursing caregivers with varied opinions.

Council members consult and collaborate to make decisions that help facilitate and ensure quality care and outcomes. They discuss everything from problem-solving, patient safety and patient experience to fiscal responsibility, care delivery and continuous improvement. Associate chief nursing officers and chief nursing officers attend meetings to answer questions, facilitate discussion and ensure communication between the Executive Nursing Institute Council and Shared Governance Practice council, but formal nursing leaders do not vote on recommendations and actions.


Many Cleveland Clinic hospitals hold nursing shared governance activities on the same day each month. When decisions are made, two-way communication between councils and frontline nursing teams helps promote standardized nursing practice across the health system.

Shared governance structure

Structure is an important part of shared governance and can vary depending on where an organization is applying shared governance concepts. The most typical shared governance frameworks are built around committees or councils.

Earlier this year, Cleveland Clinic introduced a shared governance structure for employee well-being. Our priorities were to create a structure that was inclusive, multidisciplinary, global and representative of all employees. To achieve this, we devised an advisory committee, a steering committee and activation teams.

  • The advisory committee includes Caregiver Office executives and other leaders from all U.S. and international Cleveland Clinic locations, as well as representatives from the Office of Diversity and Inclusion and environmental services and buildings and facilities teams. This team offers guidance and support to aid in decision-making processes and communicate necessary change.

  • The steering committee is made up of stakeholders in core disciplines worldwide, ranging from professional staff, clinical operations and finance to spiritual care, talent acquisition, global leadership and more. This is the decision-making group and reports to the advisory committee.

  • The activation teams, which include diverse groups of caregivers from across the health system, are responsible for implementing, activating and executing well-being efforts locally, in alignment with the health system’s well-being strategy.

Implementing shared governance

Shared governance is an ideal venue for change and improvement. When it is successfully used, it can empower employees for the good of the entire organization. But implementation can be challenging as it generally involves a culture shift. When implementing shared governance, organizations can benefit from the following:

  • Promote leadership support and commitment through effective, inclusive and open leader communication that explains the importance of shared governance to employees.
  • Provide employee education and training to help them better know and understand shared governance, how it works and how they can participate.

  • Make shared governance accessible and establish clear goals and metrics.


In 2015, when Cleveland Clinic refreshed its nursing shared governance model, a top priority was ensuring that all nursing caregivers, no matter their location or role, understood the mission of shared governance. To help with this, we introduced Shared Governance Boot Camps twice a year. Training during the event focused on methods of conducting a meeting, continuous improvement, decision-making domains, leadership and shared governance principles.

Empowering employees

Incorporating shared governance models into everyday practice is especially beneficial in today’s climate of change. Applying this collaborative approach toward leadership and decision-making further empowers workforces and improves employee engagement, teamwork, performance and employee and patient satisfaction. When caregivers feel valued, heard and respected, they recognize that their contributions matter and invest more in their organization.


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