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This article describes positive outcomes in culture, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, employee engagement, and clinical quality as a result of using shared governance, specifically unit practice councils (UPC) or staffcouncils, to implement Relationship-Based Care (RBC).
Changing the culture of any organization is well known to be a long process, taking sustained focus and work. However, changing the culture and work environment of individual departments can occur fairly rapidly if we establish an effective structure and a spirit of shared leadership. This article will highlight the power of unit-level shared governance councils to produce profound impacts on patient/family outcomes and staffengagement. Effective staffcouncils also serve to develop leadership skills in frontline staffand to inspire commitment and ownership in their departments' outcomes.
Shared governance encompasses a formal council structure that involves frontline staffmembers in decision making. My colleagues and I work through unit- based shared governance councils, which we call unit practice councils (UPCs), to implement major changes in practice and relationships using the Relationship- Based Care (RBC) Model (Koloroutis, 2004). RBC is a principlebased philosophy and delivery system that promotes the creation of compassionate therapeutic relationships with patients and their loved ones and a healthy work environment for colleagues.
The outcomes these UPCs achieve are quite remarkable. We see improvements in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, National Database of Nursing Quality Indicators (NDNQI) and other employee surveys, retention and other nurse-sensitive indicators, and other measurable clinical outcomes. Executives report stronger interdepartmental cooperation and (ultimately) improved financial results as staffing stabilizes and patient care is better managed and coordinated.
These outcomes are driven by staffas they engage in meaningful changes on behalf of patients. For example, K. Vidal (personal communication, July 9, 2012), director of nursing practice development at University Hospitals Case Medical Center in Cleveland, Ohio, recently asked a staffnurse in one of the units with the highest performing HCAHPS scores to explain their secret to success. The nurse responded, "The manager lets the nurses solve the problems," attributing the unit's success directly to the decentralization of power on the unit. She went on to describe that it is the manager's honesty in sharing issues with the staffand supporting their attempts at resolution that...