Using the Awareness, Desire, Knowledge, Ability, Reinforcement Model to build a shared governance culture

Abstract

A legacy of shared governance experience at Houston Methodist Hospital (HMH) has yielded many lessons regarding the leadership support, staff engagement, structures, and processes essential to successful implementation of a shared governance model. Shared governance is described as an effective vehicle for optimizing care delivery. Nurses play an integral role in improving the quality of care and must be competent and have access to tools, education, and resources that increase their capacity to think creatively when designing and optimizing care delivery. Creating a learning environment that instills competency and confidence enables nurses to provide care within their full scope of practice. In our experience, it was imperative that the Board of Directors and senior management understood the concepts and benefits of shared governance to receive buy-in. With their approval, the next challenge was obtaining support from nursing leaders and shared governance chairs. Implementation strategies included adaptation of the Awareness, Desire, Knowledge, Ability, Reinforcement (ADKAR) Model, identification of shared governance core competencies, and education of nursing leaders and governance chairs through ongoing educational modalities. Education on shared governance principles, concepts, competencies, roles, council structure, and processes in addition to a clinical competency focus were vital to the implementation and integration of shared governance and set the pace for success. Shared governance is a cultural change that promotes bedside clinicians’ ownership of practice and positively impacts patients, families, staff, and organizational outcomes. Over a 13-year period, the shared governance structure matured, which resulted in higher registered nurse satisfaction, improved registered nurse retention, and patient outcomes that outperformed national benchmarks.