Implementing EBP Column
Leveraging Shared Governance Councils to Advance Evidence-Based Practice: The EBP Council Journey Lynn Gallagher-Ford, RN, PhD, DPFNAP, NE-BC
This column shares the best evidence-based strategies and innovative ideas on how to facilitate the implementing of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.
BACKGROUND A community hospital with progressive nursing leadership set out to redefine and reinvent professional nursing practice. One of the key strategies in this reformation was the replacement of traditional nursing committees with shared governance councils. Porter-O’Grady (2004) has defined shared governance as a professional practice model, founded on the cornerstone principles of partnership, equity, accountability, and ownership that form a culturally sensitive and empowering framework, enabling sustainable and accountability-based decisions to support an interdisciplinary design for excellent patient care. Many organizations have operationalized shared governance through definitions such as “a dynamic staff-leader partnership that promotes collaboration, shared decision-making and accountability for improving quality of care, safety, and enhancing work life” (Vanderbilt University Medical Center, 2004). The implementation of shared governance was undertaken as an underpinning of moving away from traditional “top-down,” hierarchical nursing governance to a model that would promote staff participation, ownership, and autonomy.
The Process of Council Formation The conversion of committees to councils began with thoughtful determination of what the work of each council needed to be and then naming councils to capture the individual council activities. In this process, the following changes were made: the Quality Assurance Committee became the Quality Council; the Nursing Policy and Procedure Committee became the Clinical Practice Council; the Recruitment and Retention Committee became the Professional Development Council; and two new councils were added, the Research Coun-
Worldviews on Evidence-Based Nursing, 2015; 12:1, 61–63. C 2014 Sigma Theta Tau International
cil and the Coordinating Council. The transition to shared governance councils included drafting council charters that described the work of each group; recruitment of members for the councils; transitioning traditional committee “chairs” (who were all in administrative roles within the organization) to council facilitators; and the appointment of staff nurses as council chairpersons. An overwhelming majority of staff committee members chose to remain involved and participate in this new council approach. All of the individuals moving into these new roles were provided education and support during the transition. The two new councils, Coordinating Council and Research Council, followed very different development trajectories. The Coordinating Council launched smoothly as it was merely a meeting of all of the council chairpersons and administrative directors and the chief nursing officer. Its intent was to provide opportunities for the staff chairpersons to meet with nursing administration, provide council updates, and discuss barriers and needed assistance. Once the other council chairpersons were selected, the Coordinating Council was established and functioned well from the very beginning. The Research Council, on the other hand, was the most difficult to establish even with the advantage of a very energetic, knowledgeable administrator who was extremely committed to the establishment of this council. She eagerly stepped into the facilitator role and began to forge ahead; however, several barriers were encountered. The most daunting of the barriers were: recruitment of council members; recruitment of a staff council chairperson; convincing potential council members that they were not going to be conducting research in the only context they had been exposed (i.e., clinical drug trials); and addressing research and evidence-based practice (EBP) knowledge deficits of the council members.
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Leveraging Shared Governance Councils to Advance Evidence-Based Practice
The challenges of recruitment for the research council were the beginning of a tumultuous journey. The council facilitator set her plan for establishing the council in the same basic structure as the other councils, including: one representative (and an alternate) from each nursing unit; monthly meetings; and a staff chairperson with the administrator serving as a facilitator. She worked with several colleagues and managers to develop strategies to encourage participation in the council. Activities included: attending unit based staff meetings to explain what the council was going to be doing; sharing how important the work would be to the nurses, the organizations, and the patients; promoting the rewards that might come from participating in this work; meeting with individuals who showed even minor interest; and seeking out staff that were currently enrolled in school to leverage how participating on the council might articulate with a program they were currently enrolled in. Although these strategies did result in a handful of recruits, the results were not robust. The staff nurses were resistant to joining the research council for many reasons, but the most common issues were their lack of knowledge about research, their lack of interest in conducting research, their expressed distaste for reading research articles “based on their experiences in school,” and their repetitive expressions that “research was not relevant to nursing at this hospital.” However, during the recruitment process, four EBP “early adopters” as described in Rogers Diffusion of Innovation Model (Rogers, 2003) did emerge and became the backbone of the council in the early stages. As the council facilitator reflected on her conversations with the staff and their almost universal resistance to being on a research council combined with her thoughts about the council work she was actually describing, she realized that although the council was named the “research council,” research was not the primary focus of the work. What the organization really needed was a council to drive EBP to enhance professional practice and patient care. Although research projects might be needed along the way, the primary work was implementing current research and evidence into practice, not generating new knowledge. This revelation led to a discussion with the four early adopter members of the council and was met with overwhelming agreement and excitement. Once the council members unanimously agreed that the council should be named the EBP Council, the facilitator took the proposal to the coordinating council for discussion and approval, which was easily obtained. The name change to EBP Council afforded an opportunity to re-engage several staff nurses and led to additional participation; however, the goal of a having a council representative and alternate from each unit was still challenging. As the council facilitator and the council members continued to strategize toward meeting this goal, one of the members asked, Do we have to have a rep from every unit? Maybe that’s just not realistic right now . . . and it feels
62
like a distraction to me at this point. All we do is try to get more members; I would rather get EBP projects going on the units that ARE represented! I really think others will come; they’re just not ready yet.
Asking the questions (i.e., clinical inquiry); “Why do we do it this way?” and, more importantly, “Do we have to do it this way?” proved to be the beginning of the solution. The council decided to do exactly that (i.e., begin to grow and build EBP in the places where they had champions and interest, and let the EBP evolution begin and achieve some early successes). Once this decision was made, the EBP champions were ready to take action!
Lessons Learned The new energy and enthusiasm of the EBP council members led directly to the next challenge, that is, the members’ realization that they were not knowledgeable enough in the steps of EBP process and that they needed education and mentoring. This was another clear distinguishing characteristic of this particular council. The other councils had members who were steeped in the processes of quality, recruitment and retention, and policies and procedures, respectively, because they had been on those previous committees for years. All that had changed for those members was the governance structure, not necessarily the work to be done. The EBP council, on the other hand, had a steep learning curve to climb and needed a plan to make that possible. The facilitator and the council discussed several options to take to the Coordinating Council for approval and their preferred strategy was to send the facilitator and one council member to an EBP mentor training course to build expertise in the group. They drafted a proposal and budget, which was presented to the Coordinating Council. After some discussion, the proposal was approved and the facilitator and council member attended a 5-day EBP immersion program, and “graduated” as EBP Mentors. This deep dive learning experience provided a rich infusion of EBP knowledge and skills into the council and, ultimately the organization. In addition, the staff nurse council member’s EBP immersion experience gave her the confidence to take the council chair position. The EBP council was off and running after about a year of working through unexpected challenges and finding innovative solutions that made sense for this unique council. One of the greatest lessons learned from this council development process was that the research-EBP council was unlike any of the others, and trying to use a “cookie cutter” approach to creating it and making it successful wasted a significant amount of time and effort. Taking a step back and allowing this council to look and function differently than other councils was the key to its success. WVN
Worldviews on Evidence-Based Nursing, 2015; 12:1, 61–63. C 2014 Sigma Theta Tau International
Implementing EBP Column Author information
LINKING EVIDENCE TO ACTION r Thoughtful development and naming of shared governance councils can be leveraged to advance EBP in an organization.
r EBP councils can serve as effective mechanisms to establish, promote, and sustain evidence-based decision making as the foundation of clinical practice.
r EBP councils serve a unique purpose in organizations. They should be structured to build EBP knowledge and skills for members so that they can serve as EBP mentors to others, and lead the organizational culture shift needed to implement and sustain EBP.
Lynn Gallagher-Ford, Associate Editor, Worldviews on EvidenceBased Nursing; Director, Center for Transdisciplinary EvidenceBased Practice; and Clinical Associate Professor, The Ohio State University, Columbus, OH, USA. Address correspondence to Dr. Lynn Gallagher-Ford, Director, Center for Transdisciplinary Evidence-Based Practice, and Clinical Associate Professor, The Ohio State University, Columbus, OH; [email protected]
Accepted 13 July 2014 C 2014, Sigma Theta Tau International Copyright
References Porter-O’Grady, T. (2004). Shared governance implementation manual. Atlanta, GA: Tim Porter-O’Grady Associates, Inc.
r Leadership support is critical to the success of
Rogers, E. (2003). The diffusion of innovations (5th ed.). New York, NY: The Free Press.
EBP councils as a critical component of shared governance models. Leaders must understand EBP, advocate for EBP as a foundation of practice, and publicly navigate barriers to EBP in the organization.
Vanderbilt University Medical Center. (2004). Shared governance. Retrieved from http://www.mc.vanderbilt.edu/root/ vumc.php?site=Shared+Governance&doc=23733
Worldviews on Evidence-Based Nursing, 2015; 12:1, 61–63. C 2014 Sigma Theta Tau International
doi 10.1111/wvn.12062 WVN 2015;12:61–63
63
Leveraging Shared Governance Councils to Advance Evidence-Based Practice: The EBP Council Journey Lynn Gallagher-Ford, RN, PhD, DPFNAP, NE-BC
This column shares the best evidence-based strategies and innovative ideas on how to facilitate the implementing of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.
BACKGROUND A community hospital with progressive nursing leadership set out to redefine and reinvent professional nursing practice. One of the key strategies in this reformation was the replacement of traditional nursing committees with shared governance councils. Porter-O’Grady (2004) has defined shared governance as a professional practice model, founded on the cornerstone principles of partnership, equity, accountability, and ownership that form a culturally sensitive and empowering framework, enabling sustainable and accountability-based decisions to support an interdisciplinary design for excellent patient care. Many organizations have operationalized shared governance through definitions such as “a dynamic staff-leader partnership that promotes collaboration, shared decision-making and accountability for improving quality of care, safety, and enhancing work life” (Vanderbilt University Medical Center, 2004). The implementation of shared governance was undertaken as an underpinning of moving away from traditional “top-down,” hierarchical nursing governance to a model that would promote staff participation, ownership, and autonomy.
The Process of Council Formation The conversion of committees to councils began with thoughtful determination of what the work of each council needed to be and then naming councils to capture the individual council activities. In this process, the following changes were made: the Quality Assurance Committee became the Quality Council; the Nursing Policy and Procedure Committee became the Clinical Practice Council; the Recruitment and Retention Committee became the Professional Development Council; and two new councils were added, the Research Coun-
Worldviews on Evidence-Based Nursing, 2015; 12:1, 61–63. C 2014 Sigma Theta Tau International
cil and the Coordinating Council. The transition to shared governance councils included drafting council charters that described the work of each group; recruitment of members for the councils; transitioning traditional committee “chairs” (who were all in administrative roles within the organization) to council facilitators; and the appointment of staff nurses as council chairpersons. An overwhelming majority of staff committee members chose to remain involved and participate in this new council approach. All of the individuals moving into these new roles were provided education and support during the transition. The two new councils, Coordinating Council and Research Council, followed very different development trajectories. The Coordinating Council launched smoothly as it was merely a meeting of all of the council chairpersons and administrative directors and the chief nursing officer. Its intent was to provide opportunities for the staff chairpersons to meet with nursing administration, provide council updates, and discuss barriers and needed assistance. Once the other council chairpersons were selected, the Coordinating Council was established and functioned well from the very beginning. The Research Council, on the other hand, was the most difficult to establish even with the advantage of a very energetic, knowledgeable administrator who was extremely committed to the establishment of this council. She eagerly stepped into the facilitator role and began to forge ahead; however, several barriers were encountered. The most daunting of the barriers were: recruitment of council members; recruitment of a staff council chairperson; convincing potential council members that they were not going to be conducting research in the only context they had been exposed (i.e., clinical drug trials); and addressing research and evidence-based practice (EBP) knowledge deficits of the council members.
61
Leveraging Shared Governance Councils to Advance Evidence-Based Practice
The challenges of recruitment for the research council were the beginning of a tumultuous journey. The council facilitator set her plan for establishing the council in the same basic structure as the other councils, including: one representative (and an alternate) from each nursing unit; monthly meetings; and a staff chairperson with the administrator serving as a facilitator. She worked with several colleagues and managers to develop strategies to encourage participation in the council. Activities included: attending unit based staff meetings to explain what the council was going to be doing; sharing how important the work would be to the nurses, the organizations, and the patients; promoting the rewards that might come from participating in this work; meeting with individuals who showed even minor interest; and seeking out staff that were currently enrolled in school to leverage how participating on the council might articulate with a program they were currently enrolled in. Although these strategies did result in a handful of recruits, the results were not robust. The staff nurses were resistant to joining the research council for many reasons, but the most common issues were their lack of knowledge about research, their lack of interest in conducting research, their expressed distaste for reading research articles “based on their experiences in school,” and their repetitive expressions that “research was not relevant to nursing at this hospital.” However, during the recruitment process, four EBP “early adopters” as described in Rogers Diffusion of Innovation Model (Rogers, 2003) did emerge and became the backbone of the council in the early stages. As the council facilitator reflected on her conversations with the staff and their almost universal resistance to being on a research council combined with her thoughts about the council work she was actually describing, she realized that although the council was named the “research council,” research was not the primary focus of the work. What the organization really needed was a council to drive EBP to enhance professional practice and patient care. Although research projects might be needed along the way, the primary work was implementing current research and evidence into practice, not generating new knowledge. This revelation led to a discussion with the four early adopter members of the council and was met with overwhelming agreement and excitement. Once the council members unanimously agreed that the council should be named the EBP Council, the facilitator took the proposal to the coordinating council for discussion and approval, which was easily obtained. The name change to EBP Council afforded an opportunity to re-engage several staff nurses and led to additional participation; however, the goal of a having a council representative and alternate from each unit was still challenging. As the council facilitator and the council members continued to strategize toward meeting this goal, one of the members asked, Do we have to have a rep from every unit? Maybe that’s just not realistic right now . . . and it feels
62
like a distraction to me at this point. All we do is try to get more members; I would rather get EBP projects going on the units that ARE represented! I really think others will come; they’re just not ready yet.
Asking the questions (i.e., clinical inquiry); “Why do we do it this way?” and, more importantly, “Do we have to do it this way?” proved to be the beginning of the solution. The council decided to do exactly that (i.e., begin to grow and build EBP in the places where they had champions and interest, and let the EBP evolution begin and achieve some early successes). Once this decision was made, the EBP champions were ready to take action!
Lessons Learned The new energy and enthusiasm of the EBP council members led directly to the next challenge, that is, the members’ realization that they were not knowledgeable enough in the steps of EBP process and that they needed education and mentoring. This was another clear distinguishing characteristic of this particular council. The other councils had members who were steeped in the processes of quality, recruitment and retention, and policies and procedures, respectively, because they had been on those previous committees for years. All that had changed for those members was the governance structure, not necessarily the work to be done. The EBP council, on the other hand, had a steep learning curve to climb and needed a plan to make that possible. The facilitator and the council discussed several options to take to the Coordinating Council for approval and their preferred strategy was to send the facilitator and one council member to an EBP mentor training course to build expertise in the group. They drafted a proposal and budget, which was presented to the Coordinating Council. After some discussion, the proposal was approved and the facilitator and council member attended a 5-day EBP immersion program, and “graduated” as EBP Mentors. This deep dive learning experience provided a rich infusion of EBP knowledge and skills into the council and, ultimately the organization. In addition, the staff nurse council member’s EBP immersion experience gave her the confidence to take the council chair position. The EBP council was off and running after about a year of working through unexpected challenges and finding innovative solutions that made sense for this unique council. One of the greatest lessons learned from this council development process was that the research-EBP council was unlike any of the others, and trying to use a “cookie cutter” approach to creating it and making it successful wasted a significant amount of time and effort. Taking a step back and allowing this council to look and function differently than other councils was the key to its success. WVN
Worldviews on Evidence-Based Nursing, 2015; 12:1, 61–63. C 2014 Sigma Theta Tau International
Implementing EBP Column Author information
LINKING EVIDENCE TO ACTION r Thoughtful development and naming of shared governance councils can be leveraged to advance EBP in an organization.
r EBP councils can serve as effective mechanisms to establish, promote, and sustain evidence-based decision making as the foundation of clinical practice.
r EBP councils serve a unique purpose in organizations. They should be structured to build EBP knowledge and skills for members so that they can serve as EBP mentors to others, and lead the organizational culture shift needed to implement and sustain EBP.
Lynn Gallagher-Ford, Associate Editor, Worldviews on EvidenceBased Nursing; Director, Center for Transdisciplinary EvidenceBased Practice; and Clinical Associate Professor, The Ohio State University, Columbus, OH, USA. Address correspondence to Dr. Lynn Gallagher-Ford, Director, Center for Transdisciplinary Evidence-Based Practice, and Clinical Associate Professor, The Ohio State University, Columbus, OH; [email protected]
Accepted 13 July 2014 C 2014, Sigma Theta Tau International Copyright
References Porter-O’Grady, T. (2004). Shared governance implementation manual. Atlanta, GA: Tim Porter-O’Grady Associates, Inc.
r Leadership support is critical to the success of
Rogers, E. (2003). The diffusion of innovations (5th ed.). New York, NY: The Free Press.
EBP councils as a critical component of shared governance models. Leaders must understand EBP, advocate for EBP as a foundation of practice, and publicly navigate barriers to EBP in the organization.
Vanderbilt University Medical Center. (2004). Shared governance. Retrieved from http://www.mc.vanderbilt.edu/root/ vumc.php?site=Shared+Governance&doc=23733
Worldviews on Evidence-Based Nursing, 2015; 12:1, 61–63. C 2014 Sigma Theta Tau International
doi 10.1111/wvn.12062 WVN 2015;12:61–63
63
