Shared Leadership in Health Care

Porter-O'Grady, Hawkins, and Parker (1997) applied the concept of shared leadership to health care. This model encourages health care staff to affect the decisions made about health care organizations and patient care. The model is applied in several areas, from community health (Restall, Ripat, and Stern, 2003) to primary care (Brazill, 2002).

Although leadership has long been primarily a function of management, shared leadership allows management to receive advice from staff in an organized, documented fashion. With fiscal, political, and organizational considerations ever present, managers retain the final say on decisions. Shared leadership committees make recommendations that often become reality as long as they do not conflict with strategic or fiscal priorities. In addition, managers often attend staff council meetings in advisory roles. As such, managers have no voting rights but can provide insight where needed.

Thus, the latitude for decision making at the staff level can be high when it is allowed to be. Staff decisions need not be costly or send the organization into a tailspin: in fact, some changes they make may be relatively minor in scale but far-reaching in scope. Staff decisions can have a large impact, because they are coming from those closest to the issue. There is usually very little fluff or need for motivational, visionary rationale in a staff council's recommendation. They make the recommendation because the need is already perceived, and sometimes the change is adopted in practice before the recommendation reaches management. When they are involved in this way, staff members are truly the people who are carrying the organization where it needs to go.

A disease management organization's quality council participates in program enhancements, and the nursing staff gives input into the implications of program changes. The assessment tools, which the nurses use to telephonically monitor patients with specific diseases, underwent a fifteen-month rewrite, with the nursing staff applying their knowledge and experience with the current assessment tool. In this case, senior management recognized the value of shared leadership: they asked that the nurses who were closest to the tool actually do the work of redesigning it.

In this same organization, the principle of shared leadership is integral to all aspects of developing patient care programs. Its staff education council regularly provides feedback to the company medical director related to educational needs of the staff and reviews and approves new patient educational materials on a monthly basis. Its staff practice council is instrumental in developing care plans and documentation standards for the organization. Nurses have worked with the medical director to implement quality initiatives surrounding disease-specific needs. The people who know the patients best are influencing change that ultimately improves patient outcomes. This is a mark of effective shared leadership.


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