Hibberd J M, Storoz C E, Andrews H A
University of Alberta, Edmonton, Canada.
Nurs Clin North Am. 1992 Mar;27(1):11-22.
A case study of the implementation of shared governance in a large teaching hospital in Western Canada has been presented. The project was placed in jeopardy due to two major contingencies: turnover in the chief nursing executive position, and a sudden reduction in the operating budget of the nursing division necessitating significant layoffs. Other factors that threatened the survival of shared governance included lack of systematic, long-range planning; the number and diversity of major changes introduced concurrently in the nursing division; and insufficient support systems to sustain organizational change. In particular, some senior and first-line managers could not adapt to or accept the radical philosophical change and so they were unable to empower their staff and to provide the necessary reinforcement needed to ensure the success of shared governance. This combination of these factors contributed to the loss of momentum in the implementation of shared governance. Lowered morale in the wake of layoffs, together with union grievances, and lack of clarity of the role to be played by union representatives in shared governance produced conflict and confrontation within the nursing division and between union and management. Despite the difficulties encountered, there remains optimism and commitment to the challenge of making shared governance succeed. As this article goes to press, remarkable strides have been made in addressing the described issues. A task force composed primarily of staff nurses has developed a "customized" model of governance that meets the needs of the hospital and deals with the identified flaws of the first implementation attempt. The organization is optimistic that by taking time to develop a solid foundation for the proposed change and tending carefully to the details of decision-making processes, an effective structure to support the professional role of the nursing staff will be a reality.
本文介绍了加拿大西部一家大型教学医院实施共享治理的案例研究。该项目因两大意外情况而陷入困境:首席护理执行官职位的人员更替,以及护理部门运营预算突然削减,导致大量裁员。其他威胁共享治理存续的因素包括缺乏系统的长期规划;护理部门同时引入的重大变革的数量和多样性;以及维持组织变革的支持系统不足。特别是,一些高级管理人员和一线管理人员无法适应或接受这种激进的理念转变,因此他们无法赋予员工权力,也无法提供确保共享治理成功所需的必要强化措施。这些因素共同导致了共享治理实施过程中动力的丧失。裁员后士气低落,加上工会申诉,以及工会代表在共享治理中应扮演的角色不明确,在护理部门内部以及工会与管理层之间产生了冲突和对抗。尽管遇到了困难,但对于使共享治理取得成功的挑战,仍保持着乐观态度和承诺。在本文付梓之时,在解决上述问题方面已取得了显著进展。一个主要由护士组成的特别工作组制定了一个“定制化”的治理模式,该模式满足了医院的需求,并解决了首次实施尝试中发现的缺陷。该组织乐观地认为,通过花时间为提议的变革奠定坚实基础,并仔细关注决策过程的细节,一个支持护士专业角色的有效结构将成为现实。