In the past few months, I have been asked if there is a difference between the Lean Management System and Shared Governance. Yes, but… I see the Management system is a foundational element to the Shared Governance process and will support the work done in Shared Governance to progress toward the desired results.
What is Shared Governance?
Shared Governance is a framework that supports professional nursing practice by putting nursing in charge of their practice (Browder, Fuetnes, Holm Macy & Middlemiss, 2019). The concept of Shared Governance (also known as Professional Governance) has been around for 30 years. There are many evolving models of Shared Governance, but it generally starts with unit-based councils that bring nurses together to discuss, determine, and inform their professional practice through shared decision making. The unit-based councils are generally then supported by a system of tiered councils that include interprofessional teams to ensure evidence-base practices and policies are incorporated into the work to deliver better patient outcomes and support the teams that deliver the care. Some examples of system-based councils might be a Research Council, an Education Council, a Professional Development Council, Clinical Practice Council, etc. The goal is to ensure the voice of the person closest to the work is heard and used to develop best practices in care. In addition, the use of the Council structure can help to share information, changes, and goal setting throughout the organization.
How does a Lean Management System (LMS) fit in?
In my opinion, it can be foundational to the work of the Shared governance structure. For instance, what better way to get the voice of the nurses in problem solving than through the Performance Huddle process? As opportunities are brought forward, the use of the A3 thinking (PDSA) process helps to identify the problem, understand the root opportunities of the problem, and then work to solve the problem using the best evidence. This work can feed the unit-based council as they determine what to focus on to improve the performance at the unit level. In a Lean Management System, we talk about a Monthly Performance Review Meeting where the Leadership Team (i.e. maybe unit-based council) reviews a scorecard to understand what is currently happening in performance and how it impacts the organization as a whole. These are just a couple of examples of how the LMS can support a Shared Governance structure.
One of our colleagues, Mary Kingston, RN (former CEO of Little Company of Mary), shared with me that she believes the LMS is the skeleton or infrastructure that helps shared governance get things done. She was able to see how this helped her team not only demonstrate improvement in practice, but also reinforce and strengthen the culture in her organization. In addition, Akron Children’s shared how they used an LMS as they developed an Ambulatory Shared Governance in their article “Creating Ambulatory Shared Governance Through Lean Six Sigma Strategies” (2015).
How have you incorporated a LMS into your Shared/Professional Practice Model?
Browder, B., Fuentes, G., Holm, R. Macy, D & Middlemiss, J. (2019). Rethinking Your Unit Council Structure: An Innovative Approach to Professional Governance in Healthcare. Indianapolis, IN. Sigma Theta Tau international.
Sprankle, D., Hamlin, A., Grayem, K. & Musitano, A. (2015). Creating Ambulatory Shared Governance Through Lean Six Sigma Strategies. American Academy of Ambulatory Care Nursing. 37(2), 4-8.
Creating a Lean Management System workshop
Beyond Heroes by Kim Barnas
Catalysis Healthcare Value Network