Q. What is unit board? Clinic board?
Unit and Clinic Boards are the point-of-service decision-making, problem-solving forums for staff, managers, and other key stakeholders. The boards consider issues related to:
- local concerns of the unit/clinic
- staff and patient education
- quality of care
- patient and staff safety
- clinical practice
- other topics aligned with VUMC’s pillar goals
The local boards are typically chaired and facilitated by a team comprised of two elected staff co-chairpersons partnered with the manager of the inpatient unit, outpatient clinic, procedural or peri-operative area.
Q. Does every unit and clinic have one?
At any given point in time, an estimated 85 - 90% of clinical care areas have actively functioning local boards. The other 10 - 15% are usually in a state of revamping/restructuring their unit/clinic board or have undergone a major change of some sort that interrupts the continuity of the board's progress. This disruption can take the form of staff turnover, a management change, major expansion/growth of the area, a physical move from one location to another, or several large initiatives occurring simultaneously. Ideally, a unit or clinic board should be able to weather the storm of any transition and be the stabilizer, but unfortunately it does not always happen this way. Launching a unit/clinic board requires careful planning and educational preparation, but sustaining one requires longterm attention and nurturing of the process. The return on the investment, however, is well worth the effort. We hope that this online question & answer forum, called SharedGovernASK, will allow our multi-talented staff and leaders from all different viewpoints within our large campus and the growing satellite areas, to ask questions and share best practices. Though the implementation of shared governance is not a "one size fits all" mode, there are some key ingredients to success. Sometimes we just have to "trust the process" because typically people are more fulfilled and productive when they have some control over their environment.
Q. How does unit/clinic board work?
Again, there is no "cookie cutter" approach but there are some best practices that have been noted to work over time. They are mentioned under "how to implement shared governance." The important thing is that this must be thought of as a partnership, not a "we-they" confrontation. We must also remember that we live and work within an organization, and organizations customarily have standards, policies and procedures. These standards may change over time after careful analysis (evidence-based practice), but we should not change standards without consulting with the proper stakeholders and other experts. This is why it is so important for managers and administrators to stay engaged with the frontline staff. Leaders bring their expertise to the table, as daily clinical caregivers bring theirs. We all are content experts in our roles.
Q. What are its benefits?
Benefits are many, but satisfaction with the work environment and confidence in the delivery of quality care engenders even greater satisfaction and therefore enhanced care and service to our patients and families - and to one another. Several people together can create solutions more feasible and long lasting than any idea an individual can think of on his or her own. Collaboration also instills team ownership and accountability. We are all in this together. And we have all heard sayings such as "go slow to go fast" and "do it right the first time so you don't have to do it over!" These phrases remind us that we must not make decisions "about people without people" if there is a way to avoid it.
Q. I have never heard of unit board. How do I get more information?
There is much resource information on this Shared Governance website as well as numerous articles in nursing and other organizational culture literature about shared decision-making and facilitative leadership. A few key articles are linked here and you can find new ones every day by searching through the Eskind Digital Library. HR's Organizational Effectiveness Team offers excellent courses and coaching. When it comes to teamwork, we are all leaders. Feel free to contact Erin Tickle, Director of Shared Governance for assistance with your unit board or Lindsey Ingham, Program Coordinator for Shared Governance for information on upcoming shared governance workshops. If you are a frontline caregiver and there is no unit or clinic board in your area, the first place to start, however, is with your immediate manager. Some areas are very small and do not have a unit board because they collaborate and make decisions in other ways. Go back to the definition of Shared Governance at Vanderbilt and ask yourself if your work area has this culture.
Q. How can we stimulate participation in unit/clinic board?
Multiple methods of communication and repetition are ways to impart important messages to our colleagues. Reminders, posters, newsletters, meeting minutes, emails, unit/clinic website, and team fun and productivity are ways to stimulate participation. Ultimately, however, there is nothing that contributes to interest and sustains commitment more robustly than seeing good outcomes and results from the team's work. People are motivated when their ideas are taken seriously; they are demotivated when they perceive that "nothing ever changes." Healthcare delivery is demanding enough as it is without spinning wheels for naught. Make participation meaningful. Also, managers must be clear about boundaries for unit boards to prevent unrealistic expectations which lead to frustration. The risk here is that frustration grows into resentment.
Q. My area does not have an active unit board. We used to, but it fell apart. How can we get it restarted?
This is a common phenomenon. Because shared governance and unit board take wisdom and energy to build and maintain, it is hard to sustain it for long periods of time. The philosophy is one that comes from the heart as well as the mind, and it needs to be part of "who we are" at Vanderbilt. The quality of care for patients is best when the caregivers have a voice in how this care is delivered and when these caregivers are satisfied with and accountable for the work. A good place to begin is discussion with your manager. If you are a manager, start with your admininistrative director. There are resources for implementing and evaluating shared governance. For more information, please contact erin.l.hager@Vanderbilt.Edu. The commitment to begin and the desire to sustain starts within the leadership and the staff in your local area. If you had a unit or clinic board before and it fell apart, another tip is to figure out why, and try not to let that happen again. By being concerned about this, you are well on your way to a new beginning!
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