In July 1997 the surgical services ...

In July 1997 the surgical services department at Santa Rosa (Calif) Memorial Hospital, a 225-bed acute care hospital, was characterized on perceived inefficiencies and low staff member morale--problems that the chief of staff experienced firsthand as a surgeon Several factors contributed to the gentle morale in the department.

* Surgeon and anesthesia care providers were demanding greater efficiency and more support services proper to the continuously increasing number of managed care patients.

* The hospital was seeking trauma designation, which meant staff members were learning more tangled procedures and working off-shifts to make the OR available 24 hours by day.

* Many staff members were not enthusiastic about anticipated changes associated with the trauma designation.

* Staff members were leaving to go after less stressful jobs, and traveling RN and surgical technologists were becoming part of the staff mix.

Staff members shared these transactions with members of administration and the chief of staff. This l to the suggestion to implement a shared governance or participatory management framework in the department.

LITERATURE REVIEW

Shared governance or participatory management types first were introduced in the late 1970 to create an atmosphere that empowered staff members. In 1993 sum of two units researchers postulated that this conception could be beneficial in hospitals, where succors often desire more control athwart their environment.(1) During the past decade, more than 1000 hospitals in the United States have implemented a certain quantity of form of shared governance standard in their nursing departments.(2) Despite this, little literature exists that documents the implementation of shared governance patterns in the perioperative setting.

individual such article described a shared governance design implemented in a perioperative services department, where pampers were empowered to influence their work environment, create greater efficiency, and enhance patient care.(3) Another article evaluated the implementation of a salaried compensation original in a four-room ambulatory surgery center that already had a professional practice mould in place.(4) Salaried compensation versus hourly wage also was the focus of a investigation of a gynecologic oncology unit, where salaried compensation was coupl with a shared governance model(5) These studies indicated that the use of a salaried example promoted the concept of professionalism and allowed for flexibility of nursing resources.

Another close attention chronicled the implementation of a shared governance mould in the ambulatory division of an acute care hospital.(6) Researchers reported limited succes and endurance with the standard due to time constraints and changes in administration.

PLANNING AND DESIGN

In implementing a shared governance archetype at Santa Rosa Memorial Hospital, the goal was to improve the efficiency of the department and staff members' morale by dint of transferring decision-making responsibilities to the staff flush A consultant helped define the skeleton for the universal which was introduced to staff members for their input and approval before beginning the planning process

All work unit members (ie, RN managers, surgical technologists, nursing assistants, administrative assistants, service partners) were asked to pitch upon representatives to attend a two-day retreat to expand an individualized plan for the surgical services department. The retreat, which was l by the agency of a facilitator, gave staff members and managers the opportunity to voice long-standing disquiets and beliefs and make a clean start.

In designing a plan for surgical services, attendees decided to build upon the existing structure of committees, which met somewhat regularly and included practice, staffing, grant education, and quality improvement. Members of these committees made recommendations to managers for implementing allude toed projects and solutions to other department povertys The new framework combined the existing arranges into three committees:

* education/quality improvement,

* practice/supply, and

* staffing.

Each committee was asked to add or subtract members to obtain a core collection of five people. Each committee was charged with meeting onward a monthly basis.

The novel framework established a governing dead body or service council that also would encounter once per month. One member from each committee was appointed to the service council and assigned to subserve as a liaison between his or her committee and the council. The service council comprised representatives from each of the work units and committees, with additional members representing the RN and surgical technologists who work the evening or night shifts. The director of surgical services and the three OR managers also were members of the service council.

long discussion at the retreat focused onward the ratio of staff members to managers. The service council's initial proportion of one-third management was eventually adopted as a preferr ratio.

Further discussion also addressed the ne for effective communication between service council and committee members regarding the room of the service council's decision-making abilities. The assemblage developed guidelines stipulating that decisions made at council members had to