D159: Shared Governance Implementation in Home Care Programs

D159: Shared Governance Implementation in Home Care Programs

Shared governance can strengthen home care programs by giving frontline healthcare staff a meaningful role in decision-making, professional development, and quality improvement. In the D159 project, a shared governance framework is implemented within the Home & Community-Based Care (HCBC) department at the Iron Mountain Veterans Affairs (VA) facility. The initiative focuses on educating staff, increasing participation in organizational decisions, and encouraging employees to take ownership of performance improvement activities.

The project evaluates the effectiveness of shared governance education through three primary measures: staff knowledge before education, staff knowledge after education, and the number of performance improvement projects initiated by frontline employees. Together, these measures help determine whether education translates into greater understanding and practical participation.

D159: Shared Governance Implementation in Home Care Programs

The pre-education survey establishes a baseline of staff knowledge about shared governance. This baseline is important because employees may have different levels of leadership experience, professional expertise, and familiarity with shared decision-making. The post-education survey then determines whether the educational intervention improves understanding and helps staff recognize how shared governance can be incorporated into daily practice.

The third measure focuses on staff-led performance improvement initiatives. Tracking these activities provides a practical indicator of whether employees are applying shared governance principles rather than simply demonstrating knowledge on a survey. Employee surveys can be particularly useful when organizations use the results to develop targeted interventions and follow through with meaningful action. Huebner and Zacher (2021) emphasize that employee feedback is most valuable when organizations use survey findings to guide subsequent planning and action.

Data Management Plan

What is the source of data for the project?

The primary data source consists of digital surveys administered to frontline HCBC staff before and after the shared governance educational sessions. The pre-education survey measures baseline knowledge, perceptions, and attitudes related to shared governance. It also provides an opportunity for staff to identify how shared governance could be incorporated into their roles.

The post-education survey evaluates changes in knowledge and perceptions after the educational intervention. Comparing the two surveys provides a practical way to determine whether the education addressed identified knowledge gaps and increased staff understanding of shared governance principles.

Healthcare quality improvement depends on collecting reliable data and using it to identify opportunities for improvement. The Agency for Healthcare Research and Quality (AHRQ, 2020) notes that collecting and using quality data can support process improvement, standardization, and better-informed organizational decisions. For this reason, the project data should be systematically collected, protected, analyzed, and incorporated into the quality improvement process.

Confidentiality and data security are also essential. Surveys will be completed through encrypted digital platforms using VA-issued computers. Project data will be maintained on secure VA systems, with access restricted to authorized project team members and stakeholders. Limiting access helps protect staff information and supports appropriate handling of project data.

Key Performance Indicators and Project Deliverables

The project’s key performance indicators (KPIs) measure whether the shared governance intervention produces improvements in staff knowledge, engagement, communication, and participation in decision-making.

The project deliverables include measurable changes in pre- and post-education knowledge scores and an increase in staff-led performance improvement activities. These outcomes reflect important components of shared governance, including professional accountability, empowerment, collaboration, and ownership of practice improvement.

An internal project target was established to achieve a 30% increase in staff knowledge of shared governance by July 31, 2025. Establishing a measurable target allows the project team to determine whether the educational intervention achieved its intended outcome and whether additional education may be necessary.

Data Collection and Analysis Methods

How will the data be collected?

Data will be collected using digital surveys containing multiple-choice questions designed to assess fundamental shared governance concepts. The pre-education survey will also gather information about staff perspectives, including how shared governance could be incorporated into their current responsibilities and which educational approaches they prefer.

Survey participation will be monitored throughout the project. Adequate participation is important because low response rates can reduce the representativeness of the findings. Baseline results will also be reviewed before the educational sessions so that identified knowledge gaps can be addressed in the training materials.

Following the educational intervention, staff will complete the post-education survey. The results will be compared with baseline findings to determine whether staff knowledge increased.

How will the data be analyzed?

The project will primarily use descriptive statistics to analyze the collected information. Measures may include the percentage of correct responses, survey completion rates, and differences between pre-education and post-education knowledge scores.

Visual presentations, including bar graphs and pie charts, can help communicate changes in knowledge and summarize themes emerging from staff-led improvement activities. These visualizations can make project findings easier for leadership and stakeholders to interpret.

Descriptive analytics are appropriate for this project because the primary purpose is to describe staff knowledge, participation, and changes following the intervention. Houser (2023) explains that healthcare data analytics can support different types of analysis, including descriptive, diagnostic, predictive, and prescriptive approaches. In this project, descriptive analysis provides a practical method for identifying participation patterns and measuring educational outcomes.

Potential Challenges and Mitigation Strategies

What barriers could affect project success?

Several factors could affect the implementation of shared governance within the HCBC department. One potential barrier is low participation in the surveys. If relatively few employees respond, the findings may not accurately represent the broader frontline staff population. Response bias may also occur if employees who are particularly interested in shared governance are more likely to participate.

Another challenge is maintaining leadership and frontline staff engagement throughout the project. Organizational changes, competing workload demands, staffing concerns, and uncertainty can make it difficult for employees to participate consistently in education and improvement activities.

Leadership support can help reduce these barriers. Project leaders should clearly communicate the purpose of shared governance and explain how frontline participation can contribute to professional autonomy, collaboration, communication, and quality improvement.

Educational sessions should also connect shared governance concepts to employees’ everyday responsibilities. When staff can see how shared decision-making applies to actual workplace issues, they may be more likely to participate in councils, committees, and performance improvement projects.

Dissemination of Project Results

After data collection and analysis are completed, the project findings will be shared with relevant organizational stakeholders. The Pathway to Excellence team can use the results to evaluate whether shared governance education should be expanded to additional departments.

The High Reliability Organization (HRO) lead will also be informed of the findings. This communication may support opportunities for frontline employees to participate in additional quality and process improvement education, including Yellow Belt and Green Belt training.

If the implementation demonstrates measurable improvements in staff knowledge and engagement, the project model can provide a framework for other departmental leaders interested in strengthening shared governance. Sharing the results can help identify successful strategies, potential barriers, and opportunities for future implementation.

Project Closure and Sustainability

How will the project conclude?

At the conclusion of the project, participating frontline staff can receive small tokens of appreciation for their involvement in the surveys and educational sessions. Personalized thank-you messages can also be provided to stakeholders and members of the project team to recognize their contributions.

Project closure should also include a review of the final outcomes against the established KPIs. The project team can document changes in staff knowledge, participation levels, and staff-led performance improvement activities. These findings can help determine which components should continue after the formal project period ends.

How can shared governance be sustained?

Long-term sustainability requires shared governance to become part of routine organizational practice rather than remaining a temporary project. Continued support from the Pathway to Excellence team can help maintain employee participation and encourage ongoing professional development.

New employees should receive education about shared governance as part of their onboarding or departmental orientation. Existing employees should also have continuing opportunities to participate in councils, committees, and quality improvement initiatives.

The Nurse Practice Council can serve as an important structure for sustaining shared decision-making and professional accountability. By maintaining regular opportunities for staff input, the organization can continue to encourage frontline ownership of practice improvement.

Brennan and Wendt (2021) describe staff engagement and shared governance as approaches that can support professional ownership, empowerment, leadership development, innovation, and improvements in quality and patient outcomes. These principles provide a foundation for maintaining shared governance beyond the initial implementation period.

Why Shared Governance Matters in Home Care

Shared governance is particularly relevant to home and community-based care because frontline employees have direct knowledge of patient needs, workflow challenges, communication barriers, and opportunities for improvement. Giving these employees a structured role in decision-making can help organizations identify practical solutions and strengthen collaboration between staff and leadership.

For the D159 project, success is therefore not limited to higher survey scores. Meaningful implementation also involves staff applying shared governance concepts through participation, collaboration, and employee-led performance improvement. Combining education with measurable participation provides a more complete picture of whether shared governance has become part of everyday practice.

Key Takeaways

The D159 shared governance project uses education, measurement, and staff participation to strengthen frontline involvement in the HCBC department. The project evaluates staff knowledge before and after education while also monitoring staff-led performance improvement activities.

The primary components include:

• Pre- and post-education surveys to measure changes in staff knowledge.

• Secure digital data collection and storage.

• KPIs focused on education, engagement, communication, and collaboration.

• Descriptive analysis of survey results and participation trends.

• Staff-led performance improvement initiatives as an indicator of practical application.

• Dissemination of findings to organizational quality and leadership stakeholders.

• Continued education and Nurse Practice Council involvement to support sustainability.

By combining measurable educational outcomes with opportunities for frontline participation, the project provides a structured approach to implementing shared governance in a home care environment.

References

Agency for Healthcare Research and Quality. (2020). Collect and use data for quality improvement. AHRQ Integration Academy. https://integrationacademy.ahrq.gov/products/playbooks/behavioral-health-and-primary-care/implementing-plan/collect-and-use-data-quality-improvement

Brennan, D., & Wendt, L. (2021). Increasing quality and patient outcomes with staff engagement and shared governance. OJIN: The Online Journal of Issues in Nursing, 26(2). https://ojin.nursingworld.org/table-of-contents/volume-26-2021/number-2-may-2021/articles-on-previously-published-topics/increasingquality-and-patient-outcomes/

Houser, S. (2023, October 9). Data analytics concepts for health information professionals. Journal of AHIMA. https://journal.ahima.org/page/data-analytics-concepts-for-health-information-professionals

D159: Shared Governance Implementation in Home Care Programs

Huebner, L.-A., & Zacher, H. (2021). Following up on employee surveys: A conceptual framework and systematic review. Frontiers in Psychology, 12, 696732. https://pmc.ncbi.nlm.nih.gov/articles/PMC8696015/