The impact of shared governance in an orthopaedics department

Aim

The objective of the shared governance model was to devolve decision-making to the people that can influence outcomes with the control to exercise their influence. This devolution aimed to promote collaboration, shared decision-making, and accountability for improving clinical and financial performance.

There were four specific objectives for the 12-month shared governance proof-of-concept in orthopaedics:

1. monitor and demonstrate improvement in an agreed suite of clinical, financial and administrative Key Performance Indicators (KPIs).
2. develop a single Information Technology (IT) system to provide an easy way for the multidisciplinary team to access and monitor operational performance information relevant to them.
3. monitor and evaluate whether the shared governance model allows the collective orthopaedics team to increase activity and improve performance.
4. develop and validate a capability and governance framework to enable the HHS to identify the key characteristics that indicate readiness of a specialty to move into a shared governance model.

Benefits

• Quicker and simpler decision-making at a departmental level
• Greater clinical ownership over the operation and strategic direction of the orthopaedics department
• Improved visibility of key performance metrics that directly affect those delivering services, and the authority to respond accordingly

Background

In October 2018 the Gold Coast Hospital and Health Service (GCHHS) commenced a proof-of-concept trial of a shared governance business model in the orthopaedics department. Shared governance is a decentralised management approach, that grants clinical departmental leads with accountability for achieving agreed outcomes, supported by increased financial and HR delegations. The intention is to devolve accountability to the individuals that can directly influence the outcome, to enable them to more directly and efficiently manage the day-to-day operations of the department at a service level.

Evaluation and results

• The evaluation was both formative and summative, with key reflection points throughout the intervention period as well as a final evaluation report that recommended continued roll out of the shared governance model to other clinical departments of Gold Coast Health.
• The evaluation draws on performance trends, captured against KPIs and capability assessments, as well as a review of changes in organisational processes and decision-making captured through qualitative interviews with affected staff at the beginning of the trial and after one year of operation.
• Throughout the pilot test phase, the orthopaedics team were able to maintain or improve performance against financial and clinical KPIs. Using a self-assessment capability framework, the team reported increased capabilities in each of the assessment domains: safety and quality; workforce; governance; strategy and planning; finance and assets.
• The shared governance model and the opportunities provided through the tailored IT platform have allowed the orthopaedics team to begin to monitor patient outcomes and experiences in real time and respond accordingly. The senior clinical team collectively takes accountability for monitoring and responding and will look to expand the range of patients who complete outcome and experience assessments.
• The executive management team and the orthopaedics department are continuing to work closely together to clarify roles, responsibilities and delegations. This requires continual communication and iterative modification of the model as it develops. The orthopaedics team has demonstrated more collaborative decision-making and greater ownership over service delivery and its future strategic direction.

Lessons learnt

• Value of a an easy to use IT system to provide a single platform for all the routine information to assist operational decision-making
• Clear and continual communication between executive and departmental teams is required to clarify roles and responsibilities
• A capability framework can support departments and executive to identify the support required to take on shared governance responsibilities and agree the appropriate resources.