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Updated: Feb 26, 2026

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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System-Level Shared Governance Structures and Processes in Healthcare Systems With Magnet®-Designated Hospitals: A

Carlisa M Underwood1, Arlene N Hayne

  • 1Author Affiliations: Part-time Faculty, College of Nursing, University of South Alabama, Mobile (Dr Underwood); and Professor, Ida V. Moffett School of Nursing, Samford University, Birmingham, Alabama (Dr Hayne).

The Journal of Nursing Administration
|July 21, 2017
PubMed
Summary
This summary is machine-generated.

System chief nurse executives (SCNEs) successfully implemented shared governance structures and processes in large healthcare systems. These findings highlight the replication of hospital-level empowerment strategies across complex organizations.

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Area of Science:

  • Healthcare Administration
  • Nursing Leadership
  • Organizational Theory

Background:

  • Over 64.6% of US community hospitals are integrated into larger healthcare systems.
  • System Chief Nurse Executives (SCNEs) face challenges in disseminating best practices across complex, geographically dispersed organizations.
  • Effective leadership structures are crucial for patient care and staff well-being in integrated health systems.

Purpose of the Study:

  • To identify and describe best practices for system-level shared governance in healthcare.
  • To understand the structures and processes that facilitate effective shared governance across healthcare systems.
  • To provide insights for SCNEs managing complex healthcare organizations.

Main Methods:

  • Interviews were conducted with eleven US healthcare SCNEs.
  • Participants were selected from Magnet®-designated facilities, recognized for nursing excellence.
  • The study utilized Kanter's Theory of Organizational Empowerment as a theoretical framework.

Main Results:

  • A majority of SCNEs reported implementing over 50% of desired empowerment structures and processes.
  • Evidence suggests successful replication of hospital-level shared governance characteristics at the system level.
  • Empowerment structures and processes are present in most system-level shared governance models.

Conclusions:

  • SCNEs have effectively adapted hospital-level shared governance models to system-level operations.
  • Despite challenges in healthcare system growth, empowerment principles are being successfully integrated.
  • This study demonstrates the feasibility of system-wide shared governance in complex healthcare environments.