Shared Governance as an Interprofessional Decision-Making System in Hospitals: Implementation and Evaluation Challenges

Shared governance has been recognized for more than three decades as an organizational framework for strengthening nurses' participation in decision-making, professional autonomy, and accountability. In recent years, the concept has regained attention as healthcare organizations face workforce shortages, increasing care complexity, and growing demands for interprofessional collaboration. This Expert Opinion examines the development, implementation, and evaluation of shared governance from nursing-centered models toward broader professional and interprofessional governance systems. Building on existing conceptual and measurement work, it proposes a conceptual framework for understanding shared governance as an explicit interprofessional decision-making system that links governance context, structures, operations, decision pathways, workforce, patient, and organizational outcomes. Implementation is complicated by conceptual overlap with frameworks such as nursing excellence recognition programs (eg, Magnet®), distributed leadership, clinical governance, quality improvement structures, and interprofessional collaboration. These overlaps may blur responsibilities, duplicate structures, and complicate the attribution of outcomes to shared governance. Measurement approaches have advanced but remain fragmented. Instruments such as the Index of Professional (Nursing) Governance and the Verran Professional Governance Scale assess perceptions of governance culture, while the Council Health Survey provides a council-level measure of council functioning. However, current measurement approaches do not yet sufficiently capture interprofessional governance as an operational system, including how authority is distributed across professional groups, how decisions move through organizational structures, and how governance contributes to workforce, patient, and organizational outcomes. Based on this framework, we propose a research and practice agenda that emphasizes conceptual clarification, interprofessional alignment with existing organizational frameworks, measurement innovation, and rigorous implementation and evaluation designs. Future work should combine measures of governance culture, council functioning, interprofessional representation, decision pathways, structural characteristics, and outcomes. Such an approach can help shared governance move from symbolic or fragmented implementation toward a measurable and sustainable mechanism for strengthening professional engagement, workforce retention, interprofessional collaboration, and the quality and safety of patient care.