Abstract
It has become apparent that our current work system has been impacted by a myriad of environmental factors, many of which started pre-pandemic. Sonographers and vascular technologists have subsequently been dealing with these factors, which have resulted in exacerbating physical and cognitive stressors. These work system variables that impact sonographers can be more intense based on the day or set of workplace circumstances. Given these work system issues have been shown to be influential in an individual employee’s levels of burnout, work-related musculoskeletal pain, and cognitive stress, a clear and well-defined process should be implemented in the workplace. An overarching strategy to help mitigate these work system issues is to articulate them to management for solutions. Often sonographers and vascular technologists feel that these issues are not being taken seriously or not in context with the day-to-day workload. To address this feeling of being abandoned or ignored, adopting a shared governance style of management is advocated.
In the clinical setting, it is well-established that clinicians are being placed under increasing demand due to rising patient volume and reduced staffing/employment support. 1 In addition to causing added physical and mental stressors to the employee, a parallel and consequential secondary issue can be a reduction in patient care. The result is added risks to patient safety, which even further highlights the importance of this problem and criticality that a solution be implemented to preserve the principles of healthcare. 2
A shared governance structure is not a buzz word, but rather a progressive set of actions that empowers employees. Shared governance is an innovative organizational management model; it is the structure for the process of shared decision-making and outcomes of shared leadership. 3 Simply put, it is a method to ensure the goals of all involved parties (clinicians, management, senior leadership, etc.) are aligned. It is not surprising that the daily concerns and stressors of a sonographer are not shared one-to-one with a hospital executive. The roles each play within an organization is also different. Similarly, the expectations and deliverables of each are accordingly varied. While the overarching goal of both levels of responsibility are to enhance patient care, it is to be expected that a disconnect exists on the perceived state of a department or organization. This is what a shared governance model aims to correct.
Unfortunately, shared governance models have historically been designed from a corporate or management perspective, which undermines the idea of providing visibility into the needs of the practicing clinician. In general, this can be attributed in part to two reasons: (1) a general lack of knowledge in management or awareness of shared governance structures within the population of practicing clinicians compared with hospital administration, and (2) competing priorities between clinicians and administrators, of which those of the administrators tend to be favored. In these situations, shared governance models are typically very complex and seemingly impossible to implement. We would advocate to keep the shared governance concept simple and centered around no more than two work system issues. An example might be lowering the risk of musculoskeletal pain and improving patient throughput. Obviously, this has higher administrative “buy-in” and allows for a small group of employees to work together to generate solutions.
Shared Governance Applied in Nursing
The field of nursing has been implementing models of shared governance for the last decade and have demonstrated improvements in their work system for employee and for patients. 2 Investigators have studied this and demonstrated statistically significant impacts using such a model on nurses’ quality of work life and work-life balance. 4 Other studies have demonstrated positive results even extending beyond the employee, in which implementation of a shared governance structure enhanced patient satisfaction and quality of care for patients.5,6 The benefits and implementation strategy of shared governance models in the field are well-documented in the relevant literature. 7 These examples attribute their successful implementations to common themes, including addressing unit-based issues (i.e., specific problems vs. theoretical or conceptual), development of a strategic plan designed to address specific challenges, appropriate amount of time, and support from upper management.8,9
So, the question then becomes, how can this evidence be translated to the work system for sonographers and vascular technologists? What lessons can be learned from our nursing colleagues and what specific challenges might exist in a radiology department which may further complicate the implementation of this complex model?
Shared Governance Applied to Sonography
First and foremost, it is important for any person or group who intends to take on the implementation of a shared governance model to extensively research the topic. As mentioned earlier, one of the reasons shared governance models are not successful for the clinician is that the design comes from a top-level perspective. This is largely due to the lack of knowledge in quality improvement. The purpose of this editorial is to introduce the topic of a shared governance model but in no way intends to be an exhaustive outline on the topic.
Furthermore, it is equally important to also be educated in a broader sense on topics of quality improvement. A basic concept of quality improvement is the Deming Cycle of Quality Improvement. The Deming Cycle provides a basic method to evaluate and implement a quality-improvement initiative. Should one undertake an initiative to implement a shared governance model, it most certainly will need to be orchestrated through the Plan, Do, Check, and Act phases.
It is also important to engage all workplace stakeholders (e.g., schedulers, clerks, patient aides, transporters, etc.). The perfect starting point is to use monthly department meetings to introduce the concept of shared governance and the need for two groups of employees to tackle two work system issues. Doing so addresses one of the key factors for successful implementation, as demonstrated in nursing, which is to identify a specific issue. As an example, the choice of “attempting to reduce wait times of inpatient vascular cases to rule out deep vein thrombosis” is much easier to adopt than is “improving the quality of vascular lab outcomes.”
Once a specific issue is identified, a strategic plan on how it will be addressed can be formulated. This is a second factor needed for success as reported in the nursing literature. This should be a clear and well-defined strategy. When being developed, it is important to get interdisciplinary buy-in so that all stakeholders in the process-improvement initiative have a chance to review and contribute. Not only will this enhance the commitment to the plan by all parties, but it will also ensure it is a comprehensive and detailed description of the issue and proposed solution. It is also very important to outline realistic timelines, as this is needed for successful implementation.
After a strategic plan has been finalized, it can then be presented to upper management. Upper management support was the number one factor when it came to determining the level of successful shared governance models in nursing. A data-backed rationale that addresses the shared goals of the hospital, focusing more so on the objectives of upper management (which remember will likely be different than those of the practicing clinician), will assist with getting buy-in. Another consideration in this factor is that once upper management approval is granted, communication with them should not end. It is very important to provide regular updates to the progress of the implementation. This is where adding timelines with clear milestones will become particularly beneficial to ensure progress can be appropriately tracked.
To put the shared governance concept into a more concrete perspective, a practical example of this is in vascular technology. A common challenge facing vascular labs is the increasing volume of emergent vascular examinations scheduled after hours. This adds to the volume of call-in exams and subsequently added burden on the vascular technologists. To address this, a two-pronged approach was implemented. First, the lab manager provided the on-call schedule to the technologists and explained the needs and rationale for coverage of the emergency department (ED), allowing them to develop the rotation. This empowered the front-facing employees in addressing the situation. Next, at a department meeting, parameters were discussed with the ED staff as to what exams, protocols, and reporting would be tied to on-call schedule. The concerns of the vascular lab, namely added technologist burden, were also explained to the medical director and a representative ED physician to provide rationale for a proposed change. From here, a plan was developed to monitor the call-in volume, along with other metrics, to help eliminate call-ins that may not fit emergent criteria, agreed upon by both the ED and vascular lab.
Challenges and Opportunities
Unfortunately, there is a lack of literature on methods to apply shared governance models to radiology departments, much less to sonography labs. This means what exists in the current literature will need to be translated into imaging-specific processes. Radiology departments are highly interdisciplinary and have specific processes, all centered around imaging equipment. These represent challenges when attempting to translate and implement new governance models. However, as these are attempted, it will be important to grow the body of existing relevant literature for the profession to continually advance. Not only implementation but sustainability must also be evaluated if there is any hope of achieving long-term, meaningful outcomes.
That said, the potential benefits far outweigh the challenges and effort that will go into learning what effectively enables shared governance models to be implemented into imaging departments. Such models have several benefits beyond just those that they are trying to achieve, such as enhanced quality of life, better work-life balance, and so on. Along the way, they also increase frontline employee engagement and employee empowerment, which in turn assists with employee morale, longevity, and advancement.
Conclusion
A shared governance model is an approach that empowers frontline employees while working closely with upper management to enhance efficiency and quality improvements. Such models have demonstrated to be an effective approach to increase the quality of life for healthcare professionals while also increasing the quality of care they are providing. Most notably, this has been implemented in the nursing field with robust literature highlighting its successfulness, along with lessons learned for successful implementations. Thus, a shared governance model should be translated into various workplaces, more specifically, sonography, to enhance the quality and outcomes of the profession.
