Our learning guides:
  • Bogue Joseph Sieloff Shared Governance as Vertical Alignment JNM 2009 4-14 - This article reviews a series of empirical studies on how nursing shared governance may be made more effective through improved definitions and... Click here to learn more.

  • Joseph Laughon Bogue Whole Person Care JNM 2011 19 989-997 - This article examines nursing leadership’s roles in fostering a workplace climate that supports... Click here to read more.

  • Our newest: Slockett and Bogue Natl Physician Well Being Conference April 5 2013 - How Do YOU Excel at Keeping Yourself Well? Personal Stories and Research Results
Click here, to access these and other learning guides.
Our Newsletter:

Summer 2013 - How to Leverage Power Throughout Your Organization.

Fall 2012 - Physician Well-Being and the Future of U.S. Healthcare

Summer 2012 - GEMS: Practical, Evidence-based Steps to Excellence in Shared Governance

Spring 2012 - Leading with Courage


GEMS Guide and Process

The GEMS Process offers NPC members a better understanding of the factors that reflect and produce shared governance, a general direction toward the goal of shared governance, and support for specific manageable action steps that they design for themselves. The GEMS Process is designed with three primary goals in mind.

First, the GEMS Process has been carefully developed with and for nursing practice council members, nurses on the floor. This means that the Process is easy to use, almost entirely as part of a unit-level NPC’s ongoing meeting schedule. Outside their meetings, the GEMS NPC Self-Assessment is a very brief instrument, taking less than 10 minutes to complete in a convenient online survey. The Self-Assessment gives NPC members information for assessing their current state and identifying near-term targets as they strive, over the longer term, toward their desired future state. During regular meetings, NPC members use the GEMS Guide to gain a systematic orientation to shared governance. They learn about the attributes of effective nursing practice councils and use examples of practical and group-friendly resources for making their own progress. Both the Self-Assessment and the Guide have been thoroughly tested for NPC-friendliness in NPCs over 100 times . NPC members also use some of their time in one or two regular meetings to review feedback from the Self-Assessment and determine their own targets for progress over the coming six months using the nine attributes of NPC effectiveness as their guide. Then, they develop and pursue their own autonomously determined evidence-based action plan, drawing on the Guide for resources and suggestions as determined by their own targets for progress.

Second, the measurement tool that nurses and leaders use in the GEMS Process—the GEMS Self-Assessment—has been rigorously designed to produce reliable and valid measurements for NPC effectiveness and progress toward shared governance. Extensive prior development and testing of the Self-Assessment makes it possible for nurses, leaders in nursing and non-nursing administrators to have confidence in the metrics for the Process. Moreover, the Self-Assessment metrics permit NPCs to target near-term objectives, enabling everyone involved to see levels of effectiveness, progress over time, and how shared governance associates with—or impacts—key outcomes for nurses, units, departments and organizations. The metrics obtained from the GEMS Self-Assessment include (a) Overall NPC Effectiveness, (b) measures of effectiveness in three key phases (Foundational Inputs, Empowering Processes, and Aligning Outcomes), and (c) a diagnostic tool fo alignment of purposes up-and-down levels of the organization (individual nurses, and the unit-, department- and organizational-levels). Call or write us for additional information about these measures, including reliability and validity information about the GEMS Self-Assessment.

Third, the GEMS Process is designed to accommodate single- and multi-site implementation and testing. Courageous Healthcare’s approach is scientific. Standardization of the Process is the key to objective measurement and the testing of effects, as well as replicability and generalizability. These factors are all important for those who aspire to publish or present their results in regional or national forums. However, Courageous Healthcare also understands that “one size does not fit all.” While the GEMS Process and Materials are standardized to permit clear guidance and fair comparisons across units or sites, formative evaluation is built into our interaction with every site, including pre-implementation site assessment. For example, systems with different nursing practice council structures may need to adapt some of the GEMS Process differently for unit-based councils versus campus- or facility- or leadership- or system-level councils. Different organizations may have adjunct measures they need built into the Self-Assessment process. Similarly, different organizations may have different clinical outcome measures they want to improve using the GEMS Process. For an entirely different kind of local adaptation, the timing or length of the initial engagement in GEMS may vary from one site to another.