Innovating Nursing Shared Governance at University of Utah Health

Shared governance empowers nurses to influence clinical practice, professional development, and patient care. At University of Utah Health, internal analysis revealed that traditional shared governance structures were often slow-moving and lacked meaningful engagement from frontline nurses. While easy to implement, these models lacked the agility and inclusiveness needed to address unit-level challenges or drive system-wide improvements. In response, the Department of Nursing co-created a new Councilor Model grounded in Lean principles, Team of Teams methodology, and visual management tools supported by collaborative technologies. This approach shifts decision-making from top-down to team-based, enabling faster problem-solving, stronger ownership, and broader participation across care settings. The model now engages more than 7,000 nursing team members system-wide. Early outcomes show increased responsiveness to practice issues and improved team cohesion. Key implementation challenges include scaling across departments, addressing variable skill levels, and strengthening coordination and support structures. Advancing shared governance is a key Nursing Excellence priority for FY26, with plans to assess progress, implement data-informed improvements, and ensure long-term sustainability. This work underscores the value of team-based leadership in complex systems and the impact of co-creation in building effective, inclusive decision-making models.