Late in the middle third, a systems leadership course usually moves from persuasion to design: building the structures through which an interprofessional group communicates and decides. Shared governance, standing forums, escalation paths, structured handoff and the documentation architecture underneath them are all designable, and this stage asks you to design one rather than to describe the need for it. The doctoral standard is a proposal a reader could implement, with decision rights written down. Your section may print this as NR 721 or NR721; it is the same course. Chamberlain publishes no syllabi outside Canvas. The placement here is our teaching judgment from the course's catalog arc; your section's rubric decides what your week actually asks.
What NR-721 Week 6 asks for
How many meetings does it take to make one decision? A rural clinic network with four sites ran an operations call every Tuesday, a quality committee every month, a provider meeting every other week and a site huddle every morning. When a nurse manager tried to change how abnormal lab results were routed after hours, her proposal was discussed at all four, endorsed at three, and implemented at none, because no one of those bodies had been given the authority to decide the matter and each assumed another had. The network did not lack communication. It had four communication venues and no governance, which is a design failure rather than an engagement failure, and it is the single most common one in interprofessional settings.
The territory of this stage is that design layer. Shared governance in its published sense is a structure that locates specific decisions with the people closest to the work and writes that location down. Communication architecture is the set of channels, forums and documented pathways through which information and decisions actually travel. Both are things a leader builds, and both are assessable against literature rather than invented from preference.
Deliverables here are typically a proposed structure or plan: a governance model for a service, a redesigned communication pathway, or a written plan for a standing interprofessional forum, with a rationale grounded in evidence. Sometimes the work is paired with a short discussion. Where a discussion runs, be specific, because a proposal stated in general terms invites a grader to ask what exactly you are proposing, and posts do not reopen once submitted in Canvas.
What lifts this stage to doctoral level is the decision rights table. Anyone can propose a new meeting. A practice-doctorate proposal says which decisions that body owns outright, which it recommends on, which it must be consulted about, and which lie outside it altogether. Writing that down forces a precision most organizations never achieve, and graders reward it heavily because it is the difference between adding a forum and redesigning a system.
Keep one caution in view. Every structure you add consumes clinical time, and in a community setting that time comes out of access. A proposal that creates three new standing meetings for a four-provider clinic has failed on its own terms. The strongest versions of this paper explicitly account for the time cost of the design and, where possible, retire or merge something in exchange.
The NR-721 Week 6 method, step by step
Six moves for designing a governance or communication structure on paper.
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Inventory what already exists before proposing anything
Every standing forum, its membership, its cadence, its stated purpose and its actual output over the last quarter. Most settings have more structure than they think and less authority than they need.
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List the decisions the service actually makes
Ten to fifteen recurring decisions, written as decisions rather than as topics: who changes a protocol, who approves a schedule pattern, who resolves a disputed referral. This list is the raw material of governance.
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Assign each decision an owner and a consultation set
One accountable owner per decision, plus who must be consulted and who is merely informed. Where two owners appear, you have found a source of the conflict examined earlier in the session.
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Design the minimum structure that carries those decisions
Fewer bodies, clearer remits. Ask what the smallest arrangement is that gives every decision a home, then check that each proposed body has at least one decision it owns outright, or it will not survive.
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Specify the information flow in and out
What data arrives at each forum, from whom, in what format and at what interval, and how the output reaches the people who were not there. Structures fail at the output end far more often than at the input end.
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Cost the design in hours and say what it replaces
Members multiplied by minutes multiplied by frequency, per month. Then name what is being retired to pay for it. This single paragraph is the one senior readers look for first and the one student proposals most often lack.
A layout and word budget for a governance design proposal
Our frame for proposing one structure, sized for roughly 1,500 to 1,800 words plus a decision rights table. It is our own outline rather than anything the university issues, and your week's rubric outranks it wherever they disagree.
| Section | What belongs in it | Word target |
|---|---|---|
| The failure the design addresses | A specific decision or handoff that currently has no owner, with what that costs. | 150 to 190 |
| Current-state inventory | Existing forums and channels, with membership, cadence and what each one actually produced recently. | 250 to 300 |
| Evidence base for the model | Published work on shared governance or structured communication, and what it says about the conditions for success. | 280 to 330 |
| The proposed structure | Bodies, membership by role, cadence, remit, and the decision rights table with owners and consultation sets. | 380 to 450 |
| Information flow | Inputs, outputs, escalation path and how decisions reach staff who were not present. | 240 to 290 |
| Cost, trade and risk | Hours consumed per month, what is retired in exchange, and the two ways this design could fail. | 220 to 270 |
Evidence craft for structural design writing
Ground the model in published conditions for success, not in enthusiasm. The literature on shared governance is fairly specific about what makes it work and what makes it decorative, and citing those conditions lets you show your design meeting them one by one. That mapping is the most efficient way to earn the evidence row.
Write decision rights as a table, not as prose. Prose lets ambiguity survive. A table with a decision in each row and one accountable owner in each row makes gaps and duplications visible immediately, to your grader and to you.
Quantify the current state, however roughly. How many days a routing question currently takes to resolve, how many people attend a forum with no decision authority, how many meetings a proposal passed through. These are countable, they are usually unflattering, and they make the case for redesign without rhetoric.
Say who is not in the room. Community settings frequently exclude the roles closest to the patient, such as front desk staff, community health workers, interpreters and medical assistants, from the bodies that decide how their work is arranged. Naming that absence and addressing it in your design is both correct and reliably rewarded.
Five mistakes that cost points in this week's territory
- A new committee with no decision it owns. A body that can only recommend adds a step and changes nothing.
- Governance proposed without an inventory. Designing on top of structures you have not described produces overlap you cannot see.
- No time cost stated. Every structure spends clinical hours, and a proposal silent about that reads as unserious to any senior reader.
- Output ignored. Detailed membership and cadence with no account of how decisions reach absent staff recreates the original problem.
- Shared governance used loosely. The term has a published meaning; using it for any arrangement where people talk to each other will be marked.
Before you submit
- The current-state inventory covers membership, cadence and recent output
- A decision rights table appears with exactly one owner per row
- Every proposed body owns at least one decision outright
- Published conditions for success are cited and mapped to your design
- Monthly hour cost is calculated and something is retired in exchange
- The plan says how decisions reach people who were not in the room
Designing a governance model for NR-721?
Send the rubric and your current-state notes out of Canvas. A premium original draft comes back in 24 to 48 hours with a decision rights table, a costed structure and the evidence base mapped to it, and revisions run until the grade lands.