Our process sounds quite similar to those mentioned above. I am a member of 3 person digital marketing/comm team (all FTEs), but I am the only person charged with managing social media, my colleagues are resources/back ups as needed. At this time, we only have accounts for our main entities (Hospitals, Physician Group, College of Nursing/Medical Science, Medical Equipment corp. and HR recruitment). Our approval process sounds very similar to @rplattmmc for new accounts. We educate the departments/individuals on the time/training commitment, try to get them to narrow their goals and usually encourage them to start with providing content to our main accounts. We honestly have not had anyone take the conversation further than that since my role was created. If someone does pursue past this point, we require them to write a proposal that is reviewed by the marketing arm of our corporate leadership council and would ultimately be approved by the entire CLC. We do not try to dictate what providers can/cannot maintain their own professional accounts. If they choose to pursue that, we feel it's their own professional brand to own and we'll be a resource and require disclaimers about their affiliation with our organization. Departments are a different story. It has to be a pretty compelling reason, well-thought out goals and processes. Usually a conversation and opening our main channels to them is enough to meet their objectives.