THEORY VERSUS PRACTICE

Bridging the gap between theory and practice is a constant concern of most managers working in health care. Managers learn a variety of theories from a number of sources-formal education; job-related continuing education; outside conferences, seminars, and workshops; reading; self-study; and personal research-but the task always remains the same: make the theories work in actual practice. Often stranded between what "should be" (according to theory) and what "is" (in practice), a manger may often find that the gap between theory and practice is as broad as the Grand Canyon and seemingly as unbridgeable.

Should we ever wonder why those beautiful management theories do not work just when we need them to, we only consider the principal definition of theory. The American Heritage Dictionary of the English Language defines "theory" as

-systematically organized knowledge applicable in a wide variety of circumstances; especially, a system of assumptions, accepted principles, and rules of procedure devised to analyze, predict, or otherwise explain the nature of behavior of a specified set of phenomena.

Note that one of the foundations of this definition is "a system of assumptions." Note also that another, far briefer definition from the same source is "abstract reasoning; speculation."

The nature of a theory is such that it is not guaranteed to always be applicable. A few instances-or even many instances-of applicability do not "prove" a theory; they merely support a theory. When theory is absolutely proven in all instances, it is no longer a theory; it is a law. There are few true laws in the world (even the universally accepted Newton's law, "For every action there is an equal and opposite reaction," is referred to in most physics texts as "Newton's Third Principle"), and there are no true laws governing the world of people management.

It follows that the first lesson to be learned about theories is that they do not always apply. The second lesson is that they remain theories (ie, assumptions and speculations) until they are put into practice. After absorbing these two lessons, the manager must accept one additional bit of reality; he or she can study theories forever, even theories translated into rules of practice based on the experiences of others, and still be lacking the key ingredient required in bridging the gap between theory and practice-the manager's own involvement in a real problem. In other words, even the bet set of practical rules ever devised, or the most pertinent case study ever discussed, remains no more than an academic exercise until the manager becomes involved in "doing" rather than just "learning about." And the doing-dealing with a real problem in which the manager has a stake-remains entirely up to the manager.

However, we must not completely shun the theoretical in favor of the supposedly practical. It is true that theory not applied in practice remains no more than intellectual calisthenics, but practice unguided by theory is no more than a shot-in-the-dark, hit-or-miss behavior.

It always remains up to the individual to bridge the gap between theory and practice by absorbing what is available and applying it fairly, courageously, and compassionately to each problem that arises. It is also up to the manager to use what works and to avoid what does not work even if some theory or alleged rule say it is supposed to work.

This issue of The Health Care Manager (Issue 38:1, January-March 2019) includes the following articles for the reader's consideration:

* "Comparison of Medicare Advantage and Medicare Denial Rates" reports on a comparative examination of Medicare Advantage plans that may pay hospitals different than expected hospital rates because of differences in denial rates for medical necessity and addresses an identified trend in Medicare Advantage denials that could materially impact hospital revenues going forward.

* "Job Satisfaction Among Physician Assistants Practicing Cardiovascular Medicine in the United States" reports on an examination of overall job satisfaction and factors of job satisfaction among physician assistants practicing cardiovascular medicine in the United States; examined were retention issues, reduced health care costs, increased patient satisfaction, and improved health care.

* "Hospital Readmission and Costs of Total Knee Replacement Surgery in 2009 and 2014: Potential Implications for Healthcare Managers" addresses changes in hospital readmissions and costs for US hospital patients who underwent total knee replacement in 2009 and 2014; findings offer hospital managers a mechanism to benchmark their facilities' performances.

* "Staff Perceptions of Improving Emergency Care for Children: A Qualitative Study" reports on a study undertaken to identify staff perceptions of a service improvement for pediatric emergency care at a university teaching hospital. Semistructured qualitative interviews of stakeholders were conducted, and grounded theory approach was used for analysis.

* "Service Utilization and Costs of Patients at a Cash-Based Physical Therapy Clinic" reports on a study undertaken to describe in detail service utilization for a single cash-based physical therapy clinic; this study is likely the first to present data regarding costs, utilization, and patient demographics for a cash-based physical therapy clinic.

* "Caffeine Intake Habits and the Perception of Its Effects on Health Among College Students" reports on a study undertaken to explore caffeine intake habits and the perception of their effects on health among college students; this was a quantitative, cross-sectional study with a descriptive design.

* "Patient-Centered Medical Home (PCMH) Graduate Internship, Benefits to a Practice Manager: Case Study" advances the belief that graduate health information management students can and should be involved in collaborations with the PCMH at primary care clinics; this case study is the second of two PCMH internship studies where the value of an intern to a practice manager is demonstrated.

* "Organizational Factors Associated With Quality Perinatal Care" reports on a study of chart audit data for more than 10 000 maternity patients, using multiple regression analysis to examine the association of organizational factors and perinatal quality of care; findings suggest it is important for hospital boards and leaders to develop and implement organizational policies to enhance perinatal quality of care.

* Case in Health Care Management: "The Vocally Unhappy Camper" asks the reader to consider how to address the problem of an otherwise reasonably good worker who chronically complains and seems to perpetually spread gloom.

* "Global Challenges to HIV Prevention" advances the belief that the stigma associated with the presence of human immunodeficiency virus (HIV) and certain sexual practices are factors that prevent HIV patients from being given a diagnosis and treated at an early stage; delayed diagnosis and treatment not only worsen an individual's prognosis but also can bolster the spread of HIV socially.

* "Designing a Performance Measurement System for Accountability, Quality Improvement, and Innovation" presents a detailed approach for the design of a system of performance measures to be used to assess the achievement of a health care organization's strategic goals and its need for change.

* "Prioritizing Factors Affecting Health Service Quality Using Integrated Fuzzy DEMATEL and ANP: A Case Study of Iran" reports on a study undertaken to identify and prioritize the factors affecting service quality from the viewpoints of all health care stakeholders in the teaching hospitals and the headquarters affiliated to Shiraz University of Medical Sciences in 2015.