THEORY VERSUS PRACTICE

Bridging the gap between theory and practice is a constant concern of the manager 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 manager will 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 need 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 a theory is absolutely proven in all cases, 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 (i.e., assumptions and speculation) until they are put into practice. After following these two lessons, the manager must accept one additional essential bit of reality: he or she can study theories forever, even theories translated into rules of practice based on the experience 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 best 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-the 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 shot-in-the-dark, hit-or-miss behavior.

This issue of The Health Care Manager (HCM 22:1) is dedicated to providing stimulation on two important fronts: (1) theory and (2) rules for practice. However, it remains up to the individual manager 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 also is up to the manager to use what works and to avoid what does not work, even though some theory or alleged rule says it is supposed to work.

* * *

HCM 22:1 provides the following articles for the reader's consideration:

* "Health Informatics: Ethical Issues" reviews the new ethical challenges that have come about through advances in the technologies of information processing and communication; it suggests a solution incorporating observance of standards and regulations, promotion of codes of conduct and ethics, and creation of a culture of "infoethics."

* "Electronic Managed Care: The Utilization of Information Technology in a Managed Care Environment" describes the utilization of modern information technology in conducting managed care negotiations that effectively bring together management care organizations, employers, health care providers, and patients.

* "What the Health Care Administrator Needs To Consider When Purchasing Personal Computers" describes how to match the functionality required of the organization's personal computers with the available technology. That the admittedly highly technical nature of some of the information will at first seem beyond some readers may at least partly explain why excess computer capacity is so commonly encountered.

* "Medical Group Affiliations: Interorganizational Relationships and Organizational Performance" reports on a study of a number of interorganizational relationships and suggests how they affect organizational performance on several dimensions of performance.

* The Case in Health Care Management, "The Paperwork Just Isn't That Important," asks readers to consider what to do concerning an otherwise well-performing employee who exhibits a chronic disregard for required documentation.

* "Retention: It's All About Respect" suggests that the importance of employee retention is often overlooked in developing strategies for addressing employee shortages; it reports on research that suggests intangibles such as respect, recognition, and organizational commitment retention are more important in employee retention than other more tangible factors.

* "When Your Memory Malfunctions: Implications for the Manager" reviews some research into the functioning of human memory and enumerates the common memory malfunctions and relates these to managerial strategies.

* "Labor Relations Strategies and Tactics in Hospital Elections" explores strategies and tactics employed by hospitals in dealing with labor organizing; it reviews the apparent relative effectiveness of a number of these in influencing bargaining election results.

* "Managing Effectively in the Downsized Organization" calls for the development of new management strategies governing specific aspects of operations to enable managers to adapt to their new and invariably expanded roles in managing in the wake of downsizing or other variants of "reengineering."

* "The Manager's Approach to Employee Performance Problems" differentiates between problems grounded in motivational issues and those owing to employee skill deficiencies; it outlines a process for the manager to apply in constructively addressing performance problems with an emphasis on correction whenever possible.

* "A Manager Asks: But the Boss is Always the Boss" addresses several questions that first-line managers asked about relationships with their immediate superiors, primarily reflecting frustration with situations in which subordinate managers felt that higher management was providing inadequate support for the department manager.