THEORY VERSUS PRACTICE

Bridging the gap between theory and practice is a constant concern of the working health care manager. One learns a variety of management theories from a number of sources-formal education; job-related continuing education; outside conferences, seminars, and workshops; reading and other self-study-but one is always left with the same task: making those theories work in actual practice. Often stranded between what should be (at least according to theory) and what is in practice, the manager frequently finds that the gap between theory and practice is seemingly unbridgeable.

Should one wonder at times why those beautiful management theories seem not to work, one should perhaps consider the principal definition of theory (as set forth in the American Heritage Dictionary of the English Language):

Systematically organized knowledge applicable in a relatively 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 one of the foundations of this definition, "a system of assumptions." Note another, far briefer definition of theory: "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 "law" of Newton, action equals reaction, is referred to in most physics texts as Newton's Third Principle). And there are no laws as such in the realm 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-assumptions and speculations-until they are put into practice. Following these lessons, the manager must accept one additional essential bit of reality: One can study theories forever, even theories translated into rules for practice based on the actual 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, one 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 mental calisthenics, but practice unguided by theory is no more than a shot-in-the-dark hit-or-miss behavior.

The Health Care Manager is dedicated to providing stimulation on 2 important fronts-theory and rules for practice. It remains up to the individual manager, however, to bridge the gap between theory and practice by absorbing that which is available and applying it fairly, courageously, and compassionately to each problem that arises. It is also up to the manager to use that which works and to avoid that which does not work even though some rule or theory says it is supposed to work.

This issue of The Health Care Manager (25:2, April-June 2006) offers the following for reader consideration:

* "Delegating Decision-Making in Health Care Organizations" examines delegation from a behavioral perspective, looks at the limitations of decision-making under delegation as well as reasons for delegation failure, and outlines the principal requirements of effective delegation.

* "Implementing Performance Management in the Irish Health Sector" outlines the primary requirements of an organized approach to performance management that can enable managers working in the Irish health care system to proactively facilitate optimal employee performance.

* "Job Dissatisfaction Among Public Hospital Physicians is a Universal Problem: Evidence From Turkey" reports on a study examining a number of indicators apparently contributing to physician stress and dissatisfaction within the Turkish public health care system, suggesting that the contributing factors are far from unique to Turkey but are rather prevalent in most similar systems.

* The Case in Health Care Management, "No Longer One of the Gang," asks the reader to consider both the advantages and disadvantages involved in assuming the management of a departmental group of which one has long been a working member.

* "Six Sigma in Health Care Management and Strategy" presents Six Sigma as an effective strategic tool for improving organizational efficiency and effectiveness, enhancing an organization's ability to remain competitive, and increasing the organization's chances of survival under continued financial pressure.

* "Satisfaction for Health Care Employees: A Quest for the Holy Grail?" suggests that so much has been made of job satisfaction among nurses that some working nurses expect it as an entitlement, and that the appropriate approach may lie in not attempting to increase job satisfaction but rather working to reduce dissatisfaction.

* "Can Case Management Interventions Reduce the Number of Emergency Department Visits by Frequent Users?" reports on a study that examined the impact of nursing case management interventions on the frequency of visits by regular users of a large, active level 1 urban emergency department.

* "Shiftwork: What Health Care Managers Need to Know" examines one of health care employment's oldest problems and identifies the factors and circumstances that should be taken into account when designing work schedules for minimal negative effects on staff.

* "Health Care CIOs: Assessing Their Fit in the Organizational Hierarchy and Their Influence on Information Technology Capability" reports the conclusions of a study that examines the position of the health care organization's chief information officer (CIO) and relates the extent of CIO tenure to the adoption of health information technology.

* "The Management of a Multigenerational Team With Differing Qualifications: A Qualitative Study" reports on a study undertaken within the Italian health care system exploring the problems inherent in managing nursing teams composed of members of varying ages and technical qualifications.

* "Implementation of Problem-Based Learning in a Final Semester Comprehensive Nursing Course" defines problem-based learning, describes the kinds of results this process has achieved, and provide a review of the literature of problem-based learning in nursing education.