Theory Versus Practice

Overcoming the ever-present gap between theory and practice should be a constant concern of every working health care manager. You can learn management theories from a number of sources-for example, through formal education; job-related continuing education; external conferences, workshops, and seminars; reading and other self-study-but you are then always faced with the same task: successfully applying these theories in everyday job situations. Frequently stranded between what should be so according to theory and what actually occurs in practice, the manager finds that the gulf between theory and practice is broad and often seemingly unbridgeable.

The American Heritage Dictionary of the English Language (American Heritage and Houghton-Mifflin) defines theory as follows: "Systematically organized knowledge applicable in a relatively wide variety of circumstances: especially, a system of assumptions, accepted principles, and rules of procedure designed to analyze, predict, or otherwise explain the nature of behavior of a specified set of circumstances." Should we wonder at times while those beautiful management theories seem not to work as we think they should, we might consider in some depth the implications of the foregoing "definition"? One of the foundations of this definition is "a system of assumptions," surely supporting another listed definition of "theory": "abstract reasoning; speculation."

The nature of theory is such that it is not guaranteed to be always applicable. A few instances, or, for that matter, 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-that is, assumptions and speculations-until they are put into practice. Following these 2 lessons, the manager must accept 1 additional bit of reality: you 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-your 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 you become involved in doing rather than just learning about. And the doing-dealing with a real problem in which you have a personal stake-remains entirely up to you.

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 mental calisthenics, but most of the time, practice unguided by theory is no more than 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 you, 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 situation that arises. It is also up to you 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 (issue 36:1, January-March 2017) includes the following articles for the reader's consideration:

* "Lead Time to Appointment and No-Show Rates for New and Follow-up Patients in an Ambulatory Clinic" reports on a study undertaken to estimate no-show rates and test for association between appointment lead time and no-show rates for new and follow-up patients.

* "The Effects of the Transforming Care at the Bedside Program on Perceived Team Effectiveness and Patient Outcomes" addresses a study designed to document the impact of the Transforming Care at the Bedside program on the health care team's effectiveness, patient safety, and patient experience.

* "Hospital Chief Executive Officer Perspectives on Health Care Administration Academic Preparations" describes a post hoc review conducted to determine what preferred academic program of study (master of health administration, master of business administration, or a clinical degree preparation) may exist with current hospital executives and address potential trending of executive degree preparations over time.

* "The Impact of Race on Patient Satisfaction With Primary Care Physician" describes an empiric study undertaken to investigate factors that impact satisfaction of primary care physician by patients of different races in the United States, concluding that to some extent satisfaction with primary physician varies based on the race of patient plus a number of factors outside the control of the physician.

* The Case in Health Care Management: "All the Empowerment Jazz" asks the reader to consider the differences, if any, between true delegation and empowerment and also consider how a particular middle might better address this practice with subordinate supervisors.

* "Comparing the Financial Impact of Several Hospitals on Their Local Markets" examines several studies that measured the financial impact of hospitals on their local markets to ascertain whether there are any identifying characteristics and emerging patterns in the data suggesting the extent to which these hospitals compare to their local economies.

* "Eight Leadership Emergency Codes Worth Calling" identifies 8 dysfunctional behaviors that compromise professional standards at the ground level of the hospital and suggests calling a code when one witnesses such behaviors.

* "Meta-analysis of Specific Music Therapy Measures and Their Implications for the Health Care System" reports on an activity pursued to conduct an exhaustive search of the Journal of Music Therapy to determine whether music therapy may seem to make a measureable difference in several measures related to an individual's health and quality of life.

* "Assessing the Quality of Services Provided in the Teaching Hospitals: A Case Study of Iran" addresses an applied, cross-sectional, and descriptive-analytical study conducted in 2015 in the teaching hospitals affiliated to Shiraz University of Medical to assess the quality of services provided in the teaching hospitals affiliated to Shiraz University.

* "A Qualitative Study of Health Care Experiences Among International Students" addresses a qualitative study undertaken to explore the health care experiences of international students at a college in Indiana. Analysis of results reveals the international students' experiences with and perceptions of health care in the United States.

* "Big Data Management in US Hospitals: Benefits and Barriers" describes a study conducted to examine the emergence of big data in the US health care industry, evaluate a hospital's ability to effectively make use of complex information, and predict the potential benefits that hospitals might realize if they are successful in using big data.

* "Health Service Management Interns Serve as Practice Facilitators for Patient-Centered Medical Home Recognition: East Carolina University-Appalachian State University Initiative" describes the first year of implementation of a patient-centered medical home initiative where students in a health services management internship program act as facilitators to assist practices in the patient-centered medical home recognition process.

Charles R. McConnell

November 2016