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It is safe to say that most of us were taught that theory is a key element of research and can readily explain the advantages of using a theory in designing research. Nonetheless, a notable portion of submissions to Health Care Management Review truly lack a theoretical framework for the study. Another portion of submissions mention theory in the introduction but do not use the theory is a substantive manner. Of those that do use a theory to generate hypotheses and guide variable selection, few revisit the theory in the discussion section. Virtually none of the authors discuss their results in terms of applying the theory to health administration practice. Admittedly, some qualitative research is designed as theory development, but even these authors rarely discuss the theory in terms of direct application to health administration practice.

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This assessment is probably no surprise. But the situation reveals the presence of two dilemmas. One dilemma is that if theory is not used but the study yields interesting findings, what standards apply to assessing the value of the study? Research that is based on expertise and experience rather than on a formal theory can be legitimate and rigorous. The key in presenting such research is to be honest and disclose the origins of the research rather than to insert the mention of a theory after the research is complete, as might be done to satisfy reviewers. Research, whether quantitative or qualitative, that starts out as theoretical, however, must ultimately contribute to the development of theory. Not using a formal theory to guide the research is forgivable, but only if the research findings result in a theory or substantively challenge an existing theory. This criterion for evaluation applies to quantitative research as much as to qualitative research. Admittedly, generating theory from data is not the norm for quantitative researchers. Nonetheless, it is a possibility and a potentially productive alternative to the mere naming but not using a theory. The overwhelming amount of data in existing national, proprietary, and public databases create an irresistible temptation to look for significant relationships based on hunches rather than on formal theory. I view this as an opportunity for theory development, but only if innovative researchers use the existing data in ways that lead to the development of theory and thus contribute to building knowledge rather than adding facts.


The second dilemma is that if theory is not universally useful to or used by researchers, how can it be useful to or used in practice? Where in the cycle of research to practice and practice to research does theory fit? The reality is that we actually know less about how theories are used in practice than we know about how evidence is used in practice. Ideally, the best evidence comes from theory-based research, and thus, the use of evidence implicitly is the use of theory. However, the conscious application of theory in specific situations is a different matter. For example, I can name only a few theories that I consciously use on a regular basis. The theories that I do use are simple, have a very few key concepts, and are fun to use. Most of life is not theory based, and neither is most of health care administration. Without evidence about the usefulness of theory to practice, I am left only with the belief that a theory can facilitate the translation of the evidence into practice and the belief that theory is most useful if the theory is packaged in a memorable manner. A "neat little theory" is easier to remember and thus more readily applied to real-life situations than is an atheoretical list of variables and seemingly random relationships. In short, theory ought to be both first and last in the cycle of research to practice and in the presentation of a study.


L. Michele Issel, PhD, RN