DNP 714 Module 3 Individual Reflection 1: Theory in Healthcare Partnerships Example

The Theory I Reached For and the One I Needed: Challenges in Using Models to Build Partnerships in Health Care

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

DNP 714: Professional Relationships in Healthcare

Instructor Name

Month Day, Year

The Theory I Reached For and the One I Needed: Challenges in Using Models to Build Partnerships in Health Care

Introduction

Before this course, I used the word "theory" mostly in school. At work, I solved team problems by instinct and experience. This module asked us to use models to explain and predict relationships, and when I tried to do that with a real problem at my surgery center, I found it harder than the readings made it look.

The Problem I Tried to Explain

Our preoperative nurses and our anesthesia staff had been in quiet conflict for months. Nurses felt that anesthesia providers arrived late to see patients and then blamed nurses for incomplete preparation. Anesthesia providers felt that nurses called them for questions the chart already answered. First cases were starting late, and both groups were frustrated.

My first instinct was to reach for Tuckman's model of group development, which I remembered from school. Tuckman (1965) proposed that small groups develop in a fixed order, which later writers labeled forming, storming, norming and performing. The groups were certainly storming. But the model did not help me act. These were not new groups; most of the staff had worked together for years, and the model offered no explanation for why an established team would stay stuck.

Challenge 1: Too Many Models

The first challenge is choice. The readings introduced models at the individual, team and organizational levels, from communication theory to input-process-output models of teams. When everything seems to apply, it is hard to know which model will actually explain a problem. I spent more time comparing models than understanding my teams.

Challenge 2: Levels That Do Not Match the Problem

The second challenge is level. Tuckman describes a single group developing over time. My problem sat between two professional groups and was shaped by the schedule, which is an organizational structure. A model at the wrong level explains part of the problem and misses the rest. Later in the module, I found relational coordination, which focuses on the relationships between roles that must coordinate their work and how shared goals, shared knowledge and mutual respect shape outcomes (Gittell et al., 2000). It fit better because it described exactly the space between nurses and anesthesia.

Challenge 3: Theories Built Elsewhere

The third challenge is origin. Many team models come from the military, aviation or business. They are useful, but health care teams change members every shift, carry strong professional hierarchies and deal with patients whose needs cannot wait. Ilgen et al. (2005) note that team research moved from simple input-process-output models toward models that account for teams changing over time, and health care teams may need that more than most.

Challenge 4: Skipping Theory Under Pressure

The last challenge is time. When first cases run late every morning, leaders want a fix, not a framework. I was tempted to write a new rule requiring anesthesia providers to see patients 30 minutes before start time. A rule like that addresses a symptom and leaves the relationship untouched, which is likely why similar rules had failed before.

A Better Way to Choose

Next time I will start with the problem rather than the theory. I will ask at what level the problem lives, who must coordinate with whom, and what outcome matters, and then look for a model built to explain that kind of problem. For the surgery center, relational coordination suggested something concrete: a brief daily huddle between the charge nurse and the anesthesia lead, and a shared definition of "ready for anesthesia" that both groups helped write. Early results are encouraging, though only a few weeks old.

Conclusion

Theory is useful when it fits the problem and sits at the right level. The challenge is not a lack of models but choosing one honestly, resisting the theory I already know and making time to think before acting. That is a discipline I expect to practice as a DNP leader.

References

Gittell, J. H., Fairfield, K. M., Bierbaum, B., Head, W., Jackson, R., Kelly, M., Laskin, R., Lipson, S., Siliski, J., Thornhill, T., & Zuckerman, J. (2000). Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay: A nine-hospital study of surgical patients. Medical Care, 38(8), 807-819. https://doi.org/10.1097/00005650-200008000-00005

Ilgen, D. R., Hollenbeck, J. R., Johnson, M., & Jundt, D. (2005). Teams in organizations: From input-process-output models to IMOI models. Annual Review of Psychology, 56, 517-543. https://doi.org/10.1146/annurev.psych.56.091103.070250

Tuckman, B. W. (1965). Developmental sequence in small groups. Psychological Bulletin, 63(6), 384-399. https://doi.org/10.1037/h0022100