Ten Lessons in Collaboration

Deborah B. Gardner PhD, RN, CS


Online J Issues Nurs. 2005;10(1) 

In This Article

Abstract and Introduction

Collaboration is a substantive idea repeatedly discussed in health care circles. The benefits are well validated. Yet collaboration is seldom practiced. So what is the problem? The lack of a shared definition is one barrier. Additionally, the complexity of collaboration and the skills required to facilitate the process are formidable. Much of the literature on collaboration describes what it should look like as an outcome, but little is written describing how to approach the developmental process of collaboration. In an attempt to remedy the all too familiar riddle of matching ends with means, this article offers key lessons to bridge the discourse on collaboration with the practice of collaboration. These lessons can benefit clinical nurse managers and all nurses who operate in an organizational setting that requires complex problem solving.

Open any newspaper, business, economics, or professional magazine and the word collaboration is visibly noted in headlines, article titles, editorials, and even in advertisements. Its virtues are extolled. The nursing and health services management literature, and to a lesser extent medical literature, on collaboration is extensive (see literature review by Sullivan, 1998). Many researchers have validated the benefits of collaboration to include improved patient outcomes (Knaus, Draper, Wagner, & Zimmerman, 1986), reduced length of stay (Rubenstein, Josephson, & Weiland, 1984), cost savings (Barker, Williams, & Zimmer, 1985), increased nursing job satisfaction and retention (Baggs & Ryan, 1990), and improved teamwork (Abramson & Mizrahi 1996).

The focus on benefits of collaboration could lead one to think that collaboration is a favorite approach to providing patient care, leading organizations, educating future health professionals, and conducting health care research. Unfortunately, interdisciplinary collaboration as a practice norm is rare. This may reflect the myriad contextual forces that hold more traditional practice norms in place for both individuals and practice organizational settings. It has been my observation over the past 25 years that effective collaboration is dependent on the context including my own frame of mind. Other contextual elements that influence the formation of collaboration include time, status, organizational values, collaborating participants, and type of problem.

In hindsight, my initial experience with successful collaboration occurred as an undergraduate nursing student working with a favored nursing instructor whose willingness to partner created a culture of empowerment and challenge. It would be over ten years before I appreciated that I had been afforded such a positive collaborative experience so early in my career. Later, writing about conflict and power use in interdisciplinary health care teams, and working with a collaborative interdisciplinary education program, provided a deeper, more complex understanding. What I have since learned is that the theoretical knowledge, while important, provides little guidance in terms of "how" to grow and sustain collaborative partnerships. Axiomatically, it is much easier to talk about it than to do it. The purpose of this article is to offer key lessons in collaboration, based on both relevant literature and my experience, which may benefit clinical nurse managers, and all nurses who work in an organizational setting that requires complex problem solving.


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