TEN LESSONS IN COLLABORATION [Deborah Gardner]:
A commentary

Deborah Gardner, in her journal article entitled “Ten Lessons in Collaboration” mentioned that collaboration, though repeatedly discussed in health care circles is seldom practiced by health care practitioners. She added that most of the literature on collaboration describes what it should look like as an outcome, and only a few is written describing the methods involved in the developmental process of collaboration.

In an attempt to remedy the barriers to collaboration, Gardner provided in her article, ten key lessons. These lessons are said to benefit clinical nurse managers and all nurses who operate in an organizational setting that requires complex problem solving. Below is the summary of the ten key lessons to collaboration by Gardner:

Lesson #1: Know thyself. Many realities exist simultaneously. Each person's reality is based on self-developed perceptions. Requisite to trusting self and others is in knowing your own mental model (biases, values, and goals).

Knowing oneself is not as easy as learning the alphabet. It requires time and serious motivation in order to attain self-consciousness. Seminars, readings, and other resources must be made available to nurse managers and even nurse staff to aid them in the process of discovering themselves and throw away negative self-developed perceptions.

Lesson #2: Learn to value and manage diversity. Differences are essential assets for effective collaborative processes and outcomes.

To learn how to value and manage diversity, one must be primarily exposed to a diverse working environment. I must emphasize that this particular key to collaboration is best learned only by experience. In my opinion, well-traveled nursing professionals find it easier to learn how to manage diversity since they know how it feels to be in a strange place and that they were able to interact with people of a different race, culture, or religion.

Lesson #3: Develop constructive conflict resolution skills. In the collaborative paradigm, conflict is viewed as natural and as an opportunity to deepen understanding and agreement.

To develop constructive conflict resolution skills will entail the nurse manager to master the art of making good judgments. This key is not only evident in the administrative setting but even in small groups and organizations. Conflict resolution and diversity are two different concepts although there may be times when conflicts do arise from diversity. For me, conflict resolution is more challenging than managing diversity because resolving conflicts requires careful investigation and confrontation. Not all conflicts are evident, in fact, most of the conflicts occur in subtle ways.

Lesson # 4: Use your power to create win-win situations. The sharing of power and the recognition of one's own power base is part of effective collaboration.

Based on my observation, many of us often make the mistake of perceiving shared power with equal formal power. As emphasized by the author, shared power is not the same as equal formal power. A nurse manager should learn not only to see the distinction between the two, but should also learn the concept of self-control. Self-control restraints one’s impulses, emotions, and desires hence, enabling the nurse manager to use his/her administrative power effectively in proper and legitimate causes.

Lesson #5: Master interpersonal and process skills. Clinical competence, cooperation, and flexibility are the most frequently identified attributes important to effective collaborative practice.

Without mastering the first lesson (Know Thyself), it is impossible for one to master one’s interpersonal skills. Furthermore, a nurse manager should also know and fully understand the administrative policies as well as the nursing procedures in order to develop clinical competence.

Lesson #6: Recognize that collaboration is a journey. The skill and knowledge needed for effective collaboration take time and practice. Conflict resolution, clinical excellence, appreciative inquiry, and knowledge of group process are all life-long learning skills.

We cannot grow overnight. Collaboration is a skill that is learned through experience and perfected in a lifetime. The methods of collaboration will continuously modify itself as the profession of nursing evolves.

Lesson #7: Leverage all multidisciplinary forums. Being present both physically and mentally in team forums can provide an opportunity to assess how and when to offer collaborative communications for partnership building.

Being present physically and mentally in each task is difficult to do especially at present when we are all subjected to a fast-paced lifestyle. We may be used to think about the changes we will make in our daily routines while eating breakfast or maybe worry about the weekend affair while attending a group conference. Most of us may find it difficult at first, but with continued practice and proper motivation, we will be able to learn how to live life every moment. Living life every moment means that you are able to focus on what you have to do for a particular moment. If at 2pm you should be playing football, you will play football with nothing else in mind but the game. If at 4pm you have a conference, thinking about what to cook for dinner is out of your mind, and your concern for that time will only be about the conference. This technique will therefore increase your ability to focus as well as your ability to communicate effectively hence, enabling you to establish partnership and collaboration.

Lesson #8: Appreciate that collaboration can occur spontaneously. Collaboration is a mutually established condition that can happen spontaneously if the right factors are in place.

Sometimes the best collaborative experiences occur simultaneously. The author mentioned that sometimes trying to make collaboration happen through structures such as task force meetings may in fact decrease the capacity to collaborate.

Lesson #9: Balance autonomy and unity in collaborative relationships. Learn from your collaborative successes and failures. Becoming part of an exclusive team can be as bad as working in isolation. Be willing to seek feedback and admit mistakes. Be reflective, willing to seek feedback, and admit mistakes for dynamic balance.

As cited in the article, Hampden-Turner (1970) defined synergy as an optimal balance between individualism and integration. Too much autonomy and individualism can lead to isolation; yet too much integration can lead to diffusion. When this occurs, perspectives merge until parties have nothing new to offer each other. Should this occur, redirect focus on the individual force and adopt reflective practices, be willing to seek feedback, and admit mistakes. Collaboration is indeed a fine balance between autonomy and unity.

Lesson #10: Remember that collaboration is not required for all decisions. Collaboration is not a panacea, nor is it needed in all situations.

Collaboration under any circumstance requires good judgment. It may or may not be needed in a given situation since not all problems are complex.



REFERENCE:

Gardner, D. (January 31, 2005) "Ten Lessons in Collaboration" Online Journal of Issues in Nursing. Vol. #10 No.1, Manuscript 1. Available: www.nursingworld.org/ojin/topic26/tpc26_1.htm