The Leader as Synergist

Critical Care Nurse, Vol 22, No. 2, April 2002

The Synergy Model in Practice

Karlene Kerfoot, RN, PhD, CNAA

Karlene Kerfoot, RN, PhD, CNAA, is senior vice president for Nursing and Patient Care Services and Chief Nurse Executive, Clarian Health, Indianapolis, Ind, and Associate Dean, Nursing Practice Indiana School of Nursing.

The American Association of Critical Care Nurses' Synergy Model is a viable model for nurse leaders to use as a basis for professional practice. The leader must create a picture of the idealized organization first and describe how patients and nurses can live productively and beautifully as part of the organizational structure.

EFFECTIVE LEADERS help diverse groups of people work together in productive, synergized harmony. Patients want to be taken care of in environments of beauty and harmony with the staff, and nurses want the same thing. Relations between patients and their caregivers progress smoothly when the shared mission is building the care around the needs and characteristics of the patients. And what can be nobler than synergizing around the patient and the family?

Synergy is defined by Curley (1998, p. 70) as " evolving phenomenon that occurs when individuals work together in mutually enhancing ways toward a common goal." The American Association of Critical Care Nurses has pioneered the development of the Synergy Model. This model describes the patient's characteristics then notes that the nurse's competencies must be derived from the patients' needs. Leaders must take the responsibility for establishing the environment where this kind of care can take place. The Synergy Model provides a viable model for a leader to use as a basis for a professional practice.

Creating a Synergistic Environment

A leader cannot provide direct care. A leader must work through others to accomplish the work, but the leader is only as good as the people who are providing the care. The leader's obligation is to create the environment in which good people can provide good care. How does a leader do this?

First, the leader must start with developing an organization and infrastructure that can support synergized care. This involves the ability to imagine a desired future, through "from there to here thinking" popularized by Russell Ackoff (1981) and implement the building blocks to achieve that desired future. Ackoff advises us to think first about an ideal future and build from that. If one builds the future from the present reality, the possibilities are very limited. One option for this future is to consider the Synergy Model.

The AACN Synergy Model notes there are three levels of outcomes: those derived from the (a) patient, (b) nurse and (c) health care system. Therefore, the leader must address all three of these areas in order to create excellence in patient care (Curly, 1998). Patients come to us with certain vulnerabilities, which the Synergy Model categorizes as variations in stability, complexity, predictability, resiliency, vulnerability, participation in decision making and care, and resource availability. The required nursing competencies derived from these patient needs are, according to this model, clinical judgment, advocacy and moral agency, caring practices, facilitation of learning, collaboration, systems thinking, response to diversity, and clinical inquiry. To achieve what this model terms "safe passage" through the system, the nurse must be expert at these eight competencies. And finally, the outcomes derived from the health care system include the system's ability to survive through its ability to provide high-quality cost effective care that prevents recidivism (re-admissions) and delivers care within a framework of clinical effectiveness in which continuity of care and clinical judgment can stabilize care within chaotic environments.

The Magnetism of Excellence

Effective leaders start with the organization first. The patient care is totally chaotic without an effective organization that is magnetized around the concept of excellence in delivering patient care. The leader must create a picture of the idealized organization first and describe how patients and nurses can live productively and beautifully as part of the organizational structure. Eliminating departmental chauvinism is important to this concept. The chauvinism must be centered on patient care and not each individual department's pursuits.

Rovin (2001) describes many organizations as engaged in a war of the parts against the whole and notes that parts (departments) often try to flourish at the expense of the organization as a whole. His message to the leader is to design the organization first because the function of the parts flows from the whole. Leaders should focus on the design of the interaction between the parts because that interaction defines the success or failure of the organization.

Rovin describes highly functioning organizations as modeling after biological systems. For example, he notes that lungs do not have a function outside the body. They cannot breathe on their own. The effectiveness of the lungs is dependent on their interdependency with the heart, kidneys, circulatory system, etc. The same is true of patient care. The success of nursing care outcomes depends on the interrelationship of nursing with physicians, pharmacists, and others as well as the organizational functions of admitting, housekeeping, food service, etc. The leader's challenge is to create systems in which all these functions can interact effectively and responsively around the quickly changing needs of the patient.

Handy (1998) describes this talent as conceptual thinking skills which differs from the technical and human skills also needed by leaders. He defines conceptual skills as the ability to see what needs to be done and to articulate it in a way that gets others excited. A key success factor in leadership is the ability to conceptualize an organization as a biological system organized synergistically around the care of patients and to create the excitement of working for the whole of the organization rather than the individual parts. Hydrogen and oxygen alone are just hydrogen and oxygen. Together they create a whole new reality called water. Nurses and patients and other caregivers alone can only account for what they can do alone. However, when they are synergized with each other they create an entirely new organizational model of synergy that is much more effective than parts working alone. Synergistic organizations are magnetized around the needs of the patient and departments are magnetized with each other. In some organizations, unfortunately, departments can actually repel each other versus being drawn and magnetized together for the greater work of the whole. Health care practitioners can work with each other intuitively and look like poetry in motion when they are synergized around the needs of patients and families.

The Synergy Model is an excellent organizational framework to organize the work of nursing and patient care. This model describes the characteristics of the patient, the nurse, and the organization within which the care is given. It provides a compelling picture of how the work of patient care can be organized to provide "safe passage" for the patient through the health care system. It also provides the framework for patient assessment, career advancement for the nurse, and the organization of work between departments. The care of patients is complex and wrought with oppotunities to make mistakes. The Synergy Model can go far in eliminating the chaos often ingrained in patient care.


Ackoff, R.L. (1981). Creating the corporate future: Plan or be planned. New York: Wiley.
Curley, M.A.Q. (1998). Patient-Nurse synergy: Optimizing patient's outcomes. American Journal of Critical Care Nursing, 7(1), 64-72
Handy, C. (1998). Beyond certainty. Boston: Harvard Business School Press.
Rovin, S. (2001). Medicine and business. Gaithersburg, MD: Aspen

Reprinted from Nursing Economic$, 2001, Volume 19, Number 1, pp. 29-30. Reprinted with permission of the publisher, Jannetti Publications, Inc., East Holly Avenue Box 56, Pitman, NJ 08071-0056; Phone (856) 256-2300; Fax (856) 589-7463. (For a sample issue of the journal, visit
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