The Leader as Synergist
Critical Care Nurse, Vol 22,
No. 2, April 2002
The Synergy Model in Practice
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
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 "...an 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
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,
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 www.nursingeconomics.net)