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The Author[caption id="attachment_16752" align="alignleft" width="196"] Laurie Levknecht, RN, BSN[/caption]Laurie Levknecht is a registered nurse with 27 years of experience in a variety of clinical and administrative roles and settings. Since 2002, she has been a consultant with Elsevier’s CPM Resource Center, based in Grand Rapids, Michigan. With nearly 400 sites, CPM provides evidence-based clinical content, solutions and services to hospitals and other health-care providers throughout the US and Canada. As a transformation education manager, Levknecht specializes in cultural transformation and polarity thinking having completed the 2-year Polarity Management Mastery Program with Polarity Partnerships. She gives workshops throughout the United States on applying polarity thinking principles to health-care transformation.[/note]
As the health-care industry evolves at an ever-accelerating pace, health-care providers are faced with the challenge of transforming the way they work. They are treating more patients with fewer staff and resources. They must use standardized evidence-based practices while meeting the individual needs of the patient. They are expected to implement new technologies while maintaining the personal touch that is so important to patient care. And they are striving to maintain stability in their organizations while embracing the change needed to move forward.
Their challenges involve reconciling “polarities” – two seemingly opposing values that can complement each other when applied in a balanced way.
Polarities and the concept of interdependency have existed since ancient times. The Taoist “yin-yang” symbol represents interdependent energies – like light and dark – and the acknowledgement that life is about both. Societies throughout history have needed to find ways to provide for the collective “village” while meeting the needs of individuals.
In modern times, the business and organizational world uses “both-and” thinking as a supplement to the traditional problem solving “either-or.” Other names may be paradox, dilemmas and tensions. Many resources for leadership, change management and organizational effectiveness support one or both of these messages:
1. Highly effective leaders are effective partially because of their ability to manage polarities.
2. High-performing organizations perform well because, in part, they have created systems and processes that help them manage polarities well. Effective leaders are both clear and flexible, and high performing organizations both centralize for coordination and decentralize for responsiveness. [pullquote align="left"] Since polarities are unavoidable, they are present in every individual, team, organization and nation.[/pullquote]
Polarities are interdependent pairs that need each other over time to maintain and gain performance. Since polarities are unavoidable, they are present in every individual, team, organization and nation. Many personal polarity pairs are immediately recognizable, such as home-work, activity-rest, intuition-facts, optimism-reality, caution-courage, self-other and structure-flexibility. Every team or organization is faced with managing the energy in polarities such as stability-change, global-local, mission-margin, team competency-individual competency, and part-whole.
Because polarities are interdependent, they need each other and neither is sufficient alone. Each side is accurate but incomplete without the other. Polarity thinking is about “both-and” and invites a move away from “you are wrong and I am right” thinking to “we are both right.” This kind of thinking supplements our traditional problem solving (either-or) thinking and acting.
How polarity thinking worksBarry Johnson, founder of Polarity Management Associates, now called Polarity Partnerships, took this concept and created the Polarity Map to help visualize both-and thinking. The map has four quadrants with each pole having an upside and a downside. Upsides are about the positive results obtained when we focus on that pole, and downsides are about the negative outcomes present there is an over-focus on this side without paying attention to the other side. With an understanding of polarity principles, one can predict what will happen if the focus is only on one side. In fact, the more attention paid to one side of a pole, the more certainty there is that there will be a move to the downside of the very thing that has taken all the attention. In addition, the more you are attached to “your side” or “your value,” the more you are unable to see the potential downsides attached to it. [caption id="attachment_16772" align="alignnone" width="800"] Map used with permission of Polarity Partnerships LLC[/caption]
Applying it to your own lifeWe can fill out a polarity map together. Think for a moment about the upside of work and work life, and add your responses to the map. For example, you get paid, you have work relationships that enrich your life, you are able to contribute to society. Now fill out the other side regarding the upside of home life. You can rest and relax, you have family and friends, you keep active with personal interests and hobbies.
Now consider what happens in your life if you over focus on work life and neglect your home life. Relationships at home suffer. You are stressed everywhere. You may ultimately be less productive at work. Or what if you were to pay more attention to home life than work? Work relationships suffer. You might even no longer get paid!
Once the map is filled out, you can create action steps to keep you in the upsides of the polarities, and early warning signs to predict movement towards the downside. Because this is a personal polarity, the action steps and early warnings signs are unique to you and your circumstances. Here is an example of a map filled out for the polarity of work life — home life: [caption id="attachment_16769" align="alignnone" width="800"] Work life — home life. This is an example of a map filled out for this familiar polarity.[/caption]
Polarity thinking in health careAt Elsevier, the CPM Resource Center has partnered with Barry Johnson and Polarity Partnerships to bring polarity thinking to health care. Polarity thinking is one of the 3 principles foundational to the CPM Framework (partnership and dialogue are the other two), and it is embedded in all transformation services. Through work with the CPM International Consortium, we have identified and mapped the following 13 key organizational polarities that are occurring in this time of massive health-care transformation:
- Candor — diplomacy
- Change — stability
- Framework-driven change — project-driven change
- Individual competency — team competency
- Margin — mission
- Medical care — whole person care
- Patient safety — staff safety
- Patient satisfaction — staff satisfaction
- Routine tasks — scope of practice tasks
- Standardized care-individualized care
- Technology innovation (high tech) — practice innovation (high touch)
- Vertical — horizontal
The CPM Practice Transformation Services team uses polarity thinking in various workshops to help participants see the whole of a situation. The practice-technology polarity is introduced early in the client relationship to remind clients of the need to pay attention to both sides of this polarity. It is especially necessary when hospital systems are intent upon quickly implementing technology without paying enough attention to the practice changes that will occur. Sometimes the implementation teams don’t even have clinician domain expertise until after they explore this polarity.
During the Scope of Practice workshops, participants are invited to complete the polarity map pertaining to team-individual. Exposure to this exercise reminds them of the “both-and” nature of caring for patients and families in today’s complex environment. No one person, discipline or role can provide complete care, yet each person needs to be individually competent in their scope.
Employees at one CPM site found themselves struggling with the polarity of “standardization of the plan of care — individualization of the plan of care.” Their CPM site coordinator helped them create a polarity map, and they used polarity thinking as a tool to explore the issue. They created action steps that led to a more complete standardized plan of care, and they also became better at individualizing the plan of care. The site coordinator presented their results at national and regional conferences.
The legacy of today’s health-care leaders will be their ability to lead health-care transformation at the point of care. This ability depends on a willingness to supplement traditional problem solving (which they are great at) with “both-and” thinking. By using polarity thinking, health-care organizations have the potential to:
- Automate without dehumanizing
- Achieve fiscal soundness without decreasing quality
- Educate, but not interfere with new ideas
- Use evidence-based standardization without losing individualization
- Enhance partnerships without losing identity
- Get the routine tasks done without compromising professional scope
- Provide medical treatment without losing preventive care
- Innovate without losing stability
- Improve productivity without losing human sensitivity
- Create a healthy culture without increased cost
- Achieve clinical integration without decreasing productivity
- Decrease variability of care without being rigid
- Achieve exponential growth without wasting millions of dollars