Using polarity thinking to achieve sustainable positive outcomes

Like yin and yang, polarities are interdependent values that support each other; heres how this knowledge can be used to improve health care
By Laurie Levknecht, RN | Posted on 8 January 2013

The Author

Laurie Levknecht, RN, BSN 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 Elseviers 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. 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. Since polarities are unavoidable, they are present in every individual, team, organization and nation. 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 works

Barry 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.

Map used with permission of Polarity Partnerships LLC

Applying it to your own life

We 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:

Work life home life. This is an example of a map filled out for this familiar polarity.

Polarity thinking in health care

At 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 Because all polarities work the same way, it is apparent that organizations that pay attention to both sides of the polarities are more likely to achieve their goals related to these polarities and sustain the changes over time. Our experience has been that this list is congruent with both the strategic goals and the innovations required by health-care reform. 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 dont 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 todays 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 todays 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, healthcare 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 For more information about polarity thinking, contact Laurie Levknecht (L.Levknecht@Elsevier.com).