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Using ‘polarity thinking’ to achieve sustainable positive outcomes

Like yin and yang, polarities are interdependent values that support each
other; here’s how this knowledge can be used to improve health care

By Laurie Levknecht, RN     Posted on 8 January 2013

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 sidewithout
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 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