Polarity management: A new approach to solving problems

Have you ever felt like some problems in medical staff leadership were simply unsolvable? Many hospitals constantly struggle to find answers to the following questions:

• If we pay physicians to cover the emergency department, will we be complying with EMTALA and giving better care but bankrupting the hospital?
• Should we focus on quality or cost?
• Should decisions be based on the interests of the hospital or the physicians?
• Do we want physicians to follow our guidelines carefully or use their clinical judgment?
• If we pay nurses what they want and deserve, will we get more nurses on staff but bankrupt the hospital?

If you try to answer these questions with an "either/or" answer, you'll never come up with a good strategy because there is no right answer to any of them. But does this mean you should give up struggling with these and similar challenges? Of course you shouldn't.

The good news is that there is a powerful tool to help leaders grapple more successfully with these problems and achieve better results. "Polarity Management" was developed by Barry Johnson, PhD. Johnson has designed a tool for "mapping" polarities like these and allows leaders to understand how the polarity works. It turns out we all have a tendency to focus too much on one "pole" of these polarities. For example, you may have heard a physician at your organization claim "physicians care about quality, and the hospital cares about making money." The physician is focusing on the quality pole and ignoring, at least for the moment, the cost pole. Johnson has shown that focusing on only one pole leads inevitably to a downside of that pole, which needs to be balanced by focusing on the other pole. Once you've mapped a polarity, you can develop strategies for maximizing the upside of each pole while minimizing the downside.

When faced with a particular challenge, you should first ask whether it is a decision to be made or a polarity to be managed. A problem that requires a decision would involve a question such as, "Will we allow chiropractors to practice in our hospital?" A polarity to manage asks something like, "should we make our guidelines required or optional?" Although this second question initially sounds just like another decision, it actually expresses the polarity of balancing the need for physicians to reduce variation where it doesn't add value with the need to allow for variation when it does add value.

Johnson's approach is explained in his book, Polarity Management: Identifying and Managing Unsolvable Problems.