"Polarity Thinking in Healthcare: The Missing Logic to Achieve Transformation"

Author: Bonnie Wesorick; Reviewed by: Jack Kues, PhD, FACEHP, CHCP

As continuing professional development professionals, we often find ourselves playing the role of change agent. This may not be what we signed up for as educators, but we are facing the reality that CPD in the health professions is all about changing practice and improving care. If you add to this shift in focus the increasing emphasis on team-based care and interprofessional education, we have a totally different environment than existed just a few short decades ago. This new landscape requires us, as educators and change agents, to develop new skills and expertise so that we can be effective — or at least survive in our evolving role. With that long-winded introduction, I would like to introduce you to a concept that I have found very helpful: polarity thinking.

Like most of you, I have spent most of my career solving problems. In all too many situations, the solutions create new problems or the old problems recycle themselves and I find myself in a “Groundhog Day” scenario, addressing the same issues over and over again. Barry Johnson has developed a novel way to approaching these situations. His colleague, Bonnie Wesorick, recently published a description of how po­larity thinking can be applied to the healthcare environment. “Polarity Thinking in Healthcare: The missing logic to achieve transformation” (HRD Press: Amherst, MA, 2016: ISBN 978-1- 61014-406-3) is an overview of the concept of polarity thinking, and it includes many detailed examples of how it has been applied to various issues in healthcare environments.

The general principle behind polarity thinking is that we typically see situations as problems to be solved. If there are opposing views, such as seeing many patients in a finite period of time versus spending more time with individual patients, we solve the problem in favor of one side or the other. We often hear healthcare providers complaining that they do not have time to engage in lengthy assessments or conversations with patients because it limits the number of patients they can see and, ultimately, are not cost effective for the provider. As educators, we can help providers develop new skills or understand best practices, but our learners have to figure out how to make and sustain changes in practice.

Wesorik describes a polarity as “an interdependent pair of values or alternative points of view that need each other over time to reach outcomes neither can reach alone.” She lists a number of common polarities that we see in the healthcare arena: cost of care and quality of care, patient safety and staff safety, and individual competency and team competency.

As educators and change agents, polarity thinking can be very helpful in planning changes that can simultaneously improve practice and address barriers to change. It takes us beyond the traditional model of providing new information to promote change while recognizing the complexities of closing practice gaps. I found this model to be very helpful when I want to understand why and how current practice has developed and why, in the face of contrary evidence, less than optimal practice persists.

The book is a pretty quick read and is mostly a series of case studies. As the developer of polarity thinking, Johnson has developed a process for applying this model as part of institutional transformation. However, I found the basic reasoning behind the concept of polarities to be very useful when helping practitioners improve their delivery of care.

To help the reader understand the basic premise behind polarity thinking, Wesorik uses the example of inhaling and exhaling as an example of a simple polarity. They represent complementary processes that both must happen (although not at the same time) in order to be successful (i.e., continue living). If one or the other dominates, the larger system (i.e., human body) suffers.

Since reading this book, I have used the fundamentals of polarity thinking to help me understand a number of situations in which practice improvements and organizational changes have stalled or failed. The ability to see practice gaps as competing priorities rather than good and bad practices is invaluable to developing sustainable improvements.

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