Joy Goldman RN, MS, PCC and Margaret Cary, MD, MBA, MPH, PCC
In the March 2018 issue of The Future of Coaching, Margaret introduced the idea of using Polarity Thinking and Polarity Maps to help physicians shift from an Either/Or, problem-oriented viewpoint to an approach that includes a Both/And perspective to leverage personal and professional lives. We (Joy and Margaret) each use polarity maps with our coaching clients, who appreciate creating their own solutions in graphic form. We let clients drive the process as we facilitate their moving into a Both/And frame of mind.
Also in that issue, Sally Ourieff described the shifts physicians need to make as they move from a clinical role to a leadership role. Included in those shifts was moving from a singular department focus to more of a systemic focus, which might appear to be in opposition to a physician leader’s practice or departmental interest.
As Joy works within healthcare systems, coaching physician leaders and healthcare executives, she has observed that polarities present themselves at individual, team, and system levels. Polarity Mapping is useful at all levels to help reduce cycles of waste (aka “flavor of the month” magic wands), improve inter- and intra-disciplinary communication reduce conflict, and improve collaboration.
Here are six case studies of the use of polarity mapping on individual and systemic levels. We’ve provided examples of polarity maps used to demonstrate the power of the visual.
Confidence (Individual) and Humility (Team)
Joy was invited to coach an orthopedic surgeon who was recently appointed co-chair of an academic medical center’s Orthopedic Institute. Dr. Williams was renowned in his field and well respected as a team oriented leader. He had the highest ratings in patient satisfaction, quality outcomes, and productivity. He was gifted in problem-solving, strategic thinking, and mentoring, with a goal of doing more mentoring. He described himself as a perfectionist, never wanting to disappoint his patients or his team. During our meetings, he would frequently express his frustration at his schedule which left little time for exercise and family, both of which were very important to him. Despite Dr. Williams’ clinical confidence, he found himself minimizing his own needs as he overcommitted to others due to “not wanting to let people down.” Using the Adult Development GPS to “diagnose” Dr. Williams’s black and white thinking, focus on efficiency and logic, Joy sensed he would appreciate the structure of polarity mapping to illustrate his ultimate desire for clinical excellence while also having time for his own health and his family. Through her work, Dr. Williams was able to set boundaries that allowed him his personal time, while also referring patients to other less senior physicians who were growing their practices.
Centralization and Decentralization
Joy was brought in to a healthcare system to prepare three of their high potential physician leaders as possible successors to their existing C-Suite leaders who were facing retirement within the next three to five years. As Joy and a team of coaches worked with these three physician leaders, they noticed tensions between advocacy for their individual organizations, and required conformity to system-wide practices. These physician leaders were vice presidents in three different entities within one state. These three leaders shared complaints they were hearing about their organization’s inability to quickly respond to conditions unique to their geographical area. They believed the corporate offices didn’t understand the demands being placed in their home area. Since this theme was shared amongst these three leaders, the coaching team felt that helping the leaders leverage the polarities of Centralization and Decentralization would contribute greatly to their becoming more effective system leaders. Through this work, they organized informal gatherings to share common perspectives and engage corporate leaders in system-wide changes to remain competitive and viable.
Mission and Margin
A University-Affiliated Medical Center wanted to proactively support their physician and administrator dyads to better leverage their unique differences, which, absent support, could appear as conflicts. Joy and her coaching team were brought in to work with these dyad pairs as part of a system-wide initiative to increase partnering and teaming. Joy’s team conducted interviews with the dyad pairs. One challenge was managing conversations around quality/ patient care needs and budget restrictions. The physicians were advocates of evidence-based practices and could not easily see the effect on reimbursement and the bottom line. The administrative dyad partners were expert on the business of healthcare but felt unable to influence their physician partners in understanding the complex issues of reimbursement. The administrators also admitted ignorance of the complexities of clinical care.
In addition to formal mentoring around the business of healthcare, the coaching team decided to help the leaders map the polarity of Mission and Margin. During the process, each dyad partner felt validated in his/her opinion, and also heard the importance and validity of what had seemed to be a barrier to moving forward. Since they jointly participated in creating the action plan and warning signs, they owned the work and were able to communicate the differing perspectives to their teams, thereby multiplying the constructive, systemic impact.
Individual and Organization
Margaret worked with the management team of a large speciality practice going through changes. The newly elected chief executive officer, a physician with management training, wanted to bring the partners together in a cohesive organization. The challenge, as he told me, what that partners in the practice wanted to be partners in finances, which had higher reimbursement, and wanted to be employees when it came to having set hours. She spoke with the executive team and several non-executive partners and proposed Individual and Organization as the polarity pair for their annual strategic planning retreat. She divided the retreat participants into four groups, each working on one quadrant in the polarity map below. By chance, the chief financial officer (not a physician), whom physicians believed over-focused on the organization at the neglect of the individual, was in the quadrant representing the upside of the individual. After the exercise he told me this enabled him to better understand the importance of individual autonomy for physicians. Again by chance, one of the most vocal physician advocates for the individual was in the quadrant representing the downside of the individual. At the end of the meeting, he announced this was the most useful method he had seen to help him understand his role in the organization’s dysfunction. The magic of this exercise lies in both the process and the side conversations. As a coach, stay alert of possibilities to challenge assumptions.
Other and Self
Margaret facilitated a polarity management exercise for physician and medical student members of Physicians for Human Rights. PHR “uses medicine and science to document and call attention to mass atrocities and severe human rights violations. PHR was founded on the idea that physicians, scientists, and other health professionals possess unique skills that lend significant credibility to the investigation and documentation of human rights abuses.” Check out their report “Violence on the Front Lines: Attacks on Health Care in 2017.” This report documents more than 700 separate attacks on hospitals, health workers, patients in ambulances in 23 countries.”
In bearing witness to and documenting human rights violations, physicians often focus on the needs of others, rather than their own needs. Their personal lives, and their mental health often suffer. In taking this group through a polarity exercise, we gave them a “road map” for what to look out for in themselves and their colleagues. Walking them through the polarity loop, and having them stand in each quadrant to feel what it would be like to be in the upsides and downsides of patients and of self, provoked deep conversations about what they felt, what they wanted to feel, and their mission – to help others AND themselves.
Clinician Satisfaction and the Electronic Health Record
Margaret was invited to speak with a Patient Safety committee at a university hospital. Initially, she considered Clinician Satisfaction and Patient Safety as a polarity pair to facilitate. During her pre-exercise presentation, she realized the electronic health record (EHR) was the elephant in the room, and so suggested participants use Clinician Satisfaction and the EHR as a polarity pair, with Patient Safety being the greater good. Participants were electrified! As you see, the downsides of the EHR were the most numerous – AND the group listed the upsides for the EHR. They also came up with downsides for over-focusing on Clinician Satisfaction. As we walked the polarity loop, stopping in each quadrant, participants commented on how they could see the limitations of the point of view they came in with, and on their seeing the advantages of the view they were sure was wrong.
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