Contributor: Carey H. Gallagher
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In the last two editions of The Wharton Healthcare Quarterly, we proposed that the workforce crisis represents an “unignorable moment” — a critical point that is public, irreversible, systemic, and challenges the identity of an organization or a field. We shared our approach to deep listening needed to drive reasoned action, what we call “listening in.” Following this approach raises another question — when a leader seeks input tied to an “unignorable moment,” what are they listening for? Leaders are often flooded with feedback — so much so that it can be hard to distill key messages. How can leaders pay attention to the implications of what they hear at more than a tactical level?
One dynamic feature of leading an organization is the constant push and pull between factors that are essentially important to advancing mission and strategy. In Barry Johnson's book, Polarity Management, Identifying and Managing Unsolvable Problems,1 he named these sets of factors “polarities,” identifying them as not problems to solve, but rather dilemmas to manage. The poles of each polarity are not opposites but are instead interdependent — success for the leader and their organization is dependent on engaging with both poles at all times. For example, deploying all of an organization’s resources to fix today’s problems will generally cause havoc over the long term, while focusing only on long-term strategies may prevent an organization from sustaining itself to see those same strategies manifest in results.
Polarity management has become even more relevant in the context of unignorable moments that have appeared across the current workforce shortage.
We spoke with the CEO of “Imperion Health System” who shared that the current crisis had upended some long-held assumptions that had served her well as a leader. In our conversation she identified a key polarity: being patient-centered while also being employee-centered.
At a high level, the CEO’s role was to ensure high quality of care delivery while maintaining the financial health of her institution. This tension related directly to the poles: she needed to ensure Imperion was patient-centered to give patients a reason to choose her health system, impacting revenues. She also needed to be employee-centered, maintaining low turnover and high employee engagement. This in turn helped the facilities meet the challenges of variable volume over time, helping to provide quality care and decreasing costs. Overall, healthcare workers championed patient-centered innovations and withstood the sometimes negative impacts of those changes on their own experience, generally striking a balance between the two poles.
With the advent of the pandemic, this calibration no longer held true. Patient needs were acute, and triage was unclear. Staff was taxed in multiple ways, from the moral distress caused by the lack of knowledge about how to care for patients and prevent the spread of COVID, to risks to the employees’ own health and the health of their families.
In 2021 the CEO transitioned Imperion to running “normal” operations, while also managing the consistent presence of the pandemic. She felt able to step back and assess her new situation. She recognized the tension she experienced between being patient-centered and employee-centered as a dilemma to manage, and not a problem to solve.
Naming this polarity allowed her to flesh out the benefits of orienting toward each pole — with a patient-centered direction potentially resulting in greater revenues and improved outcomes through better patient experience, and an employee-centered direction potentially meaning less costly turnover, and maybe even a more competent workforce. Thus, both directions had implications for quality of care and financial health.
The pandemic response had underscored the value of healthcare workers, and expectations some workers had of their employers evolved considerably. It was clear different approaches would be required to help maintain excellent quality while ensuring financial viability of the organization. The CEO knew anything she and her executive team developed without input from the greater organization risked being ineffective. Now, it was time to listen.
She found employees sought investments of many kinds. They said higher salaries were integral to staying with Imperion. Employees also wanted to feel recognized along the trajectory of their careers — given opportunities to learn new ways of working, like bridging both inpatient and outpatient settings, pursuing additional education, and working in less demanding settings as they moved toward retirement.
The CEO had been waiting to increase Imperion’s footprint in primary care, which could generate revenue through new models of care and more robust referral sources. It could also enhance flexibility and learning for staff at all levels through staffing innovations and development of approaches to best serve patients who face significant social determinants of health. She saw this might be the right time to do it. Increasing salaries would mean going into debt, but it felt inevitable, and could be “amortized” over time. Listening in had helped her develop a reasoned plan that would achieve both short-term and long-term considerations for Imperion.
Applying polarity management is a five-step process:
- Name the polarity. Ensure that what you are struggling with is not an either/or choice, but rather an interdependent set of variables. Name each pole clearly and describe why the poles are interdependent.
- Identify the upsides and downsides. Describe why advancing toward each pole would be desirable and undesirable for the organization.
- Locate your position. Articulate where you believe your recent leadership decisions have positioned the organization across the poles, allowing you to better understand how others may perceive these choices.
- “Listen in.” Draw insights and feedback from people across your institution who have a particular stake in your next steps. Dig into why the group may be veering toward one pole or another.
- Metabolize and activate the input. Consider employee feedback in relation to the dilemma you are exploring and in the context of your organizational strategy. Apply what you learned to drive your next steps.
The complexity inherent in leading any healthcare organization today implies that leaders will always be managing multiple polarities. Applying polarity management as a tool can thus support a leader to make well-reasoned, strategic decisions, informed by stakeholders’ views, that facilitate addressing future needs of their organization — all too important in a time of the current workforce crisis.
Contact Carey at: [email protected]
For more information on this topic or related materials, contact CFAR at [email protected] or 215.320.3200 or visit our website at www.cfar.com.
Reference
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Barry Johnson, PhD. Polarity Management: Identifying and Managing Unsolvable Problems. (Amherst: HRD Press, Inc., 1992), 81-82