Episode 18 : Introducing Polarity Intelligence:

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Intro/Outro:
Welcome to the Smart Care Team Spotlight presented by care.ai, the smart care facility, platform company, and leader in AI and ambient intelligence for healthcare. Join Molly McCarthy, former CNO of Microsoft, as she interviews the brightest minds in healthcare about the transformational promise of AI and ambient intelligence for care teams.

Molly McCarthy:
Too often, technology makes caregivers' lives harder, not easier. It's time for smart technology to empower care with a more human touch. I'm so excited that I have two special guests today on the smart Care Team Spotlight: Doctor Tracy Christopherson and Michelle Troseth, they are co-founders of Missing Logic. The core of their work is to help leaders to overcome leadership norms that cause suffering, achieve work-life balance, create healthy work cultures and environments by leveraging polarity intelligence. Tracy is a respiratory therapist, she earned a PhD in Interprofessional Healthcare Studies from the Rosalind Franklin University of Medicine and Science. Tracy has helped thousands of individuals and leaders apply polarity intelligence in their quest to create healthy, healing, collaborative work cultures and environments. Michelle is a nurse, a recognized global thought leader, the past president of the National Academies of Practice, and a fellow in the American Academy of Nursing. Michelle has a master's of Science in nursing and studied nurse-physician relationships and nurse satisfaction. Together, Tracy and Michelle are co-authors of the book Polarity Intelligence: The Missing Logic in Leadership and co-hosts of the True Leader podcast, previously known as Healthcare's Missing Logic Podcast; this dynamic duo is known for helping leaders balance leading and living so they can be true leaders, thriving, resilient, and unstoppable. Welcome to the Smart Care Team Spotlight.

Tracy Christopherson:
Aww, thank you!

Michelle Troseth:
Thank you, Molly. We're so excited to be here.

Molly McCarthy:
Well, I'm so happy to have you both. And you know, we spent a lot of time in this podcast discussing how emerging digital solutions can transform care delivery and hospital operations. And one of the common reoccurring themes that I've heard from our luminary guests over time is the emphasis, beyond the technology, to embrace the change management required to successfully transform clinical and operational workflows at scale. So too often, the reason technology makes caregivers' lives harder, not easier, is because we don't have the framework to think about how to recognize and overcome what we perceive to be problems, which are actually not problems, but polarities. So, listeners, it's an honor today to have Michelle and Tracy, who literally wrote the book on polarity intelligence, which is actually making its market debut this week. Congratulations!

Michelle Troseth:
Thank you.

Molly McCarthy:
In this episode, we're going to introduce the concepts, approach and power of understanding polarity thinking in healthcare. So, with that background, I wanted to ask my first question. Can you introduce the concept of polarities at a high level and how you came about bringing polarity intelligence to healthcare?

Michelle Troseth:
Absolutely. It's a great question. To start with, Molly, Tracy, and I, we were leaders with an amazing movement back many years ago now to transform healthcare, leveraging technology, evidence-based practice, interprofessional collaboration, and work culture. I mean, we were in the fields doing that work, and we actually met in hospital orientation a long time ago, over 30 years ago, and we started at a 529-bed hospital in the Midwest. And we became leaders together, we like to say we grew up as leaders together. And the work that we started there, we advanced it at a local level, and we eventually advanced it globally. And we had a mentor who was a nurse, her name is Bonnie Westreich, and she was a trailblazing pioneer. She saw so many issues in healthcare that really needed to be changed to advance professional practice. And along the way, we met what we call the Godfather of Polarity—thinking Barry Johnson. And what brought us together is here we were with ourselves and our teams doing massive transformation in healthcare systems, all the complexity, working on culture, advancing practice, and we were met with resistance. Surprise, surprise. And what we did find success in wasn't always sustainable. So what we learned from Barry is the principles of polarities were a missing piece, and we brought together his principles and the concept of polarities, along with our subject matter expertise in healthcare, and it really puts us on a path for helping leaders recognize that not all challenges are problems to solve, and not all resistance is bad., it's really understanding the major polarities in healthcare and learning how to leverage them.

Tracy Christopherson:
Yeah, so I'll pick up from there. Michelle. And let me just say a little bit about what polarities are. So, polarities are interdependent pairs of perspectives or points of view. They often appear to be opposing, differing, or contradictory to each other, but they really need each other over time. So, there's an interdependent relationship between these points of views or perspectives. And you cannot get to a greater purpose without both. The best example we have of this is the metaphor of inhaling and exhaling. We have to inhale to sustain life, and we have to exhale to sustain life. We can't choose one or the other. We have to get the benefits of both, so we get the benefits when we inhale are bringing in oxygen, and the benefits of removing carbon dioxide when we exhale. Both are essential to sustaining life. If we overemphasize one and neglect the other, there's always a consequence 100% of the time. Now, in this case, it's death. The good news is our body manages that for us all the time, right? And when we get in trouble, we know where to go. And not any other polarity has that kind of significant consequence. But every polarity works the same way. So creating a polarity mindset is really having this ability to identify a polarity when we're experiencing one differentiate it from a problem, a problem has, you know, we usually choose between our alternatives or our solutions. So we use either or thinking. We choose to either go out to dinner or eat at home as an example. Right of a problem. What we're going to have for dinner? We don't have to do both. We only have to do one.

Tracy Christopherson:
But as leaders, we are problem solvers, it's our superpower. So what we want is to have leaders create this polarity mindset and be able to differentiate between the two. Understanding how to apply the principles of polarity, how they work, and really getting this kind of a more of a dynamic balance between the two perspectives. So you're getting the benefits of both. Now, we've expanded that experience and expanded on what Barry taught us all those years ago by integrating healthy relationships and meaningful dialogue with the polarity mindset piece. So that's really the polarity intelligence is having this intuitive ability to be able to differentiate and identify when I have a polarity and really leveraging relationships, healthy relationships, and meaningful dialogue to transcend the biases that we have around our own perspectives. So opens us up, to have a broader, more complete perspective of the situations that we're in and what we saw in those leaders, all across North America, we worked with thousands of them, is that they were trying to solve the same problem over and over and over... And maybe, Molly, you've had that experience in your work life as well, right? You just keep bumping up against that problem, it keeps coming back. You're like, didn't we just address this? Why is this back on our agenda? Because it's not a problem you can solve. It's more than likely a polarity that has to be leveraged or managed. But when you don't have this understanding and this knowledge, you keep looking at it through a problem lens. So when we left Corporate America in 2017, we said, okay, this is the thing leaders need most, and let's bring it to them. So that's what this is about.

Molly McCarthy:
Yeah, I love how you break it down to, you know, it's an interdependent relationship. It's not black and white. And that the example of just inhaling and exhaling, just to make it simplistic, and of course, you're a respiratory therapist. So, um, definitely appreciate that example. And, you know, I definitely resonate with the problems that just keep coming up and up and up and having, you know, I've been in Corporate America for quite some time, and I like to call that Groundhog Day, especially when you have new leaders coming in and trying to tackle the same problems, perhaps in the same methodologies. You know, reminds me of that movie. Well, thank you for that. I wanted to do a little bit of a deeper dive on the framework and methodology and maybe some examples of polarities around us, aside from inhaling and inhaling in healthcare specifically, and how approaching these opportunities not as problems but as polarities can help us achieve better results.

Michelle Troseth:
Sure, yeah... Well, the framework Tracy kind of went over it, but I'm going to reiterate it, really three components the framework that we use in player intelligence, and the first one having that polarity mindset and being able to tell the difference between a problem and a polarity, and then living the principles of healthy relationships. And this is just keeps us focused on the relationships and the work environments. And we know they're so important in healthcare. It's a caring environment, that our relationships are healthy, and it helps us stay centered on why we're there, our shared purpose, and then the skill of engaging others in meaningful dialogue, too. And that's really where the conversation between two or more people, you know, where we really listen to each other, and we share in a way that leads to deeper understanding and shared meaning. And all of those are critical when you're understanding polarities and trying to leverage polarities. And one of the ones that Tracy and I have done a lot of work on over the years, that's related to technology is the technology platform that you're using and the practice platform. This is a huge polarity, and you can't implement new technologies without supporting the best practices based on evidence, professional practice at the same time. And we have shared this polarity in a lot of different ways with organizations who are implementing major technology systems, and we've shared it in the HIMSS Tiger Report, we've shared it in Informatics chapters. We've spoken on it because, as you recall, Molly, when there was the big push to implement EHRs through the High-Tech Act, it really became all about the technology to make the meaningful use to get the money.

Michelle Troseth:
And we saw a lot of downside of that rapid implementation of technology. Now, there's clearly positive outcomes in both of these poles, just like inhaling and exhaling. However, with this rapid technology implementation, some of the downsides that we saw was poor usability design. We saw poor adoption, a lack of evidence-based information for clinicians. It became more about clicking the buttons rather than really bringing the information that you needed in context of that patient that you're taking care of. Sometimes it even caused more fragmentation in healthcare because we had multiple systems that were not interoperable. And of course, the loss of the human touch, which was a big concern. I remember with even the initial rollout of the electronic health record. So the ability to intentionally design it to support all the upsides of technology, that why we need it, and all of the upsides of having strong practice support for the clinician, no matter what their profession is—such a great example of what we need to create sustainable healthcare transformation. And, you know, because polarities never end, they never go away. We're at a phase now where we have EHR or technology implementation and a large scale. Certainly, the practice is never going to go away, but it has to be supported. So now it's all about just being vigilant, which is another principle of polarities. You have to be vigilant. You have to always be looking, are we maintaining the positive of both of these platforms so that we can course correct as technologies evolve and as practice evolves.

Tracy Christopherson:
And some other polarities that are in healthcare and certainly impact the implementation of technology as well, individual and team, right? So we have to serve each individual practitioner, clinician along with the interprofessional team. The other aspect closely related to that is task and scope of practice. So what we found in our work with implementation of the EHR is the design needed to support the scope of practice of each professional and the carrying out of the tasks and the capturing of those tasks being completed, right? So those are both aspects of every professional's accountabilities, episodic care and continuum of care. So again, more related to that. And patient safety and clinician safety is a significant polarity right now in healthcare productivity and relationships as well. So this gets back to having a healthy work culture and healthy relationships so that we can collaborate, we can communicate more effectively and get the work done. And especially right now, with the challenges with resources and resource allocation, this becomes a significant polarity, just complexity and simplicity and then tradition and innovation. So we are really being pushed to innovate right now, right? And at the same time, there are elements of tradition that have served a purpose have positive benefits. So we have to identify what are the things we need to hold on to and how do we complement that with new innovative technologies, new innovative ways of practicing and being together?

Molly McCarthy:
Yeah, those are all so important. You know, and just to recap for the listeners, Michelle, you mentioned kind of the three components of the framework: the mindset, the healthy relationships and then the skill of meaningful dialogue, really listening to understand. So I really appreciate those and the healthy relationships, Tracy, thank you for digging in on the patient safety and the clinician safety, because I know those are hot buttons right now just from individuals that I talk to, are in the environment and worried about their own safety as a clinician. I think you mentioned some great examples of different polarities, maybe ones that I actually haven't even thought about. And the other point that I want to just kind of star for everyone is that polarities never end and we must continue to be vigilant. Yeah. So really some great takeaways there. And I want to kind of dig a little bit deeper into, you know, you talked about tradition and innovation. And my next question, just to give you a little bit of background, a lot of our listeners today aspire to create smart care teams, leveraging, you know, advanced sensors in patient rooms and as well as artificial intelligence. And one of the areas that we've seen a lot of traction in is really around virtual nursing as the tip of the spear to that broader transformational journey. And so my question really is, can you give us a glimpse into how thinking about bedside and virtual caregiving is not an either, but really an and how that might simplify and accelerate the change management associated with creating these new models of care delivery?

Michelle Troseth:
We actually get excited about this because we see the potential if you do put it in a polarity mindset perspective. So we know care delivery will always include some aspect of in-person care, it's not going to go away, right? And we also know that having access to virtual care has a lot of benefits. And we're now in that phase of healthcare delivery. And the pandemic certainly expedited it, that we can now expand and evolve it. I think it's really important we do, you know, much like the technology platform and the practice platform, we need both. So first, I think it's important to just take a step back and say, what is the greater purpose of having both of these? And certainly, you know, it allows organizations to leverage resources in a different way. It provides strategic opportunities for organizations and accelerates transformation to improve patient care. So there's some big whys behind having in-person nursing care. And virtual nursing care as an example, is really important to put within the polarity mindset lens. Then it's important to identify just what are some of the positive outcomes. If we do put our emphasis on each of these poles and then realizing that if we over-focus on one to the neglect of the other, we will experience negative consequences.

Michelle Troseth:
So there's a lot of excitement around virtual nursing care. Tracy, I know that because we work with clients and we have a lot of people that we work with that are in the technology fields and informatics. And so you can really over-focus. You could over-focus on virtual care, so that's why the balance is so important. And if you do that, what could happen over time? Because polarities you don't always see it right away. But over time is you could lose the ability to deliver any hands-on care. And then also it could impact trust over time, and that rapport that you do develop when you are in person. And also another potential negative consequence could be that you lose the opportunity to provide immediate therapeutic intervention because it is too much virtual, and also the lack of ability to comfort a patient with that physical touch, which we know, you know, just someone holding your hands sometimes is incredibly healing. So you have to balance both. So it's helpful. And in the work that we do, we help people really identify what are the positive outcomes of both and what are some of the potential negative consequences if you over focus.

Tracy Christopherson:
So some important things to recognize when it comes to polarities because they're interdependent values, oftentimes we are fearful of what's unknown. If we haven't had an experience with virtual care before, we don't really know what the impact, and we're fearful. But what we're most afraid of is the thing we value most will be lost. And so we hold on to our point of view or our perspective. And so when you meet resistance, it doesn't mean that people necessarily don't want to change, or they just are afraid of losing what they value. And in this case, it's that human touch, it's the connectedness, it's the caring part of their role that they feel like if you take that away, then what am I going to do? Who am I going to be as a nurse? Right? So they have a fear, and so they're holding on to that perspective and resisting the other. So the best way to address that resistance is to acknowledge what do you value most about what you do and hands-on delivery care with the patient and really acknowledge the value of that and how it benefits the patient, and then ask them what they're most afraid of. What are you most concerned will happen and acknowledge that that is a possibility, right? That you're right. If we overemphasize the virtual aspect of care here, we could end up with those negative consequences, and then they're going to be feeling like they've been heard.

Tracy Christopherson:
What their perspective is has been acknowledged and recognized, and they're going to be more open to hearing the positive benefits that the virtual care experience can bring and how it can actually complement what they value in the hands on delivery of care. This is where the healthy relationships and the meaningful dialogue are so important, because we have to be able to sit in this tension of the opposite perspectives and meet that resistance, knowing there's wisdom in it. They know things that maybe you're not thinking of in the implementation of this, and great realizations can occur. So if we meet resistance like, oh, we can't listen to them, they're just digging their heels in, and they don't know we're missing out, there's wisdom in it. And if you want to bring people along, you've got to meet them where they're at and when you can put it in the frame of a polarity, and you can see both are essential as we move into the future of healthcare, we can no longer work and operate just totally hands on. This is a complementary element. Both are equally important.

Tracy Christopherson:
That's the other thing about a polarity. Both poles are equally important, one is not more important than the other. When you can help somebody reframe this in that way, and they know that their perspective and their point of view is equally valuable to the other, it it provides great hope and momentum for the change that we're trying to implement. So it's really important to kind of have that conversation get to a place of openness and awareness. Then you can create action steps to maintain and gain the positive benefits of both and get to that greater purpose, right? By saying, okay, here's what we're going to do to help maintain the benefits of hands-on care, let's put some action steps in place. And the same time we're going to implement virtual care, and here are the action steps we're going to take, and we're going to monitor this to make sure that we're not slipping down into the negative consequences. And we do that by identifying early warning signs. So there are signs that we're overemphasizing. And when we heighten our awareness of them we can course correct quickly. So that helps that individual feel like, oh, okay, there's a plan in place to help this not happen. And that's what's going to enable them to receive and to open up and to adopt and make the change happen.

Molly McCarthy:
Yeah, so many nuggets in this discussion. I just want to highlight a few back to our listeners, so they take them with them. But Michelle, when you were discussing the either and conflict around virtual versus in-person care is really it's not an either-or, it's how can these coexist peacefully, so to speak, and really kind of thinking about what the positives are around each of the poles. I think one thing that I've seen, and I was just recently at the ATA Virtual Nursing Meeting, is hearing from different institutions that actually implemented virtual care and really sticking to that hybrid model of that in-person as well as virtual care from a, even from a human resources perspective, so that staff are well versed in each component of care, whether it's the virtual or whether it's the in-person, especially beneficial, I think maybe for the seasoned nurses to act as resources, for example, with the newer nurses who are at the bedside, and you could have a seasoned nurse virtually. And then, you know, I think, Tracy, you hit on some really important points around when you think about each of the poles, like the fear, you know, human nature, what will we lose if we go to the other extreme or to the other pole? I think that's really important. And to really recognize, as you said, the tension of the opposite perspective, I think is probably a good portion of the quote-unquote battle that we face in change management.

Tracy Christopherson:
Yeah. Well, and when you have to think about it, this is all framed on the only thing we know, which is problem-solving. So if your solution is right then my solution is wrong. That's where you get that either. That's the only frame of reference most people have. So it's about shifting that frame of reference and say, wait, there's another way here.

Molly McCarthy:
Yeah, right.

Tracy Christopherson:
It doesn't have to be either or and they're coming from that. Well, then what I want is not right. And what you want is right. That shuts them down.

Molly McCarthy:
If we think about nursing, you know, it's an art and a science. And I think that art portion is really kind of trying to achieve that balance of great polarity. All right. So we obviously have so much to cover in this short episode today. And I wish we could hang on longer, but I typically love to end my sessions with experts like you and my dynamic duo here today, really leaving our listeners with some sage advice as we kind of go back out into our own habitats and environments. And so I would love to hear from each of you, your single most important piece of advice for our listeners, which really includes CNOs CNIOs, healthcare leaders, interdisciplinary members of our healthcare team. So where can they go to find more about polarity intelligence? And I would love for you to leave them with one nugget of wisdom.

Tracy Christopherson:
Well, only one.

Molly McCarthy:
I know. I sometimes I say okay two.

Tracy Christopherson:
All right, well, we'll do two because we have Michelle.

Michelle Troseth:
Yeah, we'll do two. We'll do two I think um, one nugget I would say just recognize that polarities are all around you every day. They're even inside of you. There's a lot of personal polarities that we all have too. And that if you can't recognize them and don't know how to leverage them, they'll haunt you. I mean, you'll always be up against it, and you'll always find yourself in Groundhog Day over and over again. So just recognize they're there. So Tracy and I say it's like gravity. You know, you experience gravity, you're experiencing polarities. But to Tracy's point, no one's ever really put a framework around it to help people understand that. So I would just say that recognize that it will help you stop wasting time, money, and resources. And having this knowledge is really what has compelled us to start missing logic and to write the book, which would be my sage advice is to go by the book Polarity Intelligence: The Missing Logic in Leadership. And we wrote this, I would love your listeners to know, we wrote this in a very simple way. We wanted it to be digestible. We wanted leaders to be able to apply it personally and professionally, and that they can actually share with their teams. We got a text from a physician last night who was in our book launch community, and she's like, I'm buying the book for my whole family and everyone's going to read it together. So there's going to be a lot of applications for it. We hope that's our goal.

Tracy Christopherson:
Oh yeah, it applies in every aspect, individually, organizationally, as a leader in our country. So I think the thing that I would say is knowing about it's not enough. You really have to become a student of applying polarity intelligence. We have been so polarized in so many ways in our personal lives, our professional lives, in our countries, our communities, and just knowing about it, it's not going to help. We have to leverage healthy relationships and meaningful dialogue. We have to start turning towards each other, not away from each other. We have to recognize that in many of these polarizing situations that we're in, there is a both and it does not an either-or. And the only way we're going to move forward is to have this kind of lens to recognize these moments when they are in front of us. Now, not every opposing set of perspectives is a polarity, but understanding what is and then leaning into it and really getting the best of both perspectives is what's going to move us individually and collectively forward in healthcare and outside of healthcare.

Molly McCarthy:
Well, thank you both, Tracy and Michelle, so much for your knowledge today. I think for me, just hearing, you know, acknowledging that polarities exist and that knowledge is power, and I'm wondering if this is a book I should get for my teenage boys.

Speaker5:
Yes, yes. Teach them young. Teach them young. Yes. Yeah.

Molly McCarthy:
Well, thank you guys so much! And just share that. Mention the title one more time, Michelle of your book.

Michelle Troseth:
Polarity Intelligence: The Missing Logic in Leadership. Yes, and we also have our podcast, which you mentioned at the beginning, Molly, the True Leader Podcast, where we go deep into these subjects as well and have guests and help people to apply. And we actually have an episode coming up. Maybe it'll air by the time this airs on the polarity of artificial intelligence and human intelligence. So that might be of interest to your listeners as well?

Molly McCarthy:
Oh yeah. Definitely. Definitely. Well, thank you both so much. I wish you the best of luck and I cannot wait to read the book. So thank you!

Tracy Christopherson:
You're welcome. Thanks for having us.

Intro/Outro:
Thanks for listening to the Smart Care Team Spotlight for best practices in AI and Ambient Intelligence, and ways your organization can help lead the era of smart care teams. Visit us at virtualnursing.com. And for information on the leading smart care facility platform, visit care.ai.

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