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Delivering Health Care in Complex Adaptive Systems III: The Diverse Challenges

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We must instead begin with the assumption that both sides of a polarity have their place. It is with a strong sense of curiosity that we engage and seek to appreciate each side of the polarity. Curiosity, in turn, leads to questioning, reality testing, and the introduction of intuition. When we are curious regarding both sides of a polarity, then we are likely to become curious regarding what the two sides of the polarity might look like when brought together. It is through this “meta-level” curiosity that we are likely to move eventually toward both/and approaches to the polarizing issue we are addressing–and toward a higher order synthesis of the two sides.

The curiosity pathway leads to spiritual growth, while the preference pathway leads to “winning/losing” and suffering. The middle way incorporates both pathways. This middle way, in turn, leads to greater complexity—which requires multiple perspective, guidance and help. Diversity and teamwork are required. It is nearly impossible to navigate a polarity by ourselves.

Barry Johnson (1996) offers us an excellent book on Polarity Management. We have offered several examples of polarity management as engaged in addressing complex health care issues (Fish and Bergquist, 2022). Johnson’s model of polarity is highly clarifying. It is quite profound—and elegant. One of us [JF] is working on how to integrate this into a major polarity we’ve been struggling with since arriving 8 years ago to create our program. We offer the experience of engaging in polarity-based team building to navigate and leverage the individual-and-team polarity in his program. The following observation by one of us [JF] has been made regarding the use of Johnson’s model:

“I am clearly what Johnson would call a Crusader for Teams.  I had an epiphany of sorts about 15 years ago that primary care would never achieve it full capacity until teamwork flourished there.  1 doctor with a different MA each clinic trying to help 1 patient navigate an increasingly complex health system has become futile and full of dysfunction, unnecessary suffering and inadequate resource support to meet the needs being brought there. So, I realized as what was then called Patient Centered Medical Home was being widely discussed, that it would not manifest until true teamwork was resourced and created within primary care. I worked at that for about 5 years at the County system I was working in—made a good deal of progress that was then disrupted severely by EPIC medical record creation that reinforced Silo separations of the staff working in primary care.

When I came to John Muir, I came with a growing sense of determination that I would found this program on teamwork—not just of doctors with doctors, but across the entire community. That work began with partnerships {dyads), then built toward teams, and is now emerging toward a genuine sense of a learning, leading and loving community (my vision for our residency program which has now become a shared vision of everyone in the community—or at least getting there).

So, I have been fanatical about team building, psychological safety, trust, health conflict navigation, team commitment, team accountability (rather than top-down), and all of us taking care of each other so we can take care of others {like the patients).

I can see now that we can use the Polarity matrix to move toward heightened strengths of both individual and team dynamics.  I think our community will enjoy that because we are seeing some of the downsides of teams and I wasn’t quite sure how to address that without looking like I’m giving up on teams—so this now will make it totally FUN. Thanks for that.”

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