Polarity Thinking: An Essential Skill for Those Leading Interprofessional Integration

Transcription

1 Journal of Interprofessional Healthcare Volume 1 Issue 1 Article Polarity Thinking: An Essential Skill for Those Leading Interprofessional Integration Bonnie L. Wesorick Elsevier CPM Resource Center, bonniewesorick@cpmrc.com Follow this and additional works at: Part of the Education Commons, and the Medicine and Health Sciences Commons Recommended Citation Wesorick, Bonnie L. (2014) "Polarity Thinking: An Essential Skill for Those Leading Interprofessional Integration," Journal of Interprofessional Healthcare: Vol. 1: Iss. 1, Article 12. Available at: This Education and training is brought to you for free and open access by Journal of Interprofessional Healthcare. It has been accepted for inclusion in Journal of Interprofessional Healthcare by an authorized administrator of Journal of Interprofessional Healthcare.

2 Polarity Thinking: An Essential Skill for Those Leading Interprofessional Integration Abstract Abstract: This paper is an overview of Polarity Thinking, a skill that is essential for successful interprofessional integration in practice, education or research. The legacy of this generation of healthcare leaders will be to create an integrated healthcare system for this society that provides safe, quality care from pre-birth to death. The challenge sits, not with knowing it is important, but with the lack of the skills necessary to achieve the goal. The focus is on the fundamental skill of managing polarities and its correlation to the integration of an interprofessional team at the point of care, the place where the hands of those who give and receive care meet. Key words: Integrated Interprofessional Care, Polarity Thinking, Interdependent Pairs. Keywords Integrated Interprofessional Care, Polarity Thinking, Interdependent Pairs. Cover Page Footnote 1. Reid, T. R. (2010). The healing of America: A global quest for better, cheaper, and fairer health care. New York, NY: Penguin Books. 2. DePree, M., (1989) Leadership is an Art. New York: Doubleday. 3. Kohn, L.T., Corrigan, J.M., Donaldson, M.S., (Eds) (1999). To err is human: Building a safer health system. Washington DC: National Academy Press. 4. Institute of Medicine (2001). Crossing the quality chasm: A new health system for the 21st century. Committee on Quality of Health Care in America. Washington, DC: National Academies Press. 5. Institute of Medicine (2003 ).Keeping patients safe: Transforming the work environment of nurses. Committee of the Work Environment for Nurses and Patient Safety. Washington, DC: National Academies Press. 6. Institute of Medicine Report (2003). Health professions education: A bridge to quality. Washington, DC National Academies Press. 7. Institute of Medicine (2011). Digital infrastructure for the learning health system: The foundation for continuous improvement in health and healthcare. Washington, DC: National Academies Press. 8. Institute of Medicine (2011). Health IT and patient safety: Building safer systems for better care. Washington, DC: National Academies Press. 9. Kenny C. (2008). The best practice: How the new quality movement is transforming medicine, New York: Public Affairs. 10. Gebbie, K., Rosenstock, L., Hernandez, L.M. (Eds.) (2003). Who will keep the public healthy? Educating public health professionals for the 21st century. Washington, DC: The National Academies Press. 11. Wesorick, B., & Doebbeling, B., (2011). Lessons from the field: The essential elements for point-of- care transformation. Medical Care, 49(12), Suppl 1, S49-S Johnson B. (1996) Polarity Management, Identifying and Managing Unolvable Problems. Amherst, Mass: HRDPress Inc. 13. Wesorick, B. (2002). 21st century leadership challenge: Creating and sustaining healthy, healing work cultures and integrated service at the point of care. Nursing Administration Quarterly. 26(5), Wesorick, B. (2008). Live a legacy or live a lie. Nurs Admin Q 32(2), Elsevier CPM Resource Center (2011). The CPM Framework : culture and professional practice for sustainable healthcare transformation. (Brochure). Grand Rapids, MI. 16. Mason J. & Wesorick B. (2011). Successful transformation of a nursing culture. Nurse Leader, 9(2), Abrahamson K., Arling P., Wesorick B., Anderson J. (2012). An application of the socio technical systems approach to implementation of electronic evidence into practice: The Clinical Practice Model framework. International Journal of Reliable and Quality E Healthcare, 1(1) January-March. 18. Wesorick, B. This education and training is available in Journal of Interprofessional Healthcare:

3 (2013) Essential Steps for Successful Implementation of the EHR to Achieve Sustainable, Safe, Quality Care. In: moumtzoglou, A & Katrinia, A. E-Health Technologies and Improving Patient Safety: Exposing Organizational Factors. Hersey, Pa: IGI Global, p Wesorick,B.,Shiparski, L.,Troseth, M.,Wyngarden,K. (1998) Partnership Council Field Book-strategies and tools for co-creating a healthy work place. Michigan: Pratice Field Publishing. 20. Staggers N., Troseth M. (2011). The role of usability and clinical application design in health information technology adoption. Nursing Informatics. In: Ball M., et al, Ed. Nursing Informatics: Where Caring and Technology Meet. 4th ed. New York: Springer Publishing. 21. Hanson D., Hoss BL., Wesorick B. (2008). Evaluating the evidence: Guidelines. AORN Journal, 88, Hanson D. (2011). Evidence-based clinical decision support in M.J. Ball & K.J. Hannah (Eds.). Nursing informatics: Where technology and caring meet (4) New York: Springer. 23. Interprofessional Education Collaborative (IPEC) Christopherson, T. (2011, November). The electronic health record: Implications for interprofessional education and practice. Paper presented at the meeting of the Collaborating Across Borders III Conference, Tucson Arizona. 25. Interprofessional Education Collaborative Expert Panel. (2011). Core Competencies for Interprofessional Collaborative Practice: Washington. DC. P Josiah Macy Jr. Foundation. (2013). Transformaing Patient Care: Aligning Interprofessional education with Clinical Practice Redesign. New York, NY Classen, D, Lloyd, R., Provost,L., Griffin, F., Resar, R. (2008). Development and evaluation of the institute for healthcare improvement global trigger tool. Journal of Patient Safety, 4(3). 28. Classen, D., Resar, R., Griffin, Fm., Federico, R., Frankel T., Kimmel N., Whittington J., Frankel A., Seger A., Brent, J. (2011) Global trigger tool shows that adverse events in hospitals may be 10 times greater than previously measured. Health Affairs, 30(4), Elsevier CPM International Consortium Summit Proceedings (2009). Grand Rapids, MI. 30. Berwick, D & Hackbarth, AD. Eliminating Waste in US Health Care. JAMA(2012): 307 (14) This education and training is available in Journal of Interprofessional Healthcare:

4 Wesorick: Polarity Thinking Polarity Thinking: An Essential Skill for Those Leading Interprofessional Integration Bonnie Wesorick, RN, MSN, DPNAP, FAAN The leaders of healthcare in practice, education and research have an accountability to address the nation s significant challenge to create an integrated healthcare system for this society. Even with phenomenal medical advancements, prestigious academic settings, numerous impressive clinical settings with the latest technology, leading research studies and break through discoveries, America is still the only industrialized country in the world that does not have a healthcare system that cares for its people from pre-birth to death in health and illness. 1 Many leaders are novices in the expertise needed to transform the present reality to an integrated system across the continuum of life. Max DePree noted that The first accountability of a leader is to know reality. 2 The effort to create an integrated system is taking place at a time when the clinical reality is experiencing inadequacies of the fundamental infrastructures and processes at the point of care. The IOM has led the effort to make transparent the realities related to safe, quality care. The call to decrease errors, stop waste, support evidence-based practice, improve individualized care, advance individual and team competency and integrate care across the continuum is deafening The effort to stop duplication, repetition and fragmentation of care calls for an integrated interprofessional team. Over the last 30 years, the Elsevier CPM Resource Center has been working with hundreds of rural, community and university settings who are members of the International CPM Consortium. The shared purpose of the consortium is to transform the culture and practice and create the best places to give and receive care. 11 It became obvious in the work with over 360 clinical settings that they were experiencing similar issues and problems. There was a pattern of putting great effort including time, money, and resources to solve problems that would appear to improve or go away for awhile but return later, and at times, more challenging than previous. Sustainability was a dream, not a reality. It became apparent that conceptualizing the change efforts as interventions to fix problems was not Published by Journal of Interprofessional Healthcare,

5 Journal of Interprofessional Healthcare, Vol. 1 [2014], Iss. 1, Art. 12 working. This lead to the understanding that these chronic issues/problems were not problems that could be solved but polarities that needed to be managed. Polarity thinking supplements our problem solving mind set with another way of thinking. What are Polarities? Polarities are free energy-interdependent pairs of values or points of view that are very different, and may appear as opposites and competitive yet need each other over time to reach a higher purpose or outcome that neither can reach alone Polarities exist in the world, wherever there is life. They are a part of each day, every important issue and every important decision. They are not problems than can be solved. They never go away but must be managed. What do Polarities look like? The picture in exhibit 1 helps visualize the definition of polarities. What do you see? The most common response is two faces and others will see the vase. Each is right but only half right unless they see both. It is natural to see only one initially. Each item (faces, vase) in the picture is referred to as a pole. This is a good metaphor for polarity because faces and a vase are very different from one another and yet is easy to see they are interdependent. If you take away the faces you lose the vase. If you take away the vase you lose the faces. The faces and vase need each other to form the whole picture. This is an important principle that helps explain polarities. The critical issue is that these two poles are interdependent. Barry Johnson realized that although the concept of polarities is not new, as evidence by the familiar Yin and Yang polarity coming from Taoism 2500 years ago, they simply were not understood, recognized or managed well in our world. 2

6 Wesorick: Polarity Thinking He understood the consequences of this reality and created a visual representation called a Polarity Map that would demonstrate how they look, work and could b e managed. 12 See Exhibit 2. The Basic Components of a Polarity Map. The dynamic structure in Exhibit 2 has a place to name each pole. Because they are interdependent each pole has 2 quadrants. The upper quadrants describe the positive characteristics, behaviors and outcomes of focusing on the pole and the lower quadrants describe the downside or negative characteristics, behaviors and outcomes of the pole. The poles are very different and there is tension/energy around them which is visualized by the infinity loop that oscillates between them. When this energy is tapped, the tension moves the virtuous arrow between the upper positive quadrants toward a higher goal or purpose that neither can reach alone. Because of their interdependence, the two lower quadrants are the negative results that will occur if one of the two poles is ignored or not supported. There is an arrow between the downsides which leads to the lower box which is the ultimate fear or the opposite of the higher purpose. The use of a metaphor in Exhibit 3 (Inhale and Exhale Polarity) will increase the clarity of each component of the map and deepen the understanding of the principles of polarity thinking. The physiological metaphor (breathing) is an excellent and familiar example. Using this metaphor we can now fill in the map. Published by Journal of Interprofessional Healthcare,

7 Journal of Interprofessional Healthcare, Vol. 1 [2014], Iss. 1, Art. 12 The names of the poles are Inhale and Exhale. Both are positive and very different. 1. The upside of the Inhale pole is increased Oxygen. The upside of the Exhale pole is decreased Carbon Dioxide. In order to live we need both. One is not more important than the other. 2. The virtuous or vertical arrow between the upper quadrants of the poles shows that together Inhale and exhale can achieve the higher purpose which is to Live. Important principle: There is always tension between interdependent poles. Tapping that tension/energy is essential to achieve the higher purpose. This important principle can be understood by doing this brief exercise: take a very slow deep breath lasting for at least 10 seconds. Did you experience tension and the need to exhale? The energy/tension is always there and in this case is a great reminder to exhale. It is the positive energy/tension between the poles that is essential to reach the higher goal that neither could reach alone. 3. The infinity loop is a visual reminder of the continuous movement of the tension, the energy between the poles. With inhale and exhale the energy flow has a short cycle (minutes) which makes it easier to see how both poles need each other over time. Other polarities may take place over hours, weeks or month but because they are energy systems which are unavoidable, unsolvable, indestructible and unstoppable the outcomes will be the same. 4. The downside of each pole describes the negative outcomes of the pole. Note that the diagonals within the quadrants are opposite, i.e. the upper quadrant of inhale is increased O2 and its diagonal on exhale side is decreased O2. This is true 4

8 Wesorick: Polarity Thinking for all polarities. So if you only focus on one pole you will always lose the up side of the other pole and then over time go to the downside of both and reach the ultimate fear, the loss of the higher purpose. 5. The vicious or downward vertical arrow between the lower quadrants shows the movement to the deeper fear which is the inevitable outcome when either pole is neglected or not given attention. The interdependency is easy to recognize within this metaphor. The principles of all polarities are the same. No one would deny that if you choose to only inhale you will die or if you choose to only exhale you will die. There is no choice with polarities, as it is not either/or but both/and. It is clear one pole is not more important than the other and they need each other so both must be supported in order to prevent the downside. It is ridiculous to say, I think inhale is more important than exhale or vice versa. However because polarity thinking is not strong in healthcare you will hear people argue that one pole (their view or value) is more important than the other because they are unfamiliar with the principles common to all polarities. It is the lack of this skill that explains why so many of the issues haunting healthcare have not been successfully addressed with much money, time and energy being wasted without sustainable outcomes. Summary of Polarity Principles: Polarities are two different values or points of view that are interdependent. Even though the values are very different and there is tension between them, they need each other. The oscillation between the poles taps the energy to reach the higher goal. If you focus on only one pole you will always go to the downside quadrant which is the loss of the other pole s positive outcomes. Both poles should have neutral names, if one is positive and the other is negative, it will look like a problem to solve and polarities are not problems to be solved. Both poles bring positive outcomes or an upside. Because they are interdependent both poles have a potential downside The negative outcomes of one pole are the opposite of the positives of the other pole. Published by Journal of Interprofessional Healthcare,

9 Journal of Interprofessional Healthcare, Vol. 1 [2014], Iss. 1, Art. 12 The downside of either pole becomes reality if either pole is neglected. There is 100% predictability that there will be negative outcomes if one pole is neglected. Polarities never go away. They are not problems to be solved. Two interdependent values in harmony provide a higher purpose neither can reach alone. Polarities are energy systems that are unavoidable, unsolvable, indestructible and unstoppable. They simply must be managed. What Gets in the Way of Polarity thinking? One of our strong skills in healthcare is problem solving. Most of us received good grades, positive reinforcement, recognition and promotions because of our strengths in problem solving. The people we care for come with problems and they expect us to fix them. No one would deny the need for this skill to be very strong. However some of the most haunting issues facing leaders in healthcare are not problems that will ever be solved but polarities that must be managed. Since many issues were seen as problems, it was expected that if given enough effort, time, money, energy it could be fixed. However when the problem to be solved is really one pole of a polarity, that approach will always fail over time as evidenced by the principles shown in the polarity map. Problem solving is an either/or solution based on an action or intervention to fix the problem. If accurate, the problem is solved and goes away. There is an end point. Polarities are never solved, they are ongoing, and there is no end point. They simply must be managed together. See Table 1 The Difference between Problems and Polarities. 6

10 Wesorick: Polarity Thinking How are Polarities Managed? There are three steps necessary to manage polarities: See, Map and Tap. The first is to know there are polarities and how they work so we can See them. The second step is to Map the polarity which requires naming each pole and filling in the map so we clearly know the content of the positive and negative quadrants, the higher purpose and greatest fear. The third step is to Tap the energy/tension between them which requires action steps to keep each pole strong. To visualize this, the Polarity Map needs to expand. See Exhibit 4: Complete Polarity Map. Published by Journal of Interprofessional Healthcare,

11 Journal of Interprofessional Healthcare, Vol. 1 [2014], Iss. 1, Art. 12 Tools to Manage Polarities We are now ready to manage polarities. Notice that the map in Figure 4 has two additional columns on each side of the basic map, Action Steps and Early Warnings. The Action Steps are those interventions that are needed to keep each pole strong. The Warning Signs are symptoms that occur if you are over-focusing on one pole and neglecting the other pole. Because of their interdependence, if you focus on one pole and neglect the other pole, the energy will go to the downside of the very pole you are focusing on and you cannot reach the higher purpose. The principles of polarity are 100% predictable. The Infinity Factor is an ongoing never ending energy system available for us to tap. Managing polarities requires vigilance and intentional action steps to simultaneously keep each pole supported over time so together they reach a goal neither could reach alone. Because of our problem solving approach we saw each pole as a problem that needed to be fixed and that approach will always fail with polarities. These questions will give some clarity. Do you believe: When staff is not safe, the patients are not safe? 8

12 Wesorick: Polarity Thinking When staff is not satisfied, the patients are not satisfied? When staff is focused on tasks, it is harder to be focused on patient s individual needs? When the focus is on individual competency it is harder to focus on team competency? When staff do not have good partnerships with each other, it is harder to have partnership with the patient? When the focus is on productivity, it is harder to focus on relationships, critical thinking? When the focus is on margin/money, it is harder to focus on mission/quality? When the focus is on Technology platform (Hi Tech) it is harder to focus on the practice platform (Hi Touch). The above statements are all polarities. They are ongoing, never going away and interdependent. However each of these poles has often been seen as problems to be solved. For example, the mission/margin polarity: If an issue is ongoing such as maintaining the margin of an organization then it is not a problem to solve and it has another interdependent pole, in this case mission. If you only focus on the margin/money and neglect the mission/quality of care you will lose market share and fail overtime to achieve the higher purpose of a vibrant, competitive, sustainable healthcare organization, and the doors will close. If on the other hand the focus is only on quality of care and you do not pay attention to the fiscal issues, the doors will close. It does not matter which pole you pick, if you choose to focus on one and neglect the other, over time you will always lose. Interprofessional Integration The transformation of healthcare requires interprofessional integration. Interprofessional integration is not another project. Success requires the work to be driven by a Framework that looks at the whole of the healthcare reality. Elsevier CPM Resource Center has guided all transformation efforts within the context of the whole and developed a Framework to guide its effort. The mother polarity here is Project Driven Change and Framework Driven Change There are many polarities associated with the goal of interprofessional integration within the context of the whole. See Table 2 for a list of common polarities that drive the work of healthcare transformation. Published by Journal of Interprofessional Healthcare,

13 Journal of Interprofessional Healthcare, Vol. 1 [2014], Iss. 1, Art. 12 For this article, only two common polarities fundamental to interprofessional integration will be considered: Routine Task Care and Scope of Practice Care and Individual Competency and Team Competency. Both are very important in the face of the work to transform the health care system and assure sustainable, safe, quality care necessary to stop errors, fragmentation, omission and commission. Routine Task Care and Scope of Practice Care Polarity The map in Figure 5 is filled in or mapped to show the process of managing this polarity. Most who work in clinical settings are very familiar with the many routine tasks of care such as vital signs, mouth care, activity, dietary needs, baths, linen change, labs drawn, treatments and x-rays done, etc. This is an important pole and as seen in the upper left quadrant there are many valuable outcomes when this pole is strong. 10

14 Wesorick: Polarity Thinking Figure 5: Routine Task Care and Scope of Practice Care Polarity. Used with Permission by Elsevier CPM resource Center The Scope of Practice Care is very different from routine tasks and when supported leads to valuable outcomes from the delivery of the professional services which include assessing, monitoring, detecting and diagnosing individual needs, taking actions to prevent complications, and honoring the wholeness of body, mind and spirit. One is not more important than the other, both need to be strong to reach the higher purpose of sustainable, quality care. The diagonal quadrants show that if you focus on one pole, task and neglect the other pole of Scope it results in the loss of positive outcomes found when paying attention to the Scope. This is true of all polarities and explains why Action Steps are necessary to keep each pole strong so together the positive energy helps them to reach the higher purpose. There is an historical pattern with this polarity. The Task pole was associated with doctors orders and getting things done and was often given the most attention. However the professional Scope of Practice for nurses, physical therapy, dieticians, respiratory, social work, occupational therapy, speech therapy, etc., is much more than doctor s orders. It is associated with the particular Published by Journal of Interprofessional Healthcare,

15 Journal of Interprofessional Healthcare, Vol. 1 [2014], Iss. 1, Art. 12 profession s accountabilities. Historically the focus on Task was greater than on Scope of Practice. Read the downside quadrant of Routines and see if these statements are familiar to you and then read the Early Warning Signs when Task are over focused on and see if they are familiar to you as well. It is important to continue to keep routine Tasks strong and maintain Action Steps to that end. The same is true of Scope. The Elsevier CPM Resource Center has found that the Scope of Practice pole is often weaker and significant action steps are needed to strengthen this pole. See Action Steps and notice they call for absolute clarity on scope as well as tools and resources to deliver the scope such as availability of evidence-based, interprofessional guidelines to support best practice which is very different from policies and procedures to support tasks. 18 Individual Competency and Team Competency Polarity The second polarity, Individual Competency and Team Competency, is at the core of quality integrated care and of course a major concern in the transformation of the healthcare system. It is also getting great attention at the national level where the focus is on an integrated healthcare system. See Figure 6: Individual and Team Competency polarity. The Individual competency pole is based on both Tasks and Scope of Practice/service for every member of the team who cares for the patient. There are no exceptions. Notice that the outcomes of a strong individual competency pole are based on knowing, individualizing, delivering and documentation of care. If the previous task/scope polarity is not managed well this one cannot be achieved. The Individual/team polarity is a great challenge today because historically whether in education or practice the focus has been stronger on the Individual Competency pole than the Team Competency. In fact often the clinicians come from their academic settings to the clinical settings with little experience in the skills of team competency and with little practical knowledge and skills for the delivery of integrated services with other disciplines. In addition the demanding clinical setting has inconsistencies in the infrastructures to support interdisciplinary partnership councils, processes to bring teams together to coordinate care or tools and resources such as interprofessional integrated evidence-based guidelines, 12

16 Wesorick: Polarity Thinking Figure 6: Individual and Team Competency. Used with permission from Elsevier CPM Resource Center. integrated plans of care and professional exchange processes across the continuum. These opportunities are essential to support team competency and the development of teamwork Considerations When polarities are not understood the major issues necessary to achieve interprofessional integration are often not achieved in academia or the clinical setting. The usual patterns continue. In academia each profession focuses on their competency, defend their usual approaches to strengthen it, teach it and feel they do not have time to change the curriculum or clinical rotations to address the team competency pole. In the clinical settings the organizations are addressing the many problems associated with quality while faced with increasing government and credentialing demands, decreasing reimbursement, inadequate staffing and little time or resources for continuing education. Understanding of polarities can change this reality. It is not the lack of importance of the goal to achieve Interprofessional Integration as evidenced by the formation of IPEC, the Interprofessional Education Collaborative It is not the lack of clarity on the potential positive outcomes. Published by Journal of Interprofessional Healthcare,

17 Journal of Interprofessional Healthcare, Vol. 1 [2014], Iss. 1, Art. 12 IPEC noted that interprofessional health teams will provide care that leads to better health care outcomes, improved patient experience of care, improved efficiency and increased job satisfaction for health providers. 25 It appears to come down to how to make it happen. 26 Tapping polarities addresses the how. It is essential that those who lead in healthcare supplement their strong problem solving skills with polarity thinking. Many of the issues that are being addressed with costly change efforts are seen as problem to be solved but in fact are not problems but polarities that must be managed as listed in Table 2. With polarities if you choose one consciously or unconsciously over the other, over time you will always lose. This loss is evident in today s reality where errors, fragmentation, lack of care coordination across the continuum continue. Classen noted that overall adverse events have not decreased but are occurring in one-third of hospital admissions even after this last decade that focused on safety efforts Berwick and Hackbarth note that in 2011 failures of care co-ordination cost $25-45 billion. 29 This reality is avoidable. However it will continue unless the fundamental polarities such as Task and Scope and Individual Competency and Team Competency are managed. The importance of the two polarities presented is even more critical when related to another major polarity that needs to be managed. This nation is on the brink of automation of both the practice and education fields. The major polarity associated with implementation of technology such as the Electronic Health Records, Learning and Simulation labs for students, is the Technology Platform and the other pole is the Practice Platform. Millions of dollars have been spent on the implementation of the Technology Platform which has been seen as a problem to be solved not as a polarity. The result has been the neglect of the Practice Platform which addresses the hands on safety issues, scope of practice issues, team competency issues. It explains why the desired outcomes and higher purpose to transform and advance healthcare has not been reached even with the spending of millions of dollars on the technology pole. Both platforms must be strong and this 18, 30 calls for significant action steps. Conclusion When leaders are not clear about how to differentiate between problems and polarities, there is wasted time, money and energy. F. Scott Fitzgerald noted, The test of first rate intelligence is the ability to hold two opposed ideas in the mind at the same time and still retain the ability to function. Polarity thinking is a skill that allows leaders to achieve this goal. Many have heard the common expression 14

18 Wesorick: Polarity Thinking I feel like I am constantly between a rock and a hard spot. When polarity is understood and guides thinking, it decreases the stress that comes from defending and making false choices between two positive interdependent issues. Equally important it brings the energy and enthusiasm that comes from no longer living a divided life, energy that can be used to address actions necessary to strengthen both poles. 14 Polarity gives leaders an opportunity to deepen their understanding of reality, visualize the capacity for transformation and take actions to reach a higher purpose. The skill of polarity thinking brings hope and the possibility for exponential growth in the work to achieve interprofessional integration. References 1. Reid, T. R. (2010). The healing of America: A global quest for better, cheaper, and fairer health care. New York, NY: Penguin Books. 2. DePree, M., (1989) Leadership is an Art. New York: Doubleday. 3. Kohn, L.T., Corrigan, J.M., Donaldson, M.S., (Eds) (1999). To err is human: Building a safer health system. Washington DC: National Academy Press. 4. Institute of Medicine (2001). Crossing the quality chasm: A new health system for the 21 st century. Committee on Quality of Health Care in America. Washington, DC: National Academies Press. 5. Institute of Medicine (2003 ).Keeping patients safe: Transforming the work environment of nurses. Committee of the Work Environment for Nurses and Patient Safety. Washington, DC: National Academies Press. 6. Institute of Medicine Report (2003). Health professions education: A bridge to quality. Washington, DC National Academies Press. 7. Institute of Medicine (2011). Digital infrastructure for the learning health system: The foundation for continuous improvement in health and healthcare. Washington, DC: National Academies Press. 8. Institute of Medicine (2011). Health IT and patient safety: Building safer systems for better care. Washington, DC: National Academies Press. 9. Kenny C. (2008). The best practice: How the new quality movement is transforming medicine, New York: Public Affairs. 10. Gebbie, K., Rosenstock, L., Hernandez, L.M. (Eds.) (2003). Who will keep the public healthy? Educating public health professionals for the 21 st century. Washington, DC: The National Academies Press. Published by Journal of Interprofessional Healthcare,

19 Journal of Interprofessional Healthcare, Vol. 1 [2014], Iss. 1, Art Wesorick, B., & Doebbeling, B., (2011). Lessons from the field: The essential elements for point-of- care transformation. Medical Care, 49(12), Suppl 1, S49-S Johnson B. (1996) Polarity Management, Identifying and Managing Unolvable Problems. Amherst, Mass: HRDPress Inc. 13. Wesorick, B. (2002). 21 st century leadership challenge: Creating and sustaining healthy, healing work cultures and integrated service at the point of care. Nursing Administration Quarterly. 26(5), Wesorick, B. (2008). Live a legacy or live a lie. Nurs Admin Q 32(2), Elsevier CPM Resource Center (2011). The CPM Framework : culture and professional practice for sustainable healthcare transformation. (Brochure). Grand Rapids, MI. 16. Mason J. & Wesorick B. (2011). Successful transformation of a nursing culture. Nurse Leader, 9(2), Abrahamson K., Arling P., Wesorick B., Anderson J. (2012). An application of the socio technical systems approach to implementation of electronic evidence into practice: The Clinical Practice Model framework. International Journal of Reliable and Quality E Healthcare, 1(1) January-March. 18. Wesorick, B. (2013) Essential Steps for Successful Implementation of the EHR to Achieve Sustainable, Safe, Quality Care. In: moumtzoglou, A & Katrinia, A. E-Health Technologies and Improving Patient Safety: Exposing Organizational Factors. Hersey, Pa: IGI Global, p Wesorick,B.,Shiparski, L.,Troseth, M.,Wyngarden,K. (1998) Partnership Council Field Book-strategies and tools for co-creating a healthy work place. Michigan: Pratice Field Publishing. 20. Staggers N., Troseth M. (2011). The role of usability and clinical application design in health information technology adoption. Nursing Informatics. In: Ball M., et al, Ed. Nursing Informatics: Where Caring and Technology Meet. 4th ed. New York: Springer Publishing. 21. Hanson D., Hoss BL., Wesorick B. (2008). Evaluating the evidence: Guidelines. AORN Journal, 88, Hanson D. (2011). Evidence-based clinical decision support in M.J. Ball & K.J. Hannah (Eds.). Nursing informatics: Where technology and caring meet (4) New York: Springer. 23. Interprofessional Education Collaborative (IPEC)

20 Wesorick: Polarity Thinking 24. Christopherson, T. (2011, November). The electronic health record: Implications for interprofessional education and practice. Paper presented at the meeting of the Collaborating Across Borders III Conference, Tucson Arizona. 25. Interprofessional Education Collaborative Expert Panel. (2011). Core Competencies for Interprofessional Collaborative Practice: Washington. DC. P Josiah Macy Jr. Foundation. (2013). Transformaing Patient Care: Aligning Interprofessional education with Clinical Practice Redesign. New York, NY Classen, D, Lloyd, R., Provost,L., Griffin, F., Resar, R. (2008). Development and evaluation of the institute for healthcare improvement global trigger tool. Journal of Patient Safety, 4(3). 28. Classen, D., Resar, R., Griffin, Fm., Federico, R., Frankel T., Kimmel N., Whittington J., Frankel A., Seger A., Brent, J. (2011) Global trigger tool shows that adverse events in hospitals may be 10 times greater than previously measured. Health Affairs, 30(4), Elsevier CPM International Consortium Summit Proceedings (2009). Grand Rapids, MI. 30. Berwick, D & Hackbarth, AD. Eliminating Waste in US Health Care. JAMA(2012): 307 (14) Published by Journal of Interprofessional Healthcare,