Not all problems are solved with “yes” or “no”
In healthcare, as well as in many other situations, we seem to strive for simplifying the problem at hand to a simple yes or no. Though we intuitively know this is not possible, we still respond as if it is doable. We strive to simplify situations and truly want things to be black and white.
Polarity management is the concept that how we look at a question and its answers is more important than just trying to solve a problem as if it were a simple math equation. The concept revolves around the idea that there are three different types of answers for problems faced.
- The first is the most simple, where there is only one correct answer, and all other answers are incorrect.
- The second is where there are multiple answers that are all correct, and independent of each other. An example of this is the answer to the question “How can I get to work today?” There are multiple correct, independent answers.
- The third type of question is one where there are multiple correct answers that are dependent on each other. An example is “Which is more important for living, exhalation or inhalation?” They both are important and dependent on each other physiologically. This latter type of question is what we deal with every day in healthcare.
This discussion came to mind from an example in a news article on how readmission penalties have lowered quality that caught my attention. The article cited was a very well done study, but the conclusion of the article (not the study) that such penalties are bad, failed to look at the issue as one of polarity management. Readmission penalties were created to improve quality and lower costs, not just improve quality. In order to “answer” the question of how to do this, we must remember that quality and lower costs have correct answers to them that are dependent on each other. Readmission penalties have been found to lower costs, but maybe at the expense of some quality measures. That does not make it a wrong answer, just one that has other dependent factors. And, maybe that cost savings was used to improve quality in a different area. My point is not about the details of readmission penalties, but about how we think through the complexities of the questions we are asking.
Managing polarity requires us to first realize the complexity at hand, and then try to optimize the solution or answer, and not strive to find the one only right answer. We then need to continuously adjust what we are doing, with our eye on optimization. We need to remember this work is ongoing and difficult. However, it is less difficult than solving the issues that arise when we look at all problems as having just a yes or no answer.