Unstoppable @ Craig

Unifying Teams in a World of Polar Opposites

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0:00 | 30:24

Hold on to your seats folks, in this episode of Unstoppable @ Craig, there are no right or wrong answers. Join host Jandel Allen-Davis, M.D., CEO and president of Craig Hospital and Toby Huston, Ph.D., director of psychology at Craig as they discuss perpetual tensions through the lens of polarity management, an approach used when you have two points that are polar opposites and yet both of them are correct. Too often as leaders, we are in the mindset that if we just work smart enough or hard enough, we will find the right solution. Perhaps, it’s not a problem to solve but a polarity to manage. 

It’s time to put on those polarity management lenses, sit back and join Toby and Jandel as they explore ways teams can move forward with a unified purpose. But first, don’t forget to subscribe to Unstoppable @ Craig.


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Disclaimer: The content in this podcast is intended for general informational purposes only and is not a substitute for professional medical advice or treatment for specific medical conditions. No professional relationship is implied or otherwise established by reading this document. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Craig Hospital is not affiliated with resources that may be referenced in this podcast. Craig Hospital assumes no liability for any third-party material or for any action or inaction taken as a result of any content or any suggestions made in this podcast and should not be relied upon without independent investigation. The information on this page is a public service provided by Craig Hospital and in no way represents a recommendation or endorsement by Craig Hospital. Any use of this content by a corporation or other revenue-seeking or -generating organization is prohibited unless first approved by Craig Hospital. 

For more information, transcriptions and behind-the-scene photos, visit https://craighospital.org/unstoppable

Craig Hospital is a nationally recognized neurorehabilitation hospital and research center specialized in the care of individuals who have sustained a spinal cord injury (SCI) and/or a brain injury (BI). Located in Denver, Colorado, Craig Hospital is an independent, not-for-profit, 93-bed national center of excellence that has treated thousands of people with SCI and BI since 1956. Learn more: https://craighospital.org

0:00:06.9Jandel Allen Davis:

Welcome to Unstoppable @ Craig, where we pull back the curtain on what makes healthy workplace cultures click, and what happens when people are empowered to expand the boundaries of what is possible. We'll explore the perspectives of employees and leaders who have carte blanched to speak their truths, tell their stories, and unlock uncommon ways of approaching challenges. I'm Dr. Jandel Allen Davis, CEO and President of Craig Hospital, a world renowned rehabilitation hospital that exclusively specializes in the neurorehabilitation and research of patients with spinal cord and brain injury. Join me as we learn from people who love what they do

and what happens when fear doesn't stifle innovation. 0:00:

50.6Jandel Allen

Davis:

George Peppard said, "I love it when a plan comes together." And if there's anything that these last two and a half years has wrought, let alone if we really look back over epochs of time, it's that, that phrase, life is lived in the gray is not just the truism. It is, in fact, truth that there are very few things that have truly that black and white sort of way that we like to talk about things. That there are ways of seeing and approaching situations, issues, opportunities through multiple lenses. There's this concept of polar opposites, perpetual tensions, adaptive challenges, technical challenges, and all of it is about swimming in the gray.'Cause I've said so many times that life is lived in the gray. And recently we were introduced to a concept called Polarity Thinking. And I am so excited to have the opportunity to talk to my friend and colleague, Dr. Toby Huston, who's the director of our psychology department, and is our current biggest rockstar, having won the Association of Spinal Cord Injury Professionals, James J. Peters Award. And apparently, while he was out at this conference, he gave as part of the award, a talk on polarity thinking. We have invited him to come in and share this concept because I think it's something that has really great applicability for how we swim through ambiguous times, which are pretty much all the time. So first of all, Toby, welcome.

0:02:26.8: Toby Huston: Thank you. 0:02:27.5Jandel Allen Davis:

It's nice to get to do this with you. And I think that through the lens of knowing that we live in the gray and that this concept of polarity thinking may have some great applicability, can you just describe

what it is and talk about it a little bit? 0:02:40.9: Toby Huston:

There's this joke that goes around in terms of if you've never owned a red car and then you buy a red car,

Yeah. 0:02:49.9: Toby Huston:

And that has happened to me in terms of seeing polarities everywhere I look. So polarity thinking or polarity management, really, is not a replacement for either or thinking, but it's sometimes described as both and thinking in which you may have two things that seem like they are on polar ends or polar opposites, and yet both of them are technically correct. So it's if you believe that you've got a problem that has one right answer, oftentimes what you really have is a polarity where there are two right poles to a situation. And trying to manage that polarity gets you further than mistaking

Yes. 0:03:39.6: Toby Huston:

And let me give you an example.

0:03:41.1Jandel Allen Davis: Yeah, that'd be good. 0:03:42.1: Toby Huston:

If we think about activity and rest, so normally we don't argue about what's better, being active or resting. We understand that both of them are important and crucial to success in life or feeling good, maintaining health. But they are a polarity. They're on two ends of the spectrum in terms of activity and rest and yet they're both correct. So sometimes when we think about polarities, you think about, is there a greater purpose that will allow us to leverage, as they say, the polarity? So if you take the example of activity and rest, and you have a greater purpose of running a marathon, if I over focus on either side of that polarity, I'm likely to get the downside of that polarity. So let's say I'm training for a marathon and I'm particularly drawn to activity is where it's at and rest is for sissies, I'm likely to get the downside of over focusing on the activity polarity. I'm gonna get fatigued, I'm gonna have muscle breakdown...

0:04:50.3Jandel Allen Davis: Injuries. 0:04:51.0: Toby Huston:

Injuries, I'm not going to have focused on the upside of rest, which is building muscle over time and that sort of thing,

so... 0:05:00.9Jandel Allen Davis: Allowing for recovery. 0:05:01.6:

Toby

Huston:

It's an easy example of activity and rest being a polarity. And if we have a greater purpose of running a marathon, we try and find ways of leveraging that polarity. It's not either/or, it's

both/and. 0:05:13.0Jandel Allen Davis:

Yeah. So how do you think about how you do balance the two, whether in your... Your example is a perfect one, but I immediately

started seeing red cars everywhere. 0:05:23.7: Toby Huston:

Yeah, exactly.

0:05:24.9Jandel Allen Davis: I start seeing lots of them. 0:05:27.2:

Toby

Huston:

So there's a whole kind of science behind this idea of polarity management and oftentimes people reference Dr. Barry Johnson who's sort of the guru of polarity management. And there are things called polarity maps where you actually identify what the polarity is and then chart out the upside or sort of the benefits of that side of the pole as well as the downside of over focusing on that pole. So you end up with sort of this 2 x 2 square of polarities with an upside of each and the downside of over focusing. And you can get really into looking at what are the action items that get you to the upside of a certain pole? What are the things that make you know you're over focusing on that side of a pole? That kind of thing. But I also think you don't have to get that deep into it. It's also just conceptually a way of thinking about things and not mistaking

a polarity for a problem that has one right answer. 0:06:

35.5Jandel Allen

Davis:

I loved hearing that part of it and the timing, the convergence of this idea of polarity thinking in my own work came up having heard someone ask on... A guy who I'm joining a new board with, ask of the CEO of the organization, what are the perpetual tensions that exist in your work? And I came back to the leadership team and said, "We should start thinking about what are these perpetual tensions." 'Cause the fact is it's not just about quality and cost or

safety. 0:07:06.9: Toby Huston: Exactly. 0:07:07.6Jandel Allen Davis:

And quality or the care... We put these things at... And the fact is that we have to figure out how to manage through all of it. I love the word manage as opposed to solve a problem. It's managed. The fact that we swim in all of this and what's the impact on us as leaders, patients, our team members who are working

with patients of learning to live alongside this tension? 0:07:34.6:

Toby

Huston:

Well, I'd start with the fact that we are not making a mistake by viewing challenges that we come across as problems. In fact, it's kind of baked in. We are developed over time to solve problems. So most of us, the way in which we went through formal education was all about problems. Most of it was about problems that had one right answer. So we had to learn our multiplication tables, we needed to know the history of who was the first President of the United States, those kinds of things. And there is benefit to being able to solve problems that have one right or one best answer. That's how we get rewarded over time. We get into an honors class, we pass the test to get into college, those kinds of things. So it's natural for us when we come up against a challenge to think of this as this is a problem that must have an answer that I need to... If I'm just smart enough or work hard enough, I can figure out the answer or the solution to this problem. And there are some things that have one right answer, but more often than not, we are actually in a polarity and we mistake it for a problem that has one right answer. And one of the issues that comes up is that if you believe and make the mistake, quote unquote, that you are dealing with a problem, but you're actually dealing with a polarity, you can make

the problem worse. 0:09:08.2Jandel Allen Davis: Yes. 0:09:09.4: Toby Huston:

Because you can drive people to the opposing poles. Because they have inherent desire or preference for one side of the pole or the other, which may not be the same as my inherent preference for a pole. One example that really resonates with me in terms of organizational that we've thought about in the past

is individualized care or evidence based practice. 0:09:

41.6Jandel Allen

Davis: Yeah. 0:09:44.2: Toby Huston:

So the answer is both are important. But we can... Let's envision a situation in which I'm a manager and I think... What I'm looking at across the board with our organization is what kind of care or sort of quality of care somebody gets is dependent on which team they end up on. That every clinician or every physician is kind of doing their own approach to what does this individual need from me? And as a manager, I think we are not paying attention to what best clinical practice is. We're not uniformly doing evidence based practice. And so I envision this as we are lacking in evidence based practice and we need to kind of move towards that. Those individual... Because I have a preference that I think that's what is going to give... I'm thinking about the upside of evidence based practice. Consistency over time, maximum patient improvement, the best prepared patient because they've gotten this best clinical practice. The folks who only see or primarily see the upside of individualized care think about this is the best way to engage patients, empowering patients, meeting them where they're at. Cookbook clinical work is reductionist and isn't the magic of this place.

0:11:15.7: Toby Huston:

Both things are true. If I think I'm trying to move somebody more towards evidence based practice, but they are thinking about the upside of individualized treatment, they're going to resist that

move because they fear losing something. 0:11:29.0Jandel Allen Davis:

Yes.

0:11:31.5: Toby Huston:

So when you're thinking about polarities, the people who are resisting or challenging a move that you think you need to make are a rich source of information because they're telling you what they value and what they fear. And if you can figure out what is the upside of the pole they are most aligned with, what is the upside of the pole I'm most aligned with, we then have a framework to talk about how do we capitalize on the upside of both poles and not get into the downside by over focusing on one or the other? I've thought about this, and this is where when I gave my talk at the Academy of Spinal Cord Injury Professionals, it was a bit of a leap because I think sometimes polarity thinking and management is thought of mostly these days in terms of at the organizational level. And I've tried to think about this as how do we think about this at the level of the patient and the clinician and sort of in practice? One of the challenges that we confront frequently, a patient who's got a new spinal cord injury, who is managing a tremendous amount of uncertainty about what is ultimately going to be my outcome may come in and we may be dealing with a polarity of the therapist is focused on skill acquisition, teaching people adaptive strategies to maximize their

function at the level of utilizing a wheelchair. 0:13:06.8: Toby Huston:

The patient may come in saying, "I'm solely focused on walking again, on getting back neurologic function. I don't want your stinking wheelchair because I'm planning on walking out of here." So if you think about that as an either/or problem, either we need to teach someone adaptive strategies or we need to focus on neurologic recovery, oftentimes you can end up in a stalemate. The patient wants one thing, the therapist wants another. Luckily, here at Craig, I think we do a good job of this, but sometimes still we get stuck in sort of a battle with a patient about what they want, what we think is, clinically, what needs to be delivered. And it's a way of thinking about, I might not need to map out this as a polarity map, sit down with a patient and take an hour going through the upsides and downsides of a polarity. But maybe I say to them,"It seems to me that we've got two important things going on here. A need to capitalize on getting you as functional as you can be at the level you are at while not losing a focus on the potential for neurologic recovery and getting you back to

as much as you can be." 0:14:25.5Jandel Allen Davis:

You're right.

0:14:27.1: Toby Huston:

And I think sometimes just saying that, it's a polarity and you don't use the language, but you say, "We've got two things that are important here. How do we capitalize on both of them while not focusing too much on one or the other so that we lose the benefits of the other?" You've now introduced the idea of polarity management, but you haven't spent an hour mapping it out in a way that you might do as an organization if you're really trying to delve into this.

0:14:52.5Jandel Allen Davis:

Well, even as an organization it's the one that is top of mind and bothersome, honestly, to me as a clinician, a physician leader is to have salvoed at an administrator, you care more

about the finances than quality. 0:15:10.8: Toby Huston: Yes. 0:15:

12.0Jandel

Allen Davis:

It's offensive. Let me just start there. And then when I... And now I'm hooked. Now I'm triggered. And that's not helpful. So I think it's interesting, even talking about the benefits of thinking this way is that both are important. Without a strong margin, you can't carry out your mission, and without a strong mission that's focused on quality and the care experience, trust me, nobody's gonna come to your hospital. You will not have a margin to invest in the business. So in some ways, just being able to say it that way without getting down into the muck of, "You just offended me," or,"You don't care about this." To the extent that we have taken the time to arm teams with the language and with the concept, it seems to me one thing that happens is, and I said this back to the... When that perpetual tensions thing came up, or concept, I came back with my mind blown then too thinking, oh, just recognizing that there are these tensions that exist changes even the temperature in the room, changes my level of anxiety, my sort of sense that I have to solve this. And it seems to me, like you said, if people can say that, oh, we are in one of those polarities, how does it actually just cognitively shift us enough, psychologically shift us enough to actually

then begin to see and hear each other? 0:16:28.3: Toby Huston:

I think that acknowledging... This is only one concept. It's not a silver bullet. It pulls from lots of other ideas, but it's one way of acknowledging that we live in the gray.

0:16:44.3Jandel Allen Davis: Yes. 0:16:45.3: Toby Huston:

That that is the nature of existing, that is the nature of relationships with patients,

that's the nature of perpetual tensions or competing ideas... 0:16:

55.7Jandel

Toby Huston:

And that we haven't failed by not solving the problem. We have acknowledged that we have a polarity that needs to be well

managed. 0:17:12.4Jandel Allen Davis:

If I were having a conversation as a... In terms of this leadership role about this polarity of quality versus cost, or we could put quality versus the care experience, 'cause that's... Those two are also an interesting... Sets up an interesting dynamic. I don't think that I would say to a person,"What are you afraid of?" But you're helping me think. I'll say,"Tell me what you're concerned about with this focus on quality or this overfocus on quality or focus on cost or focus on the care experience and not quality, blah blah, blah. I almost can see us physically moving

closer together... 0:17:50.1: Toby Huston: Yes. 0:17:50.5Jandel Allen Davis:

In those conversations which is interesting 'cause you're pulling people away from the poles. Just literally sort of... I love the phrase, campfire moments. Sitting around the campfire and being able to have a much richer conversation and a better ability to see

and meet each other's needs through this kind of thing. 0:18:06.2:

Toby

Huston:

Pushing people to tell you what their fears are about something may be coming on too strong with some folks and not with others.

0:18:11.0Jandel Allen Davis: I'm not afraid of anything. 0:18:14.7:

Toby

Huston:

Exactly. Sometimes it's as open ended as, tell me what comes to mind when you hear me say

efficiency. 0:18:24.1Jandel Allen Davis: Yeah. 0:18:24.2: Toby Huston:

What

Toby Huston:

Because then I think sometimes people will say, that means watching the bottom dollar at the expense of doing what's best for patients. That means you're only focused on this or that. I'm talking in extremes here, but I think it helps I'm using that term fear because that's kind of how polarity

thinking thinks about it as a model. 0:18:49.0Jandel Allen Davis:

So what if there's disagreement about what's the greater goal we're trying to achieve?

0:18:53.8: Toby Huston:

You have to find a way of getting everybody around the table to think about, what's the greater good? What is it that ultimately we're trying to achieve?

And it isn't necessarily one or the other. 0:19:09.1Jandel Allen Davis:

I can imagine that there are some situations, either clinically or administratively, operationally, politically, you name it, to take it even beyond our walls, where it might make sense to sit down and actually go through the

exercise. 0:19:26.6: Toby Huston: Absolutely. 0:19:27.0Jandel Allen Davis:

And I'd love to pick your brain around what might be situations where... It doesn't have to be a specific situation, but what's a group dynamic that might be going on or specific ones that we might be observing where actually sitting down and doing the work of figuring out the greater good, the fears might be a good thing? So, what am I seeing in behavior of teams or individuals that would

say "It's worth investing the time to do this."? 0:19:57.1: Toby Huston:

My thought is, if you notice that you have been working a problem for some period of time and either feel stuck, aren't making progress or see people in different camps, then you are likely in a polarity, and not a problem to be solved. So I don't think it even has to be... It's clear if you got people in different camps. Well, okay, they're aligned with one side of a pole or the other. But I think you also can think about it as, this just feels like a problem we've been doing really good work on, but we aren't making progress. Then, maybe it's because we're mistaking a polarity for

a problem. 0:20:43.0Jandel Allen Davis:

Are there some situations, or when do you know? Let's say that you agree that it's a polarity. Everybody says, "Yup, there it is." And now we feel like, "Okay, let's just make sure we check our language, watch our words, make space and time for me to hear you and you to hear me." Can there come a point along that journey where you actually aren't managing the polarity at all? And what would be

the clues that that's the case? 0:21:11.3: Toby Huston:

The model, if you go through the formal model of mapping a polarity, would take you through the strategy of thinking about, what are the downsides of over focusing on this pole? And then, based on what the downsides are, what are some early warning signs that

I'm getting to the downside of that pole? 0:21:38.6Jandel Allen Davis:

And so then back to non clinical, it's to take at least a little bit of time to know or even think about, as a leader, when you're watching folks try to work through a polarity, if they... To take some time to say, what are the warning signs that things are coming off the rails? And then helping pull it back together. And maybe that's where you do sit down, especially depending on the stakes, in a given case, 'cause you're right, it's a lot of... I'd say it's a lot of time. It'll take whatever time it takes. But if the stakes are high enough that either in terms of the clinical stakes as you describe, but even organizational stakes, it does make sense to slow down if you see that you're getting some of those warning signs that things aren't going well. And I've lived the over emphasis on... You're kind to call it efficiency, which is really code for the finances or for productivity, the way those things play out, and they are culture killers just as

much as the other way. 0:22:41.2Jandel Allen Davis:

The other thing that I think is really important that is almost the starting point is that if you have identified that you have a polarity that needs to be well managed, the very first important step is that you have to take some time to be self reflective on, all of us have some preference for one end of the pole or the other. The cop out or the easy answer is to say,"Well, I think both are important." The reality is, I have a personal preference for which I think needs more attention. It doesn't mean that I don't care any about that, but if I acknowledge which part of the pole I have a stronger gut affinity to, that gives me important information, I'm gonna have potentially

a blind spot about the downside of an over focus on that pole. 0:23:

35.1Jandel

Allen Davis:

What do you see are the cultural upsides for us as leaders, directors, all of us doing what we do and trying to keep Craig this beautiful place by thinking this way?

0:23:49.3: Toby Huston:

One of the things that comes to mind is, we sometimes think about,"Well, are people going to be resistant to learning a new thing? Are they gonna think this is sort of fluff? Or are you gonna get the eye rolls of... That kind of thing. My experience so far in talking about this in different settings is, people think about... Have this relief about, "I know this is the struggle... Something about this is a struggle, but this idea gives me a way of thinking about it and potentially managing it." And in psychology, we use this concept of reframing, reframing this from a failure into something that just is, that needs to be worked through. The mock is the mock, and it isn't bad or good, it's just that's the nature of the beast, and how do we work through that? So I think it gives people a sense of something they innately know is a challenge. No therapist wants to be at odds with their patient, but they may not know how to avoid being at odds. They know there's something that they're missing in what the patient thinks is important, and this gives me a way of like, "Okay, another way of thinking about it, or a way of not challenging but being inquisitive and thinking about it in a broader way." So I think it gives people potentially a solution or a way of

thinking about something that they innately know is... 0:25:

32.8Jandel Allen

Davis: It's great. 0:25:32.8: Toby Huston:

Is great and not being managed

well. 0:25:35.3Jandel Allen Davis:

It's funny, as you said that, so many thoughts came to mind. The first is the good old first part of the Hippocratic Oath which we take as physicians, which is to do no harm. And there's a way of not... When we don't identify... When we mistake a polarity for a problem, that we actually do harm. And you've talked about that. So I think one thing we avoid potentially by doing this is causing more harm for sure. And I know you believe this and know this too, that when I take the time to see your point of view, which is another way of saying, "Where you sit on the pole," as do where I do, there is a trust and a respect for each other in our places, in our spaces, that has the potential to really emerge if we're authentic about it. I also think that one of the things that gets all of us stuck, and it's interesting 'cause I've learned it over the years, is that we've become hideously positional and the positions are these poles. And positional thinking doesn't allow for the best of creative outcomes either, creative solutions. And I will use that word 'cause even in managing a polarity, you're gonna come up with solutions for how you're gonna manage it. And I think they're far more creative if we can get out of our positional thinking. So as I said, my mind was blown when I started thinking about this. And then as a leader, the individual thing...

0:27:03.2Jandel Allen Davis:

I love that you started this last bit with,"Take the time to reflect on where you are, which end of... And be honest with yourself." You don't need... The other thing about polarities is that there's a spectrum. And I think what we do is say,"Well, if you're on this side or that side, you immediately place yourself at the extremes. You're not at the extremes,

necessarily. 0:27:26.9: Toby Huston: Exactly. 0:27:27.3Jandel Allen Davis:

But doing that bit of self reflection is important. But the other side of it is, take your own pulse throughout this time, because I think there's also some warning signs that you're getting triggered... Oh, I shouldn't

say "you," I should own this statement. 0:27:41.4Jandel Allen Davis:

I'm getting triggered, and it's when I start to feel my anxiety going up, when I start to feel like things might be outside of control and I'm probably back to thinking about this as a problem to be solved instead of, it just is, it just is.

Toby Huston: Yes, correct. 0:28:00.4Jandel Allen Davis:

Well, I appreciate the time that we had together, and at the right time, which we may not wanna leave it too long, there's a way of

having this conversation as a hospital. 0:28:10.0: Toby Huston:

Absolutely.

0:28:12.5Jandel Allen Davis:

That's sort of the nature of how we rock and roll here, is, there's very little that I know that I don't want

every single person in the place to know. 0:28:26.2Jandel Allen Davis:

The idea of being able to see each other and truly see each other's perspectives as both having some real value and some real merit creates the opportunity, gives us that break in the muck to sit alongside each other and figure out a way forward by accepting that there really is very little in life that's super certain. There's very little, if any in life, that's black and white. And this last bit of time talking to Toby and exploring the many ways in which this polarity thinking can help us see each other in a different light and value each other and tap into a new form and a new depth of empathy, and I'd go so far as even to say some sympathy from time to time, is something that I hope that you found usefulness in and can take that back into your personal life, your professional life, and potentially allow us to get less polarized. Because while these are polarities, they don't have to be polarizing unless we are so positional or so thinking that this is a problem that we can get to a quick solution and be done, that we're not viewing these as frankly perpetual tensions. We can truly embrace those tensions and come to a much better way of living and being that actually allows us to enjoy each other and enjoy work and watch some great things flourish that we couldn't before. So I hope you found some use in this, and I truly hope that you'll come back, and I look forward to joining you with our next Unstoppable @ Craig. Thanks lots.

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Jandel Allen-Davis, MD

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