It has long been recognized that nurses and physicians speak in different ways.  Particularly in Surgical settings where providers may experience a sense of pressure with clinical demands, tools like SBAR: “Situation, Background, Assessment, and Recommendation” have been created to help standardize a communication structure between healthcare providers and improve patient safety outcomes.  We believe there’s more to this story and partnered with a community-based health system to improve learning, performance and vitality in nursing and physician leaders.  In the spirit of SBAR, we present our case study using this format.


A multi-hospital health system approached SixSEED Partners (SSP), dba Wiederhold & Associates, to conduct polarity thinking training to their physician leadership academy.  This academy consists of approximately 25 physicians who are in leadership roles throughout their system.  As SSP has been working with this system on a multi-year leadership capacity/ succession planning effort, the system has witnessed the benefit of polarity thinking in expanding leaders’ capacity to see the “both/and” along with the traditional, problem-oriented “either/or” thinking.  They now wanted us to present this framework to their physician leaders.


Since 2015, SSP was asked to create a succession planning program for seven high potential senior leaders, who, at that time, were being considered as possible successors to a CEO who was retiring within three-four years.  SSP partnered with the CEO, COO, CHRO, and another Senior Executive Vice President to create and implement a program that expanded their request to increasing individual, team, and systemic leadership capacity.  Regardless of who may or may not move into the CEO role, we wanted to help position the system to best leverage and respond to increasing complexity within their community, as with mergers and acquisitions, retiring senior leaders, and changing payment models.  Part of our work included introducing polarity thinking and measurement to these senior leaders.

What is polarity thinking?  Barry Johnson introduced polarities in his 1992 book Polarity Management: Identifying and Managing Unsolvable Problems (Johnson, 1992)The term polarity refers to a specific category of paradox. A polarity is an interdependent pair with an ongoing and predictable dynamic. Two questions help us identify a polarity. They are: “Are there two poles which are interdependent?” and, “Is the difficulty ongoing?” (Johnson 1996:2 81). Understanding polarity theory begins with recognizing the fundamental interdependent pair/polarity of “OR” Thinking and “AND” Thinking. This thinking competency-focused polarity distinguishes a polarity as a unique type of paradox that involves an interdependent pair, and from problems that are unsolvable using “OR” Thinking. Polarities are inherently unsolvable, but can be addressed effectively when key stakeholders recognize them.

For example, consider one polarity such as activity and rest.  At some point, if we focus exclusively on activity, our bodies will collapse from exhaustion, and we will be forced to rest.  Over-focusing on rest is unhealthy for our bodies and we will eventually have to move to avoid the downsides of too much rest.  This is an ongoing dance that has no end.

SSP worked with the health system to identify their most common and impactful polarities of mission AND margin; tactical AND strategic; centralization AND decentralization; and continuity AND transformation.


As SSP considered the request for polarity training for the health system’s physician leaders, knowing that they also have a nursing leadership academy, we saw the potential multiplier benefit of inviting both audiences into the same room.  Getting back to our introduction, nurses and physicians often have different, and complementary communication styles.  These communication differences, like candor and diplomacy, or advocacy and inquiry can lead to challenging conflicts and unnecessary burnout.  As a consultant team, we saw the benefit of inviting the nursing and physician leaders to participate in defining and mapping out their own polarities.  For the same amount of time and monetary investment, they could deepen the penetration of polarity thinking within their system, resulting in greater engagement from these leaders, greater performance (since they could now see a system to better leverage these interdependent tensions as compared to ongoing cycles of reaction), and greater vitality through less energy going to un-necessary conflicts.


SSP worked with the steering team for the Physician  AND Nursing Leadership Academies to design and implement an experiential day where the leaders could identify their most urgent polarities;  map out in a very visual and somatic way, their perspective, while also being able to see the upsides of their lesser preferred polarity, and the downsides of over-focusing on their preference.  As an example, physician leaders were able to see the upside of candor, while also seeing that overdoing candor can be perceived as arrogant and rude.  Nurses were able to see their preference for diplomacy, while also seeing the confusion that can occur when they overuse diplomacy and lack candor.


To our great delight, the health system had to change the venue of the training due to the numbers of leaders interested in participating in the training.  The leaders laughed and physically moved as they were able to see their bodily representation of their different perspectives.  With coaching on inquiry and dialogue, the leaders were able to be curious (as compared with judging) as they interviewed each other about their differing perspectives.  In this way, their partnering was strengthened as they learned a common language and process for better leveraging polarities in service to their greater purpose of providing quality AND cost-effective patient care.

SixSeed Partners offers a suite of inter-collaborative, interdependent and custom-designed services to increase leader and system-level capacitation within the healthcare industry. Email us at to learn how we can help you drive sustainable, transformational change within leaders, teams and entire organizations.

Smith, Wendy K., Lewis, Marianne W.,  Jarzabkowski, Paula and Langley, Ann. 2017: “The Oxford Handbook of Organizational Paradox.” Oxford, UK: Oxford University Press. (Chapter 28: “Paradox and Polarities: Finding Common Ground and Moving Forward Together: A Case Study of Polarity Thinking and Action in Charleston, South Carolina”)  Cliff Kayser, Margaret Seidler, and Barry Johnson