AM Last Page
Improving Health Care Quality: A Polarity Management Perspective Randall F. Holcombe, MD, professor, Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Polarity management is rarely used in health care,1 even though it could be beneficially applied to health care quality.
Defining Polarity Management 2
Understanding the Benefits of Applying Polarity Management
• Acknowledging that there is no single “right” answer or solution • Considering two interdependent but opposing pairs of values or points of view for a problem • Balancing alternative solutions to optimize outcomes
In general: • It is a methodology for analyzing complicated issues and incorporating disparate, even contradictory, viewpoints. • It optimizes the positive attributes of opposing perspectives while minimizing the negative attributes. To health care quality—it can address the following: • Only 54.9% of patients receive recommended care.3 • National Quality Strategy (NQS) priorities focus more on access and communication than on patient outcomes.4 • Compliance to NQS measures is only 23%–47%.4
Applying Polarity Management to Health Care Quality The overarching goal is to provide high-quality care. • Two interdependent but opposing factors drive quality: standardization and innovation • Solutions to problems are in diagonal quadrants: – Issues in the SE quadrant (e.g., uncertain outcomes, cost uncertainty) are addressed by solutions in the NW quadrant (e.g., clinical pathways, best practices). – Issues in the SW quadrant (e.g., limited options, restrained individualism) are addressed by solutions in the NE quadrant (e.g., personalized care, more options). – Ideally, clinicians should maximally employ the solutions in the upper quadrants to avoid the detrimental outcomes in the lower quadrants.
High-Quality Care 1. 2. 3. 4.
Clinical pathways Best practices Predictable outcomes Predictable costs
1. 2. 3.
Innovative
Standardized 1. 2. 3.
Potential to personalize Many options Great potential in settings of limited effectiveness
Limited number of options Individualization restrained Inadequate in settings of limited effectiveness
1. 2. 3. 4.
Uncertain outcomes Cost uncertainty Intrapractice variation Reimbursement concerns
Low-Quality Care
Adjusting for Optimal Solutions • An equal balance between poles is not always best. • Specific scenarios may drive the balance point from one pole to another: e.g., Hypertension control for cardiovascular event prevention is best perceived from a standardized perspective. e.g., The treatment of metastatic pancreatic cancer is best perceived from an innovative perspective because of limited efficacy of standard approaches.
Defining Other Areas in Academic Medicine That Could Benefit From a Polarity Management Perspective Graduate Medical Education Goal: exceptional education; Opposing perspectives: time based versus competency based Health Care Economics Goal: optimal patient outcomes and efficiency; Opposing perspectives: ambulatory versus inpatient References 1. U.S. Department of Health and Human Services. 2012 Annual Progress Report to Congress: National Strategy for Quality Improvement in Health Care. Washington, DC: U.S. Department of Health and Human Services; August 2012. 2. Johnson B. Polarity Management: Identifying and Managing Unsolvable Problems. Amherst, MA: Human Resource Development; 1992. 3. Burns LR. Polarity management: The key challenge for integrated health systems. J Healthc Manag. 1999;44:14-33. 4. McGlynnEA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348:2635-2645. Author contact: [email protected]
First published online December 9, 2014
Academic Medicine, Vol. 90, No. 2 / February 2015
259
Improving Health Care Quality: A Polarity Management Perspective Randall F. Holcombe, MD, professor, Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai Polarity management is rarely used in health care,1 even though it could be beneficially applied to health care quality.
Defining Polarity Management 2
Understanding the Benefits of Applying Polarity Management
• Acknowledging that there is no single “right” answer or solution • Considering two interdependent but opposing pairs of values or points of view for a problem • Balancing alternative solutions to optimize outcomes
In general: • It is a methodology for analyzing complicated issues and incorporating disparate, even contradictory, viewpoints. • It optimizes the positive attributes of opposing perspectives while minimizing the negative attributes. To health care quality—it can address the following: • Only 54.9% of patients receive recommended care.3 • National Quality Strategy (NQS) priorities focus more on access and communication than on patient outcomes.4 • Compliance to NQS measures is only 23%–47%.4
Applying Polarity Management to Health Care Quality The overarching goal is to provide high-quality care. • Two interdependent but opposing factors drive quality: standardization and innovation • Solutions to problems are in diagonal quadrants: – Issues in the SE quadrant (e.g., uncertain outcomes, cost uncertainty) are addressed by solutions in the NW quadrant (e.g., clinical pathways, best practices). – Issues in the SW quadrant (e.g., limited options, restrained individualism) are addressed by solutions in the NE quadrant (e.g., personalized care, more options). – Ideally, clinicians should maximally employ the solutions in the upper quadrants to avoid the detrimental outcomes in the lower quadrants.
High-Quality Care 1. 2. 3. 4.
Clinical pathways Best practices Predictable outcomes Predictable costs
1. 2. 3.
Innovative
Standardized 1. 2. 3.
Potential to personalize Many options Great potential in settings of limited effectiveness
Limited number of options Individualization restrained Inadequate in settings of limited effectiveness
1. 2. 3. 4.
Uncertain outcomes Cost uncertainty Intrapractice variation Reimbursement concerns
Low-Quality Care
Adjusting for Optimal Solutions • An equal balance between poles is not always best. • Specific scenarios may drive the balance point from one pole to another: e.g., Hypertension control for cardiovascular event prevention is best perceived from a standardized perspective. e.g., The treatment of metastatic pancreatic cancer is best perceived from an innovative perspective because of limited efficacy of standard approaches.
Defining Other Areas in Academic Medicine That Could Benefit From a Polarity Management Perspective Graduate Medical Education Goal: exceptional education; Opposing perspectives: time based versus competency based Health Care Economics Goal: optimal patient outcomes and efficiency; Opposing perspectives: ambulatory versus inpatient References 1. U.S. Department of Health and Human Services. 2012 Annual Progress Report to Congress: National Strategy for Quality Improvement in Health Care. Washington, DC: U.S. Department of Health and Human Services; August 2012. 2. Johnson B. Polarity Management: Identifying and Managing Unsolvable Problems. Amherst, MA: Human Resource Development; 1992. 3. Burns LR. Polarity management: The key challenge for integrated health systems. J Healthc Manag. 1999;44:14-33. 4. McGlynnEA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348:2635-2645. Author contact: [email protected]
First published online December 9, 2014
Academic Medicine, Vol. 90, No. 2 / February 2015
259
