Polarity Thinking: Leading During a Pandemic

ROBERT JOHNSON:
This is Public Health Review. I'm Robert Johnson.

On this episode: a method for managing the policy conflicts that impact public health.

DR. PAUL HALVERSON:
Our public health leaders are not in office long enough to make the greatest impact for the people that we all are so fiercely trying to improve and protect their health. And if we're going to be effective, we need to be on the job. And that being on the job means being a successful leader and putting enough attention into our leadership skills that we actually can live to the next battle.

ABIGAIL DUNNE-MOSES:
The beauty of polarity thinking is that it exposes the ways in which are issues that are interrelated.

JOHNSON:
Welcome to Public Health Review, a podcast brought to you by the Association of State and Territorial Health Officials. With each episode, we explore what health departments are doing to tackle the most pressing public health issues facing our states and territories.

Today: a model for working through the pandemic's toughest questions; navigating the debate over wearing a mask; addressing issues impacting the economy; urging communities to get a flu shot. The case for polarity thinking is next.

Public health leaders are being challenged—not just by the relentless COVID-19 virus, but by communities worn down over the stress of the pandemic. Reports of a growing number of infections—so far, not enough to convince many to wear a mask or avoid large gatherings.

The pandemic has forced health departments to defend their recommendations on social distancing, economic restrictions, and vaccinations. How can physicians and scientists trained in public health better engage the politics of the situation? The answer might be an approach called polarity thinking.

We're talking about it with Dr. Paul Halverson, the founding dean of the Fairbanks School of Public Health at Indiana University, and Abigail Dunne-Moses, a senior faculty member at the Center for Creative Leadership. Dunne-Moses has trained many state and territorial health officials on this and other leadership techniques. Dean Halverson is the former director and state health officer for the Arkansas Department of Health.

The first question: how is the COVID-19 pandemic testing state and territorial health officials' leadership skills?

HALVERSON:
Well, I think the primary challenge is really focused on integrating what we know about the science of public health with the implementation at a leadership level.

It's really not so much about knowing what to do, but how to do it and to communicate it in a way that people value what the scientific approach is from the public health perspective.

JOHNSON:
You were a SHO [Ed. Note: abbreviation for state health official]. You know what they're dealing with right now.

Are most of them are equipped to be successful at a time like this?

HALVERSON:
I think they are very well equipped if you look at the SHOs that are currently in office. These are people that, for the most part, have experience in public health. There's probably a good half or more of the SHOs actually have a public health degree.

So, it's not about not having the knowledge—we certainly have public health officials that have the knowledge and have the experience.

It's actually working well enough with our governors and those people that have responsibility within this state to influence the course of action, which is really about trying to use our leadership ability to support scientifically-grounded public health initiatives, and to work with the rest of the team at the governor's office level—as well as in our healthcare system—to be able to use leadership tools and techniques that will be seen as helpful and supportive of the current emergency.

JOHNSON:
Abigail, you teach creative leadership. How does the situation facing the state health officers compare to the crisis facing the rest of the world?

How do the leaders stack up against each other, in your view?

DUNNE-MOSES:
Well, and that's interesting that you would use the word stack up, because I was listening to the news yesterday and they were talking about how the rest of the world is looking at America right now to see how are they managing this health crisis.

Alternatively, it would be mainly the SHOs primarily concerned with their state—somewhat concerned with other states, but that wouldn't really be the compelling factor.

The other thing is that, typically, the span of concern is not global. But when you have a pandemic, it shifts every single polarity, every single predisposition. It challenges your preparation; and, so, leaders are being challenged more now than they ever have been before.

And it's with a point that—from my perspective—we've been teaching for years, which is prepare for globalization. And, typically, people think of it as mainly a business issue; but now, more than ever before, we understand that it is a health issue, and that globalization is not really a choice. It's something that we absolutely have to think in terms of.

JOHNSON:
You teach a concept called polarity thinking and we want to look at that concept as it applies to what the state and territorial health officers are dealing with right now.

But before we do that, can you define that for the audience? Tell us what it is.

DUNNE-MOSES:
First, I want to mention that it is the work of Barry Johnson and their organization is called Polarity Partnerships, and it is an age-old idea that he has brought into the modern world.

And it's the idea that there are difficult, complicated, intertwined problems; and when you're trying to solve those kinds of problems, using polarity thinking is the way to go.

And, basically, it says that with any complicated issue that you're facing, there are two diametrically opposed poles. However, those poles are interrelated.

And so, the idea is looking for the value in each pole and aligning your actions towards those values that increase pole to pole and diminish the fears or the downsides of each pole.

So, instead of holding your ground at one end and arguing for that end and that end alone, in an interspersed polarity, you have to be able to do what we call a both-end.

JOHNSON:
Dean Halverson—in the context of this pandemic—with leaders in public health, what does this look like?

HALVERSON:
I think this is a really important concept. Again, it's one of the great things around CCL because they focus on making practical use of polarity thinking.

And this is one in which you might imagine politics versus science. It's really not about science versus politics at all; it is the polarities related to science and politics.

And this is well-documented in the work by the Institute of Medicine in The Future of Public Health. Going back to 1988, the discussion around the fact that the science doesn't speak for itself and that what we do in public health has to be done in the context of a political environment.

Now, more than ever, we recognize you can't simply be good enough in science, doing what's necessary to be done only with the idea that people should just follow your example because you're a good scientist. You have to recognize that you do this work within the context of a political environment under which you must find people that will follow you.

And so, first and foremost is the importance of gaining the support and confidence of your governor—or your secretary, depending upon your organizational structure—and helping them to understand that doing the right thing from a science perspective is going to be beneficial to them as political leaders, and that collectively you work to try to implement scientifically-sound solutions within a political environment.

So, as Abigail has mentioned, sometimes we—oftentimes—want to try to find the boogeyman. It's not the problem. The problem is recognizing we have to be successful in both realms, if you will.

DUNNE-MOSES:
The beauty of the polarity model is that it gives you an opportunity to look at what we call polarity stacking.

Paul talked about politics and science. Underneath the politics and science is influence and information. Do you make decisions based on information, or do you make decisions based on how you can influence or how others can influence you?

So, you begin to see that it's a very agile tool at not only dealing with big categories like politics and science, but what is underneath them; and that's the beauty of this model because it helps you manage the complexity that you have to deal with on a day-to-day basis.

JOHNSON:
We've seen some casualties in public health recently. Some leaders at various levels have lost their jobs or have been forced to resign because the politics and the science aren't mixing well in a lot of places around the United States.

Could this type of thinking to help people avoid that end? Paul, what do you think?

HALVERSON:
I think so. And, in fact, I know that that's the case.

You know, we're in a very tough situation and, you know, another polarity that we may talk about is related to the economy versus good public health. The reality is, again, it can't be one or the other—it's both.

And our ability to influence and to lead in these times of stress means that we have to figure out a way to effectively communicate what sometimes people don't want to hear and help them understand that, sometimes, we have to do things that we don't necessarily want to do that may have short-term pain and, ultimately, a greater gain.

And I think, again, as we think about it from the COVID perspective, we recognize that social distancing, wearing masks, washing our hands—these are all things that are really, really important, but they are not necessarily what we want to do. But we've seen in many circumstances that, when that has effectively been implemented, we have actually been able to slow down this spread of the disease.

And so, again, it's helping people to understand its not an either-or, it's an and; and it's effectively leading with the concept of the influence of your office—plus the knowledge and experience that you have and that you bring to the table—and putting that all together in a way that people recognize that there is value in moving in the direction that you're leading.

We've seen, over and over again, great scientists who are terrible communicators and they failed to recognize that they work within a political environment. I've often said public health is political by its nature, but it needn't be partisan. We can be politically effective in our communication and our implementation—we must be—but we also need to focus on what the good science is.

And we can do all of that without being partisan in the way that creates the opposition that we see in some circumstances. This is about good science and effective political leadership.

JOHNSON:
The battle lines have been drawn over masks. We see a lot of people calling the mask issue a "freedom issue."

We worry, we wonder, we hope that we won't see the same when a vaccine is made available to the public.

Abigail, how could a public health leader at any level study up on polarity thinking right now to try and avoid the next big fight?

HALVERSON:
That's an interesting one. Paul talked about partisanship, and I want to make a point about that.

The beauty of polarity thinking is that it exposes the ways in which our issues are interrelated. And so, if I'm partisan and I say, "I'm not gonna wear a mask," and your party says, "We will wear a mask," the issue is if you hold at any one of those poles, the outcome is not good.

And so, when we begin to force ourselves and train ourselves to think about what is the upside of both sides of the aisle, and how can we intersperse and go from upside to upside—to what we call a virtuous cycle—and avoid the downsides—which is the vicious cycle. Right now, we're seeing a vicious cycle—states are spiking, the numbers are going up—that's a vicious cycle.

What polarity thinking offers is for us to be a lot more disciplined about how we're looking at the benefits of both poles. And you'd also questioned about how can we use this to avoid future arguments.

The first thing is to teach ourselves how to think in terms of polarity thinking. Right now, our educational systems prepare us to make arguments, to win arguments based on whoever is loudest or who has the biggest influence, not necessarily the person who is taking care of the intricacies of the upsides of both ends of the pole.

And so, what we see when we train SHOs and when we train physicians in physician leadership academy is that, when we introduce this idea of polarity, their capacity to apply the intelligence to difficult problems exponentially multiplies because they have to train themselves now to see the benefits of both sides. No longer can they satisfy themselves by sitting in on one pole and basically staking out at one pole.

JOHNSON:
Dean Halverson, SHOs are smart people. They can do this, don't you think?

HALVERSON:
Absolutely.

And to your point, Robert, I think that we are going to see this as it comes up to the vaccine.

But we're going to see it even sooner when it comes to vaccine for influenza because we are going to get to a point where we are going to need to be strong advocates for the influenza vaccine so that we're not dealing with COVID and seasonal flu.

And so, again, this is another opportunity, is we think about the fall, we think about the flu season. This is an excellent time for us to think about it from the polarity perspective. As Abigail has mentioned, this is actually running up to the big game, which—the big game is going to be the vaccine for COVID. When it arrives and when it's available, we're going to really need to be on top of our game. But that first scrimmage is going to happen with the flu vaccine in the fall.

It's not good enough just to simply say, "You must take it." The issue is why would you want to take it, and what are the benefits? Again, getting back to Abigail's point, you have to be able to live in the realm of both the science as well as the politics to be able to recognize that you have to win in both sides of that essential polarity; and that, in order to be effective, you have to recognize the thinking from the polarity, in particular, as it relates to the politics.

Why would a good politician want to support influenza vaccine? And then, how do you marry that with what's the best science to support the immunization campaign? And together, this is where we work together to try to implement the best assailable solution that satisfies both sides of the polarity, if you will.

This is also where we really need to work together—at the CDC level, and at the state level, and at our local level—it's the system orientation that's going to be so essential in terms of our ultimate success here.

JOHNSON:
Abigail, let's play out that flu vaccine debate.

There are a lot of good questions there. I think those are helpful if you're a SHO trying to figure out how you might be able to apply this approach to finding resolution.

Take us a little farther down the road. What else could they do if they are interested in trying this model in the flu debate context?

HALVERSON:
So, polarity thinking gives you an avenue to embrace complexity.

One of the issues that we haven't even discussed so far is the whole issue of systemic racism. We haven't talked about gender differences. We haven't talked about regional differences—one of the SHOs from Alaska was describing the challenges she faced in her state. We haven't even talked about religious differences.

And so, absolutely, not only must SHOs be politicians, scientists, they have to be medical anthropologists. Now, that seems overwhelming. But again, if you take a polarity view where you are investigating what are the aspects that can bring us to the value side so that we can be engaged in a virtuous cycle, all of a sudden you can take a curious approach to finding out: what are aspects of the way in which people live; in which ways they think; their predispositions; and how we can use that to then build not only just an argument, but an inclusive way in which people can participate in their own healthcare. Build agency into the process.

JOHNSON:
Is there a standard way to approach a problem, a form that you fill out that guides you through the work that you need to do, helps you identify the issues?

How does it look to someone who says, "I've got a problem, it has all of these pieces, and I don't know where to start. I'm overwhelmed," like you said?

DUNNE-MOSES:
Well, the very easiest way is to think about breathing in and breathing out. Breathing in is one end of the pole and breathing out is a second part of the pole. That is the simplest way to think about how polarities work.

Now, even if you didn't have a pencil and you had two people, you could have two people stand on one end, and another person stand up the other end, and have a conversation about what value does their end of the pole bring to the table. And then, have that conversation until the integration and the energy field around the two poles carry you upwards.

We have polarity maps that you can use to map out your polarity where we talk about the upsides, the downsides, we talk about actions, and we also talk about early warning signs. No one pole is better than the other. It is both-end, and when you start seeing early warning signs, numbers spiking, that is an opportunity to lean towards the other end of the pole. And so, it's not necessarily somebody is winning the argument. It's leveraging one end of the pole to catapult us towards the best possible outcome.

Also, there's an assessment where you can have several people in your organization or in your state take an assessment, and that basically will plot where you are in terms of which end of the pole are people on and whether they are on the virtuous cycle or the fear cycle. It will identify and map that all for you; and then, based on that, you can then come up with a strategic plan that is informed by both ends of the pole rather than just your opinion.

JOHNSON:
Dean Halverson, what are some of the things you have to do if you're the leader initiating this conversation?

HALVERSON:
Listen, lead, lean—all of those things, right?

And I think probably one of the most difficult things—I hope that this is what our new SHOs get out of the leadership training, in particular—is that it is important to take the time to prepare for battle, if you will. It is the point that Abigail has made, which is there are tools that are available. There are mechanisms by which you can prepare to be effective, and it's important to take the time to do that.

There are a number of leaders that just say, "Well, you know, I'm pretty smart about science and, you know, I'm pretty astute about politics. Let's just give it a go." Well, that generally doesn't work out nearly as well as we'd like to think it will. Even the most experienced people would do well to spend a little bit of time thinking through the arguments and the counterarguments.

And, again, it’s not about winning and losing. It's not about one side versus the other. It's about creating a solution that ultimately responds to both ends of that polarity, as Abigail has mentioned, and she so wisely described a process by which you can really better understand yourself.

So, this is also an important part of the leadership experiences: understanding your strengths and your weaknesses and your tendencies because, sometimes, you know, it's the old adage—when you're a hammer, everything looks like a nail. You can't solve every problem with the same tool, if you will. And so, what Abigail is describing is a mechanism by which you can use all of the tools in your tool bag, because sometimes the hammer is not exactly what you need. You really need a saw or you need a screwdriver.

And so, that preparation—working with someone that can help you better understand yourself, and the issues, and the team, and the people that you're working with—it's worth taking the time. Not in a protracted way, but in a just-in-time way to get through these issues and to be able to see them before you wind up being confronted with them.

We're all in a situation today where SHOs are being asked to be on the spot—we're all doing media interviews; we're all engaged with people that have a very important perspective that they want to get across. And it's our job to make sure that we're listening carefully and that we can create the situation under which both polarities are able to be understood and leveraged so it's not a win-lose.

It's a win-win—that's what we're working towards. It's not, "I win, you lose." It's, "We both win," and, ultimately, the solution improves public health and creates a strong economic environment, for example.

JOHNSON:
What happens to this concept when people at the other pole are focused on politics?

Maybe facts don't matter as much, maybe they're not interested in science—we see that in some of the public health issues that our leaders face today.

How does the thinking, how does the model fare when people at the other end of the pole are really not interested in what you know? That they think they know more?

Abigail, could you start? Then, Dean Halverson, maybe finish that up.

DUNNE-MOSES:
There's two other parts to the polarity map.

At the top, we have something called a greater purpose statement; and this is a statement that everybody can buy into, that this is what we want—the condition of our country, the condition of our economy, the health and the wellbeing of our children. A greater purpose statement really needs to proceed the engagement in a polarity conversation.

The other end looks at the worst possible consequences. And so, polarity thinking is not for the weak or the faint-hearted; you have to be willing to look for the worst possible consequence.

And so, for people who are stuck at one end of the pole, there are some pretty dire consequences. And that is what is expressed on the downside of the pole. And so, sometimes, people have to see the consequence, learn—hopefully—through the consequence before they begin to understand that when we're talking about polarities, we are talking about interdependencies.

We're not talking about a situation where you can just kind of hang out in a bunker on one end of the pole. It doesn't work. If you breathe in and you refuse to breathe out, there will be consequences. If you breathe out and refuse to breathe in, there are going to be consequences.

And so, it's about embracing those consequences and teaching ourselves, our children, our pastors, our friends, our political leaders how to think in terms of polarities.

JOHNSON:
Dean Halverson?

HALVERSON:
Yeah, so, I think that really is the point. It is, in fact, just as you described, Robert. It's the person that's unprepared for the response, that says, "I don't care about anything, I'm only focused on my thing."

Well, if you're doing your homework and thinking using this polarity matrix, as Abigail has described, you anticipate that. That is one of the things you anticipate and you recognize that, in order to be successful, you have to speak to that. You have to help people get to the point where they recognize that they can't simply, as I think Abigail used the expression, you can't just breathe out. Occasionally, you have to take a breath in, and that means recognizing the important perspectives of another. It is, in fact, thinking through this in advance.

So, if you're doing your homework, you anticipate that one of the responses might be someone just simply sandbagging and saying, "I don't believe any of that," so forth and so on. So, what is our response when that happens? We need to be prepared for it. We shouldn't be surprised by it, especially when we know, today, there's a lot more that we can study about individuals, and how they respond, and what their positions are, and so forth. So, let's play that out in a polarity matrix where we're actually anticipating that and then have the best answer to respond to.

JOHNSON:
Abigail, when we are talking about a SHO, this sounds like an urgent call for a team around that SHO that also can think like this.

Because, as Dean Halverson says, you need to be able to spot all of the potential outcomes and all of the objections, and anticipate that, plan for it, be ready for it. One person can't do that all on their own, especially in a public health setting or any kind of a government leadership setting.

Does the whole team need to know how to do this?

DUNNE-MOSES:
The short answer is yes.

At the Center for Creative Leadership, we teach a model that's called direction-alignment-commitment. It is our framework for understanding good leadership.

Part of what we also teach is that leadership is a social process. There is no such thing as a lone ranger leader. It's a social process. It's a dynamic of a group of people who are bringing their organization to a place where there's clear direction, there's organized alignment, and there is mobilized commitment.

HALVERSON:
You know, Robert, if I could add to this, I think this is so important because we've had a chance at the Fairbanks School of Public Health to study state health officials over multiple decades.

And one of the things that we do see is when the state health official basically is the lone ranger—they think they're the center of the world and everything sort of revolves around them, and they don't have a strong team—they're unlikely to be successful long-term because of all the reasons that were described by Abigail.

You can't do it alone—today, more than ever. We have to have a strong, trusting team—people that have your back and that want to see you be successful—and working together in a team environment and as in team engagement is critical to success. The lone rangers don't last very long anymore.

JOHNSON:
Abigail, last question for you.

Let's say we've gotten somebody on board with this. They don't know much about it beyond what they've heard on this podcast today.

What's their next step?

DUNNE-MOSES:
Well, the next step, of course, is to come to the Center of Creative Leadership and let us help you. You're not on your own.

The next step is to call Dean Halverson, who has been exposed to this idea, who is used this idea, and who understands the breadth and depth of public health. So, the next step is just to reach out.

And, of course, the first step is to have a conversation with yourself and look at the places where you are stuck at one end of the pole, and begin to immediately experiment about how you can start thinking in terms of both ends instead of either-or.

JOHNSON:
Dean Halverson, the best argument for taking those steps?

HALVERSON:
Absolutely.

The best argument is because we have a crisis in our country of state health officials that aren't on the job long enough to make the biggest difference that they can.

We need to find the success factors for public health leaders, and part of that is being effective as a leader—not just in the science but being a strong leader that works in an effective way. Leadership also has science, and there are ways in which we can be more successful. You don't have to go it alone.

Leaders are not necessarily born. They are developed, and that's the reason why ASTHO and the Robert Wood Johnson Foundation have worked so diligently over actually several decades to try to find the very best leadership training that's available. And our work with the Center for Creative Leadership is one way in which we give leaders the tools necessary for them to be successful; and that success is crucial because we need leaders that are not only being effective in the battle but being effective over a long period of time.

Our public health leaders are not in office long enough to make the greatest impact for the people that we all are so fiercely trying to improve and protect their health. And if we're going to be effective, we need to be on the job. And that being on the job means being a successful leader and putting enough attention to our leadership skills that we actually can live to the next battle.

And so, that's why leadership training is so vitally important to being a successful SHO, and to being there having the longevity and the success that's necessary to be on-board and to protect the people that you care so much about.

JOHNSON:
You can find links to the resources mentioned in this episode in the show notes.

Thanks for listening to Public Health Review. If you like the show, please share it with your colleagues.

And if you have comments or questions, we'd like to hear from you. Email us pr@astho.org—that's PR at ASTHO dot org.

This show is a production of the Association of State and Territorial Health Officials.

For Public Health Review, I'm Robert Johnson. Be well.