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Practice Tip of the Week: Polarity Management of Individual and Organization Responsibility

Tuesday, September 19, 2017   (0 Comments)
Posted by: Nadia Tamez-Robledo
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By Ellen Martin, PhD, RN, CPHQ

Director of Practice

Texas Nurses Association


All polarities have two interdependent sets of values that are in dynamic tension. One key aspect of patient safety in healthcare is the polarity of individuals and teams. 

Dr. Lucian Leape of the National Patient Safety Foundation has noted repeatedly that the “single greatest impediment to error prevention in the medical industry is that we punish people for making mistakes.” However, to protect patient safety, we do hold individuals accountable for their actions.  The Agency for Healthcare Research and Quality (AHRQ) says it best in their definition of a culture of safety:

“a culture of safety as one in which healthcare professionals are held accountable for unprofessional conduct, yet not punished for human mistakes.” 

Just culture provides the foundation for as a balanced accountability between individuals and organizations for patient safety. That is not to say that just culture is a “blame-free” response to all errors. Rather it focuses on the behavioral choices of the individual, the degree of risk-taking behavior, and whether the individual deliberately disregarded a substantial risk. It holds the individual accountable who makes unsafe or reckless choices that endanger clients or others.


The individual-team polarity is a challenging one for organizations. Individual recognition and support that honors the unique strengths of each person is important for people to feel valued and engaged. Teams can be synergistic with a common direction and sense of cohesiveness. Teamwork is vital to help ensure all team members are following policies, procedures, and to speak up when safety is at risk.


Communication breakdown is one of the most common sources of  error in healthcare.  Individuals and organizations share responsibility for optimum and effective teamwork.  Organizations provide the resources, training,  establish behavioral expectations, and develop and maintain collegial work environments. Much work has been done in this area such as the Agency for Healthcare Research and Quality TeamSTEPPS curriculum. This work includes communication techniques such as SBAR.


Individuals have a responsibility to reflect on their team competencies, seek feedback on their skills as a team member and address any gaps that prevent them from being an effective team member.  Some practice settings such as patient-centered medical homes and hospice are organized around interdisciplinary teams.  The National Hospice and Palliative Care Organization Team Competency Grid outlines behavioral competencies for novice, proficient and expert team members in several domains   that vital to team functioning such as communication and collaborative problem solving. 


Johnson, B.  (1992.) Polarity Management:  Identifying and Managing Unsolvable Problems.

Wesorick, B.  (2016.)  Polarity Thinking in Healthcare:  The Missing Logic to Achieve Transformation.

To learn more about Polarity Thinking don’t miss the TNA Leadership Conference this year where Bonnie Wesorick will share practical tips for well-managed polarities.  It’s not too late to register!  


Texas Nurses Association

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