During residency, I was called to the Operating Room in the middle of the night.  As I entered the room, I noted that an anesthesiologist was not present.  I had been summoned to remove the corneas of a patient who had died, so that they could be available for corneal transplant before the body was taken to a funeral home.  I had learned through experience “Never fight at night,” and did what I was told.

The next day, I described the situation to my Chairman who listened, but did not share my outrage.  Finally, I asked him, “What will it be, education or service?”

He smiled and asked me, “What will it be, inhalation or exhalation?”

“That’s easy,” I replied in sleep-deprived certainty, “You need to do both!”

“Exactly,” he replied as he escorted me out of his office.

My only complaint about Ralph Jacobson’s and Brian Campion’s recent article, “Problem Solving: Not Good Medicine for Health Care” (The Physician Executive. Jan-Feb 2008, 55-60), is that I wish that the authors had written it 30 years ago when I was in residency and saw events as moral absolutes.

The authors contend that what keeps healthcare leaders up at night is not their inability to solve problems but their inability to deal effectively with paradoxes, which they see as issues that defy simple solutions.  They recommend treating dilemmas as processes to explore rather than problems to solve.

You can learn more about this approach in Barry Johnson’s Polarity Management: Identifying and Managing Unsolvable Problems.

Becoming more comfortable with paradox allows leaders to listen actively, find common interests, and build a shared vision. Collins and Porra in “Built to Last: Successful Habits of Visionary Companies” quoted F. Scott Fitzgerald, “The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time and still retain the ability to function.”

What paradoxes come to mind in healthcare that we could deal with better? 

• How do you manage the short term and the long term?
• How do you balance work and family time?
• How can we become more comfortable discussing patient survival AND organizational survival to arrive at a shared vision of the future?

I welcome your input.