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They were born to oppose each other.
Thomas Jefferson was an American aristocrat from the agricultural state of Virginia. He was a sloppy-dressing, visionary philosopher, who gazed across mountains and oceans, and became America's first secretary of state. Alexander Hamilton was a self-made man. An immigrant from the West Indies who dressed meticulously, thought rationally, and focused on the bottom line as the country's first secretary of treasury. 1
George Washington, America's first president, knew that he and the country needed to manage the tension between these two strong personalities to give birth to this confederation of states. Indeed, paradox had come to America's first administration. Washington's leadership genius was his ability to manage paradox in himself and in his work.
How well do you manage paradox in your work and life? How often do feel pulled in opposite directions by competing priorities, contradictory demands or conflicting stakeholders? For example, are you, or are those around you, ever asked to:
* Get more done with fewer resources (the hospital won't fill that open radiation therapist position) and find time to learn new technologies (how to use all those features on the new PACS system)?
* Meet the technological needs of demanding physicians (they want volumetric-modulated arc therapy) and keep costs down (it's not in the budget)?
* Push the pace of change (get everyone to use all the features of the new electronic medical record) and provide a platform of stability (celebrate our core values in action).
* Excel at work and enjoy a fulfilling home life?
The Nature of paradox
Sound familiar? These are just a few examples of the paradoxical tensions felt by many radiation oncology professionals in today's challenging healthcare environment, based on my interviews with members of the Board of Directors of the Society of Radiation Oncology Administrators.
The dictionary defines paradox as "a statement that seems self-contradictory but in reality expresses a possible truth." It is derived from the Latin word paradoxum, meaning beyond belief. One reason that managing a paradox is difficult is because dealing with both issues at the same time seems beyond our traditional belief system.
Researchers tell us that in times of stress, we have an even greater tendency to focus on one issue of a paradox instead of embracing both.2 This lack of balance has negative consequences or side effects.
For example, have you ever experienced the negative consequences of over-focusing on your work-consequences such as stress, burnout, an upset spouse, disappointed children? To concentrate solely on one issue in a paradox without considering the other is like focusing treatment on a tumor without considering the impact of that treatment on surrounding healthy tissue.
A process for managing paradoxes
F. Scott Fitzgerald, author of the classic novel, The Great Gatsby, said "the sign of 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." Indeed, to be able to think paradoxically is a rare, yet highly desirable and effective skill in today's workplace.3 Here are some tips to help you manage the paradoxes in your work life based on my decade of teaching and coaching leaders at all levels of the healthcare enterprise.
Make the diagnosis
Just as treating and managing oncology patients begins by making an accurate diagnosis, we manage a paradox by first correctly diagnosing whether we are dealing with a paradox to manage or a traditional problem to solve. In fact, according to a recent study of 400 middle managers, simply recognizing that you are dealing with a paradox and not a traditional problem enhances your ability to handle it.4
To accurately make a diagnosis, it is important to understand that a paradox generally reflects the following four characteristics:
1) Two interdependent issues (e.g., increase productivity and improve service quality);
2) Two competing demands that recur over time (e.g., demands to meet physicians' needs and demands to control costs);
3) Making decisions that impact both issues (e.g., the need to decide how to provide training on a new EMR system and discuss what will not be changing);
4) Negative consequences if decisions heavily favor one issue at the expense of the other (The need to perform well at work and the need to spend more time with family).
Meet with your stakeholders
Once you have identified a strategic paradox, meet with those who are directly affected by, capable of influencing, and most concerned about the issues involved. These are your key stakeholders. For example, if you are trying to both address the needs of physicians who are upset they can't have the latest technology and to control costs (the capital budget committee is reluctant to invest in new equipment), invite the most vocal physicians, influential hospital administrators and knowledgeable therapists to a meeting.
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