I’ve just reread the book, The Opposable Mind written by Roger Martin in 2009, and it occurs to me that the perspective of the author may be helpful as we continue to think through some of the dilemmas facing our country around the COVID19 pandemic. The secret sauce so to speak that Martin promotes is the ability to hold two opposing ideas in one’s mind at once, then reaching a solution that is a synthesis that contains elements of both, but in fact improves on each. The theory proposes that a leader who is an integrative thinker refuses to be held by the binary conventional options; refutes the notion of “either or.” Rather than settling for one option or the other the leaders who are integrative thinkers produce integrative solutions after holding two diametrically opposed ideas in “fruitful tension.” (I love that turn of phrase)

A Case Study

When I think about the pandemic and an example of where the opposable mind may have helped us to reach a solution sooner, lessening loss and harm, my mind turns to the no visitor policies that were brought into healthcare delivery at the start of the crisis. These were blunt policy instruments implemented for good reason and in an environment of unknowns; the COVID19 virus was novel with no body of evidence to fall back on about the trajectory to expect.

The policy put in place was a blanket policy of no visitors in long term care, hospitals or other congregate settings. I am certain no one thought the policy would be in place months after implementation. As the pandemic advanced, these policies soon became challenged and the broader implications of a general no visitor policy became evident.  The opposing position taken by many families, patients and clinicians was that a no visitor policy was unfair, ill-conceived and in fact was detrimental to outcomes and to the wellbeing of their loved one.

An integrative approach would have considered the rationale for the “no visitor” position, then acknowledged and incorporated the fears of infection spread, and exposing vulnerable individuals and health care providers to potential harm. It would have then added into the equation the at first unknown but later expressed harms to individuals caused by being isolated from their loved ones, friends and their families. Many of the “visitors” kept away were essential caregivers who were key members of the care team prior to the pandemic.

The opposable mind solution might have been to take a broad-based risk approach rather than one laser focused on only infection control. It would likely have started with differentiating between casual visitors and essential caregivers. It may have incorporated guidelines to develop relevant local policies applicable to the community, including education of caregivers about infection control, supply of PPE, and the identification of an essential care partner by the patient. There was no single right answer to the dilemma and in seeking to find one, none was found so the problematic policy remained.

Of course, the concept of integration has been a future planning buzz word in many sectors, most importantly as it relates to patients in the healthcare system. What is different now is that our experience with COVID19 has highlighted how the concept of integrative thinking, as a component of integration, applies now and into the future. Integrative thinking is a synonym of sorts for the pandemic era buzz words “hybrid thinking” or “hybrid planning” that are circulating and that will like be permanently etched in our lexicon.

The good news is that it is not too late to embrace a more integrated way of thinking about policy options during COVID19 and beyond. The model written about by Martin is one way of doing that. He believes that integrative thinking can be learned and is a habit that he proposes can be developed so that anyone can find their way to creative non-binary solutions. COVID19 has taught us many lessons and for me, one of those lessons has been that for a novel virus, spreading through societies as a pandemic, the ability to think creatively, inclusively, flexibly is essential and serves us well as individuals, while at the same time serving the greater good of our communities.


Reference: Martin, RL. The Opposable Mind: Winning Through Integrative Thinking. Harvard Business Press, Boston, Massachusetts, 2009.

Maggie Keresteci

Maggie Keresteci

Executive Director, CAHSPR