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Thought of the Day: Leadership May 26, 2017

Posted by mariemanthey in Leadership, Thought for today.
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Leadership involves inspiring and empowering people which creates and expands organizational resources.

Therefore you can have higher productivity, lower cost, more engaged staff, and higher  patient-satisfaction outcomes.

Recent travels: UC-Davis – among the best of the best! May 23, 2017

Posted by mariemanthey in Inspiration, Leadership, Professional Practice.
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I had the pleasure of visiting UC-Davis recently, and it was delightful as always to experience the culmination of so much of our shared vision of an optimal health care system.

Nursing here actually fits something I wrote years ago, a reprise of Judy Chicago’s “Merger: A Vision of the Future”

Here is that actual piece of hers:

And then all that has divided us will merge | And then compassion will be wedded to power | And then the softness will come to a world that is harsh and unkind | And then both men and women will be gentle | And then both women and men will be strong | and then no person will be subject to another’s will | And then all will be rich and free and varied | And then all will care for the sick and the weak and the old | | And then all will live in harmony with each other and the Earth.

Here is my health care variant:

And then a collaborative practice will emerge | And then care will be wedded to cure | And then health will come to a world that is diseased | And then both doctors and nurses will be gentle | And then both nurses and doctors will be respected | And then no person will be treated as a task or a task do-er | And then health will be within reach of most much of the time, and journeys through sickness will be periods of nurturance and care | and then the act of one person caring for another at the time when they are vulnerable will be held as crucial to the human race.

UC-Davis is among that group of hospitals that I feel very nearly reaches those ideals! Thank you for having me, and I look forward to seeing you all again soon at the Symposium!

Announcement: CHCM Book Release! May 22, 2017

Posted by mariemanthey in Announcements, Creative Health Care Management, Inspiration, Leadership, Professional Practice.
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I am  excited to let you all know about Creative Health Care Management‘s newest book publication!

It is called Advancing Relationship-Based Cultures, and I love both the content and the book’s authenticity regarding health care today.

Edited by Mary Koloroutis, and David Abelson, the book explores the  culture of health care organizations, what is  necessary for optimal outcomes, and strategies to achieve those outcomes.

Advancing Relationship-Based Cultures explains and expands a fundamental and often overlooked truth in health care: It is the confluence of relational and clinical competence that advances healing cultures.

A relationship-based culture is one in which a critical mass of people provides care and service with relational competence. In these cultures, the skills that foster relational competence are actively developed, nurtured, practiced, reinforced, and evaluated. While countless thought leaders have championed the importance of improving relationships, this book provides vision and strategies for system-wide culture transformation….and it does so with a depth and authenticity that is breathtaking.

Readers of this book will understand that a strategy that includes improving all relationships will improve all other measures as well. When you empower people, giving them the tools to take excellent care of themselves, one another, and the patients and families in their care; organizations thrive and patient-care is optimal.

Chapter Overview

  • Foreword: The Giver and the Receiver Are One
  • Overview: Advancing Relationship-Based Cultures
  • Chapter 1: A Relationship-Based Way of Being
  • Chapter 2: Attuning, Wondering, Following, and Holding as Self-Care
  • Chapter 3: Attunement as the Doorway to Human Connection
  • Chapter 4: The Voice of the Family
  • Chapter 5: Loving Leaders Advance Healing Cultures
  • Chapter 6: One Physician’s Perspective on the Value of Relationships
  • Chapter 7: Embedding Relational Competence
  • Chapter 8: The Role Human Resources in Advancing Culture
  • Chapter 9: Relationship-Based Teaming
  • Chapter 10: Care Delivery Design that Holds Patients and Families
  • Chapter 11: Evidence that Relationship-Based Cultures Improve Outcomes
  • Chapter 12: Relationship-Based Care and Magnet® Recognition
  • Epilogue: Continuing the Conversation
  • Appendix

Softcover, 344 pages. (2017)

ISBN: 978-1-886624-97-9

Speak to Groups of People?? Never! May 21, 2017

Posted by mariemanthey in Creative Health Care Management, Inspiration, Manthey Life Mosaic, Nursing Salons, Professional Practice.
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Honestly, that’s how I felt in the early years of my career! The thought of speaking publicly was a nightmare.

As a student, I made a choice between the two options for my Master’s Degree based partly on which one involved less public speaking!

I was sure that speaking to large groups of people was not and would never be necessary for me – it is not a part of Nursing – and it terrified me.

I was physically affected – I’m not exaggerating – every time I had to do it for some reason.

I had nausea, I had knock-knees, I had so much static in my head that I could hardly hear my own thoughts. Every time I did it I felt like I had failed miserably, and no matter what, I would never do it again.

However, life went a different way for me.

I was part of the team that created Primary Nursing, and other people wanted to know about that process. There were two ways to communicate about it – speaking and writing. Writing took forever! The two articles we wrote in 1970 just took a really long time to put together, edit, format, get references, all of that. Then we did another article in 1973 – again, it just took a really long time. I was Chief Nurse at first one hospital and then another, and my available time was just very limited – it was really hard to fit in time for writing.

Much as I hated speaking, it was a way to deliver the information that I wanted others to know, in real time, most efficiently.

So for those initial five years of talking about Primary Nursing, it was excruciating every time. Every time I had knock knees, nausea, static in my head, the physical costs were huge. I would actually feel sick to my stomach just looking at my calendar and seeing a speaking date written on it. But I just had to go out there and do it anyway, because the importance of the message demanded it.

For me, getting up and speaking was a much more effective way to get the word out, than writing. People were curious and I wanted to let them know about Primary Nursing and its benefits for the nurse-patient relationship.  The effect Primary Nursing had on the patient’s experience – that’s what was so important. My passion about that essence of Nursing just saw no boundaries.

So, I made myself learn how to do public speaking, even though for most of the first five years, nothing got better. It was just as horrible, just as debilitating, just as uncomfortable every time as it always had been, for years on end.

Years later, little by little, it started to get better. I began to get some sense of self-confidence about it, to the point where I was actually able to look at  a speaking date on the calendar and not get terrible anxiety about it.

After that, I began slowly to not only be comfortable speaking, but to enjoy it. I began to be able to take in the visual and auditory feedback of the crowd and use that information to fine-tune my delivery. I learned how to be present with my message, and also present with the people I was delivering the message to.

And for these decades since then, speaking has been a huge positive for me. It’s still all about getting the message out – about Relationship-Based Care and other ways to enhance the nurse-patient relationship – in the best way possible.

The power of conversation is really what it all comes back to. I am engaging in a one-way conversation when I speak to audiences. I very much want for the audience to engage as well though, always. That’s why I like to speak within a schedule that allows for break-out sessions. I want folks listening to me to be able to speak with and listen to each other and me as well, and to have their experiences also be part of what is shared.

Nursing salons are another extension of that important need to connect – to hear each other and share each others’ experience.

Conversations Change People, People Change the World! – Margaret Wheatley

 

Salons – Looking Back, Looking Forward May 19, 2017

Posted by mariemanthey in History, Inspiration, Leadership, Nursing Salons, Professional Practice.
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Alternate title: Salons – Then and Now

A Talk for All Times | Nursing Forum, October 2010

Salon conversations | Nursing NewsNurse.com | 2012

 

Nursing Salons were created to provide a safe opportunity for people from throughout the diverse practice of nursing to share their stories, hear from others, come to grips with the realities of their workplace, offer support, and regain the feeling of unity.

They caught on like wildfire, not only in the U.S. but around the world as well.

At the top of this post you’ll see some links to the birth of these Salons: my article in Nursing Forum Magazine from 2010, and a note from an early adopter in 2012.

It’s interesting to relive those initial ground-breaking moments, and review the origins of all that has come to be.

Looking forward, I hope Salons continue to spread into every community and are attended by members of  all health professions.  These conversations create ripple effects throughout the system.

Imagine if doctors and nurses and professionals from other health disciplines all over the country met together and had conversations like this. Margaret Wheatley tells us that conversations change people and people change the world.

We see this happening in ways large and small at Salons. The salon in my home yesterday evening was no exception.

My dream is that doctors and nurses and all clinicians begin meeting in homes all over the US and talk to each other about the work we do.   I KNOW the health care system would be impacted in a major way.   We would migrate health care forward, in big changes and small changes, in ways that can not be specifically predicted but can be expected with absolute certainty.

I hope that everyone is able to take part in this wonderful vehicle for self-care and enhanced professional practice. And I hope that together we continue to build the best future possible for the health of society.

Have any of you has been to a salon recently? How did it go? Are any of you still looking for one near you? Are any of you planning events and considering adding a salon before/after/during? It’s always great to hear from you!

Reading List:

Turning to One Another: Simple Conversations to Restore Hope to the Future (2002) Margaret Wheatley

Absence of RAA – Problems Universal May 16, 2017

Posted by mariemanthey in Inspiration, Leadership, Professional Practice.
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..Disparity in the balance between responsibility, authority and accountability at the personal, departmental and administrative levels of operations creates dysfunctional organizations and troubled human relationships.

Case Study Working Kitchen.docx

Case Study_Small Organization.docx

Nursing_More Work Than Time

Absence of RAA in the workplace leads to many problems and struggles that make it much harder to get the work done. Not only that, but the people involved are required to spend additional energy and internal resources just to continue on, all the while contributing much less to their groups’ effectiveness than would otherwise be the case.

Today we’re looking at some non-nursing examples, because RAA has universal applicability, and it can be easier to identify things when they are at a distance from one’s own situation.

At the top of this posting, you’ll see links to the case studies we’re referring to in this post. One describes a dysfunctional restaurant situation, the other a problematic instance in a small organization.

In both cases – symptoms are unhappy workers, managers on the defensive and not leading positively, and stressful work experiences.

The main issue is lack of clarity about the scope of responsibility.   When individuals don’t have clarity about the scope of their responsibility vis-a-vis mangers, etc., the workplace becomes dysfunctional.    Conversely, when the scope of responsibility allocation is clear, but commensurate authority is not delegated, the stressful workplace becomes dysfunctional.   And finally, when responsibility has been clearly allocated, but is not fully accepted by the individual, the workplace is stressful and becomes dysfunctional.   Responsibility Authority and Accountability need to be sequential and commensurate.   Any disparity or imbalance creates a stressful and dysfunctional workplace culture. When workers are given responsibility without authority and accountability, they are prevented from doing their useful best.

When managers are given authority but never held accountable, they do not have the opportunity to learn and grow.

Managers and staff perceive each other through their own filters, clouded by their own life experiences and expectations, and impacted by organizational and external forces outside the control of either of them.

Often people feel their situation is hopeless, and they just check out.

In these difficult times, it’s important for each of us to bring our best self forward in pursuit of our goals.  Success in one’s work life often results in the perception that one’s life is successful….and it is!    RAA and related concepts are useful in that process.

Acceptance of allocated responsibility is an important strategy because it results in actually experiencing the reality that we always have choices. We have small choices and a few big choices available to us pretty much continually, if we are honest.

The act of simply making a choice is powerful, even when the choice itself is small.

Like staff nurses who have more work to do than time available, everyone in the workplace needs to honestly assess to the best of their abilities and skills what most needs to be done, and then Own Those Choices. Letting go and trusting people to interact with us as needed in a healthy way about our choices (and their choices) frees up a wonderful amount of energy.

We can model the behavior we want to experience. We can manage our feelings from within the situation, look at it objectively, and assess the likelihood of it becoming something we  consider tolerable/optimal.

We can decide to stay in situations that we don’t like because of reasons that are valid – making even that choice is itself an improvement, and opens up other choices.

The suffering martyr/victim posture is limiting and destructive, and is never necessary or useful. By taking care of ourselves more, we’re also acting in the best interests of those around us (in the long term certainly).

We’d love to hear your stories of your struggles, journeys, lessons and useful insights!

 

 

Symposium Update! May 15, 2017

Posted by mariemanthey in Academia, Creative Health Care Management, Inspiration, Leadership, Professional Practice.
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5 Reasons to Attend the 2017 International Relationship-Based Care Symposium – June 20-22 – Minneapolis, Minnesota

The 2017 International Relationship-Based Care Symposium is only five weeks away! It will be an event filled with inspiration, practical action, healing and hope for the future. Need more reasons to attend? Check out the brochure here, and book your flight!

  • Like-minded People with Shared Commitment:Surround yourself with an international community of health care leaders who are transforming the way health care is provided. You will leave inspired and have a renewed commitment to achieve excellence in health care.
  • Dynamic Speakers: David Cooperrider will engage you in the synergistic process of Appreciative Inquiry to boldly envision and commit to a collective future for health care. You will discover more about compassionate partnerships and the art and science of healing relationships with Robin Youngson. Maestro Roger Nierenberg will place you in the middle of a professional orchestra for a multi-sensory experience in organizational dynamics.
  • Celebrate Outstanding Work in the Field:Honor colleagues and learn from stories of extraordinary innovation with the healthcare teams who discovered them. At the Symposium Poster Extravaganza, health care leaders from all over the world will share innovative strategies designed and implemented at their organizations to advance Relationship Based Care and Cultures of Excellence.
  • Interprofessional Continuing Education: We’re proud to be partnering with the University of Minnesota Interprofessional Continuing Education to offer contact hours for this event. The symposium will highlight the critical role of interprofessional relationships in the domains of safety, quality, and experience of health care.
  • YOU WON’T HAVE ANOTHER CHANCE UNTIL 2021! The symposium is only offered every 4 years. Don’t miss this opportunity. Participants from 2013 said, “The most powerful conference I have ever attended!” and “I came here this week with hopes of finding a way to break the barriers between MDs and RNs, and I’ve taken away with me so much more. This has not only been a career changing milestone but a personal stepping stone that I will never forget!”

Read more about the Symposium and register today at chcm.com/symposium. See you in Minneapolis!

Blast from the Past: Feisty Former Chicagoan (1978) May 13, 2017

Posted by mariemanthey in History, Inspiration, Leadership, Manthey Life Mosaic, Professional Practice, Values.
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Primary Nursing: Hospitals bring back Florence Nightingale

ChgoTrib_2.78_PageOne
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This article was one of the first in mainstream media about Primary Nursing, Marie Manthey .. and Florence Nightingale!

The picture on page 1 is so wonderful, isn’t it?

Here are some excerpts from the article, which you can see directly via the links at the top of this post.

“We’re not just dealing with inert lumps of flesh that hurt” Davis says. “We’re dealing with people’s emotional well-being, too. And that’s what makes nursing exciting again.”

Chicago Tribune: Sunday, February 2, 1978

by Joan Zyda

Sometime after World War II, the American registered nurse was forced into being less like Florence Nightingale and more like a factory foreman.

The shortage of nurses resulted in assembly-line nursing, which brought with it an assortment of nameless, often uncaring persons who trained for brief periods before being turned loose on patients. They were practical nurses, vocational nurses, technicians, orderlies, nurse’s aides, and nursing assistants.

If you’ve been in a hospital in the lst three decades, you have seen this production line in action. Somebody took your temperature, somebody else gave you a bath, somebody else took your blod pressure, somebody else brought in your food tray, somebody else …

Conducting this “orchestra” was, and still is, the chief duty of the registered nurse in most hospitals. Despite years of learning to care for sick people, she ends up in a supervisory job that takes her out of the mainstream of patient care. If she sees patients at all, it’s only briefly when she gives them a shot or a pill, or if there’s a “problem.”

“The patients are completely perplexed and often get irritable or depressed by this fragmented and impersonal care; it frights and frustrates the doctors; the morale of nurses sinks to an incredible low, resulting in a high turnover rate and absenteeism; and it has caused a decline in patient care at many hospitals,” says Dr. William Shaffrrath, diretor of the National Joint Practice Commission in Chicago.

The commission was set up in 1972 by the American Medical Association and the American Nurses Association to solve the growing dissatisfaction with hospital nursing care.

Teh solution, with which the commission has been shaking the pillars of medicine, is to put the registered nurse back at the patient’s bedside, where she can use her training. Some hospitals have already done this, including Rush-Presbyterian-St. Luke’s Medical Center, University of Chicago Hospitals, Good Samaritan Hospital in Downers Grove, and Evanston Hospital.

“Most nurses we talked to are frustrated. They don’t want to be supervisors,” Schaffrath says. “They prefer hands-on nursing in the Florence Nightingale tradition. They want to walk cot to cot, tending to and cheering on the patients.”

Schaffrath credits Marie Manthey, 42, a fiesty former Chicagoan and now vice president of patient services at Yale-New Haven Hospital in Connecticut, for blowing the whistle on nursing. She has advocated for the “return to the bedside” alternative in articles in several prominent medical journals.

As a registered nurse for 22 years, Manthey has had an inside look at the failings of her profession.

“Registered nurses have become faceless people, and it’s the system’s fault,” she says. “Nursing has become extremely production-oriented with very little concern for human needs. Most nurses are embarrassed about that. They say, almost apologetically, ‘Well, I’m just a staff nurse,’ which equates to, ‘I’m just a housewife.’

“But if nurses got their identity back,” Manthey says, “they’d be a proud people again. Then they’d be saying, ‘Hey, wait a minute. I am a staff nurse. I am an important person.”

“Nurses are supposed to be in the thick of things,” Manthey says firmly.

Manthey has coined her remedy, “Primary Nursing” a system whose main goal is just that — to get the nurse to provide total nursing care to a patient during their hospitalization. That means the same nurse does all the work for a patient from admission to discharge.

“The Nurse and the Patient get to know each other,” Manthey says.

With Primary Nursing, the nurse takes over many tasks she used to assign her aides.. because they’re all relevant to patient care.”

/ end content on front page of article, clip 1of2

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For further content from this article, see clipping number 2, and/or let us know if you’d like us to post further excerpts here.

Isn’t it amazing to look back and remember the days when Nursing was at that factory-process level??

What Would Nightingale Do? May 12, 2017

Posted by mariemanthey in History, Inspiration, Leadership.
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Happy birthday, Florence Nightingale!

Florence’s life and career continue to be an inspiration for Nursing as well as leaders in general. She was an extraordinary strategist who had powerful insights into organizational dynamics. Facing a challenge, she would assess the pockets of power, align herself with strong allies, and convince people that a solution to the problem would be found.

She was able to make tough choices, including letting some things go until they had to be fixed.

I’m reminded of the story of her arrival in Crimea. The British Military Surgeons refused to let her enter the hospital. They did not want to deal with a “do-gooder” … and a lady at that.

The fact that she arrived with a ship fully loaded with medical supplies, dressings, bedding, food, clothing, etc. gave her the leverage she needed.

She responded to their refusal to let her enter the hospital by refusing to allow the ship to be unloaded. For some days it sat in the harbor with desperately needed medicine, equipment and supplies — until finally surgeons changed their minds and invited her and her nurses to come work in the hospital. It seems clear to me that during those days the ship was in the harbor, there were patients who suffered because they didn’t have the food and medicine on the ship.

The lesson I take from this is that the strategy of letting a failing system fail might be better than the situation-by-situation “fixes” nurses engage in, which take them away from the patient.   Complex systems call for systems-based solutions.  Strategy is important.

We need the courage of Nightingale to focus our energy where it will be best used for patient care now, as she did back then.

RAA Series May 2017 Part II of III May 10, 2017

Posted by mariemanthey in Creative Health Care Management, Professional Practice.
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By Marie Manthey

When the design of nursing service delivery and function allocation is organized with integrity and balance between Responsibility, Authority and Accountability (RAA), the hospital workplace culture is efficient, quality of care is high and organizational trust is in place. That dynamic is similarly true in all other workplace environments.

Working theories and ideas and practices from general industry have been put to use in our work over the years creating Primary Nursing, Relationship-Based Care and leadership practices, now we will also be expressing these ideas in terms of nursing as well as other workplaces.

In using these concepts to design the organization of work, four questions need to be answered. They are:

Who has decision-making authority, and for what time frame?

Is work allocation basically by task/skill levels or whole function assignment?

How is communication handled?

How is the whole function managed?

These four elements ultimately govern how most work is assigned and performed.   The way they are defined has a profound impact on the experience of the workers and the quality of the work.   I was astonished during the formative years of Primary Nursing to see major changes in both performance level and personal growth of individuals when the organization of work changed! That’s all that changed: not the patients, not the doctors, not the staffing, not the hospital systems.   With the same staffing levels, the same level of knowledge and skill of the workers, the same amount of tenure and experience, the quality of work dramatically improved, the culture of the unit did a 180 change and all involved, patients, nursing staff, physicians and others commented on the extraordinary difference they experienced.

For me personally over many years, I have observed whole nursing staffs move from a state of dependency-framed entitlement-voiced victim thinkers, to a group of professionals able to assume their legitimate role as full participants in the collaborative management of patient care.   In order for that collaboration to be real, registered nurses need to be in the role of Primary Nurse where they fully experience the professional autonomy that their license affords them.

Implications for Teamwork

Throughout my years of experience with these concepts, one issue has become crystal clear:   The morale of the work group has a profound impact on the quality of the work.   Furthermore, I fully realize that morale is the result of the interpersonal relationships of the work group, the way the staff treats each other in the face of these every day realities of hospital work. Strong team work and healthy staff relationships create positive morale. These and other attributes of Relationship-Based Care are essential to optimal patient care delivery.

Healthy interpersonal relations require three behaviors.   These are:

Open communication

Functional trust and

Mutual respect

Interestingly, it seems that liking/loving your team mates is not at all essential to healthy team work.   In fact, it matters little, if at all.   What is absolutely vital however is for each member of a healthy work group to accept responsibility for managing relationships using these behaviors.

Open Communication

Of the three, the most challenging is open communication.   It has been my experience, that difficult conversations are often avoided.   In highly stressful situations, this is even truer.   I have found that more often than not, the culprit is inadequate communication skills.   Most of us simply don’t know how to say hard things tactfully.   And the effort to learn that skill is often at the lowest point of a busy person’s priority list.

It is incumbent on everyone to find ways to deal directly with one another about difficult issues tactfully, and for others to learn how to not accept one workers complaint about another, unless it is to help the complainer figure out how to deal directly with the issue.

Functional Trust

In the sense used here, trust means trusting one another to do the work assigned in the right way.   This impacts interpersonal relations in many ways, as well as the effective utilization of the resource of support workers.

It is the person who mistrusts that has the biggest impact on team functioning and therefore it is incumbent on that person to identify and openly communicate to the mistrusted person what they need to do to regain trust.

Mutual Respect

This element is also absolutely key to healthy team work, and requires moving beyond role valuation when that valuation creates dysfunction.

It is vital that each member of the team be recognized as having equal potential for improving or destroying morale, and for contributing to their teams effectiveness.

Are these elements in place where you work now? What has your experience been, currently or at prior work places?

Questions or Comments? Join the conversation!

Part III of this particular mini-series on RAA is coming soon!