Leadership, by the book: the Army Manual book July 10, 2017
Posted by mariemanthey in Leadership, Professional Practice, Values.Tags: Decision-Making, Empathy, Florence Nightingale, Health Care System, Mindfulness, Nurse Managers, Trust
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Re: U.S. Army's Army Field Manual 6_22 on Leader Development i.t.o. psychological & psychiatric criteria for leadership.
This content is written by Prudence L. Gourguechon, widely known national expert on psychoanalysis for the fields of business, law, politics and marketing.
“Despite the thousands of articles and books written on leadership, primarily in the business arena, I have found only one source where the capacities necessary for strategic leadership are clearly and comprehensively laid out: the U.S. Army’s “Field Manual 6-22 Leader Development.”
“The Army’s field manual on leadership is an extraordinarily sophisticated document, founded in sound psychological research and psychiatric theory, as well as military practice. It articulates the core faculties that officers, including commanders, need in order to fulfill their jobs. From the manual’s 135 dense pages, I have distilled five crucial qualities:
Trust
“According to the Army, trust is fundamental to the functioning of a team or alliance in any setting: “Leaders shape the ethical climate of their organization while developing the trust and relationships that enable proper leadership.” A leader who is deficient in the capacity for trust makes little effort to support others, may be isolated and aloof, may be apathetic about discrimination, allows distrustful behaviors to persist among team members, makes unrealistic promises and focuses on self-promotion.
Discipline and self-control
“The manual requires that a leader demonstrate control over his behavior and align his behavior with core Army values: “Loyalty, duty, respect, selfless service, honor, integrity, and personal courage.” The disciplined leader does not have emotional outbursts or act impulsively, and he maintains composure in stressful or adverse situations. Without discipline and self-control, a leader may not be able to resist temptation, to stay focused despite distractions, to avoid impulsive action or to think before jumping to a conclusion. The leader who fails to demonstrate discipline reacts “viscerally or angrily when receiving bad news or conflicting information,” and he “allows personal emotions to drive decisions or guide responses to emotionally charged situations.”
“In psychiatry, we talk about “filters” — neurologic braking systems that enable us to appropriately inhibit our speech and actions even when disturbing thoughts or powerful emotions are present. Discipline and self-control require that an individual has a robust working filter, so that he doesn’t say or do everything that comes to mind.
Judgment and critical thinking
“These are complex, high-level mental functions that include the abilities to discriminate, assess, plan, decide, anticipate, prioritize and compare. A leader with the capacity for critical thinking “seeks to obtain the most thorough and accurate understanding possible,” the manual says, and he anticipates “first, second and third consequences of multiple courses of action.” A leader deficient in judgment and strategic thinking demonstrates rigid and inflexible thinking.
Self-awareness
“Self-awareness requires the capacity to reflect and an interest in doing so. “Self-aware leaders know themselves, including their traits, feelings, and behaviors,” the manual says. “They employ self-understanding and recognize their effect on others.” When a leader lacks self-awareness, the manual notes, he “unfairly blames subordinates when failures are experienced” and “rejects or lacks interest in feedback.”
Empathy
“Perhaps surprisingly, the field manual repeatedly stresses the importance of empathy as an essential attribute for Army leadership. A good leader “demonstrates an understanding of another person’s point of view” and “identifies with others’ feelings and emotions.” The manual’s description of inadequacy in this area: “Shows a lack of concern for others’ emotional distress” and “displays an inability to take another’s perspective.””
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From an intraprofessional leadership perspective, this is a universal summary of essential leadership skills from a valid source. Going back to Florence Nightingale, great leaders when matched to this set of criteria have great capacity to be powerful leaders who truly make a difference. Hospital origins were deeply linked to the military mindset of regimentation, discipline, following the chain of command, and maintaining discipline. Sometimes in ways that de-humanized patient care.
This value-based list of leadership skills represents an exciting awareness important values that can greatly improve performance and promote better engagement.
My own learning during the early development of Primary Nursing included an invaluable gift from ‘military literature’. I don’t remember the exact document or book, but I know the conceptual paradigm of Responsibility Authority and Accountability came directly from a description of a military ‘chain of command’ writing. We were not using words like that in nursing during PN’s early development.
Every sector has a contribution to make to the collective well-being!
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References:
http://www.latimes.com/opinion/op-ed/la-oe-gourguechon-25th-amendment-leadership-mental-capacities-checklist-20170616-story.html
Role of Nurse Manager: Needs Support to be Supportive June 13, 2017
Posted by mariemanthey in Creative Health Care Management, Leadership, Professional Practice, Uncategorized.Tags: CHCM, Decision-Making, Empathy, Health Care System, Hospitals, Nurse Managers, Primary Nursing, RAA, Relationships, Staff Nurses, Trust
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I’m reminded frequently about how strongly a leader’s influence drives the quality of work done…on nursing units and in every workplace. The clarity of role definitions in the workplace – and in particular how the role of the leader is defined – is essential to effective leadership.
Leadership is often confused with limitless power. Unclear scopes of responsibility for leaders and others creates confusion, unsatisfactory outcomes and personal stress among workers which in most cases results in bad outcomes. This seemingly simple element is often the culprit of toxic work environments.
Leaders Empower Staff – that is the name of a basic curriculum component of CHCM’s work, and it’s also a phrase which sums up much of our leadership philosophy and seminar focus.
We believe that the people who do the work should be empowered to make decisions about the work, and good leaders actively support that by intentionally putting that power in the hands of their staff.
There are many specific skills and practices that need to be in place for the leader to do that and to support that structure. One of our accompanying basic beliefs is this: nobody walks in to a leadership role with everything already in place to be successful. Each new leader will have some parts of the skills set, and they’ll need to gain the rest on the job.
Each time a new leader is hired, there needs to be a systemic process of determining what they need to be successful in that role, and to provide the training, support, skills development, mentoring, etc.. necessary in order for them to grow in to that role.
Otherwise, insecure, ill-prepared leaders may assume that empowered staff are a threat to their authority and therefore to their success. These leaders …at all levels in a hierarchy…..will hold on to power to feel secure. Staff then are hindered from contributing at their highest level, restrained from using their actual knowledge and skill, and devalued within the workplace. Morale is negatively affected.
Staff need to be developed professionally so that they are confident and comfortable using their legitimate power. Within their scope of responsibility, they need to learn how to identify operational problems, to generate solutions, to implement the solutions. This level of employee engagement is a dream scene for most executives.
Both staff and leadership need to accept the fact that as humans, they’ll make mistakes, and that those mistakes are to be treated as opportunities for growth, not punishment. Integral to that is for leadership to actually react that way to mistakes!
Leaders do constantly need to bring their best selves to the job, to actively create for themselves a goal behavior pattern based on best leadership practices, and do their best to live up to those goals.
Accountability is crucial.
In some workplaces – within healthcare and outside of it – the accountability of leaders is sometimes problematic. It is easy for leaders to obfuscate personnel problems, particularly if they don’t know how to or don’t want to deal with them.. The obfuscation may show up as being able to provide assurance to those they report to that staff are fine, operations are fine, progress towards goals is happening, the ship is tip-top. They may not share sufficient detail about problem employees, hence obfuscating their own responsibility to act, resulting in avoiding personal accountability as leaders. A great deal of the angst, stress and toxicity in workplaces today is due to inadequately prepared leaders who are not held accountable for learning the basic skills necessary to create a culture of safety and empowerment.
Our values, principles and practices of Creative Health Care Management focus on changing workplace cultures so that all members of the team (starting with the leader) have the support they need to produce efficient and effective productivity. The clear allocation of responsibility coupled with the delegation of commensurate authority and accountability are the key components to leadership and management success in every workplace.
The Nurse Managers who gain these leadership skills are the MOST essential element to creating a relationship-based environment that is healing for both the staff who work there and the patients who receive care there.
Nursing: More Work to do than Time Available June 6, 2017
Posted by mariemanthey in Leadership, Professional Practice.Tags: Decision-Making, Escape Victim Mindset, Hospitals, Mindfulness, Reflective Process, Self-Care, Staff Nurses
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Nursing staffs often face unpredictable peaks in workload. These peaks can occur at any time and maybe be caused by any of a number of factors: unexpected admissions, sudden changes in patients’ acuity levels, or true life-or-death emergency situations.
These peaks are sudden, stressful, and highly charged emotional events.
As workload escalates, experienced staff members begin prioritizing and scanning: scanning the care environment, selecting the next most important thing to do, and doing it.
This triage process may go on for minutes or hours, is informed by high-level critical thinking, and results in patients receiving safe and adequate care but not receiving every item of ordered or desired care.
Those non-delivered care items are not consciously omitted, nor are they forgotten. In fact, they lie waiting in the nurse’s professional- thinking brain space until the stress is over, the documentation is done and they have left for the day. On the way home, these ‘undone’ activities float to the surface and cause feelings of guilt, failure and anger – anger because the quality of care delivered didn’t meet the nurse’s own standard for care.
I believe that the treatment for this situation is to acknowledge explicitly throughout the profession and throughout the health care system that, as professionals, nurses have the right and the responsibility to determine what to do and what not to do when there is more work to do than time available. And when questioned, nurses need to be able explain their rationale for the decisions that were made.
Common sense requires recognition of this reality.
Recognition and understanding of heretofore ‘hidden truths’ about nursing work can lead to much more productive research and practices, and can help dispel legacy myths about nursing practice…that we always give total patient care. That leads us right into the dysfunctional mind set of fear and guilt about staffing that now is all too often present in the life of a staff nurse.
More about ‘hidden truths’ relation to nurse resources and nurse workload in another posting.
Discipline without Punishment (Poll!) May 30, 2017
Posted by mariemanthey in Creative Health Care Management, Leadership, Professional Practice.Tags: CHCM, Decision-Making, Escape Victim Mindset, Health Care System, Hospitals, Nurse Managers, RAA, Relationship-Based Care
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A crucial component of the Responsibility/Authority/Accountability paradigm is accountability, which means looking at results and determining what lessons can be learned, what needed behavior changes can be identified, what course corrections can be made.
Sometimes there is a need for the manager to address a staff nurse’s behavior directly, and the best way to do that is via positive discipline, which never includes punishment. The derivation of the word punishment is penalty, while the deviation of the word discipline is learning. We need a shift to discipline and away from punishment.
Punishment for mistake making and behavior problems is punitive when it incudes the intention of making the person feel shame or guilt. Guilt as a behavior modification tool seems to be coming back in to popularity again, and that is truly mind-boggling. And it is punitive.
I’d like to hear about your experience! Please join the conversation by participating in these two polls, and/or commenting.
Readers, please share examples of experiences when punishment (suspension, shame or guilt) was the goal; in contrast to times when discipline (learning) was the goal.
Absence of RAA – Problems Universal May 16, 2017
Posted by mariemanthey in Inspiration, Leadership, Professional Practice.Tags: Decision-Making, Escape Victim Mindset, Mindfulness, Nurse Managers, RAA, Reflective Process, Relationships, Self-Care, Staff Nurses
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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!
It’s About Safety…..not maintaining ‘margin’ July 14, 2013
Posted by mariemanthey in Leadership, Professional Practice, Thought for today.Tags: Decision-Making, Health Care System
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Good crew supervisors do not focus on safety (what?) but rather on good supervision, crew cohesion, and work ethics. Safety is the result. Supervisors who constantly talk about safety have more accidents than those who focus on working relationships. ….safety has to be built into the system and is a byproduct of deeper personal and organizational commitments.
These comments are from an article re. safety for forest firemen. The current healthcare system obsession with bureaucratic mechanisms to ensure patient safety are adding complexity and chaos to an already chaotic system…..thereby actually increasing the incidence of errors. We need to use good supervision (not fear-based control), healthy staff teamwork and strong work ethics in health care just as they do with their firefighting crews.
Nursing Salon on Jan 17, 2008 January 21, 2008
Posted by mariemanthey in Nursing Salons, Values.Tags: Decision-Making, Health Care System, My Salon Updates, New Salons, Nurse-Patient Relationship, People, Reading List, Relationships
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The group at this Salon was another interesting mixture of different ages: from a couple of student nurses, to several new as well as senior Staff Nurses, Nurse Managers, an Educator, a retired Physician and a couple of Clinical Nurse Specialists.
The discussion eventually focused on pressures created by the health care system and the relationship issues present in current practice settings. Systems and Relationships.
As usual, the electronic medical/health record was front and center, but not only the usual age-related differences in use and perception. This discussion also focused on how electronic records are changing the thought processes nurses use. A very experienced NICU staff nurse mentioned the reality that critical thinking also refers to decisions about what not to do, which is equally as important as the decisions about what to do. However, the structure of the EMR requires those decisions to be revisited in order to complete documentation.
That comment just opened the door to more discussion about the control over practice thinking that is mandated by the EMR. An experienced Delivery Room nurse commented about the problem of trying to put in q2min. vitals during a critical episode (not having learned typing), while another commented on the ease of her system that automatically inputs physiological data from another computer system. Both realities impact the nurses’ thinking.
And of course, this whole discussion was framed around the issue of relationships: nurse/patient, physician/nurse and nurse/nurse. We talked about how important is is for students to learn, while in school, to manage themselves in these highly stressful situations. It also became clear that if that skill is not learned in school, it must be learned in the workplace. The key to healthy relationships is the ability to manage oneself.
At the end of the evening, comments reflected the belief that the human contact between patient and nurse is the eternal and important truth about nursing and that there is hope it will always remain at the core of our practice.
Here are a couple of follow-up emails I received.
Marie,Thank you for allowing me to attend your last Salon with my preceptor, Michael P! I had a wonderful time. You are an excellent cook and an engaging conversationalist!
I am in the process of writing a paper about the CNS impacting organizational culture. While researching, I came across a paper written by Lorraine Hardingham, a nurse clinical ethicist, who defends her position that “as human beings, we are essentially interrelated, and therefore, both personal and professional integrity, rightly understood, is relational in nature.” It seemed to fit with that night’s themes of Systems and Relationships. I attached the article if you are interested.
You mentioned that you’d be willing to send files on how to start a Salon. I hope to finish the CNS program in May and pass the certification exams. Then, I would love to start a group here in the Fargo-Moorhead area. Please send your information when it is convenient for you.
Again, thank you for a memorable time of connecting at your home.
With deep regard, Patrick S.
And from Deb M:
Again, another stimulating evening Marie. I come home all revved up and unable to sleep with thoughts racing through my brain. Thank you so much for these incredible forums! I am able to feed my body and my soul and I thank you
Building Professionalism: Trust and Risk Taking August 14, 2006
Posted by manthey in Creative Health Care Management, Leadership, Professional Practice.Tags: CHCM, Decision-Making, Trust
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M. B., a nurse from Alberta emailed me with some comments about professionalism:
I highly value the principles of professionalism but find in some workplaces and amongst some nursing colleagues that this has varying connotations and meanings. I have put this question to various professionals in health care and some exclaim that it does not truly exist. The more I search I have come to realize that professionalism in an institution is largely dependent on leadership’s belief and value of professionalism.
The extent of the leadership’s belief is reflected in how professionalism is exercised and maintained in culture of that work environment. If this belief is low, then any kind of behavior is acceptable in that work environment. If it is high, then that the culture will be of mutual respect and high trust. This indeed would be the ideal workplace but I am afraid I have been exposed to both in my life time career, thus far. The first is “hell”, the second is “heaven”.
I was very confused about the meaning of “professionalism” for a long time as well. Then I was taught about the definition used by sociologists, particularly the professionals use of autonomous decision making. I think our lack of clarity about what decisions we can rightly make (despite the clarity of language in the license) leads to the ambiguity that exists at all levels
So, first of all, there is the matter of professional practice. And then the matter of professional behavior. I find it useful to concentrate on the first: professional practice. This is where, as my friend from Alberta notes, leadership is critical. If the CEO, COO, CNO, CFO — the top leaders of the hospital — do not accept the notion that nursing is a profession with decision-making authority, they will not trust nurses.
This lack of trust creates a workplace environment that is antithetical to the normal risk-taking of decision-making. This lack of trust in employees sets up structures and behaviors that result in negative interpersonal relations. Nevertheless, I have seen many examples of creative and courageous leaders (below the level of the “Os”) who have been able to create healthy unit or departmental level cultures in spite of a lack of support from the highest level.
I know these statements are a simplification of highly complex factors, but trust is one of the major reasons some hospitals are heaven for employees, while others are hell. Couldn’t agree more. Like many of us, M. B. is looking for ways to build up professional nursing:
I am looking for more tools, any works that are currently out there to share with others to move nursing in this direction.
Creative Health Care Management has some 3-day programs that can transform nurses and their practice. One is called Leading an Empowered Organization and is for unit and departmental leaders and managers. The other two are Leadership at the Point of Care and Reigniting the Spirit of Caring, both for clinical care-givers. All three are set up so we can ‘train-the trainers’ and license the programs for use by associations, large systems, and individual hospitals
M. B. speaks for so many of us when she ends with:
I believe nursing is an honored and privileged profession/family to belong to.
Marie Manthey's Nursing Salon 