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EVERYBODY, SOMEBODY, ANYBODY, AND NOBODY July 24, 2017

Posted by mariemanthey in Leadership.
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As you know if you follow this blog, we take RAA – Responsibility, Authority and Accountability – very seriously.   We feel that that paradigm has the power to create healthy workplaces, excellent health care and healthy nurses, doctors, and staff.  Anywhere. These discussions are serious, practical, conceptual, and (we hope) useful.

Variety being the spice of life, today’s entry into the conversation is provocatively different. Today we provide to you a highly-scientific, term-by-term description (or not) of what it’s like when RAA is not in place. Anywhere. Well ok, not that scientific or academic – but highly accurate nonetheless!    Think of how often in your personal and private lives you have experienced this exact dynamic!

In this world, there are four kinds of people: EVERYBODY, SOMEBODY, ANYBODY AND NOBODY.

There was an important job to be done and EVERYBODY was asked to do it. EVERYBODY was sure that SOMEBODY would do it. ANYBODY could have done it but NOBODY did.

SOMEBODY got angry about it because it was EVERYBODY’S job. EVERYBODY thought that SOMEBODY would do it, but NOBODY realized it wouldn’t get done by ANYBODY.

It ended up that the job didn’t get done, but EVERYBODY accused SOMEBODY and NOBODY accepted responsibility.

Moral: EVERYBODY’S job is ANYBODY’S. NOBODY can be SOMEBODY unless he’s willing to do ANYBODY’S work.

How about you? All EVERYBODYs, NOBODYs, ANYBODYs, and SOMEBODYs  welcome – tell us your story.

Leadership, by the book: the Army Manual book July 10, 2017

Posted by mariemanthey in Leadership, Professional Practice, Values.
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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.””

===========================

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

From: Longfellow To: Nightingale July 4, 2017

Posted by mariemanthey in History, Inspiration.
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Santa Filomena

Poem by Henry Wadsworth Longfellow

Whene’er a noble deed is wrought,
Whene’er is spoken a noble thought,
Our hearts, in glad surprise,
To higher levels rise.

The tidal wave of deeper souls
Into our inmost being rolls,
And lifts us unawares
Out of all meaner cares.

Honor to those whose words or deeds
Thus help us in our daily needs,
And by their overflow
Raise us from what is low!

Thus thought I, as by night I read
Of the great army of the dead,
The trenches cold and damp,
The starved and frozen camp,–

The wounded from the battle-plain,
In dreary hospitals of pain,
The cheerless corridors,
The cold and stony floors.

Lo! in that house of misery
A lady with a lamp I see
Pass through the glimmering gloom,
And flit from room to room.

And slow, as in a dream of bliss,
The speechless sufferer turns to kiss
Her shadow, as it falls
Upon the darkening walls.

As if a door in heaven should be
Opened and then closed suddenly,
The vision came and went,
The light shone and was spent.

On England’s annals, through the long
Hereafter of her speech and song,
That light its rays shall cast
From portals of the past.

A Lady with a Lamp shall stand
In the great history of the land,
A noble type of good,
Heroic womanhood.

Nor even shall be wanting here
The palm, the lily, and the spear,
The symbols that of yore
Saint Filomena bore.

Meeting Challenges – Ripple Effects July 3, 2017

Posted by mariemanthey in History, Inspiration, Leadership, Professional Practice, Values.
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Nursing through a lens of history.

As we celebrate the victory in battle that lead to the signing of the Declaration of Independence this weekend, my thoughts are on how often nursing is spotlighted and impacted during wartime.  A cataclysmic example of this is the lasting affect  of Florence Nightingale’s work during the battle of Crimea.

That situation was a terrible one, full of despair and unpredictability.  Florence went voluntarily into that mess  because of how desperate it was, and acted on her values, knowledge and skills to change that reality. The depth of the damage to soldiers and the impact of her reforms  set in motion a profound  reaction, which in this instance included seeds of change vastly greater in scope than that particular problem.   The death rate among hospitalized soldiers was amazingly reduced due to her reforms, and the whole country of England honored her for this achievement.

In particular, she provided compassion, and she managed the environment to a degree of sanitation that was new to that setting. The depth and cohesion of her response to that situation was beyond what anyone expected.  No one involved in that war would have  predicted or imagined that the outcome of that war would be the modern practice of nursing.

When people engage in the struggle to do their best in difficult times, positive outcomes are more likely.. not only in that moment, but decades and centuries later.

Reading List – Treasures! June 30, 2017

Posted by mariemanthey in History, Inspiration, Leadership, Professional Practice, Values.
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Here are some books I’ve enjoyed and gained a great deal of insight and resources from. I’d love to hear your thoughts on these and your favorites as well!

The Power of Now by Eckhardt Tolle — I learned the incredible value of learning how to observe my thinking…..thus creating the opportunity to grasp a powerful truth.   That I am more than my thinking.   I am a whole being and by stepping away from my thinking I learn that my thoughts do not define who I am.    My being is more than my thoughts.   That awareness shifts my perspective on life.. Fascinating and exhilarating!

Small Great Things by Jodi Picoult – an ambitious tackling of the racial issues of our time, through the setting of nursing.   A highly experienced black nurse is forbidden by her nurse manager from taking care of the baby of a white supremacist couple….at their insistence.   The story from there presents a dilemma for the black nurse that results in a life-changing lawsuit.

Blessed Unrest by Paul Hawken (2007) – the world is undergoing transformational  changes of people, on a  small scale – in conversational salons and discussion groups, between neighbors and friends. These group conversations are about serious topics like spirituality and the role of governments.   And he makes the point that conversations can change people and people change the world.

The Immortal Life of Henrietta Lacks  by Rebecca Skloot incredible (true) story of medical ethics involving HeLa – two dime-sized tissue samples taken from Henrietta. The cells possessed unusual qualities and yielded amazing benefits for science; the effects for Henrietta and her family were.. less. Bioethics, racial injustice, and history co-exist in this story which starts in Baltimore, involves the Tuskegee Institute, and spreads benefits globally (for specific groups and humanity in general). Talk about health care disparity – really incredible. Recognition, Justice and Healing – hopefully this book brings us a step closer to these goals.  The film, staring Oprah Winfrey, premiered on HBO this past April and will be on DVD soon!

Role of Nurse Manager: Needs Support to be Supportive June 13, 2017

Posted by mariemanthey in Creative Health Care Management, Leadership, Professional Practice, Uncategorized.
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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.

Personally… Being Mortal by Atul Gawande June 11, 2017

Posted by mariemanthey in Inspiration, Manthey Life Mosaic, Professional Practice.
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I lost a close friend recently, after a long struggle with some chronic medical conditions.

It’s a sad period, but one comfort is that his last days went as well as they possibly could. I’m reminded of this book: Being Mortal, written by practicing surgeon Atul Gawande.

In the book Atul explores what it means to ensure that the positive meanings of one’s life extend through the final phases of that life, clinically and in all other ways. Atul has completely defeated the normative medical profession’s reluctance to address that period after medicine stops being applicable. He explores what continues to be important for the person themself and their family.

I found it extremely moving and useful – not just for that period but for everyday. Highly recommend!

Additional Resources:

NY Times Book Review

Frontline: PBS Special

Pennsylvania Library Book Discussion Notes

The Guardian Book Review

Silo’s to Synergy: Symposium of Empowerment June 7, 2017

Posted by mariemanthey in Creative Health Care Management, Inspiration, Leadership, Professional Practice.
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In my career as change leader, I have constantly paid attention to what worked – and done more of that.

I’ve paid attention to what didn’t work – and tried to avoid that in the future.

A tactic for change that I’ve long been aware of is reaching outside the bounds of one’s own work area, and making connections with people who do different kinds of work. Finding common values and shared tactics with those people whose work is different from mine. Learning from their perspective on these shared values has been invaluable.

Oftentimes people in other areas have already invented this or that wheel, that I can use to get where I’m going faster (without having to invent it myself).

Much of the literature I’ve absorbed and learned from is written for a non-nursing audience – it was written for general business usually. Or sometimes was from other areas of the health care industry.

By reaching across the distance and making connections with others who share our goals, the work we can achieve together increases exponentially.

The CHCM International Relationship-Based Care Symposium will be that process, an accredited program curated specifically for leaders who want to achieve all they can in their careers.

We hope all of you attend who are able, and for those of you who can’t we will make available the materials and information as possible. It won’t be sufficient to create the experience and the relationships gained by attending, but we’d like to expand the positive outcomes in all ways possible!

Stay tuned, and if you have been able to see your way clear to attend just recently – it’s not too late to sign up!

Discipline without Punishment (Poll!) May 30, 2017

Posted by mariemanthey in Creative Health Care Management, Leadership, Professional Practice.
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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.

Memorial Day Remembrance: Nurses Serving! May 29, 2017

Posted by mariemanthey in Academia, History, Inspiration, Leadership, Professional Practice.
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Wartime nursing is unique, but also those periods in history tend to have an outsize effect on peacetime nursing as well. During World War II for example, huge changes took place. No one wants war, but we can honor those who served. I personally find this period fascinating, and with my work with the Heritage committee at the University of Minnesota School of Nursing’s Alumni Society, have been able to delve into it with great delight. Here are a few notes on some of what took place then, creating our present moment today.

As of 1943 the US Public Health Service had already funneled $ 5.7 m into nursing education, to stem the inevitable shortage of nurses, even as they knew that amount would be insufficient.

So Frances Payne Bolton, US Rep from Ohio, set in motion the Cadet Nurse Corps which was signed in to law that year. Under that program $150m was dispersed for scholarships and direct stipends – uniformly across the country, without regard for race and ethnicity, to all nursing schools.

Not only did this result in a massive surge of paramilitary recruits (targets were met every year), but nursing schools themselves radically transformed. The program was terminated in 1948, but by then 124,000 women had been enrolled, and nursing schools – especially those serving non-white populations – took huge steps forward in the condition of their facilities and equipment.

Here in Minnesota,  Katherine J. Densford, Director of Nursing at the U of Minnesota, was another leader active during that period, serving as president of the American Nurses Association among other positions.  She worked closely with Payne Bolton and Roosevelt to help supply nurses to the front lines – the University of Minnesota School of Nursing educated 10% of all US Cadet nurses educated during that period.

Densford also determined that the lag time between when nurses completed the recruitment application and when they were actually inducted actually took 6-8 months initially. She spear-headed efforts to reduce the bureaucratic tangle and as a result that lag time was reduced down to only 4-6 weeks!

A much needed -addition to the  Powell Hall nurses dormitory was built at the University of Minnesota with  Cadet Funds, and this is where I had my office while Primary Nursing was being created.

Another tidbit I wanted to share: May 1944, the national induction ceremony was held in DC, and it was for all nurses being inducted around the country, and so it was broadcast nationally on the radio.   KSTP carried in the Twin Cities. Thousands of nurses attended the induction  in Minnesota at the Northrop auditorium. The program included a song composed for the occasion, sung by Bing Crosby.

The ‘snappy’ nurse cadet uniform was actually created by Edith Heard – a famous Hollywood costume designer.  Wearing this uniform gave Cadet nurses the same ‘perks’ given to military men and women….like free admission to movies!

This bold initiative was a vital part of the war effort, serving both the military and civilian hospital needs.   This memorial day is a good time to remember the dedicated nurses who saved the lives of soldiers on the battle field.

 

Additional resources:

U of MN School of Nursing History

Leadership at the U of MN School of Nursing

Smithsonian website for the National Museum of American History, Kenneth E. Behring Center: