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

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


“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 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.”


“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!




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!

Celebrating books: ‘Should’ – taking back your power over words [to post whenever too busy for notes!] June 23, 2017

Posted by mariemanthey in Creative Health Care Management, Inspiration, Leadership, Professional Practice.
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In the midst of all the Symposium goings-on, we wanted to take a minute and celebrate the work of one of our CHCM staff member, Rebecca Smith. At CHCM she is involved in all the writing activities of the company, and also consults in the area of human communication/relationships.

Creative Health Care Management last year re-issued Rebecca’s book: ‘Should: How Habits of Language Shape Our Lives‘, due to its very useful applicability to the health care environment.

In ‘Should’, Rebecca explores the power of language at a psychological level – the power it has to hold us back or to move us forward. It is another non-silo work, applicable to everyone in every part of their life. Including, of course, nurses.

I had the privilege of providing the foreward for the 2016 edition and here’s an excerpt from that:

‘The culture of nursing is replete with all forms of oppression, but I have always thought that the most insidious among them is self-oppression, often referred to as victim mentality. There is no question that our work is hard or that there is, and will always be, more work to do than time or resources to do it. In fact, it is no mystery why people in all disciplines within health care might slip into feeling victimized or oppressed.

But that doesn’t mean self-oppression and victim mentality are the only choices available to us.

Self-empowerment — the opposite of self-oppression — is possible for all people in all circumstances (remember how self-empowered Nelson Mandela became during his time in prison!), and just as the name implies, it happens from the inside out. It happens because of the decisions we make to empower ourselves, and one of the most direct routes to doing so comes through noticing and changing the language we use to describe our lives. If our language is full of references to our own powerlessness, what kinds of stories do we end up telling ourselves about who we are, what we do, and how much we matter?

Part conceptual, part workbook, this work is full of concrete, applicable ideas. If you’ve already read Rebecca’s book, we’d love to hear about your experiences with her ideas. Otherwise we strongly encourage you to pick up a copy for your self-empowerment library!


RAA Part III – Achieving Full Experience of Will Power June 15, 2017

Posted by mariemanthey in Creative Health Care Management, Manthey Life Mosaic.
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This is part III of an initial series of articles about RAA. Here are links to the previous parts:

RAA Part I



After 10 years of experience applying these ideas to professional roles and organizational structures, I began thinking about them in relation to my own life.

By this time one thing I knew for sure was that when nurses accepted responsibility for the Primary Nursing (PN) role, they experienced empowerment and manifested less victim behavior than before…..and much less than those who’s did not accept responsibility.

I also knew for sure that accepting responsibility was an experiential activity……not an intellectual activity.   You can’t just think you are responsible….you have to experience it, to literally place yourself in the position of being responsible, in order to have full access to legitimate authority.

In PN, this only seemed to occur when the nurse established a responsibility relationship with the patient.   The explicit establishment of that relationship was necessary in order for the nurse to experience responsibility acceptance. The closed door of power (personal or other) only opens when an individual experientially recognizes their responsibility.

So, my epiphany moment occurred when I asked myself the question of whether or not I had accepted responsibility for my life.

I immediately remembered with resentment areas of my life where I felt victimized.   My ex-husband, a former boss….etc.   With great clarity I knew that if I had truly accepted responsibility for all aspects of my life, I would not feel victimized by past events. As this thought process evolved, I recognized that accepting responsibility for one’s own life involves the three major components of behavior: thinking, feeling and acting.

So, accepting responsibility for my thinking meant I had to develop new thought processes.  Often, my thinking fell into automatic pathways developed over the passage of life.   These pathways needed to be examined and in many cases changed, as they led directly to victim thinking.

The new thinking required the development of new neuron pathways, and then also lots of deliberate practice until consciousness of choice became my automatic thought process in response to situations and events in my life. This involved learning to make space in my reactions to events and people for the experience of choice.

Likewise, accepting responsibility for my feelings meant I had to learn some skills for handling feelings in an appropriate way which also often involved changing the way I think.   The connection between thinking and feeling began to be more manageable. Further, accepting responsibility for my actions helped me recognize the connection between thinking and acting and how action can positively influence thinking and feeling.

This overall development required me to develop new ways of being in my life, and the results have been increased positive energy, increased choices, and increased well-being.

Nursing: More Work to do than Time Available June 6, 2017

Posted by mariemanthey in Leadership, Professional Practice.
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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.

Belief: Health in Healthcare June 4, 2017

Posted by mariemanthey in Creative Health Care Management, Inspiration, Manthey Life Mosaic, Thought for today.
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From the notebook of Marie Manthey, 1982


CNM (CHCM now) believes that the relationship between mind and body is absolutely integrated and that the state of mind clearly influences the health of the body.

Management of health professionals, therefore, must consist of teaching this relationship as a management value and teaching managers how to manage their lives.

Basic principles of management should be taught at both the humanistic and scientific levels.

Advanced management training programs we developed promote the use of unique creative living approaches to solving complex organization problems.

Hospitals must be healthy so that the staff can help patients regain their health. The organizational diseases of disinterest, apathy, anger, isolationism,  generally negative interpersonal relationships and the illegitimate punitive use of power are manifestations of disease and can be treated by changing attitudes and perspectives and teaching basic truths of human existence and behavior.

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!



Gratitude breeds gratitude;discontent breeds discontent April 26, 2014

Posted by mariemanthey in Thought for today.
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Everyone is free every day to choose how they want to experience the day.   As Dr. Phil says, ….we get to choose to contaminate or contribute…..every single day.    Often, the stress and workload in bedside nursing and in most hospital managerial roles can obscure this truth.    It can seem like everyone else has more impact on our experience than we do.

However, we can opt to contribute by intentionally reflecting on  the aspects of our lives and work that we are grateful for…..and we can intentionally refuse to spread discontent  by not engaging in it….even when we are invited to do so by a colleague.

It is time for each of us to take back the power we have to manage our own lives.   Choices have consequences.    Let us be clear about that and aware daily that we own our life experience.

A Marie Manthey Master Dialog for Nurse Managers: What Does and Doesn’t Work in the Real World June 25, 2013

Posted by mariemanthey in Announcements, Creative Health Care Management, Leadership.
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Please join me for a day-long dialog on maintaining resiliency, intention, presence, and mindfulness while doing the toughest job in health care today. Along with reflection and dialog, the day will be rich in time-tested take-aways that can be applied to practice.

July 12, 2013
CHCM Office, Minnetonka, MN
Registration Form & Pricing Details

July 30, 2013
CHCM Office, Minnetonka, MN
Registration Form & Pricing Details

Marie Manthey’s Master Dialog for Nurse Managers is also available for onsite presentations. Call Creative Health Care Management at 800-728-7766 to schedule.

Good Sunday Morning November 15, 2009

Posted by mariemanthey in Academia, History, Leadership, Values.
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I had to cancel my salon last month due to a heavy travel period.  In six weeks I was in CA, MI, NY, Germany (10 days) and Ireland.  It was an interesting experience because in 90% of the work I was speaking about Primary Nursing and Leadership.  About the past and the future. About the present, and Being Present.  There is a tremendous hunger within nursing to re-member, to re-connect with the basic values of the nursing profession.  And the enormous challenge is the workload and complexity issues that nearly overwhelm nurses is some settings.

During this past year I have been seeped in history.  Both of nursing in general and in the history of the School of Nursing at the University of Minnesota where a centennial celebration took place last week. This school is the first on-going school of nursing to start in an academic institution anywhere in the world, as far as we can tell.  (Columbia TC started at a graduate level).

I have been studying the work of the instigator of this school, a physician named Richard Olding Beard. His writings clearly demonstrate why nurses need to be educated, not merely trained, as the title of one article attests: “The Educated Spirit of the Nurse”.

So last week was the culmination of a very busy two months for me and I am now getting back to semi-retirement, whatever that means.

One more thing: the Centennial Gala was the time of an announcement about the establishment of the Marie Manthey Professorship for innovative practices.  If you would like more info about supporting creativity and innovation, add a comment or just email me. I am very excited about it.  Recruitment for the position has not yet started, as fund-raising continues.