jump to navigation

Reading List – Treasures! June 30, 2017

Posted by mariemanthey in History, Inspiration, Leadership, Professional Practice, Values.
Tags: , , , , , , , , ,
add a comment

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.
Tags: , , , , , , , , , ,
add a comment

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.
Tags: , , , , , , ,
2 comments

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

Learning Objectives for upcoming RBC Symposium! June 2, 2017

Posted by mariemanthey in Academia, Creative Health Care Management, Inspiration, Leadership, Professional Practice.
Tags: , , , , , ,
add a comment

Register Today for the International Relationship-Based Care Symposium, co-sponsored by the University of Minnesota School of Nursing!

From Silos to Synergy: Showcasing Fierce Commitment to Extraordinary Care

June 19-23, 2017

Join experts in compassionate care, leadership, and organized development at the 2017 International Relationship-Based Care Symposium. During this event, you will identify strategies that you and your team can use to improve interprofessional collaboration; and learn practical tools and actions to achieve committed partnerships, cross-departmental teamwork, and cultural transformation.

Accreditation

In support of improving patient care, this activity is planned and implemented by the University of Minnesota, Interprofessional Continuing Education and Creative Health Care Management. The University of Minnesota, Interprofessional Continuing Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

Upon completion of this activity, learners should be able to:

  • Identify how health care systems investing in Relationship-Based Care are improving interprofessional collaboration and cross-departmental teamwork.
  • Articulate how a culture grounded in mutual respect, trust, commitment, and accountability promotes well-being of patients, families, colleagues, and self.
  • Describe how all members of the health care team can experience joy and meaning in their work through full engagement and shared purpose.
  • Discuss how to cultivate a health care culture that promotes synergy between health care disciplines to bring the organization’s vision and mission to life in daily practice.
  • Identify best practices in interprofessional partnership resulting in improved health care outcomes.
  • Define ways in which technology can be a powerful vehicle for strengthening partnerships between the health care team and the patients and families they serve.

Don’t miss this exciting opportunity, we are looking forward to seeing you there!

Absence of RAA – Problems Universal May 16, 2017

Posted by mariemanthey in Inspiration, Leadership, Professional Practice.
Tags: , , , , , , , ,
add a comment

..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.
Tags: , , , , , ,
add a comment

5 reasons image

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!

A Labor Day reflection: CHOICE AT WORK! September 1, 2014

Posted by mariemanthey in Inspiration, Values.
Tags: , , , , , ,
4 comments

​​
I am one of the lucky ones….I knew nearly all my life that I wanted to be a nurse. When I was 5 years old, I was hospitalized for a month. During that period I truly felt abandoned by my parents and worse yet – when they did come – a very painful procedure was performed on me each time. The only positive moment during my stay was when a nurse named Florence Marie Fisher colored in my coloring book. For reasons only known to God, that meant to me that she cared for me….in the fullest sense of that word care.
I knew from then on that being able to do that for another person was exactly what I wanted my life to be about…..and I’ve never looked back!
What made it full of wonder is that I have been able to learn so much about how to live from my work. A beautiful framework for living came through my work when I was involved in the original development of Primary Nursing. The Primary Nursing framework builds the concepts of Responsibility, Authority and Accountability (RAA) into a dynamic whole that can serve to correctly inform the proper relationship among people….the proper structure for an organization….the proper content of a job description.

When each of those three elements – Responsibility, Authority and Accountability – are viewed in their proper sequence, functionality is enhanced. When Responsibility is legitimately allocated, Authority commensurately delegated and Accountability mechanisms are designed for recognition and education (and not for punishment)….then all aspects of an activity can be optimally functional, and personal relationships can be healthy.

But the most important thing I finally learned (sometime in my mid-forties) is that these same elements are at work in my life. The moment I call my epiphany occurred with a blinding flash of insight…..during which I instantly saw that as long as I blame someone else for whatever is wrong in my life, I am not accepting responsibility for myself. I decided to learn how to change that, and I have never found it necessary to feel victimized by any person or situation or institution again.
What does all this have to do with work? I believe we all have choices every day about all aspects of our work …..and that the choices we consciously (and unconsciously)make have the power to either expand our spirit….or to destroy it. I am continually amazed at how many people tolerate working in dysfunctional systems …..or in toxic workplace cultures.  I know there are many factors operating that may reduce one’s awareness or perception of choices. Nevertheless, I have come to believe that even in the most oppressive environments…consciousness of choice instead of focus on victimization is the key to being able to grow spiritually.
Ultimately, I think the real lesson to be learned is that we have a choice to manage ourselves…..or not. Self management means being aware of the importance of healthy interpersonal relationships. Open communication (no back-biting) functional trust and mutual respect are the three key ingredients to healthy interpersonal relationships. Open communication means taking the time to learn the tactful way to talk about difficult issues with co-workers….it is a skill we can choose to learn. Trust is a choice we need to be willing to risk giving…..because withholding it breeds only more mistrust….and mutual respect requires the judgment to see everyone (at all levels of status and education) as being of equal importance to the overall workplace morale.

And I have learned that morale influences the quality of the product (nursing service) more that any other single or combination of factors. In my world that means that the morale of a nursing unit staff will have more impact on the quality of care patients receive than does any other single or combination of factors. And morale is solely determined by the way staff members treat each other in the context of workplace realities, including the reality of more work to do than time available.
These incredibly valuable lessons came to me from my work experience…..and they dovetail completely with what I have learned in recovery.
Consciousness of choice ….of how to respond to my co-workers….of how to be present in my work…. of my values of integrity and authenticity…all of these and more are the opportunities of learning and growth I have received through my work. And I know that all of this came about because Florence Marie Fisher colored in my coloring book when I was five years old. She created a caring relationship with me…..and permanently influenced my life.
She never knew that. I published a book about Primary Nursing in 1979, and dedicated it to her. The publishers tried to find her, but where unable to. Recently I came across those onion-skin copies of the publisher’s letters to a couple of State Boards of Nursing trying to find her and remembered that they were unsuccessful in locating my Florence Marie Fisher. But I thought to myself that afternoon few months ago……Google! And so I googled her and found her obituary…which also listed her survivors. I have since had the pleasure of meeting her son and grandchildren and telling them about the impact she had….not only on my life…but also on my work, which has in turn influenced the experience of nurses and patients throughout the United States and internationally. Of course they had no idea…..her simple act at work of coloring in my coloring book was a sublime act of co-creation. As nurses we can all find ways to choose to color in a coloring book. It is a choice we have to make, individually, and repeatedly. It is a choice that will not be documented….cannot be charged for….and that has a major impact on the lives of at least two people, the patients we care for and on ourselves. The choice to ‘be with’ the patient, instead of just ‘doing for’ changes the nursing experience for each individual who experiences this choice.

The Choice of Every Nurse Every Day…an excerpt of my introduction to this new book….. June 24, 2013

Posted by mariemanthey in Creative Health Care Management, History, Inspiration, Professional Practice, Values.
Tags: , , , , , , , , , ,
9 comments

Advancing-Professional-Nursing-Practice-Book

A painting is not created by a free floating hand making marks with oils on canvas. The hand belongs to an artist connecting with his or her mind, body, and spirit, not only to the process of creating a painting, but to those who will one day see the painting. The hands of the artist are not where the skill lies. Without the whole person showing up in the creation of the painting, there is no art; there is just painting.

The art of nursing can be thought of in much the same way. The nurse can show up as little more than a pair of hands doing tasks, but this is not nursing; this is just doing tasks.

The art of nursing (as is perhaps true of any art) is about connection. In the art of nursing, the nurse connects to the patient, and the nurse also connects to the profession of nursing. Advancing Professional Nursing Practice is about the art of both of those connections. It is a book in which the ANA standards are named and explained, connecting nurses to the practice and performance standards of their profession. It is also a book about Relationship-Based Care, which is a care delivery model that connects nurses to patients and families by removing barriers to the nurse-patient/family relationship and improving relationships throughout the organization.

I’m always happy for nurses who get to work in cultures that support healthy relationships throughout the organization, and I share the distress of those who work in environments that seem to be fueled by chaos and competition. It is the choice of the nurse, however, whether to show up in either environment as a whole person, fully invested in the care of patients and families; or simply as a technically competent task doer.

In 1966, the way I viewed nursing was changed forever by an article I read in the American Journal of Nursing. It was written by Sister Madeleine Clemence, and it was called “Existentialism: A Philosophy of Commitment.” The way I saw it, this learned nun, a woman far ahead of her time, was challenging me, a young nurse leader, to show up as a whole person in my work. Her article challenged me to change my own practice and to mentor others to do the same:

“Commitment can mean many things: a promise to keep, a sense of dedication that transcends all other considerations, an unswerving allegiance to a given point of view. In existentialism, commitment means even more: a willingness to live fully one’s own life, to make that life meaningful through acceptance of, rather than detachment from, all that it may hold of both joy and sorrow.”[1]

It was no accident that Sister Madeleine was talking about “acceptance of, rather than detachment from, all that life may hold” in the context of the nurse’s work. As a nurse herself, she could see that the work of the nurse is secular for all, but sacred for only those who commit themselves to making it so. As we go about the work of nursing, are we solving problems or are we entering into the mystery of what it means to be with a person who is suffering, vulnerable, and afraid? She quotes philosopher Gabriel Marcel, writing, “A mystery is a reality in which I find myself involved…whereas a problem is [merely] in front of me.”

It raises a provocative question for nurses: Am I involved with my patients, or are they merely in front of me?

Over a century-and-a-half ago, Florence Nightingale helped to make nursing an art through bringing compassion into her own practice and then writing about it so that others might see that when the basic relational needs of the patient are tended to, there is a healing that takes place whether cure is possible or not. She famously encouraged the soldiers of the Crimean War to write to their loved ones. She understood the simple human truth that connection is healing—connection with loved ones (be they near or far), connection with one’s own thoughts and feelings, connection with the realities of one’s current situation.

The compassionate focus on connection that Florence Nightingale brought to nursing is still there, but it has gotten lost in the shuffle over and over; throughout history every time there was a major change in the world of health care. Here is some historical background:

Prior to the Great Depression, private duty nursing was the main avenue of employment for the nation’s RNs. As the Depression eliminated this avenue for many, RNs returned to their home hospitals as temporary workers, often on a volunteer basis, sometimes working for their room and board. As such, they found themselves working in a highly regimented, task-based, time-focused system of care that was designed to control practice and teach student nurses. This eventually became the main avenue for employment of RNs and remained so until fairly recently.  This move from more autonomy for RNs to less autonomy is a pattern that has repeated itself throughout modern history.

After WWII, the proliferation of new hospital beds coupled with the baby boom (which greatly reduced the nursing workforce), resulted in team nursing, a delivery system designed to maximally utilize technical expertise and assistive support staff under the direction and supervision of an RN. Again, the focus was on assigning and supervising the performance of tasks, since the only person educated to provide a therapeutic relationship was nearly always consumed with supervision and the performance of tasks requiring a higher skill level than that of her staff.

The system upheaval that characterized the last 30 years of the twentieth century, which was driven by finance, technology, and regulation, resulted in most health care organizations dealing with higher patient acuity coupled with severe cost cutting, which again resulted in a focus on managing the tasks of care rather than managing therapeutic relationships. The resulting dehumanization within the care system drove a spiral of regulations and system constraints that further complicated (and continue to complicate) an already intensely complex adaptive system.

The age we live in is no different. As we deal with the myriad changes of health care reform, we’re seeing, once again, a return to task-based practice. This time, however, it feels different to me in various ways. I’m heartened by the numbers of organizations that are embracing Relationship-Based Care. The publication of See Me as a Person is another example – it addresses the need for nurses and other caregivers to be “in it” with their patients rather than merely ministering to their bodies. As the next major societal shift in health care advances, whatever it is, the profession of nursing must continue to define itself. Society trusts us to do so, and our covenant requires it.

Nurses must ask themselves some important questions: What exactly is it that must always be present in order for nursing to really be nursing? What is the actual core of nursing? What strengthens that core? And what must be present in order for that core to even exist? In short, what is the nursing imperative?

I would ask you to mount your own inquiry, and come up with your own answers. Here are mine:

The nursing imperative is a two sided coin. On one side there is the imperative to be clinically competent in both technical skills and clinical judgment. The other side is the willingness to step into being with the human being for whom the nurse is caring. In health care, people experience vulnerability at every level of their being: mental, emotional, physical, and spiritual. The privilege of nursing is having the knowledge and skill, the position and relationship, to interact with a vulnerable human being in a way that alleviates pain and increases mental, emotional, physical, and spiritual comfort. This is the privilege of nursing—the being with a vulnerable human being. If this privilege is ignored or overlooked, nursing isn’t happening. No matter what is happening in a care environment, authentic human connection with the vulnerable human beings in our care can and must happen. That, to my mind, is the nursing imperative.

It’s clear that half of the nursing imperative is that we have a mastery of the technical aspects of nursing, but the other half of the nursing imperative—and it truly is no less than half—is staying present to the vulnerability of others. This book seeks to address the dual nature of the nurse’s work, both the instrumental and relational. If you are a nurse (or about to become one), I’d ask you to keep this dual nature in mind as you read this book.

Marie Manthey, MNA, FRCN, FAAN, PhD (hon.)

March 8, 2013


[1] Clemence, M. (1966). Existentialism: A philosophy of commitment. American Journal of Nursing, 66(3), 500-5.

From where I stand….. October 20, 2011

Posted by mariemanthey in Leadership, Professional Practice, Thought for today.
Tags: , , , ,
2 comments

This is the ‘best of times and the worst of times’ for nursing.   As I travel around the country, I see and hear about nursing departments that are delivering the highest quality nursing care humans have even received.    There is a peak of highly personalized, humane care focused on the individual being delivered, which provides opportunities for true healing to occur.   A level of care we could only dream about years ago.   Care that is highly competent, highly holistic, and highly personalized.   And in these places, nurses truly experience a level of joy that enriches and energizes their whole lives.

And then down the street ….or at the other end of town, there is another place, where the workplace culture is toxic, staff are angry and fearful (the same thing?) and patients are viewed as sources of trouble, annoyances to be dealt with, etc.

In other words, the contrasts between good and great hospitals and the worst ones is sharper than ever.    And the finding that my colleagues and I see over and over again is that the difference is in the culture and in leadership.   In other words “the protoplasm is the same”.

And of course, a whole huge chunk in between these two extremes.   The good news is the bad ones can change.   The bad news is they have to see that the problem is leadership and culture… and BE WILLING to change!

I’m curious what those of you working today think about these observations.   Are you working in one of the best or one of the worse?    Have you had a family member in one or the other?    The best or the worse of times.

Is Polite “Doing For” Really Enough? January 17, 2009

Posted by mariemanthey in Professional Practice.
Tags: , , , , ,
5 comments

One of the consultants at Creative Healthcare Management recently sent me this description, written while her daughter was receiving care at a major medical center in the Midwest. My question to readers is this: if you see yourself in this description, what can you do to “be with” rather than just “do for” your patients?  Or does anyone want to explain why “doing for” is really enough? Responses are welcome.

“Care has been fine, but not extraordinary.  They  received Magnet designation in 2007 and have a great deal of pride.  Everyone asks each time they leave the room if there is anything else we need — and they have clearly received customer service training (AIDET).  The manager just visited our room and was gracious and emphasizing that we let them know if there is anything they can do.  The trouble is, they are doing … But there is no “curiosity”, no whole picture perspective — when asked the nurses rarely know the plan — I rarely see a therapeutic process; the nurse comes in to give meds, check if there is anything needed.  So very nice, polite — but detached.  I found myself charting my perspective using the boundary diagram from my article in the field guide on boundaries for the therapeutic relationship. Underinvolvement is the main descriptor I would use.

We have had some lovely exceptions. The pharmacist, who we know from the transplant team, spent 20 minutes with us yesterday making sure that we had all questions answered and providing some background information. A physician sat at eye level and began by asking Alicia about her and what this means in her life right now.  She was able to talk about school, and it went on from there.  He was extremely encouraging — reminding us that it has always been the case that my daughter would outlive the life of her kidney, and that we will take each challenge as it comes.  We do not have the biopsy results yet, but if it is early rejection we are dealing with, that can be treated and the kidney can continue to serve her.

I try to stay clear and unemotional about the lack of professional consciousness I see in so many nurses.  I feel so sad, because when they only focus on the things they are doing, they lose sight of the human being and the power of their care and they lose the amazing satisfaction that would come from a connection.  I am clear that it would take no more time to connect and involve the patient than to come in and out doing for the patient.  I believe the nurses on this unit like their work, and that transplant nursing would be extraordinarily satisfying.  So, the nursing care is fine.  The question is, is that enough?  I have nothing I would complain about, and I believe most patients would say the care was very good because the staff is responsive.  My daughter asked why so many people (nurse,  physician, nurse practitioner) give her the same information as though she is hearing it for the first time.  Not one nurse has asked Alicia about herself or what this hospitalization means to her — what she might be worrying about — what is most important to her.  This morning as I walked for my coffee I noticed no one looked up anywhere through the hallways to the cafe, so I began initiating and spoke to people even when they were looking at the ground.  I got responses in return and I am teaching my daughter how to be the initiator of relationships so that she can be seen and receive what she needs.  I have also had to work with her to monitor her responses (she got rather hysterical when experiencing pain and not feeling heard by the nurse — who I understand called her a whiner– I was out of the room at the time) — I followed up with the nurse and worked to help her feel safe and less defensive, we came up with an approach to Alicia’s pain and by the end of the day it was managed.  I had to intervene though, because I could see that the nurse was irritated with her and I want Alicia to learn how to care for relationships so she does not get written off.  She will need to be an expert as she will be needing care all of her life. “