Group Process in Healthcare Quality PDF

Group process in health care quality Dr. Ganna POLA Introduction Nurse leaders in today’s health care organizations must be skilled group facilitators with an exquisite ability to manage and lead the collective work of people. A significant percentage of work completed in organizations today is done...

Group process in health care quality Dr. Ganna POLA Introduction Nurse leaders in today’s health care organizations must be skilled group facilitators with an exquisite ability to manage and lead the collective work of people. A significant percentage of work completed in organizations today is done through collective efforts, either in work groups, committees, or teams. Understanding the characteristics of each of these entities and basic principles for attaining successful outcomes increases the leader’s effectiveness. Introduction In the 1990s, many health care organizations attempted to convert their traditional hierarchical, bureaucratic structures to a team-based structure, with varying degrees of success. Teamwork is the new imperative for various reasons. Changing reimbursement, managed care organizations, increasing complexity, technology advances, rapid information dissemination at the worker level, and the shift to a knowledge worker–based service society are some of the social and economic forces operative in health care. These forces converged to create great change in health care delivery. Introduction A major trend in the late 1990s, creating successful teams was thought to provide the strength and structure to deal with work complexities and changes. When the redesign, integration, merger, and partnering strategies settle, a decentralized and organic structure called the knowledge organization emerges with a growing emphasis on the role of teams. Although interdisciplinary teams have always played an important role in home care, hospice, and other community settings, hospitals and large health care organizations are placing more emphasis on teams as a part of their core structure. Introduction Developing effective teams of professionals from different disciplines has proven to be difficult. However, effective knowledge work teams can create a form of synergism in which the outcome is greater than the sum of individual efforts. Such synergism confers a competitive edge and boosts productivity under conditions of constrained resources. Developing a teambased structure is one way to enlist employee participation. Team building is a strategy for designing, implementing, developing, and nurturing work teams in organizations. Introduction Nurses do not work in isolation. In many nursing care delivery settings, nurses function in a work group environment or as a part of a team. Group work is a major managerial accomplishing work through others. strategy for Introduction In some occupations, people work in relative isolation from others, but that is not the reality of the work of nursing. As health care restructures and becomes more complex, a greater value is being placed on high-performing and cohesive work groups. This is because complexity and cost-control factors in the health care environment have dictated the use of interdisciplinary and crossfunctional work teams. Therefore nurses need to learn how to function constructively in group situations and continually build their skill set in team collaboration. Introduction In nursing, group process theory relates to both how to be therapeutic with clients and how to work as an employee within an organization that is often large and complex. Nursing has at its core both a caring and a coordinative function. The nurse’s coordinative role is at the hub of all client care information. (For example, nurses collect, process, and integrate the initial assessment and laboratory data; handle the tracking of all therapeutic interventions for the client; are at the bedside in hospitals for surveillance of minute-byminute changes; and are the major point of contact for clinical care delivery in many settings and sites.) (For example, if analgesics are given in a hospital, nurses track whether that intervention has worked, whether alternative pain strategies might be needed, and what psychological reaction the client might have.) Nurses predominate in actual client care in home health, long-term care, hospice, and many other settings. Introduction Nurses have to work collaboratively, not only with other nurses and their nurse manager but also with people who do not share the same Professional background, such as those in the administrative structure of the organization, other providers, the supply department, or the legal staff. These interpersonal and collaborative activities shape the essence of nursing practice. Group interactions A basic understanding of groups helps nurses function more effectively. These principles apply to any group, whether an actual team, a committee, or an informal group effort. Group interactions are composed of the following elements The process that the group undergoes to reach outcomes: This relates to the unique way the group interrelates and begins to work together. The leader can assess group process through observation. What is the process that occurs while accomplishing its task? The standards that regulate the group’s behavior: This relates to the specific values and norms that are chosen for group processing. Which ones are chosen; which are discarded? The process of problem solving or decision making that the group adopts: Does the group solve problems? How are decisions made? Are they group decisions made by consensus, or are they individual decisions made with group input (as occurs when the group participates but the decision is made by a leader or manager)? Group interactions are composed of the following elements The communication that occurs among group members: What are the internal patterns and styles of communication used by group members? To whom does the group communicate? Do they report as a subcommittee to a full committee? If a team, does the team have frequent communication with external team leaders? What are the internal and external modes of communication for group input and output? The roles played by each member: Members will adopt a variety of group roles within the group, but roles are fluid. Members may take on different roles in different situations. For self-awareness, knowing what part one played in his or her family helps an individual recognize roles that he or she might gravitate toward in groups. It is important to remember when assessing group interactions that roles in the group are not always clearly established by the leader or the group. In this situation, each group member moves in and out of group roles that best suit him or her. Clarity in the more formal roles such as team leader, facilitator, recorder, and time-keeper is Groups tend to go through a series of stages in their work and development Farley and Stoner identified these as : 1. 2. 3. 4. Orientation Adaptation Emergence Working Stages in the work and development The first stage, orientation, occurs when the group first forms and the members begin to relate to one another and the task. The group needs to develop trust and define boundaries in order to establish involvement and identification. The second stage, adaptation, occurs as the group begins to develop a collective identity and differentiate roles. The group needs a facilitative structure and climate to maximize its processing and to work through the establishment of roles, rules, norms, and a common language. Stages in the work and development The third stage, emergence, occurs as control issues arise. Disputes, disagreements, confrontations, alliances, and power struggles mark this stage of determining control over the group in order to emerge with a more consolidated identity. The final stage, working, occurs when conflict and dissension dissipate and the group achieves greater cohesion through negotiation. The group is now focused primarily on decision making and productivity. The stages may overlap and are not necessarily sequential. The group leader pays attention to the stage of the group as a way of monitoring the group’s development and progress. WHY PEOPLE JOIN GROUPS? WHY PEOPLE JOIN GROUPS? In nursing, the formation of groups occurs primarily for one of two reasons: 1. To provide a personal or professional socialization and Exchange forum 2. To provide a mechanism for interdependent work accomplishment. Groups can be social, professional, or organizational in purpose. WHY PEOPLE JOIN GROUPS? The following are some reasons why groups would be established in organizations: Group activities can create a sense of status and esteem. Groups allow an individual to test and establish reality. Groups function as a mechanism for getting a job done. The work to be accomplished requires the complexity of knowledge and skill possible only in a group configuration. WHY PEOPLE JOIN GROUPS? The work group provides an institutional and professional identity for an individual nurse, and work groups become a focus for interpersonal relationships, support, and social integration. Interpersonal relationship elements such as work group cohesion, communication, and social integration remain consistent moderate-level predictors of nursing job satisfaction. Being part of a healthy group or team is also related to the level of organizational commitment by the employee. Individuals with an emotional connection to their work group have lower levels of turnover WHY PEOPLE JOIN GROUPS? Work groups can be disrupted by factors such as downsizing, reorganization, absenteeism, and turnover. Work group disruption has been shown to be linked to negative outcomes. There was a relationship between work group disruption and interpersonal relations. Work group relationships can reinforce behaviors and reinforce rationalization, thus leading to deviant behaviors becoming passively or actively accepted ADVANTAGES OF GROUPS Veninga identified the following five majör advantages of group problem solving over individual problem solving: ADVANTAGES OF GROUPS 1. Greater knowledge and information: Obtaining a broader and wider range of knowledge and experiences creates a higher-quality input into group problem solving. The insights of one member can stimulate the thinking of others. With the increased specialization of health care workers today, this is especially true. 2. Increased acceptance of solutions: If there is a decision to be made in an organization, people can get together in a group to talk about it so that the people themselves are more committed to the decision. When individuals who are going to be affected by a decision are part of the decision-making process, they do not have to be convinced of the rightness of the decision and are more likely to be committed to implementing it. ADVANTAGES OF GROUPS 3. More approaches to a problem: Complex problems typically are more manageable when a number of perspectives are mixed together to address the problem. The advantages include blending and complementing individual learning and problemsolving styles to capitalize on strength through diversity. 4. Individual expression: Groups allow for individual expression, and in organizations specifically, there may be few mechanisms for expression of individual perspectives. Sharing information and getting input are done best in groups. Sometimes groups allow people to Express themselves—for example, if they are anxious about a change or if morale is low. ADVANTAGES OF GROUPS 5. Lower costs: If the group is functioning in a positive and constructive manner, the use of a group can be less expensive than the use of individual effort to accomplish a task. Group decision making is cost-effective if it saves time. For example, when a group meets for one session as opposed to the leader meeting multiple times with multiple individuals, the leader and possibly the group members save time. Furthermore, costeffectiveness may result through the division of labor ADVANTAGES OF GROUPS Sometimes when the work output of a group of nurses is analyzed, meetings appear to be very costly endeavors. For example, when the number of hours spent by all committee members is multiplied by their individual hourly salary and fringe benefit cost and added together to compute a committee total, the sum of costs for the group may be astounding. This is another reason for paying attention to how well the group is functioning. ADVANTAGES OF GROUPS A well-tuned and functioning group is positive for an organization. Often such a group is less expensive and time-consuming in terms of solving complex problems. Participation and involvement in a group decision typically results in individuals being more committed to a decision, even if there is disagreement. DISADVANTAGES OF GROUPS Group decision making can be derailed at a number of points in the process. The three disadvantages commonly noted about group decision making are the potential for premature decisions, individual domination, and disruptive conflicts DISADVANTAGES OF GROUPS Premature Decisions The disadvantages of group work include the fact that decisions can result from pressure. Once a majority vote is taken, the minority experience an element of pressure because of psychological dynamics related to subtle pressure for group acceptance and conformity. This is often referred to as “groupthink.” It may be difficult to be a “devil’s advocate” or to adopt the role of bringing alternative critique points to the group for consideration because of a concern about not being personally socially accepted. For example, derision and humiliation can occur if members react with strong negative opinions. This response stifles further input. DISADVANTAGES OF GROUPS Individual Domination Some of the disadvantages of groups relate to the possible emergence of dominating or argumentative members who obstruct the group process. These members make it an unpleasant experience for all involved. In a sense, they sabotage the work of the group. An example occurs when the group is not functioning well or the members are not adhering to the task of the group because of a chronically negative individual or other distractions (e.g., socializing, avoiding the task, not preparing themselves). It becomes costly and time-consuming for the group to divert its energy and productivity to working out interpersonal dynamics rather than moving forward on the group’s task. DISADVANTAGES OF GROUPS Disruptive Conflicts If people perceive an adverse effect on a group member or members or if they feel threatened, conflicts usually emerge. Conflicts can accelerate in a competitive environment when members vest in their own position. Conflicts may also occur over personality differences, differences of opinion, or clashes of values. Although it may seem contradictory, conflicts can serve as a control mechanism in a group and may actually result in far superior outcomes. When group members are comfortable respectfully disagreeing with each other, a premature acceptance of decisions can be avoided because opposing viewpoints are considered. However, group members and leaders need to become skilled and comfortable in handling interpersonal dynamics. DISADVANTAGES OF GROUPS A group or committee has certain powers, tasks, and functions, as well as certain parameters or latitude in terms of how far to go in making a decision. Decision power is a matter of degree, with four distinct points on the continuum of authority for decision making: autocratic, consultative, joint, and delegated. Range of decision powers DISADVANTAGES OF GROUPS On one end of the continuum is an autocratic decision procedure in which the leader makes all of the decisions. In this process there is input, perhaps, but not necessarily a vote. For example, in certain legislative committees the chairperson may or may not be able to put forth legislation or block a bill. It may be the case that an autocratic leader controls the power and the committee exists mainly for the sake of appearance. This type of committee is set up for reasons other than making participative decisions. It is hoped that very few of these structures are found in human service organizations because they can generate increased cynicism. DISADVANTAGES OF GROUPS A consultative decision procedure occurs when decisions involve employee participation but the leader still makes the final decision alone. Group members may make certain recommendations, but these must then go to the leader, chairperson, or head of the group, who makes the final decision. There is more participation with this type of procedure, but the ultimate decision is not under the control of the group members. DISADVANTAGES OF GROUPS Some decision procedures result in joint decision making. In this approach, the entire group decides, whether by a two-thirds vote, simple majority, consensus, or some other process. In a joint decision procedure, the employees have as much influence as the leader. The leader has one voice, one vote. The leader can use persuasion, but when it comes to the final vote, the leader’s vote is equivalent to that of any other member of the group. This is fundamentally different from the leader making the decision with group input. DISADVANTAGES OF GROUPS Finally, at the other end of the decision continuum is the delegated decision procedure. This occurs when the committee chair or leader allows participants to make the final decision. For example, in true self-scheduling, the leader may set up the basic parameters but the staff members (usually through the work of a smaller, designated team) actually decide what schedule they work. The true test of a delegation decision procedure is whether the leader overrides the followers’ decision. Technically, the leader would not have the authority to veto or override. If it is truly a delegation situation, the leader would go forward with the approach that the decision is the choice of the group. DISADVANTAGES OF GROUPS It is advisable for the followers in any group to determine who has the authority to make decisions. Knowledge about what type of group it is and what delegation or decision procedures can be anticipated is critical to participation. A leadership or conflict moment may occur when a group assumes that the decision procedure rule in effect is delegation and the decision is its to make but the leader has a different idea. Clarity before beginning work on an issue avoids unnecessary conflict and augments productivity.