Week 4: Collaborative Interdisciplinary Groups

Choose a group that you are currently part of or one that you have recently been a member of. Discuss the purpose of the group and the expected outcome(s). Consider how this group moved through the stages of group formation. Think about your role in the group. Did you experience the dominator, the aggressor, or the blocker? What strategies would you apply to this group today, based on this course content?

Scholarly references to support your response are required.

In your current healthcare organization, consider the types of power that you observe and discuss one of these types within a specific situational context. What factors may have impacted power such as gender, formal authority, race, or anything else? Describe the strategies that you would select for each individual in this situation to ensure a more equal base of power.

Scholarly references to support your response are required.

Week 4: Introduction

Table of Contents

Welcome to Week 4!

This week, you will expand your understanding of group process and the use of power in nursing leadership and management. The many task forces, councils, and committees within organizations required for transforming the organization to achieve the organizational goals and objectives necessitate acquisition of specific competencies. Working to facilitate effectiveness in group work leads to competent implementation, measurement, and evaluation of change. Power (of the individual) is determined by the ability to select effective communication patterns and demonstrate collaborative behavior within the group process. Identifying the sources of power and how to expand power to improve the ability to achieve improvement is an important skill for leaders to master.

Outcomes

3

Analyze selected leadership topics for their relationship to holistic care principles and cultural diversity (PO1, PO3, PO5)

Weekly Objectives

  • Describe group-formation stages and expected behaviors.
  • Analyze how specific group roles impact group cohesion and work completion.

4

Examine evidence-based communication strategies that respect cultural diversity and promotes caring environments for staff and patients (PO 2, PO3)

Weekly Objectives

  • Explain the role of leaders as change agents in group development.
  • Differentiate the characteristics expected for unparalleled group performance.

7

Identify various team strategies for problem-solving that enhance patient-centeredness and value-added care. (PO 1)

Weekly Objectives

  • Distinguish between the various forms of power.
  • Discuss strategies to improve power.

Week 4: Reading

Marquis, B. L. & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed.).Philadelphia, PA: Lippincott, Williams & Wilkins.

  • Chapter 13: Organizational, Political, and Personal Power
  • Chapter 16: Socializing and Educating Staff  in a Learning Organization
  • Chapter 19: Organizational, Interpersonal and Group Communication

Hogg, M. A., Van Knippenberg, D., & Rast, D. E. (2012). Intergroup leadership in organizations: Leading across group and organizational boundaries. Academy of Management Review, 37(2), 232–255.

Johnson, S. L. (2011). An ecological model of workplace bullying: A guide to intervention and research. Nursing Forum, 46(2), 55–63.

Kaufman, B. (2012). Anatomy of dysfunctional working relationships. Business Strategy Series, 13(2), 102–106.

McMurry, T. B. (2011). The image of male nurses and nursing leadership mobility. Nursing Forum, 46(1), 22–28.

Mind Tools. (2012). Forming, storming, norming and performing: Helping new teams perform effectively, quickly. link (Links to an external site.)Links to an external site.

7 secrets to success of Steve Jobs. (2011). link to video (Links to an external site.)Links to an external site.

Week 4: Lesson

Table of Contents

Group Process and Power in Nursing

Organizations: A Network of Teams or Groups

Nurses can be considered a team in the organization, just the same as physicians, pharmacists, imaging technologists, and others. The organization has many teams, where some are large and small, and some are formal and informal, and some are permanent and temporary. Each team or group in the organization has a specific purpose. From the organizational viewpoint, the organization is a network of numerous, connected groups.

The formal groups of the organization are acknowledged to have a specific purpose and achieve specific outcomes. Informal groups are not generally acknowledged but nonetheless function with a purpose that may be social, professional, or related to special interests. These informal groups may work in the same department and be a group of friends. Or they may all have an interest in learning more about the electronic health record, coming from across the organization.

Just as the informal leaders discussed in past weeks can champion change, so can informal groups. These informal groups can improve workflow and improve productivity. These groups also provide social needs that may be missing from the formal-group structure (Gilley et al., 2010). Can you identify the informal groups that you belong to or that exist in your work area? To identify these informal groups you can construct a social network analysis (Hoppe & Reinelt, 2010) in which individuals identify coworkers who help them or communicate with them outside of work or enjoy a specific activity.

Understanding formal and informal groups can help leaders to place individuals from informal groups into formal work groups that will become more effective more quickly because the individuals already have a personal relationship that should translate into a new group identity.

Cross-Functional and Problem-Solving Groups

Healthcare organizations have homogeneous groups of the same professional categories that tackle issues or problems relating only to that group. However, as integrated as healthcare systems are, there are few groups that are not cross functional. Cross functional means that professionals from different groups form a new group with a specific purpose. These cross-functional groups are expected to work collaboratively to achieve a stated outcome.

The use of cross-functional groups has become more popular in organizations as a method of preventing silos, where one group fails to have any interaction with other groups. These cross- functional groups may be permanent or temporary in nature. Some groups, such as a quality assurance committee, may be a permanent group in which, across time, members filter in and out of the group. Other groups may be created to solve one distinct issue and, once accomplished, the group is dissolved.

Group Effectiveness

When we work with a good group, we instinctively know that there will be a good outcome because everyone is working together. Yet a more common experience, or at least the experience that is recalled most often, is that of groups that struggle to work together. Many times, these struggling groups find that, in frustration, one or two members take on the full role of the project just to ensure that the project is finished by the deadline. So as nurse leaders, how do we ensure that the groups we are members of and those that we facilitate are effective?

First, we need to define what that effective group looks like. The effective group has high member engagement and performance, group members are satisfied with their roles in the group and how the group works, there is heterogeneity or variability within the group that leads to dynamic interchanges, and group synergy is such that the group could continue over long periods of time. The effective group has a vision of the quantity of work, the quality of work, and the timeliness of the outcomes. The group meets deadlines or other expectations such as productivity benchmarks. The members of these groups receive professional and personal satisfaction and fulfillment. They appreciate the contributions of their group members to the whole team and are willing to continue the relationship into the future.

The synergy aspect of the group is one that should be nurtured. Synergy means that the product that is created is greater or better than any one person could produce. Synergy is a goal for intraprofessional groups and interprofessional groups. The value of the group and its goals, iterated by the facilitator and demonstrated through results, should indicate that (a) people meet personal needs being in a group, (b) the level of creativity is higher than for one individual, (c) better decisions are made as more aspects to the problem are considered, (d) reliance on group members creates high commitment to project completion, (e) group dynamics control group-member actions and behaviors to achieve positive outcomes, and (f) groups pull the best from within an organization to deal with a specific issue or problem, which overcomes the inertia within a large organization.

When should a leader consider convening a group? There are generally three situations when groups have an advantage over individuals. These situations include (a) when there are a number of experts (who may have differing opinions) or no experts; (b) if the issue or problem is complex, groups can split up the work and share their findings; and (c) because support within a group setting allows for creativity and innovation, decisions that reflect this newness or risk are brought forward. However, groups can also facilitate new-employee orientation and improvement of job skills and offer socialization that engages everyone in the workplace.

Group Phases or Stages—Problems in Groups

Most likely, you have been a part of a group in which there is a view that, within a group, each individual does not need to work as hard as he or she would individually because there is always someone else to take up the slack. Leaders should understand that this phenomenon is not unique to specific types of groups but is found in organizations that place high value on individual contribution. In a group, there is little opportunity to be singled out as unique or for your high-value contribution, not just to the group but to the organization. The potential solution to this issue requires that the group size remain small, defining each individual’s role within the group and identifying the individual accountability for the work assigned. Lastly, there must be a meaningful reward that will motivate those in the group who seek individual recognition. Some rewards may be as simple as a thank-you note or as grand as a public acknowledgement of the contribution.

Other issues that leaders must deal with in groups are personality conflicts and work styles. The solution requires that the leader go back to the beginning and reiterate the vision, purpose, and expected outcomes. The priority of the group’s work must be stressed, and deadlines must be reached (again) through consensus. Then it is the leader’s responsibility to ensure that group members know of a coming deadline and what they are to present, and if this does not occur, initially, the leader must speak one on one with any individual who is causing problems. Remember that lack of motivation and enthusiasm for the group work may originate with the purpose of the project, poor perception of the group or group members, and poor leadership (Adams & Anantatmula, 2010).

Leaders must also facilitate the growth of the group and nurture it though the life-cycle phases or stages of group development. There are five phases or stages of group development. These phases include (a) forming, (b) storming, (c) norming, (d) performing, and (e) adjourning.

 

The forming phase is the time for the leader to establish behavioral and working expectations, allow the group members to get to know each other and each other’s expertise, and define the task or purpose for the group. The storming phase helps to clarify role expectations and identification of barriers or challenges to the group work. The honeymoon of formation is over, and group members determine group-member strengths, styles, and methods to reach the group outcome. Norming occurs as the group members are collaborative and coordinated in their group work. Group members demonstrate acceptance of one another but tend to disallow or discredit opinions that are not aligned with the majority of the group members. Leaders must watch for this level of harmony that may be a sign of suppression of some group members or their ideas. Performing is the complete integration of the group, when they are accepting, appreciative, and functioning well. Leaders will continue to watch for underlying conflict between group members and seek immediate resolution. The last phase of the group is the adjourning phase. Well-functioning groups will complete their tasks and separate. Yet, should they be needed to form a group in the future, they are also willing to come together again to meet future organizational needs.

Foundation of Group Performance From a Systems View

Jim Collins (2001) in his seminal book, Good to Great, likens a leader to a bus driver. He explains his point like this:

 

“You are a bus driver. The bus, your company, is at a standstill, and it’s your job to get it going. You have to decide where you’re going, how you’re going to get there, and who’s going with you.”

Most people assume that great bus drivers (read: business leaders) immediately start the journey by announcing to the people on the bus where they’re going—by setting a new direction or by articulating a fresh corporate vision.

“In fact, leaders of companies that go from good to great start not with ’where’ but with ’who.’ They start by getting the right people on the bus, the wrong people off the bus, and the right people in the right seats. And they stick with that discipline—first the people, then the direction—no matter how dire the circumstances” (Collins, 2001, para. 34).

This message is extraordinarily important in organizations and within group work; leaders must have the right people in the group to ensure that the work can and will get done. The systems message here can be addressed through the inputs, throughputs, outputs, and feedback. Leaders ensure a strong foundation for group work to set the group up for success. The inputs that need to be ensured include (a) adequate resources and setting such as technology, structure, rewards, and information; (b) identification of the purpose or task to be completed with clarity and level of complexity; (c) correct group size; and (d) determine who will be in the group by ability, values, personality, and diversity (Schermerhorn, Osborn, Uhl-Bien & Hunt, 2012). The throughputs are the group process addressing the behaviors and roles of group members, ground rules for expected work action, the level of cohesiveness of the group and effectiveness of communication, and the outcome. The outputs for the group are related to the level of effectiveness, which translates to the performance to reach the outcome, the level of group-member satisfaction, the degree of heterogeneity, and the relative ability for the group to be sustained long term (Schermerhorn, Osborn, Uhl-Bien & Hunt, 2012). Feedback comes through inputs, throughputs, and outputs as the group moves forward through the group phases and task completion. Feedback offers opportunities for correction.

Interprofessional Groups

Most graduate students have heard of the phases of group process and at this stage in their academic careers have had the opportunity to be a member of a group, and some have had the opportunity to facilitate a group. Understanding that the phases of group process and facilitation are very important among similar professionals, but the real challenges in group participation and facilitation come when there are multiple professionals or professional groups that must come to a consensus on a solution. Healthcare organizations have many of these professional groups, sometimes identified as a task force or work group. At times, the membership in the task force or work group is made up of one profession. At other times, there may be individuals from multiple professions assigned to the task force or work group. Nurse leaders and nursing issues are often at the center of these groups, therefore the nurse leader becomes a focal point within healthcare organizations to become active within interprofessional groups and the facilitator of interprofessional group process.

The term used here, interprofessional group, relates to individual groups in which there is a solid identity associated with the group members (such as all physician groups or all nursing groups) and a situation in which the groups must collaborate on decision making. Intraprofessional groups are those that are characteristically discussed in leadership textbooks when it is the relationship between members that are of equal status that is the concern. In the interprofessional group interaction, there is often a difference of power and status within the organization. Leaders must be able to manage the interprofessional group to achieve a high level of collaboration, respect, and concept understanding to ensure that group conflict does not erupt (Hogg, Van Kippenberg & Rast, 2012).

An example of an interprofessional group issue is one that may occur between nurses and physicians. Regardless of the topic, based on professional values and ethics, each group may present different and conflicting views. These differences can lead to disruptive and heated arguments and demonstration of disrespect to individuals and group members, with the outcome being a failure to compromise from both sides. This failure to reach a compromise and consensus decreases organizational effectiveness and leads to loss of high-level patient care.

Thus nurse leaders must have the ability to identify intraprofessional group dynamics in order to be able to facilitate interprofessional group consensus. Nurse leaders learn the social identities of the intraprofessional groups in order to better grasp the similarities between interprofessional groups. Knowledge of the social identities allows the nurse leader to be an effective facilitator who will gain consensus on contentious issues.

Effective Coordination, Cooperation, and Collaboration

Interprofessional group participation and facilitation is a high-stakes leadership activity. It is through the effective coordination, cooperation, and collaboration in these groups that the organization achieves its vision to strive for and maintain high-quality care. Although it should seem obvious that achieving a good outcome is paramount, the effectiveness and level of productivity of these groups is not a foregone conclusion. The reason for less-than-positive group results can be related to competition between the groups for the resources and attention of administration or other power sources. Or there can be challenges related to the different professional perspectives and problem-solution methods that confound reaching positive results. The goal of interprofessional group leadership is to diminish competition and align solution methods to optimize the group’s performance.

Power and Influence: Personal and Organizational

Power is the ability to get someone to do what you want them to do. There are many types of power that leaders may select to get the results that they are working to achieve. The consideration of influence is noted when power is wielded; it is positive if action is taken and negative if others do not take the action desired. Formal leaders have the authority behind power that tends to get the attention of those who report to them and allows the leaders to observe their influence, which may be either positive or negative. Informal leaders have power and influence, as they are interdependent forces among the staff that others have come to respect. The foundation for power at the informal-leader level may be the level of expertise that is within the individual. Others will seek out and obey direction from the informal leader when the response is ethical and meets patient needs. Leaders in organizations must appreciate the power and influence that they have as a combination of personal and organizational aspects. Clearly appreciating the many aspects of power and influence will support leaders in all aspects of their work, including leading and facilitating groups.

Summary

The dynamics and components of group processes and power and influence is a part of leadership that is addressed daily within organizations. Understanding the impact of the leader and the details of the group dynamic allows the leaders to select the best approach within the realm of their sphere of influence.

References

Adams, S. L., & Anantatmula, V. (2010). Social and behavioral influences on team process. Project Management Journal, 41(4), 89–98

Gilley, J. W., Morris, M. L., Waite, A. M., Coates, T., & Veliquette, A. (2010). Integrated theoretical model for building effective teams. Advances in Developing Human Resources, 12(1), 7–28.

Hogg, M. A., Van Knippenberg, D., & Rast, D. E. (2012). Intergroup leadership in organizations: Leading across group and organizational boundaries. Academy of Management Review, 37(2), 232–255.

Hoppe, B. & Reinelt, C. (2010). Social network analysis and the evaluation of leadership networks. The Leadership Quarterly, 21(4), 600–619.

Schermerhorn, J. R., Osborn, R. N., Uhl-Bien, M. & Hunt, J. G. (2012). Organizational behavior (12th ed.). Hoboken, NJ: John Wiley & Sons, Inc.

 
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