Working with Allied Health Professionals

This work is a reflective piece based on my experience of working within a multi-professional group setting. I will be using the model by Gibbs model (1988) to aid my reflection and present my account. Although I will be contemplating how the group performed as a whole, ultimately I aim to guide my own learning, thus aiding my preparation for future similar situations.

Task Description

Once strategically placed within an inter-professional group of students, we were asked to work as a team to develop an IPL strategy for the pre-registration training of Allied Health Professionals. Our efforts were to be centred on creating a twenty minute presentation based on our idea to our AHP peers. This was carried out over a week, with our presentation was expected to be given on Friday afternoon.

Our Implementation of the Task and Personal Thoughts

We first assembled and became acquainted with each other on Monday morning. Initial introductions and group communication were aided by a simple but effective exercise to assist preliminary group collaboration. This activity was fun, and valuable in helping us begin to establish the group relationship, and personally extinguished any uncomfortable feelings which I may usually have in a situation like this. I also felt confident that this particular group of individuals worked well together and at this point I had no concerns about the task ahead.

Subsequently, we were given our main task. Although I felt that there were some very valid and intelligent thoughts brought forward during our brainstorming, I began to worry that there were perhaps too many which differed somewhat, and that as a group we were not using our time efficiently. In addition, people could not agree on the simplest practicalities, which I felt was unhelpful.

The group met again on Wednesday morning, with each individual bringing their contribution of research to share. We discussed a possible structure to the presentation, although as the meeting went on it became clear that there were unquestionably some conflicting views on what our approach should be. At this point, I began to feel doubtful that the group was capable of decision-making, and started to feel anxious about our assignment. In addition, I felt that one particular member of the group seemed to feel strongly about their own outlook on the task, and that perhaps they were slightly negative regarding other ideas, unhelpful for the overall morale of the group.

The following day we met in a skills lab to take some photographs for our presentation, which was successful. This was followed by a short discussion, where some of the members of the group voiced their concerns that they had lost track of how the group would present. It was then disclosed that one particular idea had been developed outside of the meetings and that there was no need to be concerned, which made me feel excluded from the decision-making. As a result, I resolved to prevent my thoughts becoming too negative by concentrating on my particular research and presentation role, accepting the decision made.

On the day of the presentation, we met up beforehand and rehearsed using our amalgamated slides. I was pleasantly surprised about how the whole thing flowed, and felt relieved. The group as a whole also seemed reassured.

Evaluation

Individual Performance

I believe that I tried my upmost to show commitment to the group and its task, and to give support when necessary. This is reflected in the peer evaluations that I received after the task was over. At the same time, I also tried to keep the group focused and remind them of time constraints.

Nonetheless, I have come to realise that I was anxious and distrustful that the group would not be able to finish the work that had been set. Because of my unease of the group’s relatively slow progression, I think that I subliminally withdrew from the group in that I was only confident in my own individual component of the work, deciding to stop being concerned with the overall work. One of the manners of conflict identified by John Hunt (1987) is unhelpful ‘flight’ behaviour (psychological, physical or symbolic withdrawal), which blocks and inhibits group work. In my opinion this describes the negative way in which I acted, which on reflection was likely detrimental to group effectiveness.

Group Performance

I think our final presentation artefact was successful, reflected by the unexpectedly positive feedback which we received. I found this surprising, because of the amount of conflict and lack of decision-making that went on during the process. Charles Handy (1993) is of the opinion that although groups collaboratively produce fewer ideas than individual brainstorming, the quality of the ideas is superior in that they are more thought through and better evaluated. Even though our proposal is not what I would have gone for individually, I have come to realise that collaborative ideas are of sound quality and should not be distrusted.

Despite our conflict, I realise that with regards to ethical concerns all of us were extremely understanding of certain members’ individual needs. For example, instances where it was necessary to consider child care issues whilst deciding meeting times were all taken into account, with everyone being very considerate and accepting. I appreciate that acting fairly and in a reasonable way to each other is critical, as agreed by the first of the four ethical principles drawn up by Beauchamp and Childress (1995): Respect for autonomy.

However, in my opinion it is important to recognise that group effectiveness seemed to break down as the week went on. Aspects contributing to this included conflicting ideas, poor decision-making and lack of time for healthy group development. I firmly believe that the latter was especially damaging to our group communication. The group’s decision-making was so meagre that individual members of the group had no choice but to take initiative and make decisions without the entire group’s permission. Although I felt that this represented group decision-making failure, in hindsight it probably saved us from ultimate failure of the task.

Analysis and Reflection of my own and my group’s performance

Within this section are a few key elements that I regard as being important aspects of this experience to learn from:

Team-working

In my opinion, there were some very good aspects within our team-working, taking into account our ultimate success. Spears (1992) describes the METHODS model, which uses an acronym for its seven concepts. I have thought about this with regards to my group experience, and feel that the team worked well in carrying out individual research, then coming together to educate each other to provide the necessary sustenance to produce the presentation. In addition, I think the team came up with exciting although challenging ideas that took the theme a creative step further, when a more demure approach would have been acceptable. Hence in my opinion, we achieved the Dream element of the model, taking the time to be imaginative.

However, I think more effective team-working would have been possible if we had set clear goals to be met in our meetings, which would have avoided anxiousness and confusion. In addition, I think we would have benefitted from some outside feedback to improve our working and reduce conflicts. Furthermore, although many creative ideas were put forward, some were unfortunately met by some negative attitude – damaging to the innovative environment.

On reflection, I think that our group would have undoubtedly benefitted by planning our work using the METHODS model. In particular, I will definitely strongly advise my future groups to use goal-setting to encourage improvement, to gain feedback throughout and to optimise team success by encouraging innovation rather than cynicism.

Decision-making

I think that the group’s decision-making was poor due to a combination of the large number of ideas, avoidance of conflict, and lack of planning and organisation. Although in my opinion lots of ideas can only be positive, group meetings lacking structure and orientation meant that this large amount of suggestions made things confusing, hence positive decisions were impossible to achieve.

As observed by C. Handy (1999 p.173), the decision-making procedure could be by authority, majority, consensus, minority or no response. During our group work, the only decisions made were negative, via a minority or no response process. I think that this is because we failed to decide upon an appointed decision-making method during the early stages of group development.

In my opinion, the role that I played within my group experience affected the decision-making negatively, in that I was so concerned the task would not be completed, I avoided conflict and went along with the strongest voice in the group. Looking back, my thinking was to try to aid progression, as I thought that further conflict would slow things down further. Works by Hall (1971) includes advice for good decision-making, for example the recommendation that group members should avoid changing their minds merely to avoid conflict, and to actively seek out differences of opinion. This is something I will take with me and implement in future situations.

From this reflection, I have learnt that forward planning is key. For example, an authoritative leader should be appointed from the beginning, as should a method of decision-making. In addition, meetings should be planned and well structured, with goals set to be met by the end of each one.

Diversity and Difference

Current theory by Cox (1993) states that although diversity in groups often leads to disagreements, it also means more productivity than with a group which is more homogenous, including a higher level of creativity and innovation. In my group experience, there was some definite heterogeneity within group members’ characteristics, including different personalities, attitudes, and in turn influence and group integration. I think that this was the cause of the conflict that occurred, although as I have already mentioned, the group did collaboratively produce a vast range of ideas and importantly was successful in its end goal. I believe that although conflict would have been absent had there been less diversity, so would have the quantity and quality of imaginative ideas.

To reflect upon my group role, I will use Holm and Stevenson’s prompt questions (1994):

What was my role in this situation and was I comfortable?

Belbin (1981) noted that if any of the eight team roles is absent or inadequate, the overall team will be off-balance. Prior to meeting my group, I carried out a Belbin’s Team Roles Questionnaire, finding that typically I am an Implementer and Teamworker. In retrospect, whilst I was part of this particular group, I believe that I took on a different role. Although I remained an Implementer, in my opinion I acted more as a Completer-finisher than a Teamworker, considering my anxiousness that the group was inefficient and that the task may not get done on time. I believe my role changed to facilitate the group’s progression and even out an imbalance. This change did cause me to feel slightly uncomfortable, mainly due to the unease associated with it.

How did others act? Were the actions appropriate?

Looking back, I think that in particular there were too many team workers. The group regarded the conflict and tension that had occurred as negative, and people were keen to avoid this as much as possible. Although our actions were appropriate given our situation and the task at hand, things may have been implemented in a more effective and planned way.

From this reflection, I have come to realise that some diversity (although associated with disagreement) is positive, and ultimately necessary for good productivity. Additionally, although each team role is associated with some negative aspects, all are crucial for good team-working. I will bear all this in mind in future, and will no longer shy away from some healthy conflict.

Management of power and conflict

When the group met after each individual’s research, there was some tension and disagreement over the group’s priorities, and the method by which the task should be carried out. As conflict continued pressure mounted, not helped by time constraints of the room booking. The Tuckman stages of group development (1965) describe part of the Storming stage as the group beginning to settle disagreements and setting priorities, however this was unachievable due to lack of time available.

As a result of this situation a clear leader surfaced, providing much needed structure and clarity. She listened to everything that all had to say, somehow having the ability to create an innovative environment whilst simultaneously bringing some degree of organisation into the proceedings, precisely what the group was actively looking for. She also had huge confidence in the group as a whole, emitting positivity and confidence, vital to the needs of the team at the time. Although the storming stage was not entirely complete, the norming stage commenced because of this newly-found structure.

Even so, as I have described disagreements were not all entirely resolved. This resulted in tension and some continuing conflict being present within the group throughout the rest of our time together. This was unfortunate, as one particular member of the group began to interpret some of the discussion as being a personal attack, thus becoming defensive. However, I am pleased to say that on the day of the presentation we managed to set aside all hostility and presented our work proudly together and as a team.

From this analysis element, I have come to realise that time should be made for healthy group development to allow time for conflict resolution.

Clinical Reasoning

One of the CAIPE principles of effective Interprofessional Education (2002) is to respect the contribution of each professional within the patient care pathway. As a group, I think we demonstrated this, as there was much amicability in considering each other’s needs, responsibilities and alternative responsibilities in order to reason meeting times and the amount and type of individual work each person took on. It was reassuring to realise that this is possible within interprofessionals.

One of the thoughts behind interprofessional learning is that it enables professionals ‘to learn with, from and about each other to improve collaboration and the quality of care’. In terms of my own personal experience of the group work I think I have certainly significantly enhanced my knowledge of other healthcare professionals alongside the undertaking of the task. This module has allowed me to further appreciate the value of the IPL activities that are in place as part of our learning, for example the observation of MDT meetings. I appreciate that my learning would benefit from developing my clinical reasoning skill set further, and I have identified this as an essential area for my professional development.

Conclusion

The conclusion is a fundamental part of the Gibbs model of reflection, prompting reflection on what else I could have done. To aid this, I shall continue to refer to a selection of Holm and Stevenson’s reflection questions:

How could I have improved the situation?

By easing my anxiety in having more trust in my peers and in the group as a whole, my personal experience would have been much more positive. In addition, forward planning, for example the setting of goals and early decisions as to how the group will work would have been beneficial.

Do I feel as if I have learnt anything new about myself?

I have become aware that I am able to be flexible according to the needs of my group in the role that is required of me. I see this as a positive concept, as during my time as a healthcare practitioner, I will come across a diverse range of situations, where malleability will be key.

Has it changed my way of thinking in any way?

I have come to realise that individuals are diverse in their characteristics, attitudes and beliefs, and appreciate that this diversity is very positive within a group setting. I have also come to realise that a degree of conflict is good for productivity and creativity (although time must be allocated for any conflict to be resolved).

Action Plan

Attend a successful team worker course to work on my group skills.

Find ways of relieving anxiety, by perhaps attending a course on this.

Strongly suggest use of the METHODS model during future group scenarios to aid effective team-working.

Strongly propose to decide on a decision-making procedure early on in a future group situation.

Actively make time for healthy group development.

Ask for relevant and professional feedback to be given to the group throughout.

Try out different reflection models for different experiences to help me determine which are most useful for my own personal learning and to aid me in becoming a successful reflective practitioner.

Participate in as many IPL activities as possible to develop my clinical reasoning skills.