Effective Teams (continued): 
Integrative Group Process

In this section, we recommend specific changes to the meeting process for improvement teams.  Our recommendations are based on the literature regarding what works in teamwork.   You can review the literature by examining the background section on effective teamwork.

Step 1: Select the Best

What is the idea?

The composition of the group is an important and generally controllable aspect of the group. The facilitator could choose group members based on whether they are an expert in the subject and represent an interest group or perspective affected by the judgment. TQM / CQI suggests that coworkers affected by improvement project be asked to participate in the team. The essential requirement is that people closest to the process that is being improved should be involved.. Some authors believe that some meetings should be staffed by people from the outside of the organization rather than from the inside.

"When there is no quality requirement for a decision, the use of experts would probably waste organizational resources. If the group's decision affects individuals or groups outside the organization, coworker membership is inappropriate. coworkers are less likely to develop a decision acceptable to outsiders because of their local orientation and because outsiders would have no influence in the decision (Stumpf, 1978)."

If the coworker is an expert in the subject and well respected, there is no reason to ignore him/her in favor of an external expert.

The number of experts in the group should depend on the purpose for convening the group. Experiments with groups of various size have shown that if the quality of the group's solution is of considerable importance, it is useful to include a large number of members (e.g., seven to nine) so that many inputs are available to the group in making its decision. If the degree of consensus is of primary importance, it is useful to choose a smaller group (e.g., five to seven) so that members can have their opinions considered and discussed (Cummings, Huber, and Arendt, 1974, and Manners, 1975). It is a general rule of thumb that the group size should not be smaller than three to five. Groups that meet face to face should not have more than nine members as each member may not be able to participate adequately.

Heterogeneity of the group's background is closely related to the size of the group and is another important aspect of design of successful groups. A necessary, though not sufficient, requirement for accurate group judgments is to have an appropriate knowledge pool in the group. Since no one person is an expert in all aspects of a problem, diverse backgrounds and expertise are imperative for achieving this heterogeneity. Involving people from different functional units of the organizations helps bring different expertise to the problem. Difference in background and knowledge could, however, accentuate the conflict between the group members and, if neither originality nor quality are criteria for evaluating the team's work, the facilitator should select group members to minimize differences in their backgrounds.

Getting people to devote their time to a meeting is difficult. Many remember wasted efforts in other meetings and avoid new meetings. There are a number of steps the facilitator can take to increase participation. First, examine the purpose of the meeting. If it is difficult to obtain participation, perhaps the facilitator is solving the wrong problem. People who are close to a problem, invariably care about it and are willing to address the problem. But if they feel the problem is not real, or the search for solution is a formality, they are less likely to participate.

The next step a facilitator can take to improve meeting participation is to clearly communicate to group members concerning the meeting logistics and expectations. The communication should clarify why is the meeting important, and what can be expected at the end of the meeting. It should clarify the logistics of the meeting (i.e., when, where and how) and emphasize that the meeting is an ad hoc group.

We find that it is useful to remind the group members about who else is being invited. People are more likely to meetings were people they admire are present. It also helps to emphasize who nominated the potential group member and that there are very few people asked to participate. We find it useful to emphasize that the group member's contribution is unique. Finally, it helps if group members are reimbursed for their time by providing them with an honorarium.

Step 2: Meet Before the Meeting

No-surprises

What is the idea?

Before face-to-face meeting, group members are individually interviewed. If group members live far apart the interviews are done by phone. Whether done by phone or face-to-face, the interview is scheduled ahead of time. During the interview, which takes roughly one hour, the facilitator explains the group's task, elicits the group member's opinions, and walks the expert through the steps in the IGP process, so there will be no surprises in the actual meeting. The bulk of the interview time, however, is spent listening to the group member and trying to understand the reasoning behind his or her choices If the group has to make a judgment, the group member is asked to list the arguments for or against a position.

In particular, if the group is to create a process chart, the facilitator asks the member to do so and listens to why specific steps are important in the process. If the group's task is to suggest alternative solutions, the facilitator obtains a list of viable alternatives and tries to understand what evaluation criteria are important for evaluating these alternative. If the group member's opinions depend on many rules, the facilitator tries to solicit these rules. The point is that no matter what the task is, the facilitator tries to not only accomplish the task but also understand the reasoning behind it.

Early in the telephone conversation, the facilitator prompts the participant with open ended questions and encourages reflections on personal experiences. Thus, one may start with requesting the participant to recall an occasion where he/she attempted a similar evaluation. Later, the facilitator asks the participant more focused questions. Thus one may ask for a listing of evaluation criteria.

After interviewing each group member individually, the facilitator collates the responses of all participants; we refer to this collection of responses as the "straw man" list. The face-to-face meeting starts with a presentation of the "straw man" list and proceeds with a request for improvements. Constructing the list before the group meeting has three advantages:

1. It increases the accuracy of the group's judgment by ensuring that the group process will not prevent an individual from presenting his/her ideas;
2. The phone interviews save the group some working time by collecting members' ideas before the meeting.
3. Because the "straw" model serves as a blue print to guide the group discussion, it saves additional time by partitioning the group task into smaller, more manageable discussions.

Step 3:  Redo the List

Better the Next Time Around

What is the idea?

The facilitators collates the alternatives and the straw man list of reasons and lists them on flip charts. One alternative or one reason per chart. The flip charts are spread around the room so any member can see what has been said to date. The group convenes to revise the alternatives or the "straw man" list of reasons.

The facilitator introduces himself/herself, explains the group's task and agenda, restates the importance of the task, and asks members to introduce themselves. We find these introductions as an important part of the process. If members are not explicitly introduced, they will do so implicitly through out their deliberations. Let group members describe their achievements and importance so that the group can move to other issues.

The facilitator presents the "straw man" list, asks the group to revise the list, and focuses group's attention on one of the reasons in the "straw man" list for a starting point. The focus on one reason at a time is an important way of managing group's time and conflicts. As group members suggest new ideas or modifications, the facilitator records them on the appropriate pages in front of the group. Thus the facilitator serves as a secretary to the group making sure that ideas are not lost. Recording the group's comments reassures the group members that their ideas are not lost and are being put in front of the group for further consideration. The process continues until the group identifies, discusses and revises all relevant factors.

Through active listening (e.g., nodding, asking for clarification) and recording of group member ideas on the flip charts, the facilitator plays the important role of directing the discussion, preventing premature closure of ideas (Van de Ven and Delbecq, 1971), returning the group to task related activities, distributing the group's time over different aspects of the task, restraining critical comments during generation of ideas, and always separating people from ideas so that ideas are judged on their own merits. The facilitator uses the instructions developed for Group Communication Strategy as guidelines for this phase of interaction. The facilitator should not participate in the content of the discussions; and should not reword what has been said in his/her own terms.

Step 4:  Rate Ideas Before Discussion

Let Numbers Do the Talking

What is the idea?

In this step of IGP, the facilitator helps the group weight the relative importance of different arguments made by the group. This task is done individually and without discussion until a major difference between the group members is identified.

On a piece of paper, the reasons suggested by the group are listed. The group member is asked to assign a number to each reason concerning how important it is. A score of 100 is the most important and a score of 0 is considered not important.

Group members answer the questions individually but in the presence of one another. Seeing each other working helps the group members exert more effort on the task at hand. As the group proceeds, the facilitator collects the group's response and puts the answers on a flip chart. The scores are not listed in the flip chart in a manner that identifies who has said it. One purpose of this step is to encourage the group to consider the merit of ideas and not who has expressed them. When there are major differences among the ratings, the facilitator asks the group (not any particular person) to explain their reasoning.

Step 5: Discuss Major Differences

Discus Issues not Each Other

What is the idea?

IGP focuses the group's discussion on the group's logic. Instead of discussing which alternatives are preferred, the group discusses which reasons or which criteria are important. This approach to discussion has been shown to reduce conflict among group members (Hammond et al., 1976; Rohrbaugh, 1979). Disagreements among group members have many different sources. Some disagreements are due to fatigue and unclear problem specification. These disagreements are reduced through clarifying the assumptions behind group member's perspectives. Still other disagreements are due to differences in knowledge and experience. Discussion may reduce these conflicts if group member's succeed in communicating the rationale for their judgments. Some group members may see a considerations others have missed or a flaw in the logic. Other disagreements are due to value differences. Better communication may not reduce this type of conflict. IGP reduces conflicts that are due to misconceptions and miscommunications and accepts other conflicts as inherent in the task.

In order to save group time, the facilitator should identify major differences among members, and focus the group's attention on them. Small differences are probably due to errors in estimating numbers and not due to substantive issues. When there are major differences in rating of a reason or a criteria, the facilitator stops the group from rating the importance of remaining reasons and asks for a discussion. This is done without identifying what is the group average (norm) or who are the people whose ratings differed from the average. Disclosures of the members involved could have ill effects by polarizing the group. For example, Castore and Muringham (1978) showed that disclosure of individual member preferences lowers the later support for the group's decision. The person who disagrees is not as important as the existence of the disagreement and the need to resolve the disagreement through discussion.

After the group has discussed their differences, the facilitator asks group members to individually rate the importance of the reason or criteria again. This process of estimating, discussing, and re-estimating the importance of a reason leads to more accurate results than the use of other processes that eliminate anyone of the three steps (Gustafson et al., 1973).

Step 6: Ignore Small Differences

Show Consensus

What is the idea?

Although the facilitator encourages group members to resolve their differences through discussion, at some point, it is necessary to stop the interaction and mathematically resolve minor group differences, such as by averaging the estimates from various group members. If major differences remain, it is necessary to report these differences.

Once the reasons are well understood, the facilitator applies the reasoning to the alternatives at hand and highlights the alternative chosen by the group.

In few days after the meeting has ended: a report is written about the meeting. This reports contains several different topics including the following:

• Why was a meeting convened?
• Methods used to facilitate the meeting and analyze the findings.
• Did group participants arrive at a consensus?
• If so, what was the group's reasoning? This section should provide a detailed account of the reasons (criteria), the relative importance of each, and the final rating of each alternative.
• Conclusions and next steps in the group's task.

A document about the group deliberation is important not only to people who were in the meeting but also to people who were not. Cinokur and Burnstein (1974) had individual subjects list the persuasiveness of pro and con arguments. The net balance of persuasiveness of the arguments correlated with attitude change produced by group discussion. But, more important, other individuals not present in the group discussion, who were exposed to the same arguments, changed their attitudes in the same way. The work of Cinokur and Burnstein shows that the information content of group discussion is important in convincing people outside the group.

What Do You Know?

Advanced learners like you, often need different ways of understanding a topic. Reading is just one way of understanding. Another way is through writing. When you write you not only recall what you have written but also may need to make inferences about what you have read. The enclosed assessment is designed to get you to think more about the concepts taught in this session.

1. List the steps in the nominal group process? Do not provide an explanation of each step, merely list the steps. 
2. How is Integrative Group Process different from Nominal Group Process?  
3. Of all the techniques you have learned here, which process or component of the process you can use in your project groups. Why? Be specific for why are you preferring one approach to another. Why do you think one approach is more useful than another?

Email your response to the instructor.  For full credit of your work, in the subject line include the course number and your name.  For example, subject line could be:  "Joe Smith from HAP 586 what do you know section in teamwork"   Please do not include attachments and submit your responses within the body of the email.  Keep a copy of all assignments till end of semester.

Presentations

To assist you in reviewing the material in this lecture, please see slides and narrated lecture.  In addition, you can review slides on empowerment and cooperation.    Narrated lecture require use of Flash.  A 10 minute segment of this lecture is also available on YouTube: 

More

1. Recent research on team effectiveness.
2. Creating cohesion through changes in group processes. 
3. Mosel and Shamp discus methods for enhancing quality improvement team effectiveness. 
4. Impact of teamwork on outcomes of care.  
5. Enhancing quality improvement teams.
6. Bibliography on cost effectiveness of clinical teams of nurses and physicians.
7. Assessing a teams potential problem solving skills.