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MODULE 7
Groups
&
Change: Theory and Practice
By: Dr Peter Tylee
On successful completion of this module you will be able to:
This module provides a brief introduction to two important areas of knowledge for PHC practitioners. An understanding of groups, and that special category of groups referred to as teams, is vital. It can be used in self-reflection to work on one's own performance in one or more teams or groups, in assessment of the operation of groups encountered in institutional and community practice, or to inform the process of helping to establish new groups. As nurses frequently act as agents of change, an appreciation of some of the theory and practice issues associated with change is also worthwhile.
No doubt you are well aware of the saying that knowledge is power. Hopefully, even though we can only address groups and change at an introductory level, you will find the material presented here empowering. You are encouraged to adopt an enquiring attitude in all of your practice to facilitate further learning about these important and practical concepts.
2.0 Groups: Definition and Characteristics
Just what constitutes a group seems a straight forward matter; after all, everyone (aside from a few hermits perhaps) has experience of membership in many groups, right? You might have learned in formal studies of families how wrong this reasoning can be! Membership in a family, whether involving initiation, extension and management or mere participation for many years, does not mean that one can claim expertise in professional assessment and intervention with families. Similarly, whilst one may draw many lessons from experience in one or more groups, such experience itself does not necessarily lead to expertise in working in and with groups. Accordingly, this part of this module will begin with a definition and discuss various characteristics of groups. A possible distinction will also be drawn between groups and teams.
2.1 Definition of the Term 'Group'
Stanhope and Lancaster (1992, 278) claim that "A group is a collection of interacting individuals who have a common purpose or purposes." They further observe that: "Each member influences and is in turn influenced by every other member to some extent. The members' characteristics bring a composition to the group that in part determines the degree and kind of influence among them." The key elements in their definition are, they state, member interaction and group purpose, as illustrated in the following diagram.
(Source: Stanhope and Lancaster, 1992, 279)
A somewhat extended definition is offered by Spradley and Allender (1996, 214) who begin by citing Robbins' (1993, 285) definition of a group as "two or more individuals, interacting and interdependent, who have come together to achieve particular objectives". Their own definition states that: "A group is a collection of persons who engage in repeated, face-to-face communication, identify with each other, experience interdependence, and share a common purpose or purposes." Spradley and Allender (1996, 214) claim the following characteristics of groups are suggested by their definition.
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(Clark, 1994; Veninga, 1982) |
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(Konopka, 1954) |
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(Veninga, 1982) |
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The requirement of face-to-face communication in the above definition, though a popular notion for a long time, seems unnecessary. Whilst the vast majority of groups are face-to-face in nature, groups certainly do exist without this feature. For example, this author is a member of a group, which fully qualifies for that label, where the dozen or so members regularly meet in cyberspace, but never face-to-face. Similar groups exist within multi-national corporations where specific work groups are formed. Such groups are becoming more common with the advent of the internet as a major communications medium and will certainly find expression within the health sector.
It is clear however, that purpose and interaction are central to the concept of a group, and that interactivity takes on both inter-individual and corporate dimensions. This latter dynamic is seen in the outcomes of a two-way process in which members both shape and are shaped by the group. Accordingly, the following definition of a group is offered.
| A collection of interacting individuals with a common purpose such that a number of characteristics are demonstrated, constituting a recognisable dynamic. |
This recognisable dynamic will be discussed further shortly, but it is important to realise its effect in the definition. Consider a handful or so of parents who regularly arrive on a Saturday morning to watch their son or daughter play a team sport at a local venue, perhaps soccer or net ball for instance. In some cases these parents start talking, recognise their common interest in their children (and their sport), feel that their own similarities and differences fall within acceptable bounds and over a period of time form certain bonds. One might observe that they begin, tentatively at first perhaps but more confidently over time, to assert opinions about the sport, maybe the coach, the referee and eventually about a wider range of matters. A group is forming!
In other cases however, a similar number of parents might attend the same type of situation, they interact out of civility or necessity, may even stand shoulder to shoulder and shout similar advice to the referee but they do not bond and hence, no group exists. So a collection of interacting individuals with a common purpose is not enough to constitute a group.
2.2 Clarification of the Term 'Team'
The terms 'group' and 'team' are frequently used interchangeably, as if they were synonymous. This may be quite acceptable, but many teams do seem to possess qualities which set them apart from groups, which raises the question as to whether a distinction between the terms might be useful.
Cooley (1956 in Thomas 1988) described the features of groups acting in both primary and secondary modes. They are as follows.
In the secondary mode.
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In the primary mode.
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Thomas (1988, 14) concludes that: "This primary group mode is clearly characterised by a we orientation and an identification with group goals as much as individual goals. The secondary is more of an I or individual orientation, in which the formality of rules and regulations tends to guide the behaviour and activities of the group."
It is this primary mode which seems closer to the notion of a team. Perhaps a team could be thought of as a group which has achieved some maturity and a depth in interrelationships which strikes a balance between team and individual goal relatedness. To further explore the distinctions which might be drawn between groups and teams you are referred to the substantial body of literature on team building and team development.
One way of considering the characteristics of groups is to review what makes up the dynamic referred to in the definition offered above. We could say the dynamic is a function of:
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As you can see, there can be plenty of depth to the analysis one can apply to groups. All of these factors are interacting to provide the group dynamic, and dynamic it is. Groups have relatively more and less stable features from time to time, but they are never static!
It is important to realise the power within the two-way relationship that permits individuals and the groups to which they belong to influence one another. Sampson and Marthas (1990) capture something of this as follows:
| Some roles fit certain people better than others. When there is a lack of fit between what the role demands and what the person feels capable of doing, we usually note symptoms of tension and discomfort both for the individual and for the particular role system (eg, the group) in which the person is involved. |
This is a fairly mild example to which everyone can relate to some extent. They also offer the following:
| The constraints of a particular kind of hospital or unit structure, one in which staff members perform routine duties in a distant and formal way - technically proficient but humanly sterile - give rise to a behavioral syndrome called hospitalism. Our search for the bases of this syndrome must focus on the structural patterns within the organization that promote this behavior rather than on qualities within the personalities of either the patients or the staff. In many respects, even the most humane and concerned health professional who is placed within this type of organizational structure will in time come to take on many of the behavioral attributes of hospitalism. Knowledge of group structure is thereby vital to the health professional who would both diagnose a group's problems and know something about the proper intervention strategy to employ. |
It is sobering to recognise that the operation of group norms can have an effect capable of altering member's very perceptions. Little wonder then that groups can alter their members' behaviour.
3.0 Groups: Phases, Stages and Types
There are two main approaches to describing what happens when a group forms. Both acknowledge that there tends to be a predictable pattern from group to group over time. Spradley and Allender (1996, 225-226) present the developmental approach. The other approach describes a group life-cycle. They can be roughly aligned with one another as shown in the following table.
Table 7.3.1 Life-Cycle and Developmental Stages of Groups
Life-Cycle |
Developmental Stages |
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| 1. |
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| 2. |
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| 3. |
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| 4. |
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The first two steps tend to be quite similar in outcomes but the focus between the two approaches differs after that so they cannot be properly aligned. However, both approaches offer useful insights into the operation of groups.
There are, of course, many different types of groups which are of direct relevance to nurses. The following is not an exhaustive list, but an indication of the range.
Activity 7.3.1
| Read at
least one of the following chapters on groups. Chapter 17, Working with groups in the community in Stanhope and Lancaster (1992) Chapter 10, Working with populations and groups in Spradley and Allender (1996) |
4.0 Change: Definition and Types
Accounting for change has stimulated many theories and models. We have become accustomed to acknowledging the high rate of change in modern society and don't tend to think the statement that 'change is the only constant in society' is a non-sequitur! Toffler's (1970) best seller, Future Shock, captured this well. [For many of you 1970 was well before you were born, but it was in modern times, trust me!] Interestingly, Toffler (1979) identified five ways in which societal changes were influencing the nursing role. They were:
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You should clearly be able to identify the link between these forecast (and continuing) changes and the implementation of primary health care.
4.1 Definition of Change
So what does it mean to change? For our purposes, it may be defined as to alter or vary. To change something is to make it different in purpose or operation or effect or appearance or any other meaningful quality. In most situations, for a change to be registered as existing or as having happened, the difference needs to be relatively permanent. However, in social environments change is a complex and continuous process.
4.2 Types of Change
Classification of types of anything is an exercise in reductionism and is therefore undertaken with some risk. Overall however, it can be quite useful to consider change as being represented in various types. Duncan (1978 in Lancaster & Lancaster, 1982, 6) classified change simply as either haphazard, where "change is generally random with no effort being made by the participants to prepare for the onset of the change" or planned, where "change results from deliberate and conscious actions taken to adjust the operations of a given system to meet the demands of the situation".
Sampson (1971 in Lancaster & Lancaster, 1982, 6) described three types: developmental, spontaneous and planned. Developmental change, as the name suggests, refers to the types of change one identifies in development, where individuals, groups and organisations may be described as progressing from infancy toward maturity. Spontaneous change refers to those situations of change which are unpredictable and generally unanticipated, such as those provoked by natural and uncontrollable events outside the system which experiences the change. Planned change is different to these. It includes deliberate intention to intervene in the ongoing condition to produce a new condition.
You may well choose to create your own classification scheme. Whatever you choose, it is likely that planned change will appear and it is planned change which concerns us here.
5.0 Change: Theories and Models
Lancaster and Lancaster (1982, 7) assert that "Since the ability to identify and implement planned change is an integral component of the professional nursing role, it is necessary to summarize some key aspects of change theory". We are concerned with social change, that is, change associated with people, where they live, work and play. This will include all settings and situations, from hospitals and other complex organisations to small groups of professionals or community members.
In section 5 of this module we will look at two general ways of accounting for social change and then briefly explore a range of individual change theories and models as they developed over time.
5.1 Two Ways of Accounting for Change
Two basic perspectives are worth considering here. They are the conflict approach and the systems approach.
Olsen (1978, 330) claimed that "most social changes are preceded by conflicting forces seeking to prevent change" and that there is plenty of evidence that conflict promotes change. The conflict may be totally within an organisation or group or between the organisation or group and some outside entity. Conflict only achieves social change when there is "some kind of relatively permanent and extensive alteration in the organisation as a result of the conflict" (Olsen, 1978, 330).
The suggestion is that when groups experience conflict they are stimulated to change in order to reduce the conflict. It is important to recognise that the motivation to change is the desire to reduce the conflict and not necessarily acceptance of the value of the proposed change.
Often, a proposed change results in conflict, due to such factors as:
Let's just consider the first of these factors. All organisations (and many groups) have members who seek to maintain the status quo due to vested interests; typically in terms of income, status, power and prestige. It is important not to underestimate or trivialise these forces. Consider the following case.
| In the cardio-thoracic operating suite of a major Australian
metropolitan hospital during the 1980s an infecting organism inside the cardiopulmonary
bypass machine resulted in the deaths of several patients. Attempts to remove the organism
over several days without stopping the operating schedule failed and more people died. The
nurses who worked in the suite had stated from the outset that the theatres should be
closed until the problem was rectified but the surgeons refused and nursing administrators
would give no support to their colleagues. Considerable conflict ensued in what was usually a very tense environment anyway. The conflict reached the point where the nurses refused to work (remember such specialists are not readily replaced) and, although initially outraged, the surgeons finally listened and acted on the nurses demands to remove the conflict. Note that there is no justification for concluding they were significantly motivated by ethics. They were motivated to reduce the conflict sufficient to enable them to do more surgery. [You may be interested to learn that the nature of the relationships between the surgeons and the nurses had indeed changed "relatively permanently" as nurse power had been discovered!] |
If the concept of change is something which is intermittent and relatively permanent according to the conflict model, the systems perspective is quite different. According to the systems model change is continuous and unavoidable.
You have already been introduced to systems theory and should be able to apply it to an understanding of change. Remember, any force acting on a system can influence every part of that system and if the effect disturbs the system's state or stability the system will act to re-establish quasi-equilibrium. The motivation to change then, is not a reduction of conflict, but a desire or need to re-establish quasi-equilibrium. Since systems exist inside other systems, which in turn exist inside other systems, and so on, and given the dynamic nature of open systems, it is clear that according to the systems model all social systems are continuously changing. These changes may be so minor that we don't notice them, or so major that we can't help but notice them.
Activity 7.5.1
Consider
the 1998 dispute on the Australian wharves.
Consider the progress of the dispute and some of its outcomes.
Please jot your ideas down and then briefly contribute your conclusions to the discussion forum. (You can use the links at the top or bottom of this module.) |
5.2 Theories and Models of Change
So called Classical Change Theory is attributed to Lewin (1951) who described a three step change process essentially as follows:
Lewin considered that the above process took place in a context of two opposing forces, or sets of forces. On the one hand there are driving forces which facilitate change and move the participants forward in its implementation. There are also restraining forces which impede the change. This means that change can only occur when the driving forces outweigh or overcome the restraining forces. We shall consider some of these forces later.
An expansion of Lewin's work, including the steps and the notion of forces was offered by Rogers (1962) who described five stages, which you can see in the comparison table below. Rogers tended to focus more on the individuals involved as participants in change and maintained that each one could initially either accept or reject the change. Later, those who had initially accepted could reject it and those who had initially rejected it could adopt it. The issue then is whether the participants have a keen interest in the change and a commitment to work towards implementing it.
Comparison of Steps in Change Process: Lewin and Rogers
| Lewin | Rogers |
| 1. Unfreezing | 1. Awareness |
| 2. Interest | |
| 3. Evaluation | |
| 2. Moving to a new level | 4. Trial |
| 3. Refreezing | 5. Adoption |
Lippitt (1973) believed that change was even more complex than was explained in the models by Lewin and Rogers. It is interesting to consider that the perception of the pace of change in society was becoming an issue during the 1970s, but this is merely an aside. However, you will notice certain similarities between the nursing process (and other rationalist problem solving processes with which you are familiar) and Lippitt's proposed process for planned change, since the nursing process also emerged as an issue during the 1970s.
Lippitt (1973, 52) identified seven steps in the process of planned change, as follows:
A similar comparison to the above table is offered below.
Comparison of Steps in Change Process: Lewin and Lippitt
| Lewin | Lippitt |
| 1. Unfreezing | 1. Diagnose the problem |
| 2. Assess motivation & capacity for change | |
| 3. Assess change agent's motivation & resources | |
| 2. Moving to a new level | 4. Select progressive change objectives |
| 5. Choose appropriate change agent role | |
| 3. Refreezing | 6. Maintain the change once started |
| 7. Terminate helping relationship |
As you can see, what started out as the development of models to explain change became a virtual prescription for the implementation of change. Let's explore that further in the next section.
6.0 Change: Implementation Methods and Issues
In this section we will first consider various aspects of the way planned change unfolds during implementation, including the nature of the people involved. A brief introduction to various strategies for the implementation of change will follow. We will conclude with a list of some key elements in this process.
6.1 Implementation Issues
The main concerns when introducing change can be identified as the change or innovation itself, the way the innovation will be presented or communicated, the timing of the implementation, and very importantly, the nature of the people who must adopt the change. Let's examine them in turn.
Rogers and Shoemaker (1971, 22) identify five aspects of the innovation itself which are significant. They are:
The communication of the innovation to the participants is critical in determining whether it will be accepted. Basically, good interpersonal and organisational communication skills are required. Several observations were also made by Rogers and Shoemaker (1971, 23) on this point, including:
Timing is always a critical factor in the implementation of an innovation or change. A good idea introduced at the wrong time could be lost. If the proposed participants are sick, tired, overworked, over stressed, upset, angry, distracted by other pressing matters, or just plain changed out, they are unlikely to adopt the change with the enthusiasm and vigour you might hope for!
This clearly suggests that the participants may respond in a variety of ways to the proposed change. Once again, Rogers and Shoemaker (1971, 357) offer the following description of the range of responses one may encounter.
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The pacesetters. They are venturesome, curious, eager for new experiences and enthusiastic. Often considered radical and disruptive but frequently bring great change, albeit amidst controversy. |
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Seek to moderate their enthusiasm and vigour in introducing an idea according to the readiness of the organisation. Tend to be well established members of groups whose opinions are sought. Tend to avoid introducing radical ideas which might lower their esteem in their group. |
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These accept innovations just ahead of the masses. Followers with deliberate willingness and dedication to the innovation but rarely lead. Constitute an effective support group for the innovation. |
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Adoption is an economic necessity for this group. tend to view the innovation with scepticism. May not be active dissidents but cannot be counted on for support. |
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Tend to be socially isolated within the organisation and to be suspicious of change. May discourage others from participating by their negativity. |
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Openly reject the innovation and actively encourage others to do so. |
The strategies which may be adopted to implement change are based on various assumptions and target a variety of levels. Hersey and Blanchard (1977) identified four levels of change and a relationship with time and difficulty. The four levels of change are:
The nature of the relationship with time and difficulty is quite simple. As the target of the change progresses through the above list, the time required and the difficulty in achieving the change both increase. this is illustrated in the following diagram.
(Source: Hersey & Blanchard, 1977, 3)
One change scheme suggested by Chin and Benne (1976) presented three different strategies as follows:
A second change scheme is offered by Hersey and Blanchard (1977) and includes two strategies.
6.3 Key Elements in the Implementation Process
Nine key elements are presented here as discussed by Lancaster and Lancaster (1982, 21,22).
| 1. Involvement | No one knows everything so respect the knowledge and wisdom of others and involve those who will be affected from the beginning. People usually cooperate with change they perceive as non-threatening and beneficial. |
| 2. Motivation | People participate in activities towards which they are motivated. People tend to be motivated if they feel their contribution would be valuable for the outcome, if they are listened to and feel respected. |
| 3. Planning | Includes considering where the system is inflexible as well as what, how and when change can be brought about. |
| 4. Legitimisation | To be accepted, any change must be sanctioned by the people in control of the organisation, by the participants in the change and ultimately by those who will be affected. |
| 5. Education | Re-education or a switch from one way of thinking to another is usually implied by change. |
| 6. Management | Managing change by delegation is useful for developing others. Find a balance between leading the change and developing leadership capacities in the participants. |
| 7. Expectations | A variety of expectations is appropriate. Expect outcomes to be somewhat different than what was originally planned; expect resistance, unforeseen problems and unbelievable reactions from some. |
| 8. Nurturance | Recognition and support for participants is imperative. People need to be acknowledged for what they do right. |
| 9. Trust | People must trust that the leader of the change has thought carefully before involving them in the change process. |
No doubt you could add some more "key elements" of your own. Perhaps you could reflect on some changes with which you have been involved in some way and distil a set of key elements which reflects your own assumptions and experiences.
7.0 Change: Reactions and Resistance
In this final section of module 7 we examine individual reactions to change with a brief review of the emotional cycle of change (Kelly & Conner, 1979). We shall also explore the issue of resistance to change. Notice that we refer to the issue of resistance rather than the problem of resistance since resistance is most definitely not all bad, as we shall see.
7.1 Reactions and Responses to Change
Kelly and Conner (1979) described an emotional cycle in response to an introduced change, starting from a point preceding awareness of the proposed change and concluding after the successful implementation of the change. The cycle describes a relationship between time and pessimism. The three assumptions underlying the model or cycle are:
People who actively engage in an innovation tend to be optimistic concerning it.
The more that is learned about the proposed change the greater the tendency to doubt whether participation is a good idea.
The level of optimism and pessimism about the change is related to the information available concerning what will be required from each person and the overall organisation.
There are five stages in the cycle as outlines below.
| I. Uninformed optimism (certainty) |
This is the honeymoon phase. The idea looks great, morale is high, obstacles look small and opponents seem merely uninformed. |
| II. Informed pessimism (doubt)
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With early progress the impact on other goals becomes clear, resources seem scarce, co-workers are viewed as obstacles and energy wanes. Critical problems have become evident but solutions and resources are missing. Morale drops and people wonder why they became involved. |
| III. Hopeful realism (hope)
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Here goals can be modified if necessary and the desire to quit can be dealt with openly. This is a productive stage now that the unrealistic optimism of the honeymoon phase has been balanced by some pessimism, resulting in a more cautious and methodical optimism. |
| IV. Informed optimism (confidence)
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Participants grow in confidence in their ability to succeed faced with evidence of progress. Encouragement, recognition and support from the leader of the change are essential to ensure continued progress. |
| V. Rewarding completion (satisfaction) |
The result of a successful change experience. The result may not be quite what was originally expected but the change reflects the input of many participants. |
The cycle is illustrated in the following diagram.
The Emotional Cycle of Change
(Source: Lancaster & Lancaster, 1982, 18)
The model does reflect the reality of implementing change within organisations and indeed in other settings too. It seems somehow apt that the diagram looks like a mountain climb!
7.2 Resistance to Change
Resistance to change may be defined as "any conduct that serves to maintain the status quo in the face of pressure to alter the status quo" (Zaltman & Duncan). However, some consider that resistance to change, to deserve that label, requires an element of self-interest. One might argue that a decision to reject change based on an informed, rational assessment that it will be dysfunctional (for example, in relation to some professional objective) does not constitute resistance. One could debate this point for some time but for our purposes, rather than sink into semantics, we can take it at face value and accept the first definition.
Virtually all change meets with some resistance due to either:
the nature of the change itself, or
misconceptions about what it might mean
Most resistance seems to be based on fear and results from threats to the integrity of those faced with change in relation to:
Other social factors can lead to resistance such as:
Each proposed change is weighed against one's experience to see if:
Clearly, if any of these is answered in the negative resistence is likely. Those who oppose change may:
Resistance can be minimised when:
It is very important to realise that resistance is NOT all bad. It can be managed badly and it may not be used to full advantage by managers and change agents who lack confidence and creativity. Nevertheless, resistance may:
resistors should therefore be taken seriously and listened to carefully in all situations. The change agent may learn a great deal from them and they may (even unwittingly) become allies - though perhaps never converts! So, go change the world!
Try the following brief self-test to complete this module.
| 1. List the three (3) defining elements of groups. |
| If you encountered difficulty with this question, return to the applicable section in the module by clicking here. |
| 2. List any five (5) of the eight (8)
major factors which together are responsible for what we know as group dynamics. |
| If you encountered difficulty with this question, return to the applicable section in the module by clicking here. |
| 3. List the phases of the group
life-cycle or list the developmental stages of groups. |
| If you encountered difficulty with this question, return to the applicable section in the module by clicking here. |
| 4. State two (2) major approaches to accounting for change. |
| If you encountered difficulty with this question, return to the applicable section in the module by clicking here. |
| 5. According to Hersey and Blanchard (1977) what is
the easiest level at which to effect change?
If you encountered difficulty with this question, return to the applicable section in the module by clicking here. |
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