Integrated Medical Education Resources: 120107P

Presentation at the Grand Round of the Pediatrics Department at 08.00-09.00 am on January 7, 2012 by Dr Omar Hasan Kasule Sr. Department of Bioethics Faculty of Medicine KFMC

AGENDA

1.0 Introduction (1 minute)

2.0 Methodology of the workshop (2 minutes)

3.0 Principles of group work (20 minutes)

4.0 The health care team (10 minutes)

5.0 Learning outcomes and self assessment instrument (5 minutes)

6.0 Open discussion – 10 minutes

1.0a MEETING BY CHANCE VS MEETING BY CHOICE

In a few situations we meet people by choice. We choose whom to associate with. We have a common objective, something binds us together denovo.
In most life situations we meet people by chance. We do not choose the people to team with in advance. We do not know anything about them. We cannot opt out.

· The health care team falls between the two extremes: choice vs chance.

1.0b DISCUSSION ON CHANCE VS CHOICE:

(a) My marriage to my spouse was by chance my family arranged everything

(b) I am attached to the US, my country of birth; my mother crossed the Canadian border to see the Niagara falls and had a premature delivery

(d) I came here because I heard good reports about the head

(e) I have complete control to choose who sits next to me in an airplane

(f) There is no way I can accept to work on a ward with consultants I do not like

(g) I chose my neighbors in the residential district very carefully and got no problems

2.0a FORMATION OF GROUPS: ILTIQA, INTIQA, IRTIQA

Formation of a group starts with the initial meeting, iltiqa. The meeting may be by chance or by choice.
The second stage in group formation is selection, intiqa. As members interact, selection, intiqa, takes place based on similarities / dissimilarities.
The third stage is rising above, irtiqa: the challenge to stay together and rise above issues that may break up the group, patience and forbearing, a. accepting minor injustices to keep the group together

2.0b FORMATION OF GROUPS: DISCUSSION

(a) I select residents only from my town because we are culturally compatible, get on well with one another and produce better work

(b) I deliberately mix consultants, residents, and interns of different temperaments so to generate tension and competition for better work

(c) I need not interview nurses sent to the ward because they are all the same. I just take them in if they are no good I throw them out and get new ones

(d) I have zero tolerance for misconduct among my residents however minor it may be. They are out on the first error.

(e) I always insist on my rights even if minor because if minor rights are violated major ones will also be violated. I do not answer letters that does not address me correctly with my full titles

3.0a TYPES OF GROUPS

A group is any gathering of people.
A task force is adhoc. It is put together to achieve an objective and is dissolved after that.
A team has continuous membership and continuous objectives and function.
People can be in various groups at the same time or subsequent times

3.0b TYPES OF GROUPS: DISCUSSION

(a) He is obnoxious but I do not mind working with him on this adhoc committee because it is temporary; I will not see his face after 2 months

(b) I feel stuck, I was posted to a department in my hometown whose members are all young and far from the retirement age. They are all US trained and I do not like their approach to pediatric diagnosis but I have to be with them for years.

(c) I was annoyed that they did not select as me team leader when we played a friendly match against the medical department. They upped the annoyance when they did not push me to lead the prayer during the break in the game. They should know that as head of department I am their boss.

4.0a MATURITY OF GROUPS

A group identity: correct answer to ‘who are we?’
Mature groups have optimized feedback, decision-making procedures, resource utilization, communication
Mature groups have clear goals accepted by members, cohesion, flexibility of organization
Members of mature groups have interdependence and participate in leadership functions
Mature groups accept minority views

4.0b MATURITY OF GROUPS: DISCUSSION

(a) The chairman being most knowledgeable and experienced speaks to silent members. He exhaustively explains the pros and cons. When he gets no response from the members, he dictates the unanimous decision for the record.

(b) We have been married happily for 30 years and never had a single problem. Our secret is that we never discuss our duties and rights. Each one of us just does what pleases the other and the other party reciprocates.

(c) Our family has had no problems over the past 20 years because we are silent most of the time. There is no chance for quarrels that can create bad feelings.

(d) We have avoided collisions in our department because we accept any decision made by senior members to avoid negative feelings even if we think a better decision could have been made.

(e) Members of our department get along well with one another because we always find an excuse for any mistake or misconduct according to the hadith of the Prophet about finding 70 excuses for your brother

5.0a GROUPS IN THE QUR’AN AND SUNNAT

Importance of groups: Muslims are enjoined to mobilize in groups[1]. Islam encourages working in groups but makes it clear that seclusion is better than bad company[2].
Similarity is the basis for group formation[3]. People are attracted to those like themselves[4]. Persons who have nothing in common or who do not share common interests can not form a successful group
Cooperation and sharing: Cooperation in doing good is the basis for group work[5]. People in a group can share resources especially at times of scarcity[6].
Transparency: There must be openness and trust in the group. Secrecy and concealment destroy groups[7]. Secret talks between some members of the group are prohibited[8].
Unity: Members of a group should have empathy for one another being the similitude of one body or one physiological entity[9]. Group must be solid[10]. Members should support one another so that they stand together like a strong wall or building whose different parts reinforce one another[11]. Separation from group is condemned[12].
Group productivity: The excellence of work in a group is illustrated by congregational prayer whose reward is 25 times that of a solitary prayer[13].
Norms: A group must adhere to and respect some norms. Allowing some members to break the norms will destroy the group[14].

5.0b GROUPS IN THE QUR’AN AND SUNNAT: DISCUSSION

(a) Our group functions very well. We were all secrets personal and professional

(b) We stick together in good or bad. We are loyal to one another. We protect our members who commit professional mistakes.

6.0a THREE PRINCIPLES FOR GROUP WORK

Consensus: The consensus of the group is protected by Allah from error, al ijma ma'asum. Thus, a group is less likely to reach a wrong conclusion than an individual working alone.
Leadership: Humans must select and follow a leader for proper and purposeful conduct of their affairs; this means those followers must congregate in groups under a leader.
Cooperation: The general directive of the Qur'an to believers to co-operate in doing good requires that people work in groups.

6.0b THREE PRINCIPLES FOR GROUP WORK: DISCUSSION

(a) I feel like I am weak because I always find a way to agree with my colleagues and never forcefully present alternative views

(b) I sometimes find myself opposing an idea that I think is right because my colleagues may think I have no original thoughts of my own

(d) I hate contributing to departmental projects because my role may not be noticed. I would rather research and publish articles

7.0a FIVE ATTRIBUTES/CHARACTERISTICS OF AN IDEAL GROUP

· Group culture and norms: Qur'an, sunnat, common and inspiring goals, collective and not individualistic, conforming to norms

· Members in the group must feel secure and not suppressed. They are accepted with their shortcomings and human weaknesses. They express their opinions freely, criticize, and accept criticism.

· Group dynamics: Good communication, loyalty, group feeling, asabiyyat (double-edged sword). Trust and confidence, collaboration and cooperation, mutual support, sharing (sorrow, happiness, failure, and success), transparency.

· Competence and commitment. group and personal responsibility, standards of excellence, individual roles (expected, perceived, enacted, and assigned), group task roles (the roles that the group has to carry out), group maintenance roles (roles necessary to maintain the group), negative individual roles (aggressor, blocker, recognition-seeking, player, and dominator, playing politics)

· Leadership: A leader should be selected on the basis of effective leadership, ability to run meetings well, ability to make sure the work is done, and ability to hold the group together. A domineering leader is risky. A leader must have vision. The leader must identify and resolve conflicts early.

7b FIVE CHARACTERISTICS OF AN IDEAL GROUP: DISCUSSION

(a) Our team is very productive because our leader encourages us to compete with one another

(b) I dare not say anything when we meet as a group because if I erred they would all attack and humiliate me

(c) I am very happy with the very strong group feeling, asabiyyat, in our department it keeps united but discourages us from interacting with others in other departments

(d) Our group functions despite presence of different characters: aggressors, blockers, recognition-seekers, players, and dominators, and politicians.

(e) Our group would have fallen apart a long time ago if we did not have dictatorial leadership that does not allow any dissent

8.0a THE PROBLEM OF DIVERSITY

· Diversity=productivity: If all members of the group were similar in all personal, biological and social characteristics the group could function together better but would not have the same achievements as a diverse group.

· Accepting and using diversity: Dealing with diversity is not denying the differences but we need to acknowledge them and be aware of their impact on our behaviour and decisions. This awareness prevents biases

8.0B THE PROBLEM OF DIVERSITY: DISCUSSION

(a) Our leader is very wise; he prevents misunderstanding by assigning tasks to sub-groups based on ethnic and social background

(b) I have trouble working in diversity. If I ever become the leader I will enforce uniformity in everything: dress and appearance, speech, style of work etc so that each member works as a cog in a big machine

9.0 ADVANTAGE OF GROUP WORK: SUPERIOR PERFORMANCE

Salat al jamaat 27-fold

Group arithmetic: 1 + 1 = 11

Integration, stimulation, motivation, innovation, emotional support, & endurance.

Co-coordinating, channeling, and complementing individual performance

Do not suppress the individual

10.0 DISADVANTAGES OF GROUP-WORK:

· Group think: feeling invulnerable, know, can do anything, arrogant, right and everybody else immoral or wrong

· Suppression: The strong desire to maintain group cohesion may lead to a false feeling of unanimity when actually people disagree but just suppress their opinions in the interests of the group.

· Mismatch of members: No shared vision, incompatible background experiences, and intra-group conflict.

11.0 FUFILLING DUTIES OF BROTHERHOOD

· The 5 basic duties including returning greetings, accepting invitations

· Tolerance, forgiveness, helping the oppressed, solving problems, fulfilling needs, compassion and kindness, gratefulness, protecting the honor of others, fulfilling promises and commitments, respect, sincere advice or nasiiha.

· Avoid underrating and humiliating others

· Removing any annoyance from the public places, imatat al adha an al tariiq[15].

· In general, everybody must behave with the best of manners, husn al khulq[16].

12.0 POSITIVE BEHAVIORS and ATTITUDES

Mutual love, tawadud,
Empathetic caring for one another, rahmat & hilm[17];
Leniency, rifq, in everything[18];
Co-operation and mutual support, ta'awun[19];
Generosity, karam[20];
Truthfulness, sidq[21];
Patience, sabr[22];
Modesty, haya[23];
Cheerful disposition, imbisaat[24];
Calling people by their favorite names, ahabb al asma[25];
Recognizing the rights of those older than you, irfan haqq al kabir[26];
Self control in anger, malk al nafs inda al ghadhab[27].

13.0 NEGATIVE BEHAVIORS and ATTITUDES

Harshness in speech[28]
Rumour mongering, namiimat[29]
Excessive praise of others in their presence, al ghulw fi al thana[30]
Mutual jealousy and turning away from other, tahasud & taba'ud, & tadabur[31]
Not interacting, hijrat, for more than 3 days following a misunderstanding[32]
Anger, ghadhab[33];
Spying on the privacy of others, tatabu'u awrat al nas[34]
Repeating the same mistake twice[35]
Volunteering information about your personal weaknesses, al satr ala al nafs[36], unless it involves correcting a mistake related to the general medical work

14.0a CAUSES OF GROUP FAILURE

Constituted on the wrong
Members cannot communicate
No commonality (interests, attitudes, and goals)
Moral diseases: envy, hasad; hypocrisy, nifaq; rumor mongering, namiimah; back-biting, gaybah; lying, kadhb; show-off, riyah; pride, kibriyah; love of leadership, hubb al riyasa; spying on one another, tajassus; and negative thoughts about others, dhun al soo.
Seeking personal credit for group work alienates and demotivates.
Denying credit where it is due annoys and alienates

14.0b GROUP FAILURE: DISCUSSION

We have not been able to function smoothly because the chairman is research oriented, the consultants are service oriented and the college lecturers only want to teach
I stopped working with anyone in the department because of jealousies and competition. I prefer solitary work and keeping out of the way
I never tell my colleagues about my new publications for fear of jealousies
The atmosphere in this department is toxic: rumors and innuendos and suspicions
We work for ajr from Allah and do not mind if our contributions to the department are not acknowledged

15.0 ETIQUETTE of TEACHING & LEARNING in THE HEALTH CARE TEAM

· The hospital health care team is complex and multi-disciplinary with complementary and inter-dependent roles.

· Members have dual functions of teaching and delivering health care.

· Most teaching is passive learning of attitudes, skills, and facts by observation.

· Teachers must be humble, make the learning process easy and interesting, be a role model, express emotion appropriately, encourage student questions, repeat to ensure understanding, and not hide knowledge.

· The student should respect the teacher for the knowledge they have, listen quietly and respectfully, teach one another, ask questions to clarify, and take notes for understanding and retention, and stay around in the hospital and with their teachers all the time to maximize learning.

16.0 ETIQUETTE of CARE DELIVERY in THE HEALTH CARE TEAM

· Each member of the team carries personal responsibility with leaders carrying more responsibility.

· Leaders must be obeyed except in illegal acts, corruption, or oppression.

· Rufaidah’s model: kind, empathetic, capable leader and organizer, clinically competent, and a trainer of others, and assisting all in need.

17.0 THE HEALTH CARE TEAM: GENERAL GROUP DYNAMICS

· Basic duties of brotherhood and best of manners must be observed.

· Positive behaviors: mutual love, empathy, caring for one another; leniency, generosity, patience, modesty, a cheerful disposition, calling others by their favorite names, recognizing the rights of the older members, and self control in anger.

· Negative attributes: harshness in speech, rumor mongering, excessive praise, mutual jealousy, turning away from other for more than 3 days, and spying on the privacy of others.

18.0 THE HEALTH CARE TEAM: SPECIAL GROUP DYNAMICS

· Gender-specific identity should be maintained in dress, walking, and speaking

· Free mixing of the genders is discouraged but professional contact within the limits of necessity is allowed.

· Modesty: The gaze should be lowered. Modest and covering must be observed. Display of adornments that enhance natural beauty must be minimized.

WORKSHOP ON TEAM WORK AND TEAM SPIRIT

Held at Children’s Hospital KFMC on January 7, 2012

Dr Omar Hasan Kasule Sr

LEARNING OUTCOMES

I. PRINCIPLES OF GROUP WORK: LOs

1. Define and describe various types of groups, formal and informal

2. List and describe advantages of group work

3. List and describe disadvantages of group work

4. Describe the processes and stages of group formation and group break up

5. How is the set-up of the health care team different from other groups

6. Describe characteristics of mature groups

7. List and describe common causes of group break up

8. What behavioral diseases destroy groups

9. List and describe characteristics of an ideal group

2. ETIQUETTE of TEACHING/LEARNING in HEALTH CARE TEAMS: LOs

1. Describe the composition of the health care team

2. Describe the dual functions of teaching and delivering care

3. Summarize the teacher’s etiquette

4. Summarize the student’s etiquette

3. ETIQUETTE of CARE DELIVERY in THE HEALTH CARE TEAM: LOs

1. Describe responsibility in a health care team

2. Describe leadership in a health care team

3. Describe the necessary skill matrix in a health care team

4. THE HEALTH CARE TEAM: GENERAL GROUP DYNAMICS: LOs

1. List and describe basic duties of brotherhood that must be fulfilled in a team

2. Describe additional duties of brotherhood to be fulfilled in a team

3. Describe Islamic guidelines on the etiquette of inter-personal interaction

4. List and describe positive behaviors and attitudes

5. List and describe negative behaviors and attitudes

5. THE HEALTH CARE TEAM: SPECIAL GROUP DYNAMICS: LOs

1. Describe guidelines on dress for both genders in a team

2. Describe legal guidelines on gender mixing in a health care team

3. Describe legal guidelines on seclusion in a health care team

4. Describe legal guidelines on lowering the gaze in a health care team

WORKSHOP ON TEAM WORK AND TEAM SPIRIT

Held at Children’s Hospital KFMC on January 7, 2012

Dr Omar Hasan Kasule Sr

I. MATURITY OF THE GROUP: SELF ASSESSMENT EXERCISE

Criterion	High	Satisfactory	Poor
Giving and accepting feedback
Democratic decision making
Group cohesion
Flexibility of members
Use of all member resources
Members feel free to disagree
Everyone is free to express an opinion
Humor is the norm
Communication is effective
Group sets clear strategies and goals
Interdependence Among members
Shared participation; not dictatorship
Listening to minority views

II. GROUP EFFECTIVENESS: SELF ASSESSMENT EXERCISE

Productivity	High	Satisfactory	Poor
Positive handling of complaints
Positive conflict resolution
Commitment to goals
Action-orientation
Apathy of some members
Encouraging creativity and innovation
Competence of team managers/leaders
Effectiveness of meetings and discussions
Effective communication
Trust among team members
Making sure decisions are understood by all
Feeling good as a team member
Principled behavior

[1] Qur'an 4: 71

[2] Bukhari Kitaab al Fitan Hadith #7084

[3] (Bukhari 4:348, Hadith #)- not yet checked

[4] (Bukhari 8:122-123, Hadith # 196) not yet checked

[5] Qur'an 5:2

[6] (Bukhari 3:402, Hadith # 666, Bukhari 3:400-401, Hadith # 663) not yet checked

[7] Qur'an 58:9-10

[8] Qur'an 4:114

[9] (Muslim 3: 1368, Chapter 1067, Hadith # 6258?)- not checked

[10] Qur'an 61:4

[11] (Bukhari 8:34, Hadith #55)- not checked

[12] (Abu Daud 3:1332, Chapter 1706, Hadith # 4740)

[13] (Hadith No. 620" Bukhari 1:277 , Hadith # 466, Muslim 1:314, Chapter 234, Hadith #1360, Bukhari 1:351, Hadith # 618) not checked

[14] (Bukhari 3:406, Hadith # 673) – not checked

[15] Bukhari Kitaab Al Adhan K10 Baab 32 Hadith #652

[16] Tirmidhi Kitaab Al Birr Wa Al Silat No 25 Baab No 55

[17] Mukhtasar Bukhari Hadith No 2018

[18] Tirmidhi Kitaab Al Birr Wa Al Silat No. 25 Baab No 67

[19] Mukhtasar Bukhari Hadith No 2026

[20] (Mukhtasar Bukhari Hadith No 2028

[21] (Mukhtasar Bukhari Hadith No 2039

[22] (Mukhtasar Bukhari Hadith No 2040 Bukhari 8:121)-wrong meaning/reference

[23] (Mukhtasar Bukhari Hadith No 2043, Mukhtasar Bukhari Hadith No 2044

[24] (Mukhtasar Bukhari Hadith No 2045

[25] (Mukhtasar Bukhari Hadith No 2055 Bukhari 8:240, Mukhtasar Bukhari Hadith No 2056 Bukhari 8:242)-wrong ref

[26] Tirmidhi Kitaab Al Birr Wa Al Silat No. 25 Baab No 15

[27] Bukhari Kitaab Al Adab No. 78 Baab No 53

[28] (Mukhtasar Bukhari Hadith No 2029

[29] (Mukhtasar Bukhari Hadith No 2032

[30] (Mukhtasar Bukhari Hadith No 2033

[31] (Mukhtasar Bukhari Hadith No 2034

[32] (Mukhtasar Bukhari Hadith No 2038

[33] (Mukhtasar Bukhari Hadith No 2041

[34] Abudaud Kitaab Al Adab No. 40 Baab No 37

[35] (Mukhtasar Bukhari Hadith No 2046

[36] (Mukhtasar Bukhari Hadith No 2037

120107P - TEAM WORK AND TEAM SPIRIT