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
(c) I joined this department without knowing
anything about it; I had no other alternative
(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.
(c) We tolerate deviations from standard
procedures to avoid conflicts as long as patients are not harmed.
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
(c) As professionals we know what to do; the
function of leaders is for formalities but they interfere in our work
(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
