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Group Facilitation Made Easy

I have worked with small groups that have gathered to undertake work that would be impossible for one person to do alone. These groups have generally focused on four areas: professional training using a seminar format, group psychotherapy, consultation groups, batterer’s intervention and didactic anger management classes. In most of these situations, I have been asked to act as facilitator or trainer. In the seminar groups, I am clearly the trainer. In the other formats, I am the facilitator who assists the group in gaining from the unique experience of learning and sharing in a group. In French, the word facile means "easy." It is the aim of facilitators to make the work of a group easy.” This involves coming up with a plan and process that will help participants accomplish their goals. In all of the groups in which I have participated, I have found it useful to provide participant workbooks with an outline and, when possible, ancillary videos and other visual learning material. Facilitation involves helping people co-operate and act collectively. When a group works together in this way, they experience many benefits, including:

• Synergy: The energy or motivation to work on the task is better or higher than working on the same task in isolation. 
• Positive outcomes: By using the collected experiences of many individuals, the quality of what is produced is higher than if it had been attempted by one person. 
• Broader impact: Each person in the group interacts with others outside the group, broadening the impact of the work. 
• Greater resources: The individuals in a group can pool their knowledge, information, personal experiences, and other resources to help the collective do its work.

In this article, I will share some suggestions that may help you strengthen your group facilitation skills relative to anger management, stress management, communication and emotional intelligence.

Prior to the Meeting

Effective facilitation involves 80 percent preparation and 20 percent presentation. Facilitators should make themselves aware of any factors that may hinder or help the group's work. Make sure to review the material to be discussed and establish continuity between sessions. Be thorough, using what I call the "three p's for planning": participants, purpose, and process. Find out as much as possible about participants (those who will be attending) and the results of their assessments. Ask questions and learn as much as you can from the facilitator who conducted the assessment. Remind the participants at each session that the purpose of the program is to teach skills to enhance their skills in recognizing and managing anger, stress, communication, emotional intelligence.  As you develop this statement, keep in mind that groups often establish unrealistic goals for themselves, only to be mired in the reality of their circumstances. Realistic goals are those based on the nature of the task, the number of participants, and the time available. Achieving practical plans will enable groups to experience a sense of accomplishment and satisfaction that can give them the motivation they need to complete their task. (That is why it is important for facilitators to remember that the work is theirs, not ours.) They will be responsible for that work after they have completed the required number of sessions. As you prepare to work with your group, remember that every group deserves your unconditional respect and love. This is the spiritual side of all small group facilitation. Envision success for the group even before meeting them. If you do this, you are more likely to be effective in helping the group develop or enhance skills in managing anger, stress, assertive communication and increasing emotional intelligence.

At the Start of the Meeting

Plan to begin your meeting with a welcome, a goal statement, an explanation of the agenda, and group introductions. New members should be introduced last and asked to share their control log and assessment summary as well. Old members should be asked to summarize their experience in the group and further goals during their attendance. It is extremely useful to have each person say something within the first 10 percent of your time together. This helps each participant find her or his voice in the group. Short activities with this goal are known as climate setters, icebreakers, and warm-ups. A start-up activity can relate directly to the task or generate information about group members' lives outside the group. I often begin by referring to the goal and agenda of the group and then ask everyone to introduce themselves briefly with their name and one reason they are participating in the program. Be sure to clarify roles at the beginning of any meeting, including the expectations of the facilitator's role compared with that of participants.

Have participants answer these three questions:

• What are your expectations of yourself? 
• What are your expectations of other group members? 
• What are your expectations of the group facilitator?

Discussing these questions will help surface realistic perceptions of your role as a facilitator and increase the likelihood of group ownership of the task. Ask members to share their thoughts in small groups of three or four and to prioritize two or three key expectations for the different roles. This activity will lead to a series of statements that can help the group to arrive at a mutual understanding of the facilitator as process guide and participants as owners and contributors to the task. Mutually agreed-upon statements of roles can be posted and used as a reference throughout the life of the group. Check in on group agreements regularly. This will ensure smooth functioning for the facilitator and the group.

Structuring the Meeting

After the group has completed its introductions, the facilitator presents a sequence of activities and discussions, which are contained in the client, work books. To the extent possible, material in the client workbook should be personalized to those in attendance.

The Importance of Ancillary Material for Visual Learners

It is essential to use the Contrasting Wheels of Behavior as well as the related DVDs and other visual material when conducting anger management groups.

Keeping the Group on Track

One of the major tasks of the facilitator is to keep the group focused on the task of the group and the material in the client workbooks. It is critical to deter the group from unrelated material. This is easy to day by simply stating, "Our discussion has to remain on the topics in the workbook.

Disruptive Participants

Often, people who want to improve their facilitation skills identify problem behaviors displayed by participants. They want to learn how to deal with the behaviors so those behaviors no longer hinder the group. I hesitate to spend time thinking about what to do when things go wrong in a group. I believe if we do a good job of staying with the topics in the workbooks, preparing and planning, we greatly increase the likelihood that people will stay on track. Your own enthusiasm for knowing the task and the process, and your confidence that the group will be effective in achieving this task, is highly infectious. Doubt about whether participants can do it or work together co-operatively can have self-fulfilling prophecy tendencies, and is highly contagious. Be enthusiastic about the task and the group's capacity to work well together.

Closing the Meeting

The closure of a meeting is a time to evaluate what has happened, share learning's, express appreciation, and announce the lesson for the next session. Allow 10 minutes of your time together for closure.

George Anderson, MSW, BCD, CAMF

Emotional Intelligence, A Core Leadership Competency

A look back at George Anderson’s recent appearance at the The Association of Nigerian Physicians Of The America’s Annual Conference, held in Las Vegas. George gave a presentation titled “Emotional Intelligence, A Core Competency in Healthcare Leadership”. There were 500 physicians, nurses and pharmacists in attendance.

Anderson Newsletter

Current Trends In Coaching "Disruptive Physicians"

Effective January 1, 2009, The Joint Commission (JCAHO) issued new guidelines to respond to the negative behavior of physicians that often places patient care at risk while increasing medical errors. These new standards made it mandatory for Hospitals to establish written policies designed to address what is defined as "disruptive physician behavior." The following is one definition of what is considered "disruptive behavior":

Disruptive conduct can take many forms. Raised voice, profanity, name-calling, throwing things, abusive treatment of patients or employees, sexual harassment, disruption of meetings, repeated violations of policies or rules, or behavior that disparages or undermines confidence in the Hospital or its staff may be disruptive behavior, although this is not an exhaustive list. Unacceptable disruptive conduct can also include such behavior as:

I.    Attacks (verbal or physical) leveled at others that are personal, irrelevant, or go     beyond the bounds of fair professional comment.

2.     Impertinent and inappropriate comments written or illustrations drawn in patient medical records, or other official documents, impugning the quality of care in the Hospital, or attacking particular practitioners, employees, or Hospital policy.

3.     Non-constructive criticism, addressed to its recipient in such a way as to intimidate, undermine confidence, belittle, or to impute stupidity or incompetence.

4.     Refusal to accept medical staff assignments, or to participate in committee or departmental affairs on anything but his or her own terms or to do so in a disruptive manner.

5.     Imposing idiosyncratic requirements on the Hospital staff that have little impact on improved patient care but serve only to burden employees with "special" techniques and procedures.

When a practitioner's conduct disrupts the operation of the Hospital, it affects the ability of others to get their jobs done, creates a "hostile work environment" for Hospital employees or other practitioners, or begins to interfere with the practitioner's own ability to practice competently, action must be taken. Courts have consistently held that if a practitioner creates disharmony or disruption, the Hospital has a duty to intervene.

In addition to written policy and promotion of these new policy guidelines, physicians who are determined by the appropriate hospital committee or disciplinary unit to be "disruptive" must be mandated to participate in an appropriate intervention to address these issues and acquire appropriate interpersonal skills along with self-control, empathy, self-awareness and other key emotional intelligence skills.

Rarely are these physicians psychiatrically impaired, substance abusers or sexual abusers. Therefore, none of these options are available as resources without specific justification and documentation.
The typical physician referral is a highly skilled surgeon who is accused of throwing an instrument, cursing a staff member, yelling at co-workers or was impatient or discourteous to a patient. Stress is almost always a significant factor in the physicians' behavior.
Resources For "Disruptive Physicians"

Physicians and Healthcare Organizations nationwide are under pressure to find coaching resources for "disruptive physicians." Mandating any physician to participate in an intervention for "disruptive behavior" is difficult for Physician Well-Being Committees, Medical Directors and Hospital Credential Committees as well as State Medical Licensing Boards.

Leaders responsible for managing physicians are willing to look the other way or do almost anything to avoid complying with this new Joint Commission requirement.
By delaying the decision to take action based on a distaste for adversarial tension, pressure begins to mount as the year comes to an end. Many organizations need to show evidence that they are following the Joint Commission Policy relative to mandating assistance for "disruptive physicians".
Two of the three major programs for "disruptive physician behavior" are already filled for 2017. These programs are the Distressed Physician Program at Vanderbilt University School of Medicine at Nashville and the PACE Program at the University of California School of Medicine at San Diego. Both the Vanderbilt Program and the PACE Program only accepts 8 physicians each quarter for its respective classes.

The largest provider of individual coaching for disruptive physicians is Los Angeles based Anderson & Anderson, APC. The uniqueness of the Anderson & Anderson curriculum is that it was specifically designed for "disruptive physicians." The Practice of Control, the client workbook and all of the DVDs, CDs and ancillary training material are carefully designed to improve assertive communication, increase self-awareness, self-perception, social awareness and relationship management and stress management.

Anderson & Anderson has a well trained Certified Coaching Faculty with the capacity to offer the internationally recognized EQ-i-2.0 Emotional Intelligence Assessment and intensive coaching On-site anywhere in the U.S. followed by six months of Aftercare and Post Tests. Emotional Intelligence Classes For The Prevention of "disruptive" Behavior at Work. In order to keep JCAHO accreditation, every hospital now must have a system in place for recognizing and effectively dealing with disruptive physicians — whether they’re on staff or simply have hospital admitting privileges.
In order to minimize the risk of adverse events and malpractice suits, medical groups must have the awareness and skill set to intervene effectively when a colleague or employee first begins behaving unprofessionally.

Organizations that identify and deal with disruptive behaviors and performance problems at the earliest stages can not only save a considerable amount of time and money — but also mitigate risk.
Since Emotional Intelligence is the core of most of the intervention programs for "disruptive behavior," it seems reasonable to offer general courses in emotional intelligence to physicians, nurses and other ancillary staff.

Such courses may focus on leadership, interpersonal relationships, self-control, social awareness, relationship management, stress management, decision -making or any of the many other emotional intelligence scales.

The American Medical Association as well as local medical associations are offering and/or promoting presentations on how to prevent or manage disruptive physician behavior. Kaiser Permanente of Southern California has taking the lead in being proactive in preventing the consequences of "disruptive physician behavior" in hospitals and healthcare organizations.

 George Anderson, MSW, BCD, CAMF, CEAP