Table Of ContentFacilitating
Groups in
Primary Care
A manual for team members
Marion Duffy and Elaine Griffin
Tayside Centre for General Practice
University of Dundee
Boca Raton London New York
CRC Press is an imprint of the
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Contents
Preface v
List of tools vi
List of case studies vii
Acknowledgements viii
1 Introduction 1
2 How to use this handbook 5
Theory 5
General Practice 6
Case Study 6
Tips and Tools 6
Facilitate Your Own Practice 6
3 A general introduction to facilitation skills 7
What is facilitation? 8
Facilitators in the NHS 9
Facilitators and the development of practice teams 11
Limitations to using external Facilitators 11
How you can act in a facilitative way 12
Are you suited to the formal Facilitator role? 13
Key principles of facilitating a group 14
Types of behaviour for the Facilitator to avoid 14
Varying your leadership style 14
The relationship between the Facilitator and the group 15
Criteria for excellence in the Facilitator role 15
4 How groups work 17
The advantages of working in groups 18
The stages in the evolution of a group 18
Milestones to synergy 20
Indicators of an effective group 20
Conditions which impair the workings of a group 21
Teams and groups in general practice 22
Problems which typically occur in primary healthcare teams 25
Helping and hindering behaviour in groups 26
Facilitating improvement in an existing group 29
Clarifying the task and process of an existing group 30
iv
Contents
Facilitating a new group 31
Taking on the formal Facilitator role 31
The two primary skills of facilitating 32
General guidelines for facilitating groups 33
Situations and interventions 35
How to deal with ‘problem’ people in groups 37
Planning to use tools in a group setting 39
5 Making meetings more effective 53
Formal meetings 54
Informal meetings 54
The purpose of meetings 55
Terms of reference for a meeting 55
Characteristics of an effective meeting 56
Convening and chairing a successful meeting 56
Disillusionment with meetings 58
Decision making in meetings 61
Factors which aid effective problem solving 64
Factors which hinder effective problem solving 64
The need for meetings 65
The variety of practice meetings 65
Features of meetings in general practice 65
Facilitating the planning and review of practice meetings 66
Identifying the roots of a problem 69
To stimulate creative thinking 72
To encourage wider participation in discussion 73
To make decisions by consensus 73
6 Qualities, skills and opportunities 81
The essential qualities of a Facilitator 82
Opportunities to facilitate within your own practice 83
Maximising the benefit of working in groups 84
Reflection and feedback 85
Giving feedback 86
References 89
Preface
In recent years general practice has provided an almost constant experience of
change, much of it imposed.
Practices have been asked to become team based, to embrace new techno
logy, to construct practice development plans, to devise multi-disciplinary
protocols for managing patient care, to introduce regular audit procedures and
now to present their ‘practice perspective’ to the Local Healthcare Co
operative or Primary Care Group.
There are many guides and manuals available, offering techniques for
improving teamwork and for instigating and managing change - from team
development kits to SWOT analysis to needs assessment to action planning. Few
of these take a ‘step back’ to discuss who will guide the process and what skills
those people will need.
This handbook draws on the experience of a number of research and
development projects managed from The Tayside Centre for General Practice,
University of Dundee, and is grounded in the work of modern day general
practice in the United Kingdom. It does contain tips and techniques for
improving the working of groups, but its central purpose is to equip those
individuals working in general practice with an understanding of how people
work together and how they can be helped to do that more effectively. With
that aim in mind it will be of benefit to any member of the primary care team.
Facilitators are often used in business settings to assist groups with change.
The role of the Facilitator is essentially to make something easier (see Chapter 3
for a more detailed description). Many practices have used external Facilitators
in the past. While there may always be a place for them in some situations, we
believe that individuals in-house can help to facilitate their own group, thus
reducing the need for outside intervention.
Marion Duffy
Elaine Griffin
September 1999
List of tools
• Ice breakers
• Inlaws and outlaws
• Planning for a small group
• Clarifying the task and process of an existing group
• Reflections card game
• Root Cause Analysis
• Meetings Checklist
• Brainstorming
• A round
• Giving feedback
List of case studies
1 The Yellow Practice: facilitating development
2 Sally: facilitating audit
3 The Red Practice: task focused group
4 The Violet Practice: setting up a new group
5 The FED Project: facilitation skills, qualities and effects
6 The Pink Practice meeting
7 The Brown Practice meetings
8 Analysis of low morale in The Grey Practice
9 Use of ‘The Five Whys’ in The Silver Practice
Acknowledgements
The authors gratefully acknowledge the financial support of Roche Pharma
ceuticals without whose sponsorship this handbook, its sequel Facilitating
Organisational Change in Primary Care, and the accompanying workshops,
would not have been developed. Roche responded to a need, identified by the
authors, for a handbook for those working in primary care that was
contextualised for that setting. Facilitation posts are increasingly being
advertised by healthcare organisations yet those who take on the task find
little published material to help support their own development in the role.
Additionally, practice-based professionals need to develop facilitation skills so
that they can maximise the effectiveness of teamworking in the organisation
and provision of healthcare.
Eight general medical practices from the Tayside and Grampian regions of
Scotland participated in the workshops that accompanied the development of
this handbook. Their active engagement in the skill development process and
their feedback on the relevance and value of both the handbook and the
training have been of considerable benefit to the authors. We extend our
thanks to them.
Fifteen general medical practices in Tayside participated in the project
entitled Facilitating Education and Development (The FED Project). Many of
the case studies in this handbook are based on experiences during that project,
although some details have been altered to ensure confidentiality. We acknow
ledge the practices’ willing co-operation in that project.
We would also like to thank colleagues at Tayside Centre for General
Practice and Tayside Audit Resource for Primary Care (TARPC) for sharing
their past experiences of using facilitation as a tool for personal and practice
development. In particular we mention Arlene Napier who gave generously of
her time and resources in the development of the content for the handbook,
and the Practice Audit Co-ordinator ‘Sally’ who gave an insight into
facilitating audit in her own practice.
And finally, we must acknowledge the support and encouragement of our
own families for whom the production of this handbook must have imprinted
the name ‘The Facpack’ forever in their memories. Thank you for your
encouragement and practical support.
Chapter 1
Introduction
Summary
The introduction describes the focus of the handbook as ‘working in
groups’.
It sets the context by helping you to focus on how your practice works
together and describes a practice which used a Facilitator to help it
establish its goals for development.
Please note that, for reasons of convenience, we refer throughout the
handbook to the facilitator as of female gender. All references can be
assumed to refer to facilitators of either gender.
This handbook looks at facilitating groups in primary care through
knowledge and understanding of the context of general practice, and of
how groups typically work together. As the need for meetings has increased
in the current climate, the handbook focuses on what typically happens
when groups work together in a meeting session and suggests an approach
which uses facilitative behaviour to make that process of working together
easier.
You will be asked to think about how you might act in a more facilitative
way, and whether the formal role of Facilitator is one to which you might
aspire.
