11 Group Process

Learning Objectives

• list key concepts for working in groups

• describe the Delphi Method and the nominal group process

• practice the nominal group process

Comments on exercise just completed

THURSDAY interim presentationeach group to take 8 minutes, to talk about a work in

progress

FOCUS on techniques used, their effectiveness, supplemented with findings

don't be fancy

helps you see what you have learned, and where you may want to go

gets the others to see what you have learned, and they may have helpful ideas

OverviewComing to end of intro to techniques

no one gets good at too many methods

much has been extractive, but there have been participatory ideas too

today we discuss another series of group processes, and another way to observe

Overview

May 17, do RAP 90’s fast paced idea

guest lecturers present ideas & applications

meanwhile, you work together in groups on your projects

Idea generation: Group Process vs Individual Process

Individual Idea Generationperson can think up twice as many ideas in a

group than alone

general impression: group participation facilitates idea production, – think about meetings of group with TA or

instructor

Individual Idea Generationnumber of ideas produced by a individuals

independently is considerably less than produced by an equal number of individuals together– studies confirm this

Group Idea Generation

Brainstorming

shared problem solving: all members of a group spontaneously contribute ideas

Brainstorming

shared problem solving: all members of a group spontaneously contribute ideas

group settings can hinder creative process, intimidate people– very culture dependent– American Indians– Asians, others, not wanting to confront or be

critical, or be ridiculed– physical arrangement of space

Brainstorming

Principles for generating ideas– have clearly defined subject– try to maintain ‘criticism free’ setting when

ideas generated, • ideas flow freely, • not be hampered by critical comments or

attacks from other group members

– all ideas receive approval • or neither praised nor criticized

Brainstorming

Principles for generating ideas– related atmosphere– sufficient time– small group– leader or not?

Brainstorming

Limitations– discussion generally succumbs to influence of few

individuals due to status, personality & other forces

Post idea generation– analysis is separate function, apart from idea

generation– ranking of ideas by group members– task force to review suggestions & make

recommendations– group leader to choose

Nominal Group Technique (NGT)“nominal” refers to process in which individuals

are together in a group, – “in name only” since verbal exchange is excluded or

limited

reflects silent and independent generation of ideas

History:Developed and tested in late 1960’s by Van de Ven

& Delbecqderived from studies of decision conferences, of

aggregating group judgments and from social work studies of problems surrounding citizen participation in program planning

ObjectivesAssure different processes for each phase of

creativity in problem solving– fact finding phase

• problem search & generation of data about problem or about different proposed solutions

– evaluation phase• information synthesis, screening and choosing among strategic

elements of a problem or component elements of alternative solutions

Objectivesbalance participation among members

voting techniques for group judgment

Preparation: membersMembers can be heterogeneous, unlike a focus

group– heterogeneous groups can be more creative – there can be communication difficulties

• individuals should be able to speak a common language – if have doctors and patients, doctors should not use medical

jargon– could have a variety of social scientists

Preparation: membersmembers in an NGT should be

– interested in the problem – have either experience or education which makes

them a resource to the group– flexible so they can openly explore various points of

view

selection bias– if suspect, try a different mixture of participants in

future groups

Preparation (leader)leader (facilitator): skills necessary

understanding of NGT process

self-confidence to lead group through process steps

legitimate so accepted by group– male nurse poor leader for female research medical

staff

ensure all participants are able to express their views and the keep particular personal or professional views from dominating the discussion

Preparation: supplies: table & chairs

flip chart for each table,

3x5 cards for each table,

felt pens,

paper & pencil for each participant

focus of NGT meeting on list of ideas placed on flip

chart – rather than on individual

participants

– open U, with flip chart at open end of table

5 to 10 participants, leader or recorder

flip chart

Determine purpose of meeting, structure proposed question,

assemble members

Process: leader’s welcoming statement:

cordial welcome– sense of importance concerning the group’s task– members gathered because of analytic abilities &

problem solving skills– clarify importance of each member’s contribution– indicate of use or purpose of the meeting’s output

Process: leader serves as recorder Resists non-process clarifications

Presents question in writing; PRETEST THE QUESTION

Models good group behavior by writing in silence

Sanctions individuals who disrupt the silent independent activity

Avoids leading: “any answer that comes to your mind should be written on the worksheet”

Process of NGT1. Silent generation of ideas in writing

2. Round-robin feedback from members to record each idea

(could have people hand in idea slips anonymously, might be good for some situations)

3. Serial discussion of each recorded idea for clarification and exploration

4. Individual DISCRETE voting on priority ideas

5. Discussion of preliminary vote

6. Final vote

Process of NGT1. Silent generation of ideas in writing

2. Round-robin feedback from members to record each idea,

-one idea from each group member in each go around,

-written in a terse phrase on flip chart

3. Serial discussion of each recorded idea for clarification and exploration

Process of NGT1. Silent generation of ideas in writing

2. Round-robin feedback from members to record each idea,

3. Serial discussion of each recorded idea for clarification and exploration

4. Individual DISCRETE voting on priority ideas

5. Discussion of preliminary vote

6. Final vote

silent generation of ideas in writingadequate time for thinking

facilitates work by other group members reflecting & writing together,

• constructive tension created by observing other group members working hard

avoids interruption of each other’s thinking

silent generation of ideas in writingsufficient time for search & recall

avoids premature focusing on single ideas

eliminates dominance by high-status or aggressive members in idea generation

keeps group problem centered

Round-robin feedback from members to record each idea, one idea

from each group member in each go around, written in a terse phrase on flip chart

equalizes opportunity to present ideas, only one idea each time around– members can hide substantial number of

ideas if had to present entire list at once

separate ideas from personalities,

Round Robin Feed backplaces conflicting ideas briefly and comfortably in

front of group

forces group to fully explore problem

write ideas on language used by participant

group’s patience on this step is brief, so write as quickly as possible

Written record and guideideas to be presented in brief words or

phrases, variations on themes are desirable, • can give numbers or letters as a label

increases ability to deal with large number of ideas– avoids loss of ideas– confronts group with an array of clues– encourages hitchhiking

• (ideas written on flip chart may stimulate another member to think of an idea he had not written before so he can add that idea & report it)

Serial discussion of each recorded idea

for clarification and exploration

Serial Discussion Guidelines:

leader verbally defines the role of the step as clarification

leader should pace the group to– avoid arguments or – neglect of some items at expense of

others

Serial Discussion Guidelines:

avoid discussion focusing on particular idea

eliminate misunderstanding

opportunity to express logic behind items

allows members to disagree without argumentation

Individual DISCRETE voting on priority ideas

independent (discrete) judgments in writing helps eliminate social pressures

can rank from 5 to most important item to 1 for least important, could place this on separate 3x5 cards, collected, shuffled & recorded– can also have numbers/letters on each of 5

cards & rank then in order for those non-literates

– five items are about the most you can rank

Individual DISCRETE voting on priority ideas

expressing judgments by rank-ordering increases accuracy of consensus

displaying the array of individual votes highlights areas needing further clarification or discussion

Discussion of preliminary vote

shows the distribution of the group’s response

provides group members with final opportunity to clarify their positions

ensures that “spread” votes really reflected differences of judgment,

people can change their minds

voting, discussion, then re-voting

Final vote

• can rank as before, or rate each item

Advantages

different group processes for independent idea generation, feedback & voting

increased attention to each idea

increased opportunity for each individual to assure her or his ideas are heard

avoids arguments & extraneous interactions

Advantages

more egalitarian

ensures participation, avoids dropping out

may generate more options & ideas per unit time

keeps discussion focused

Limitationscross-fertilization of ideas diminished because of

structure imposed by NGT

reduced flexibility, – structure is imposed on meeting

puts people on the spot to produce something

composition of group is important, need minimal level of education

bringing people together may be cost-prohibitive, but consider the use of video or web-conferencing

Comparison with Brainstorming

average number of unique ideas

average total number of ideas

quality of ideas produced, varies– can have collective ignorance rather than wisdom– triangulate

research suggests that when group task is to generate information on a problem (idea generation), interacting groups inhibit creative thinking

Class Exercise NOMINAL GROUP PROCESS

Question:

What should be done by the University of Washington administration to lessen the stress on public health students at UW?

Nominal Group Technique: Break into four groups

present the question in writing

select one person to be recorder

silently generate ideas in writing

in turn, write each idea on blackboard or flip chart, without debate

Nominal Group Exercisemove group discussion serially through ideas for

clarification and elaboration (but not advocacy)

compile and display preliminary vote on item importance in descending order

hold brief discussion for clarification, interpretation, and refinement of results

obtain, analyze and display final vote as descending order of ranked priorities

Review of Nominal Group Technique

pre-test question – pre-tested– related to meetings objective

leader should avoid leading the group with exemplary answers

focus groups can clarify issues and help frame the (challenge) question for the NGT

NGT: participants can be from diverse cultural backgrounds,

less threatening than other forms of idea generation

NGT: if use flip chart, have a record of the meeting, preferable

to blackboard

NGT: round robin idea generation equalizes opportunity

to present ideas, only one idea each time around

members can hide substantial number of ideas if had to present entire list at once

separate ideas from personalities, since who contributed what is not stressed, with each persons ideas are not clustered

NGT: discussion of ideas can/should proceed serially to

avoid focusing on one, and is for clarifying ideas only

NGT: used with minimal literates, and with aphasic people

stress that worksheets will not be collected

recorder has to assist participants with what is written on flip charts

NGT: Applicationsone MPH student from CAR used it in rural

settings there for his MPH thesis to determine local perceptions of how clinics could be improved under cost-recovery

study in the Philadelphia school district to determine adolescent perceptions of 3 study questions (what characteristics of a care provider, site, and getting more people to come for care) that were generated from focus groups (JAMA 273 1913, 1995)

Ginsburg, K. R., G. B. Slap, et al. (1995). “Adolescents' perceptions of factors affecting their decisions to seek health

care.” JAMA 273(24): 1913-8.Philadelphia 9th graders 39/42 schools (6821 students)

– Majority were Black, then White, then Latino

Focus groups to frame study questionsNominal groups to general student responsesSurveys to assess importance of 35-40 items, inc. Likert,

– Three surveys, then merged to one survey

Focus groups to have students explain variables associated with decision to seek care, adding qualitative depth

Provider characteristics– Hand washing, clean instruments, honesty, respect,

cleanliness, know-how, carefulness, experience, HIV -ve, equal treatment of all, confidentiality

– SES, sex, race little variation

NGT: Applicationsidentifying design criteria for improving mental

health services for Mexican-American farmworkers in California (Am J Prev Med 1985 1 47-55)

developing treatment guidelines by providers for various diseases– VA ambulatory care clinic in Pocatello, ID– changes in US health care system that would

facilitate improved care for NIDDM in US– HMO treatment guidelines for sinusitis and

dyspepsia– standardization of measures of arthroscopy of knee

NGT: Applicationsimproving efficiency in pharmacies (input from

manager, pharmacist, full-time and part-time sales people) generates input from all employees

NGT: Applicationsimproving curriculums and solving other

problems in various educational institutions (used on students & administrators)– use of learning contracts among nursing students– implementing different models of nursing practice

in South Dakota– developing university student safety programs

NGT: Applications

caregivers in chronic care settings – different groups of caregivers (nurses,

orderlies, professionals, student orderlies, volunteers) communicating with residents having different disabilities (e.g. dementia, aphasia) (little change needed in communicating with people having such disabilities)

NGT: Applications

patients in nursing homes– evaluating different measures of functional status

bridging gap between different levels of workers– researchers and practitioners in one study of

community nursing– incorporation health promotion ideas from

personnel from health and from social services

Appropriate foridentifying elements of a problem situation

identifying elements of a solution program

establish priorities where judgments of several individuals must be aggregated into a group decision CONSENSUS BUILDING

Table 2-2 Comparison of Differences among Interacting, NGT & Delphi Groups, Pg 32, Delbecq & Gustafson