Table Of ContentGROUPS
A guide to small group work in
healthcare, management,
education and research
Glyn Elwyn
Trisha Greenhalgh
and
Fraser Macfarlane
Illustrated by Siân Koppel
First published 2001 by Radcliffe Publishing
Published 2016 by CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742
©2001 Glyn Elwyn, Trisha Greenhalgh and Fraser Macfarlane
Illustrations ©2001 Siân Koppel
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
ISBN-13: 978-1-85775-400-1 (pbk)
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Contents
Preface iv
About the authors vii
Contributorship ix
Acknowledgements x
Part 1 Introduction 1
1 What is a group? And what does it do? 3
2 The group in its wider context 21
Part 2 The small group process 33
3 Setting the scene for effective small group work 35
4 Facilitation 49
5 Methods used in group work 73
6 Forming 97
7 Storming and norming 115
8 Performing 129
9 Evaluating the group process 147
10 When groups go wrong 159
Part 3 Small group work in educational settings 173
11 Evidence for the effectiveness of small group work in higher
education 175
12 A case study of the use of small groups in postgraduate
education: teaching evidence-based healthcare 191
13 The virtual group 201
Part 4 Small group work in organisational settings 221
14 Group problem solving and decision making 223
15 Groups across boundaries: multidisciplinary and
multi-agency team working 243
16 Project management 257
17 Leadership 271
Part 5 Small groups in research 283
18 Focus groups 285
19 Consensus research 299
Index 311
Preface
Why another book on group work?
There is a growing body of both theoretical knowledge and practical experi-
ence which shows that small group work is an extremely powerful tool for
achieving deep learning in an educational setting, building teams and effect-
ing organisational change, undertaking complex tasks such as problem
solving, strategic planning and redesigning processes. There has also been an
increasing recognition of the ‘group’, both within sociological research and in
other areas such as health, education and politics, as has been witnessed by
the widespread use of focus groups, Delphi panels, and so on.
We felt that a new book on the small group process was needed for two
reasons. On the one hand, many (arguably most) people in key positions
in higher education and the workplace still fail to recognise the power and
potential of small group work. They rely mainly or exclusively on old-fashioned,
autocratic and didactic methods of teaching, training and organisational
development, and they don’t read the persuasive but somewhat specialist
literature that supports the use of groups in a wide range of settings.
On the other hand, small group work is becoming extremely popular in
many organisations. ‘Away-days’ are fashionable for senior management, and
considered de rigueur by those who may have management responsibilities
but little understanding of the tasks involved. Activities described variously
as ‘action learning’, ‘problem-based learning’, ‘focus groups’ and ‘learning
sets’ are increasingly offered to (and sometimes inflicted on) students, course
participants and staff. Many people who attempt to run small groups have
had no formal training and are not aware that the inappropriate and indis-
criminate use of small group techniques can be ineffective, disheartening and
harmful to both individuals and organisations.
Small group work methods have always been used in the world of medical
education. The tradition of the ‘firm’ for example, where medical students are
attached to a clinical team, is based on forming a small unit of peers who have
the opportunity of supervised hands-on experience of talking to and exam-
ining patients to develop their clinical skills. The vocational training schemes
in general practice (from the 1970s onwards) and the ‘evidence-based’ medicine
workshops (which changed the face of medical practice in the 1990s) all use
small group techniques. Many medical schools (Maastricht in the Nether-
lands and Newcastle in Australia, to name some well-known examples) have
emulated the problem-based small group approach pioneered at McMaster,
Preface v
Canada. Nevertheless, the skills of forming and facilitating small groups do
not fall into place merely because organisations decide to change their learn-
ing structures. This book looks at ‘groups’ and their use in many spheres of
life, and emphasises the need to become skilled at using them appropriately.
Who wrote this book?
This book has been written and illustrated by a multidisciplinary team of
authors with backgrounds in higher education, academic research, manage-
ment, organisational development, information technology and graphic design.
One of us began life as a zoologist and teacher but is now a forensic psych-
iatrist, two are medical doctors who write and do research, and a fourth is a
biochemist turned manager.
Our aims at the outset were:
1 to provide a practical guide to when and how to use small group work
in educational, organisational and research settings, based on our own
extensive experience of running such groups for a range of different tasks
and situations
2 to encourage the wider and more appropriate use of small group work in
these different settings
3 to provide an accessible summary of the theoretical principles of small
group work, drawn from a range of different disciplines and specifically
incorporating pedagogical, sociological and management perspectives
4 to promote the concept of the small group as a generic tool that can be
used in many different environments for different purposes
5 to cross-fertilise ideas and techniques between the academic disciplines
of higher education, sociological research and management, and raise
awareness of common ground between these disciplines
6 to explore the application of the established principles of small group
work to the virtual environment
7 to develop our own knowledge and skills in this area.
Who should read this book?
If you are getting to a position in your career, in whatever field, where you
have to work in a group (or a team – hear the debate later), then you will
benefit from reading this book. It will give you insights into the way that
groups form, stabilise, battle and – occasionally – produce amazing results
in a very short time. If you have any form of responsibility for leading (or
facilitating – learn about the difference later) a group, then the book will
vi Groups: a guide to small group work
provide a primer on how to set about the many tasks you will face. Never
before has the workplace environment been changing so rapidly in either the
public or the commercial sectors. One of the central theories that underpins
successful change management in organisations is the need to involve, and
work with, all key stakeholders both within the organisation and at the
interface between organisations. The benefits of investing in the training of
facilitators and applying formal principles of small group working are increas-
ingly being recognised. The book will also provide you with examples, drawn
in many cases from healthcare, of ways in which small groups are being used
in education, research and management.
The book is therefore aimed at those who want to start using small group
work in any of the following contexts:
• higher education – this book will appeal to educators in all disciplines in
higher education
• management within organisations – the European Union is encouraging
a new climate of industrial relations that includes support for worker
participation in all decision making. NHS organisations, in common with
others outside the health sector, are increasingly seeking to demonstrate
their investment in, and involvement of, staff in their organisational
processes
• research– the focus group is a well-defined qualitative research technique
which is often poorly understood and misapplied. Other techniques (nominal
groups and Delphi panels) are becoming widely appreciated as useful
methods of generating ideas and achieving consensus. Many of the gen-
eric skills of facilitating small groups are transferable to the setting of the
research focus group.
Glyn Elwyn
Trisha Greenhalgh
Fraser Macfarlane
August 2000
About the authors
Dr Glyn Elwyn BA MRCGP MSc is a medical doctor. He gained a degree in
Welsh and Drama and a medical degree from the University of Wales College
of Medicine. He now works as a clinical senior lecturer in general practice,
and is researching ‘shared decision making’ – how clinicians and patients can
best share information about the pros and cons of treatment choices. He has
organised many educational courses (including evidence-based healthcare
workshops), and more recently has been setting up tutor-led groups to study
the feasibility of using portfolios (a collection of reflections and learning
experiences) as a vehicle for self-directed learning by general practitioners.
Dr Elwyn also implemented a study in 1999 on the effect of asking general
practices to use ‘away-days’ to design and implement a ‘practice development
plan’, and is investigating the concept that organisations ‘learn’ and have
collective memories. He is a Director of CeReS (Centre for Research Support
for Primary Care) in Wales. He is the co-editor with June Smail of Integrated
Teams in Primary Care (Radcliffe Medical Press, 1999) and he edits Evidence-
Based Patient Care(Oxford University Press, forthcoming 2001).
Dr Trisha Greenhalgh MD, FRCP, FRCGP is a medical doctor who gained a
degree in social and political sciences from Cambridge and a medical degree
from Oxford. She trained as a hospital specialist (in diabetes) before moving to
general practice and academic research. She is currently Director of the Unit
for Evidence-Based Practice and Policy at University College London, where
she provides postgraduate ‘training the trainers’ courses in evidence-based
healthcare using small group methods. She also uses small group techniques
extensively in research into the cross-cultural aspects of patient education
in diabetes. Dr Greenhalgh is developing a fully web-based Master’s degree
course in primary care, and hopes to explore the use of small group techniques
in a virtual environment. She is the author of How to Read a Paper: The Basics
of Evidence-Based Medicine(BMJ Publications, 1997), co-editor with Dr Brian
Hurwitz of Narrative-Based Medicine: Dialogue and Discourse in Clinical Practice
(BMJ Publications, 1998) and co-author with Dr Anna Donald of A Hands-on
Guide to Implementing Evidence-Based Medicine(Blackwell Science, 2000) and
Evidence-Based Healthcare Workbook: For Individual and Group Learning (BMJ
Publications, 1999).
Fraser Macfarlane BSc MBA MIPD is associate lecturer in health services
management at the University of Surrey and an independent consultant
viii Groups: a guide to small group work
with Granville Sansom Personnel and Management Consultancy Ltd. He was
introduced to problem-based small group learning as an MBA student at the
London Business School. He has since used these techniques extensively in
training and team development in the work environment of health service
organisations, especially NHS health authorities and trusts, and in the evalu-
ation of a number of major projects in the academic and service sectors.
Dr Siân Koppel is a forensic psychiatrist who gained a degree in zoology
at Imperial College London and a medical degree at the University of Wales
College of Medicine. She completed her training in general practice before
moving to forensic psychiatry. Dr Koppel is also an illustrator. Her drawings
and sketches of colleagues – many of them produced during the many hours
spent doodling whilst perhaps listening to eminent (and not so eminent)
teachers – now grace the walls and slide trays of those who feel able to with-
stand the accurate caricatures represented. She has illustrated many booklets
and, most recently, Dyspraxia: A Hidden Handicap(Souvenir Press, 1999).
Contributorship
All three authors contributed to all of the chapters, but the lead authors were
as follows:
• Glyn Elwyn: Chapters 3, 4, 5, 6, 7, 8, 17 and 18
• Trisha Greenhalgh: Chapters 1, 2, 9, 11, 12, 13 and 19
• Fraser Macfarlane: Chapters 10, 14, 15 and 16.
Siân Koppel provided the illustrations and is married to Glyn.
Trisha is married to Fraser.
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