1. 11 Group Process

2. Learning Objectives list key concepts for working in groups describe the Delphi Method and the nominal group process practice the nominal group process

3. Comments on exercise just completed

4. THURSDAY interim presentation each 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

5. Overview Coming 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

6. Overview May 17, do RAP 90’s fast paced idea guest lecturers present ideas & applications meanwhile, you work together in groups on your projects

7. Idea generation: Group Process vs Individual Process

8. Individual Idea Generation person 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

9. Individual Idea Generation number of ideas produced by a individuals independently is considerably less than produced by an equal number of individuals together –studies confirm this

10. Group Idea Generation

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

12. 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

13. 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

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

15. 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

16. 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

17. History: Developed and tested in late 1960’s by Van de Ven & Delbecq derived from studies of decision conferences, of aggregating group judgments and from social work studies of problems surrounding citizen participation in program planning

18. Objectives Assure 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

19. Objectives balance participation among members voting techniques for group judgment

20. Preparation: members Members 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

21. Preparation: members members 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

22. 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

23. Preparation: supplies: table & chairs flip chart for each table, 3x5 cards for each table, felt pens, paper & pencil for each participant

24. 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

25. Determine purpose of meeting, structure proposed question, assemble members

26. 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

27. 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”

28. Process of NGT 1.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

29. Process of NGT 1.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

30. Process of NGT 1. 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

31. silent generation of ideas in writing adequate 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

32. silent generation of ideas in writing sufficient 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

33. 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,

34. Round Robin Feed back places 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

35. Written record and guide ideas 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)

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

37. 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

38. Serial Discussion Guidelines: avoid discussion focusing on particular idea eliminate misunderstanding opportunity to express logic behind items allows members to disagree without argumentation

39. 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

40. 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

41. 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

42. Final vote can rank as before, or rate each item

43. 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

44. Advantages more egalitarian ensures participation, avoids dropping out may generate more options & ideas per unit time keeps discussion focused

45. Limitations cross-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

46. 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

47. Class Exercise NOMINAL GROUP PROCESS

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

49. 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

50. Nominal Group Exercise move 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

51. 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

52. NGT: participants can be from diverse cultural backgrounds, less threatening than other forms of idea generation

53. NGT: if use flip chart, have a record of the meeting, preferable to blackboard

54. 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

55. NGT: discussion of ideas can/should proceed serially to avoid focusing on one, and is for clarifying ideas only

56. 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

57. NGT: Applications one 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)

58. 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 questions Nominal groups to general student responses Surveys 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

59. NGT: Applications identifying 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

60. NGT: Applications improving efficiency in pharmacies (input from manager, pharmacist, full-time and part-time sales people) generates input from all employees

61. NGT: Applications improving 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

62. 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)

63. 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

64. Appropriate for identifying 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