Few would question that modern medicine and the healthcare industry in which it is practiced has benefitted incalculably from advances in technology. The evidence is plain to see, from pharmaceuticals to functional magnetic imaging (fMRI) to medical health smartphone apps (a ‘telehealth’ means of reaching patients who may otherwise find access to healthcare services onerous).
Yet, in our gratitude and wonderment at such inestimably valuable, life-saving innovations, we might be inclined to overlook something vital. Namely, while our species has since its inception been the inventor and user of technology par excellence (some scientists even favor designating us Homo technologies rather than Homo sapiens because of this), we remain curiously social animals. Curious because it’s not always transparent to us why we say and do the things we do, nor what leads us to interpret remarks, postures, facial expressions, and even physical features in the ways that we do.
It turns out that the social dimension of human living is as fundamental to us as our technological inventiveness, if not more so. The encounters we have with one another may determine how we use, or misuse, technological innovations, especially if we identify other human beings as strangers or outsiders to our own group. Immediately, multiple options come into play: is the ‘stranger’ a friend or foe? Do we invite in and seek friendship and new learning, or do we exclude, ostracize, or attack? Can we build mutually beneficial relations with the ‘out-group’ and learn from one another, or do we succumb to fear and adopt adversarial relations? Do we emphasize differences or recognize commonalities? By refusing to recognize the kind of newcomer we are encountering as of a similar kind to ourselves, we may become decidedly unkind.
Yet matters are no less complex (and no less powerful) when we move from the inter-group to the intra–group – to what goes on between people when they form a group, as in a family or a workplace, or even a social club.
In what follows, we will seek to explore the occasionally fraught but always fascinating topic of what goes on between people in groups, or ‘group dynamics’, with an emphasis on why this social dimension of human thought and behavior is of pivotal importance to healthcare leaders. Leaders, that is, whose management responsibilities and vision must extend beyond the efficient deployment of medical services to encompass human agents in healthcare teams, without whose collaborative efforts such deployment would fail.
Group dynamics in healthcare – why healthcare leaders should explore them
One of the features that distinguish a group from a mere cluster of individuals is that a form of cohesiveness or collective identity has started to grow but hasn’t yet emerged. Yet group identity might better be conceptualized as the outcome of what people do rather than as some kind of substance that they are. And it may not be steadily cohesive: differences of viewpoint and of habitual individual styles of speech and behavior may come into conflict and undermine cohesion. Not only that, but at the other extreme, through mutual loyalty and/or reticence about ‘going against the grain’, some groups may succumb to groupthink, a form of shared viewpoint or consensus that (often unwittingly) excludes other possibilities and tends to thwart innovation, learning, and discovery.
While consensus is not inherently bad, it can become an obstacle, especially if a healthcare manager has, for example, brought talented and qualified people together to solve a problem, as in a task force, selection panel or steering/advisory committee. As the Harvard Business Review noted in a fascinating article from 2022, even though such groups aim to reach consensus around, say, a proposed new initiative, product, service, or procedure:
“… research shows that consensus-based problem-solving groups are often where innovative ideas go to die. These groups are highly prone to groupthink – quick agreement around status quo solutions with little discussion or deliberation.”
Earlier research by the authors of this piece (Jennifer Mueller, Sarah Harvey, and Alec Levenson) had found that groups possessing at least one member who was prepared to challenge the status quo, were less susceptible to groupthink and more capable of innovation. The latter often ensued from liminal (rather than literal) ideas arising from the challenge to the status quo, a form of playing/experimenting with new conceptualizations before seeking to implement them. In that way, an old consensus could be deconstructed and a novel one (more suited to advances in technology, for example) could be crafted in its place.
So, with that illustration of group dynamics, let’s move on to an exploration of what these processes are, and why an understanding of them is essential to any healthcare leader seeking to bring people on board with novelty and change – a perpetual feature of the continually evolving healthcare sector.
Group dynamics: what they are and how to spot them
We’ll open this section by fleshing out our provisional definition of group dynamics as ‘what people do in groups’. The term ‘group dynamics’ was originally coined in the 1940s by social psychologist Kurt Lewin, who noticed that people often began to adopt distinctive roles when brought together into a group. These roles, and the behaviors and speech acts that bring them to life, constitute the ‘stuff’ or material of group dynamics, affecting the conduct of the group and the individuals within it.
Healthy or positive group dynamics can be seen at work when participants develop sufficient trust in one another to challenge each other cordially but clearly, hold each other to account, and work together effectively to accomplish a task to realize a goal.
Conversely, a negative group dynamic can also take possession of group interactions, almost like a malign spirit, wherein an influential group member, perhaps in concert with others, acts to deter free discussion with an implicit form of intimidation, such as mockery or other forms of mild humiliation – which is perhaps not so mild when on the receiving end.
Clearly, roles in groups have an important impact on the functioning of the entire group – for better or worse.
We might further think of roles as possessing formal and informal characteristics: a group leader, for example, may encourage the free expression of thoughts and ideas amongst participants to solve a pre-identified problem. Yet while this may be a formally designated role, its ‘actor’ will inevitably bring pre-existing personality styles into play in fulfilling it. A good-humored and receptive leader, for instance, may implicitly convey subtle but powerful cues that they are interested in whatever new ideas might emerge from the participants and their discussions within the group. A more controlling and censorious personality style, however, may have the opposite effect, unwittingly cultivating an atmosphere in which self-censorship and obedient groupthink seem the safest options.
People who recognize their own aptitudes as group leaders upon reading this article may be attracted to a career in healthcare leadership. To do so, it is crucial to obtain recognized credentials, which are typically advanced degrees (Master’s level or higher). Thankfully, for those whose existing employment and/or family commitments preclude returning to college full-time, a number of reputable and well-established brick-and-mortar universities are now offering advanced healthcare administration programs fully online.
Operating at the intersection of healthcare and business, Ottawa’s prestigious Telfer University offers a fully online course, allowing students to progress through the program from their own homes around existing work and family commitments.
Equipped with the requisite qualifications and a deeper understanding of group dynamics that effective leadership, such graduates have the potential to become truly visionary leaders in any group they find themselves in.
Elements of group dynamics
It is clear that merely placing people in a room doesn’t form a group, in the sense of a collaborative social entity displaying cohesiveness, common purpose, and free thought. In other words, groups need to be formed – this is the initial step in the development of a functioning, cohesive group capable of productive collaboration.
Let’s walk through the crucial steps in the full development of a functional group.
The earliest, embryonic phase of a group’s development is not too far removed from the ‘putting people in a room’ scenario mentioned earlier, especially if they have little or no pre-existing familiarity with one another. At this point, they are individuals sitting together. But when invited to discuss the purpose of the new group and explore how it might achieve its goals, the first emotional tendrils of ‘togetherness’ or cohesiveness begin to bind the new members into a ‘proto’-group. Mutual familiarity develops and, crucially, the earliest manifestations of mutual trust (or, less favorably, mistrust).
Discussion rarely innovates if it’s characterized solely or too predominantly by agreement. This is more akin to the ‘groupthink’ described earlier, which may be comfortable and even helpful in the earliest phases, but rarely generates novelty and invention. For that, a measure of disagreement or difference appears to be necessary. In a ‘good’ group, disagreement may on occasion be heated but not acrimonious and tends to be experienced as the engine of new insights. For example, taking account of a deficiency one group member may have overlooked tends to strengthen progress toward new solutions, not sabotage it. However, the ‘storming’ phase of group development can, as its name suggests, be stormy: contests over power and influence between group members can emerge. If a positive group dynamic is to develop, these conflicts must be addressed and overcome.
For example, if a debate becomes heated and a participant vehemently disagrees with an idea expressed by another, a power contest may take root. A healthcare manager charged with leadership of the group process may be able to defuse this into a more collaborative exchange not by means of a head-on challenge (Respect other people’s point of view!), but by getting alongside the protagonists.
Saying something like: “That was an interesting idea, and I wouldn’t want it to get lost because emotions are getting a little high. Could you say it again, but in a way that makes it hearable to [the ‘offended’ participant]?” This may be far more productive than a confrontation. And ‘hearable’ in this context is implicitly an invitation to rephrase the idea or disagreement more tactfully and less abrasively.
Norming, or normalizing, indicates that a group is indeed beginning to cohere around its objectives, with participants growing more familiar with (and hopefully appreciative of) each other’s styles of expression.
By this point in group development, participants are familiar (and accepting) enough with their own and each other’s roles that they can work together to perform the group’s necessary tasks. More cohesion, free debate, and collaboration are characteristic of this mature stage of a group’s evolution.
All good things come to an end, and well-functioning groups are no exception. When a group has achieved its goals, the process of disbanding is nigh – a phase that might favorably be accompanied by declarations of mutual appreciation and genuine post-group friendships.
Healthcare leaders and group dynamics
We have only scratched the surface of group dynamics in healthcare settings in this article. But it should by now be clear that insightful and visionary healthcare leaders would be well-advised to gain a deep understanding of group dynamics, as they are managing individuals as well as systems made of people who must collaborate.
Insights into group dynamics equip healthcare leaders to prevent policy task forces, steering committees, or selection panels from succumbing to unwitting self-sabotage. Guiding group dynamics in more productive and collaborative directions entail knowing how they can ‘turn’ and lead to dead-ends, stalemates, and innovation-killing groupthink.