Using reflective practice as a management development tool in a Victorian Health Service

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This article was downloaded by: [University of Reading]On: 22 December 2014, At: 09:35Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UKReflective Practice: International andMultidisciplinary PerspectivesPublication details, including instructions for authors andsubscription information: reflective practice as amanagement development tool in aVictorian Health ServiceCarlene Boucher aa RMIT University , AustraliaPublished online: 04 May 2007.To cite this article: Carlene Boucher (2007) Using reflective practice as a managementdevelopment tool in a Victorian Health Service, Reflective Practice: International andMultidisciplinary Perspectives, 8:2, 227-240, DOI: 10.1080/14623940701289246To link to this article: SCROLL DOWN FOR ARTICLETaylor & Francis makes every effort to ensure the accuracy of all the information (theContent) contained in the publications on our platform. 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Terms &Conditions of access and use can be found at PracticeVol. 8, No. 2, May 2007, pp. 227240ISSN 1462-3943 (print)/ISSN 1470-1103 (online)/07/02022714 2007 Taylor & FrancisDOI: 10.1080/14623940701289246Using reflective practice as a management development tool in a Victorian Health ServiceCarlene Boucher*RMIT University, AustraliaTaylor and FrancisCREP_A_228828.sgm10.1080/14623940701289246Reflective Practice1462-3943 (print)/1470-1103 (online)Original Article2007Taylor & Francis82000000May paper reports on a research project undertaken at Northern Health Service in Melbourne,Australia to explore how reflective practice groups could be used to help managers developimproved management skills. Reflective practice is an approach to management and organizationdevelopment that integrates, or links, thought and action with reflection. The six reflective prac-tice groups met regularly for six months and were assisted by an external facilitator. An evalua-tion of the impact of the meetings was undertaken via a series of focus groups and interviews.The findings of this evaluation suggest that there is a place for reflective practice groups as a wayof developing managers in health service organizations (particularly their people managementskills) and that those in organizations responsible for management development should considerincluding reflective practice activities as part of a strategic and systematic management develop-ment strategy.IntroductionThis is an account of a research project that took place at Northern Health Servicein Melbourne, Australia for seven months in 2003 2004. Established in July 2000,Northern Health Service provides a wide range of quality health care services to theexpanding communities in Melbournes northern suburbs. The Health Service iscurrently located on four sites and provides a unique mix of services includingmedical, surgical, emergency, intensive and coronary care, pediatrics, womens andmaternal health, mental health, aged care, palliative care, and rehabilitationprograms. These are provided through inpatient, ambulatory and community-basedprograms. It serves an economically and ethnically diverse population including*School of Management, RMIT University, Level 16, 239 Bourke St, Melbourne 3001 VIC,Australia. Email: by [University of Reading] at 09:35 22 December 2014 228 C. Bouchermany people who, in the past, have had limited access to appropriate healthcareservices.The project was undertaken by six staff from RMIT University in conjunction withtwo members of the Human Resource Management Department at Northern HealthService.The purpose of the research project was twofold. First, it aimed to make acontribution to the skill development of a group of managers at Northern HealthService. Second, it aimed to produce data that could be used to develop a modelfor using reflective practice approaches in the health industry. This paperdescribes how the groups were conducted and the sorts of matters that werediscussed by participants. It also reports the findings of an evaluation of theproject.The project came about as the result of previous collaboration between staff fromRMIT University and Northern Health Service. This previous work had also involvedthe use of reflective practice groups as a means of helping staff to develop their skills.We believed that this approach was useful and so wanted to engage in a more formalresearch project to examine the effectiveness of reflective practice as a managementdevelopment tool. For Northern Health Service an added benefit was the expectationthat the managers taking part in the project would develop improved managementskills.The nature of reflective practiceThe concept of reflective practice has its origins in the belief that in the context ofprofessional practice, problems and other complex issues are best dealt with by peoplewho can flexibly and intuitively draw on their knowledge of practice (or their informaltheory), rather than apply rules drawn from formal theory (Foley, 2000, p. 51).For the purposes of this project, reflective practice has been defined as a processof disengaging from or stepping back from an experience and taking time to deliber-ately and carefully review it, think about it and construct meaning from it (Doyle &Young, 2000, p. 18). Reflective practice can be used as a management and organiza-tion development tool to integrate or link thought and action with reflection. It is alearning technique that has been used in the health field for a number of years withclinicians (Johns, 1998; Duggan, 2005) and more recently with managers (Gardner& Boucher, 2000; Greenall, 2004).When used to develop the capacities of managers, it involves helping people tothink about and critically analyse their actions with the goal of improving theirmanagement practices. Vince (2002) suggests that reflective practice in organizationsshould contribute to the questioning of the assumptions that underpin how the orga-nization works. Engaging in reflective practice requires an individual to assume theperspective of an external observer in order to identify the assumptions and feelingsunderlying their practice, identify how these assumptions and feelings impact upontheir practice and determine if they need to change in some way to become moreeffective as a manager (Cherry, 2000).Downloaded by [University of Reading] at 09:35 22 December 2014 Reflective practice as a management tool 229The reflective practice approach adopted for this studyThe term reflective practice is used in the literature to describe a range of group andindividual activities. In most cases these activities share a number of features: Description and examination of ones actions, assumptions and their conse-quences in a critical way (Foley, 2000). Theorizing about those actions and assumptions, thus creating explanations aboutwhy things happened in a particular way (theorizing) (Lashley, 1999). Making a judgement about the appropriateness of ones action and making adecision to try to behave the same/differentially next time or in similar situations inthe future (Barnett, 1995). Making broader links to learn about other aspects of ones assumptions andbehaviour (Horup, 2004).Reflective practice activities may also include practicing changed behaviour,resulting in a process similar to an action learning cycle (Yeo, 2006). In this project,participants were encouraged to close the loop by practicing new behaviours butopportunities to do this did not always eventuate.The literature suggests that learning that occurs during reflective practice activitiescan occur at the individual, group and organizational level (Horup, 2004). The mainfocus in this study was individual learning but the findings suggest that a significantamount of the learning that occurred was located at the group level. This learning wasnot about how the group operated, but rather collective learning that emerged fromthe interactions of group members.The literature also suggests that learning can be focused on learning about how todo managerial tasks or learning about oneself in the role of manager. The former ismore about developing skills and attributes whilst the latter is more focused on devel-oping self-awareness (Talbot, 1997). These two aspects of learning are not mutuallyexclusive and the aim of this project was to focus on both types of learning. This wasa considered decision made by the research team based on a view expressed by seniormanagers in the organization that this was the type of learning most lacking amongstthe project participants.Unlike action learning sets that often focus on specific organizational problemsand are conducted in a structured way (Fry et al., 2000), in this project eachreflective practice group developed its own way of operating within broad guide-lines. The task of each group was to collectively reflect on their managementpractice. They did this by sharing their individual and collective stories, focusingon issues of concern to them. Individuals were then expected to develop strate-gies for addressing these issues. They would then take action in the workplaceand report back at the next meeting. In many cases the participants were engag-ing in a series of cycles of action learning (Cherry, 2000). There was no require-ment to identify particular organizational issues to discuss and act on and norequirement to take up particular roles in the group (other than that of a learner)(Fry et al., 2000).Downloaded by [University of Reading] at 09:35 22 December 2014 230 C. BoucherThe choice to use this approach to reflective practice was based on the researchersmore than 20 years experience in working with such groups and previous experienceworking with similar participants. It was a model that had developed over time. Theemphasis was on reflection-on-action (Schn, 1983). The approach was similar towhat Vince (2002) calls peer consultancy groups but, in this case, with a facilitator,more participants and without the conversation structure adopted in that model. Itwas about making connections for the self: review and reflection underpinned byfriendship and mutuality (Vince, 2002, p. 70).MethodologyAction research is: a family of research methodologies that pursue the dual outcomes of action andresearch action research profits from the use of a cyclical or spiral process in which theresearcher alternates action with critical reflection its cyclical/spiral process and pursuitof both action and research as defining characteristics of action research. (Dick, 2002, p.159)This project employed a conventional action research methodology in which therewere two cycles of action/reflection.At the micro level, the researchers met regularly to collectively reflect on theirinvolvement in the project, to learn from each other and to plan the next steps. At themacro level, the work reported in this paper was the first phase of a multi-phasedstudy that is ongoing. The evaluation of this phase was used to design the next phasewhich will be completed shortly.MethodsThe reflective practice groupsAn invitation to be involved was made to all managers at Northern Hospital andBroadmeadows Health Service (two of the campuses of Northern Health Service). Aseries of information sessions were conducted to provide staff with information aboutthe project. Once managers had indicated that they were interested in taking part theywere allocated to a group. Those who chose to be involved included nurse managers,allied health managers, managers of support services (non clinicians) and managersof programs who had a clinical background but no longer had a clinical role. Mostwere female. Ethics approval for the project was obtained from both RMIT Univer-sity and Northern Health Service and each manager was advised that they could takepart in the reflective practice groups but opt out of the research aspect of the projectif they chose to do so.In line with the agreed research protocol, the six reflective practice groups met fort-nightly at their workplaces for one and a half hours from September 2003 until March2004 (12 meetings each). The groups consisted of between fourseven staff each thatdid not report to each other. A total of 34 people took part in the groups. There wereDownloaded by [University of Reading] at 09:35 22 December 2014 Reflective practice as a management tool 231four groups at Northern Hospital and two groups at Broadmeadows Health Service.An RMIT University staff member facilitated each group. Each of the facilitators hadexperience working with these types of groups.The group members were not given ground rules for behaviour but all groupsdiscussed their ground rules in the first few meetings. Matters such as confidential-ity, trust and a commitment to the group (by attending physically and emotionally)were the main issues discussed. The group members were encouraged by the facili-tators to realize that it would take time for them to trust one another at the levelrequired for this type of reflective work. Trust actually appeared to develop quitequickly (two to three meetings) but the issue of regular attendance remained prob-lematic in most groups and this will be taken up later. Different approaches toreflective practice were used by the groups. Participants in some of the groups wereencouraged to keep learning journals in which to record events in the workplace andalso to record their recollections and reflections on the group meetings. Somegroups used guidelines provided by the facilitator to record critical incidents(Tripp, 1993) that they wished to discuss. Some groups initially elected to selecttopics to discuss at particular meetings but this practice ceased after a few meetingsas the group seldom stuck to the topic. What generally happened was that the groupmembers initially caught up with each other, sharing with each other what theyhad done about issues discussed at the previous meeting. Individuals would thenindicate that they had an issue they wished to discuss. Occasionally a groupmembers issue would be discussed for the majority of the meeting but more gener-ally twofour issues would be discussed during the 90 minutes. Group membersgenerally took turns with every group member bringing issues they wished todiscuss to the group.Some group members developed the habit of catching up with each other outsideof the meetings, sometimes for general support and sometimes to discuss particularevents that had taken place between meetings.The issues discussed varied considerably but could be classified into the followinggroups: Staff issues (usually focusing on how to manage poor performance). Personal issues such as coping with difficult staff, job stress, role conflict, role over-load and work/life balance. Taking up the role of the manager and the appropriate use of managerial power. Authority issues involving their managers, peers and more senior staff. Skill development in areas such as conflict management, negotiating and runningmeetings.The role of the facilitator was primarily as process consultant (Schein, 1998), help-ing group members explore their issues. They also helped the group develop effectiveways of operating. They helped group members deal with disagreements andconflicts. They helped individuals deal with difficult emotions that arose as part of theconversations (especially anger at senior managers and peers). At times they acted asresource people, providing group members with relevant reading.Downloaded by [University of Reading] at 09:35 22 December 2014 232 C. BoucherThe meetings were generally informal in tone. Group norms and expectations werediscussed in the early meetings and it was agreed that what was discussed in the meet-ings would be kept confidential. No instance of this confidentiality being breachedwas identified and this was important as the workplaces are relatively small and manyof the participants work closely with one another. At times they became quiteemotional and some group members did cry on occasion when they (or someone else)were discussing and incident that was particularly distressing. There was also laugh-ter. At times interactions between members were tense. Many of the groups initiallydecided that when discussing their own staff or other people they would not namepeople to protect their identity. They tried to do this but found that given theirfamiliarity with each others workplaces, they could usually work out the identity ofthe person being discussed. In fact misunderstandings occurred occasionally withmisidentification. As the group members developed confidence in one anotherscommitment to keep discussions confidential, the names of people being discussedwere used more and more. This proved helpful as people could share their sometimesquite different perspectives about people and events and this created more informedconversations.The evaluationAt the beginning of the project it was decided that an evaluation of the usefulness ofthe groups meetings would be undertaken for a number of reasons. First, the researchteam were eager to develop the most effective approach to reflective practice in thiscontext. Second, Northern Health Service which was funding the project neededevidence of the usefulness (or otherwise) of their investment of peoples time as wellas money. Third, while reflective practice and action learning approaches are oftenused in healthcare, there has been little rigorous examination of their usefulness as amanagement development tool, with perhaps the exception of action learning sets(Mumford, 1996).A qualitative approach was taken to the evaluation. As argued by Given (2006)qualitative research approaches are particularly helpful when wanting to answer whyquestions. Qualitative research, by nature, can address many of the why questions. Where quantitative approaches are appropriate for counting incidents related tohuman behaviour these approaches cannot explain why these behaviours occur(Given, 2006, p. 378). In this research we wanted to know not only what factors facil-itated and inhibited the development of reflective practice but why and how thesefactors operated. We also wanted to know not only what people had learnt but howthis had impacted upon their management practice.The evaluation consisted of five, one-hour focus groups with the reflective practicegroup members conducted by an RMIT University staff member who had not facili-tated that particular group. The aim of the focus groups was to ascertain the opinionsof staff about the ways in which participation in the groups may have changed the waythey managed. They were asked to describe their experience of the being in the group,what they had learnt (if anything) and how they thought the working of the groupsDownloaded by [University of Reading] at 09:35 22 December 2014 Reflective practice as a management tool 233could be improved. Five interviews were also conducted with senior managers whosestaff had taken part in the groups. The aim of these interviews was to ascertain ifsenior managers thought the conduct of the groups had resulted in any changes in thebehaviours of the individuals who took part in the groups. They were not asked toidentity any individual staff members. The data was transcribed and analysed usingthematic analysis (Coffey, 1996).FindingsThe findings are presented in two sections. The first section presents a summary ofthe data from the 28 reflective practice group members who took part in the focusgroups. The second section presents a summary of the data from the senior manage-ment interviews.Comments from reflective practice group participantsThe managers were asked what they thought they had gained from being part of areflective practice group and how had their thinking and/or behaviour as a managerhad changed. Some participants could pinpoint specific changes in their behaviour.These changes mainly related to how they communicated with their staff and gavefeedback to them. There were some reports that participants had come to understandmore about the role and how lonely it could be. And felt OK with that cos Ive sortof realized that I have to do that in order to yeah I cant be the buddy I was in thethick of it I think when I started this group. They also described how they now under-stood the role of manager differently and how staff often projected their frustrationsonto managers. Some of them are very strong personalities and quite forceful and when they come out andtalk to you about things and, just have to remember thats who they are. So I dont getuptight with them anymore, I just sort of accept what they say and just move on and dealwith whatevers popped up. And I think thats sort of taught me to calm down a little bitand not get too defensive, theyre not talking to me as me theyre talking to me as amanager. And thats how I have to differentiate the difference.They also mentioned that they had realized they needed to develop support systemsfor themselves as managers and some were planning to use the relationships they haddeveloped in the reflective practice groups on an ongoing basis. Weve almost become like a bit of a mentor, because we tend to touch base with each otherat other times during you know, the fortnight around, whats happening or, and thats aninformal way, you know, its not that well sit down and have a formal cup of coffee andgo over it, but just as you meet with people in your everyday life, its like, you, now howare you going with that situation?Most of the participants reported that they now thought that they now stopped tothink more before they acted and that they felt they had more options around howthey dealt with particular issues. Downloaded by [University of Reading] at 09:35 22 December 2014 234 C. BoucherJust coming up with different ways to manage it maybe, if it arose again.And also, I think it was issues that we were going to have to deal with and it was actuallyallowing us to sort it out beforehand, before doing it on the ward, and I suppose havingthe strategies in place, and then come back to the ward and actually deal with that, withthe problem.I am thinking about some of the issues that were raised and some of the strategies that wereraised and perhaps changing the way that I am doing. I am actually getting those littlewarnings that I am doing things, and to remember to act this way or that way or it justreminds me a bit, so it has been useful in that sense.In a more general sense, participants also reported being more strategicallyfocused: also enabled me to look at longer term results and try and just modify someof the things, the way I or we in the department do things.Some participants were able to identify specific issues that they had discussed in theRPG and were now handling differently. Yeah, and I mean the big thing with ours was staff morale and the nature of our job as well,and that was great to sort of come up with some strategies to put in place. I think it hashelped.A few held the opinion that participants may not have been personally stretched (bybeing encouraged to explore deeper factors that motivated their behaviour) as muchas was required for really effective reflective practice. The other view was also put. I, there was one session where I felt like I exposed myself quite a bit, like I guess I took arisk in that I exposed a bit of my personality that I wasnt so proud of and that I was usedto not ever talking about. So and that did pay off, like I did feel afterwards, I felt actuallya bit sick afterwards to be honest, but then the next day it definitely paid off. It was almostlike a bit of a break through for me and I sort of, identified something and having alwaysknown it but having spoken about it in a group and coming up within the group, comingup with the suggestion and how to deal with it, like it has definitely changed my practice.So yeah, I took a risk and as I said I felt a little bit like exposed afterwards, but it has defi-nitely paid off.One change in behaviour that was specifically mentioned by three of the partici-pants was an increase in the number of tasks they delegated: refraining when peoplecome with a problem, so they come with a problem that I actually take on board withwhat theyre saying but then actually delegating back the solving part to them.Many participants talked about how one of the most common topics of discussionin the reflective practice groups was about dealing with difficult interpersonal situa-tions or with difficult people. The participants reported that they had not only learntways to deal with particular situations and people but also had developed moregeneric skills to help with these issues such as patience, not taking complaints person-ally and managing conflict and disagreements. For me there was quite a lot of changes that I had to make, and they were changes thatwere well and truly overdue, because Im not a naturally assertive person and I had a lotof trouble with those issues, staffing, people taking advantage of me in the new role that Ihad and me just not sure how to deal with it. So for me it was a lot of reflecting withinDownloaded by [University of Reading] at 09:35 22 December 2014 Reflective practice as a management tool 235myself and looking at what I was doing and looking at what I was not doing and whatneeded to be done. So I did have to make a lot of changes which I think Ive done.In summary, the changes in behaviour and thinking generally reported by theparticipants were modest (but discernible to them and others), significant and mostparticipants were able to describe some beneficial change. No participant reportednegative change.Senior manager interviewsThe senior management group members who were interviewed were able to discussthe impact of the reflective practice groups on the participants based on the conver-sations they had had with various group members and also based on their directobservations of those staff. They were not asked to identify particular staff. Theyreported a number of general benefits as well as some specific behavioural changes.The most common general benefits reported by the senior managers were the timeand space created for their managers to discuss issues, especially those issues to dowith managing staff. We all share the same general problems, and people problems, generally speaking, and soI think that from a personal point of view, it offers a lot for the individual to be able tonetwork and also to get a bit off their chest at times, if they would like to do that.The other general benefit they mentioned was the capacity to network with peerswith whom their staff may not normally have a lot of contact. I think what they found positive about it was the networking component which is a byproduct I guess of them being in the room with colleagues they dont always necessarilyhave such a length of time available to just sit in the room and in that sense it continues tohelp with ongoing working with those people Some of the senior managers also linked the work done in the reflective practicegroups with other change efforts being undertaken in the health service and indicatedthat they thought that the reflective practice groups were contributing to the positiveimpact of other change efforts: but a combination of a few things that had been goingon in XXX theres some good team stuff sort of happening there at the moment andI think it all helps.The senior managers generally reported that they thought the reflective prac-tice groups were helpful and in some cases could identify particular changes inbehaviour that they attributed to participation in the groups. Some indicativeexamples are provided below. In one case a group of managers who work interde-pendently were part of the same reflective practice group and their managerreported that: It has made a bit of a difference and within my XXX area, the communication betweenthe managers is actually flowing through to the staff, in that especially if were needingstaff, instead of, Well, you cant have my staff they are sharing, and theres communica-tion going on.Downloaded by [University of Reading] at 09:35 22 December 2014 236 C. BoucherAnother senior manager reported a significant change in the way one of the manag-ers communicated and raised issues. One of those individuals that I have a day-to-day experience with, because the position isintegral to the work that I do is that Ive noted just in the way that first of all, commu-nicates with me, and talks about issues that has not talked about previously with me. Since entering the program, and I believe that its given XXX a sense of confidence, notoverly confident, mind you but more inclined to talk about a problem or issue that confronted with that he probably would not have shared with me before, which is great.Another senior manager reported that one of her staff had dealt with a significantpersonal disappointment much better than she had initially expected. So I sort of said well, tell her that she can come around to talk to me to get some feedbackabout that, and she didnt but she saw me in the corridor and called after me and said,Hey, I just want to tell you that Im OK, I really am OK. So I think that that wasagainI thinkwell, I think, as I said, it sort of helped her process, but it sort of helped her to beassertive enough to sort of come to me, you know, make me feel OK about it as well.Several senior managers reported that they thought particular managers were nowmore proactive and willing to use their initiative rather than wait for direction. She certainly has developed in the role taking the initiative to instigate a different wayof doing and how we manage all those sorts of things.I dont know, just sort of and my interaction with the XXX now compared to sixmonths ago, theres a bit of less apathy around it, so I think its actually even rejuvenateda bit of So, I think the ANUMs are justfeel a little bit more listened to and a bit moreproactive around that.An interesting by-product of the reflective practice groups that was reported by thesenior managers was that at least three of the groups planned to continue to meet inone form or another. They had realized the benefits of regular discussions and weretaking responsibility for organizing these themselves. I see the XXX have introduceda regular forum for themselves, which never happened before.The changes covered a broad range of skills but focused mainly on communicationskills, interpersonal skills and taking more initiative.DiscussionThe outcomes of this research project indicate that both participants and theirmanagers reported modest but significant improvements in the participants manage-ment skills and their capacity to take up their roles as managers by the end of theproject. In particular this study found improvements in a number of areas that arecritical to the effective management of staff (Greenall, 2004). The participants hadimproved communication skills, especially in the area of giving feedback. They weremore comfortable dealing with difficult staff-related situations. And they were moreable to delegate work. All of these capabilities are central to effective managementpractice (Pedlar et al., 2001). The senior managers experienced the participants asbeing more proactive and showing more initiative. Finally, they reported a change inDownloaded by [University of Reading] at 09:35 22 December 2014 Reflective practice as a management tool 237the way some of the participants dealt with difficult situations. Rather than react, theynow stopped to think about their options and were able to take a longer-term view.As reported elsewhere (Greenall, 2004; Mumford, 1996; Lashley, 1999; Doyle &Young, 2000; Gardner & Boucher, 2000; Boucher, 2001a, b; Yeo, 2006) improvedmanagement practice is a recognized outcome of participation in reflective practiceactivities and this study was able to identify some specific improvements thatoccurred in this instance.The evaluation phase of the project also provided some helpful information aboutthe design and conduct of the reflective practice activities.The need to develop trust between group members (and between members and thefacilitator) is an issue that has received some attention in the literature on reflectiveapproaches to learning (Barnett, 1995; Sense, 2005), although little is written abouthow this might be achieved. In this study the need to develop mutual trust wasdiscussed by group members at their initial meetings. In fact, high levels of trust(evidenced by a willingness to be very open with each other) developed quickly. Threefactors that contributed to this can be identified. In many cases the group membershad had little interaction with each other previously and so had no pre-existingrelationships. Where prior relationships existed, the relationships between the groupmembers (and throughout the organization as a whole) appeared to be largely func-tional and so the chance for existing dysfunctional dynamics to be imported into thegroups was limited. Care was taken to ensure that staff who reported to each otherwere not in the same group. Data from the evaluation indicated that this contributedpositively to the development of openness and trust in the group. This was not somuch because participants did not trust their manager or subordinates, rather theywere able to discuss issues (often about their manager or subordinates) that it wouldnot have been appropriate to do if they were in the room. Finally, the externalfacilitators were seen to create an environment that fostered trust and were also seenas being also to be neutral when disagreements occurred amongst group members.The advantages of using external facilitators in these sorts of environments has beenreported previously (Yoong, 1999). The findings of the evaluation also support thedecision to use a loose rather than a tight structure (i.e. not action learning sets) forthe group meetings. Group members generally found the flexibility offered by thisstructure to be beneficial.The evaluation data also indicated that some participants thought their learningwould have been enhanced by some formal theoretical input, a hybrid learning modelthat has some support in the literature (Martin, 1994; Densten & Gray, 2001).ConclusionsThe findings of this project suggest that there is a place for reflective practice groupsas a way of developing managers in health service organizations and that those in orga-nizations responsible for management development should consider including reflec-tive practice activities as part of a strategic and systematic management developmentstrategy. This is particularly true given the evidence that traditional managementDownloaded by [University of Reading] at 09:35 22 December 2014 238 C. Boucherdevelopment programs may not meet the unique needs of health services managers(Currie, 1997; Davies, 2006).Some of the essential features of an effective reflective practice program in theAustralian public healthcare context that have emerged from this research aredescribed below. One would need to exercise caution when generalizing these find-ings to other contexts.A management development process based on reflective practice works whenrelationships in the organization are basically functional and the group participantshave the capacity to develop friendly, collegial relationships that facilitate the devel-opment of trust and mutual support. The potential for this to happen can beenhanced by not including managers who have a line relationship in the same groupand by using external group facilitators.It is critical that there are regular meetings and that individuals make every effortto attend as many meetings as possible. It was clear in this study that the more conti-nuity there was in meeting attendance the more individuals and groups learnt. In thiscase peer pressure played a positive role with group members encouraging each otherto attend. Also, participants made extra efforts to attend because they felt a sense ofcommitment to their colleagues.Most participants were very clear that their manager supported their participationin the reflective practice groups. This support was important as it encouraged partic-ipants to attend meetings and to give priority to the development of themselves asmanagers. The public support of such a program by senior managers is important asothers have previously found (Miller, 2003).From the outset the decision was made by the research team that all of the participantsin the groups would be volunteers. This decision was based on the assumption thatin this case, managers should not be forced to take part in an activity of they did notwish to as this could lead to dysfunctional dynamics developing in the groups. As hasbeen pointed out elsewhere (see Hackett, 2001) this may mean that a self-selectionprocess occurred where people who knew that their learning styles and preferenceswere suited to this type of learning chose to take part whilst people with other approachesto learning did not. Also, as mentioned earlier, some participants thought that includingmore theoretical input in the program would have been helpful. Both of these supportthe proposition that there is a need to offer a range of management developmentactivities, not just reflective practice, as part of a management development strategy.In an industry as turbulent and complex as public health in Australia, managersneed to be skilled at managing all aspects of their domain. This study suggests that aformalized reflective practice program, based around regular group meetings is auseful tool for helping these managers develop the skills to manage the issues they faceon a daily basis.AcknowledgementsThis research was made possible by the very generous support provided by manymanagers working at Northern Health Servicethank you. This project is beingDownloaded by [University of Reading] at 09:35 22 December 2014 Reflective practice as a management tool 239funded by and undertaken at Northern Health Service. The researchers are Ted Lipi-arski, Gael Bignell, Carlene Boucher, Julie Wolfram-Cox, Anne Smyth, SallyanneMiller and Naomi Raab.Notes on contributorCarlene Boucher is Associate Professor of Health Services Management at RMITUniversity. Her teaching and research interests focus on developing practicalways of helping managers improve their practices and to develop the emotionalresilience to grow and flourish in management roles.ReferencesBarnett, B. 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