Dr Craig Peck is currently the Head of Paediatric Dentistry at The University of the Western Cape’s Dental Faculty. He obtained a B.Med.Sc Degree (Medical Virology & Medical Physiology, 1994), a B.Ch.D Degree in Dental Surgery (1997), a Master’s Degree in Philosophy (M.Phil.) in Health Professions Education (2018) and a Postgraduate Diploma in Interprofessional Education in Health (Magna Cum Laude, 2022). His interest in interprofessional education (IPE) stems from the lack of interprofessional collaborative practice (IPCP) globally, which manifests as poorer health outcomes for patients. The need to infuse IPE into university curricula is clear, but the degree of its success will ultimately be determined by faculty members through optimal buy-in, engaging consultation and the awareness of change and conflict management, as well as attention to value-ethics.
Change Management
The need for introducing undergraduate students to the principles and aims of interprofessional community-based care (through IPE) within a University is clear and aligns with the WHO’s transformative approach to improve collaboration between healthcare professionals. In order to effectively bring about this level of transformation, the journey needs to be effectively spear-headed to guarantee continual growth and development of the departments through appropriate and effective change. Change is therefore a normal and essential entity to ensure that a University is better positioned within the marketplace, while addressing the ever-growing healthcare needs of the community through IPECP.
Leadership style is intrinsically and intricately linked to the way this change is managed. The more one is able to inspire and motivate others to follow the process for the common good of themselves and the organisation, the more effective and sustainable the change process will be. This transformation process is delicate and requires conscious attention to aspects such as communication, collaboration, empathy, understanding, trust, ability to listen and addressing the fears/ concerns of others.
Organisational change can only truly happen when each individual actively changes themselves to be better aligned with the change process and its objectives. Therefore, any plans relating to change, must take the people it affects and intends using to effect its action into account (such as attitudes and behaviours). Any proposed change management plan is 80% dependant on effective leadership and only 20% dependant on good managerial skills.
Faculty leaders of all healthcare disciplines must understand what the adaptive capacity of all staff and stakeholders is – as well as that of the University as a whole. A key function will be to successfully develop and nurture this adaptive capacity of all stakeholders, thereby developing faculty (and University) resilience with positive intent. As Charles Darwin theorised in his 1859 epic book “The Origin of Species by Means of Natural Selection”, it is not the strongest or the fittest of a species that survives, but the ones who have the best ability to adapt to their changing surroundings.
In order to better control this change management process before, during and after the change, attention should be given to the variety of possible organisational change barriers (and community change barriers) which could derail the process. These are essentially humanity factors which regulate the way in which people will react to change (positive or negative), showing that behaviour is the real way in which things get done. Such factors include emotions, priorities, strengths and weaknesses, personality types, expectations, emotional intelligence, competition and perceptions, to mention but a few. This would similarly relate to barriers amongst the student populations (with regards to learning IPE and actioning IPECP), as well as to the stakeholders where IPECP will be formalised.
Leadership styles such as Autocratic Leadership, Dictatorships and Transactional Leadership, as well as those strategies which emphasise management of function/ situation over that of individuals, will not be able to reflect the positive effect of change in the way that others do. The approach to the successful integration of change management and leadership strategies for IPE introduction should occur on both a top-down and bottoms-up manner. The bottom-up approach will require faculty leaders (HOD’s) to better learn how to effect a desired change within the organisational culture of the University. Unless augmented with a concurrent top-down learning process, the bottoms-up approach is likely to fail if used in isolation. A top-down approach results in the creation of structure and continual motivation for employees, thereby maintaining their engagement throughout the change process. If executed well, it could also provide emotional and social support to all stakeholder involved with the implementation of IPE and IPECP.
Before making any decisions with regards to the change (i.e. the mission and vision of IPE and IPECP respectively) within the undergraduate healthcare curricula, it is advisable to develop a suitable change management plan. Such a plan should include aspects such as what the intended size/ scope of the change is, the reasons for the change (detailed clearly and specifically, with supporting evidence) and what the possible impact of the change on all individuals could be. It should also identify the level of expectant disapproval of the change and recognise any associated problems with the change – actioning and/ or implementing it.
Twelve critical success factors should be considered when developing an organisational change management plan. These provide a useful framework to draw insights from for the inclusion of IPE and a drive towards IPECP, which include: shared vision, planning, communication, integration, motivation, confidence, workload management, evaluation, accountability, stakeholder involvement, enabling behaviours and understating resistance. Having a greater awareness of the importance and relevance of the above-mentioned factors and addressing them with transparency, will enable all role players to manage the proposed change in the University with a greater degree of success and harmony.
A variety of suitable change management models are available which could be implemented to facilitate the change associated with introducing interprofessional community-based education at the University. The most appropriate models which would yield greatest success, include Kotter’s 8-Step Model, the ADKAR Model and the CHANGE Model. Kubler-Ross’ 5-Stage Model would also be of benefit as this model is focussed on the stakeholder’s reaction to the change process – their acceptance of it and its effects on them. These models provide a step-by-step and detailed plan of action throughout the change process – the road maps which are used to guide and warn people along the path of change. They also demonstrate action and identify how the various steps of the change process lead into each other and result in unity of action. While the models illustrate a very linear association between the steps, more often than not, they tend to overlap each while sequential driving towards the common goal. It is also possible to employ different models in different situations depending on the specific demands of the organisational culture (or even merge various models into a tailor-made and more specific one).
Given that the introduction of IPE as a concept might be novel for a University, it would seem reasonable to expect some degree of deviation, amendment and/ or supplementation of a defined model, and it is suggested to adopt the most appropriate one(s) and incorporate the key tenants thereof in a flexible and adaptive manner.
Conflict Management
Conflict can be defined as the internal discord that results from differences in ideas, values or feelings between two or more people and is to be expected (on some level) with the introduction IPE into the undergraduate curricula.
Any effective leader should be able to fully address and successfully transform spoken and unspoken tensions into positive and productive solutions. They are able to achieve this through a deep and genuine understanding of all issues, parties concerned and the final outcome. In order for this process to reach its fruition the necessary level of maturity, effective communication and a positive mind-set must be applied to all conflict areas. Conflict is a natural and expected part of any transformational process and in itself, is a growing experience – for individuals and the University alike.
The main causes of conflict within the workplace include include poor communication, differences in personalities, differences in values and competition. Additionally, personal problems, previous experiences resulting is preconceptions and assumptions, the protection response or defensiveness and pressure points, could be a trigger for a specific personality type. For optimal interaction during IPE implementation, inclusiveness and mutual respect must be prioritised and perhaps staff development workshops are needed in this regard as well, so that issues of the past do not hamper this process moving forward.
Knowing where the conflict is rooted and remaining sensitive to human values, opinions, circumstances and feelings of others, one can approach conflict from all perspectives. It is important to establish and maintain effective communication and negotiation throughout conflict management. All communication should be relevant, transparent and focused on the positive outcomes of conflict resolution. These include team building/ unification, empathy, improved co-operation and harmony which results in increased productivity. Communication during conflict management resulting from IPE introduction should discuss both the good and the bad (of the situation, event and/or those involved), addressing both verbal and non-verbal communications. Focus on the importance of developing a mutually acceptable plan forward, based on fairness for all. The implementation thereof should involve all parties on all levels at all stages, in order to ensure unity and harmony. This plan should be both doable and sustainable and steps for its implementation fully and openly discussed with all stakeholders.
The creation and maintenance of bonds between all respective stakeholders involved with the implementation of IPE in the University is vital – and similarly when IPE gets actioned as IPCP. When relationships fail, conflict is inevitable but when they are nurtured, the risk of future conflict is greatly reduced. This bond should be based on mutual respect, co-operation and positivity where people regard each other as ally’s working towards a common goal, which is encompassed by the concept of “Positive Regard”. Effective leaders should be able to separate the ‘person from the problem’ by remaining impartial, avoiding negative responses/ reactions and exaggerated emotions and have a genuine desire to diffuse a situation. Everyone needs to feel that their basic needs (acceptance, worthiness, value) are being met, as well as respected, understood and upheld by their colleagues.
One’s ‘minds-eye’ needs to switch negative emotions to positive ones by focusing on the benefits on effective conflict management (beyond fear, failure, pain, danger). Conflict situations should be regarded as opportunities and not obstacles – opportunities to build stronger bonds through honest and safe dialogue, thereby effecting transformational change within your organisation. The emphasis should be on the positive aspects of conflict such as innovation, personal and professional growth and improved productivity. For the most part, this remains person-specific, but a University should be sensitive to these emotions and create a culture of active engagement for collaborative problem-solving when introducing IPE.
The law or reciprocity, which is the foundation for co-operation and meaningful collaboration (i.e. what one gives out, one receives) is vital to instil positive beliefs of social responsibility, awareness and maturity amongst all followers. This implies being able to identify and acknowledge the views, values and feelings of those involved in the conflict in order to allow for concessions to be made in reaching resolutions through mutual understanding and empathy. This might apply equally well within a University (with staff and/ or students), as well as at the community level where IPECP will be ‘housed’.
Specific tools and models can be applied to assist during conflict management which would help to methodically deal with specific issues of conflict and issues which are not directly related to the conflict. These include The Circle of Conflict, The Conflict Resolution Model, The Human Needs Theory, The Conflict Tree or The Conflict Map and can be applied on an individual as well as in a participatory/ group manner. By applying such tools, the root cause of the conflict can be properly and directly addressed through effective communication and empathetic understanding.
For this reason, it would be deemed essential that the established University IPE task team work and engage with all relevant stakeholders on a regular basis, acting as proactively as possible with regards to the identification of possible causes of internal or external conflict.