1.

CASE STUDY:-

Health care or healthcare is the maintenance or improvement of ​health via the ​prevention​,

diagnosis​, and ​treatment of ​disease​, ​illness​, ​injury​, and other ​physical and mental
impairments in people. Health care is delivered by ​health professionals (providers or
practitioners) in ​allied health fields​. ​Physicians and physician associates are a part of these
health professionals. ​Dentistry​, ​midwifery​, ​nursing​, ​medicine​, ​optometry​, ​audiology​,
pharmacy​, ​psychology​, ​occupational therapy​, ​physical therapy and other ​health professions
are all part of health care. It includes work done in providing ​primary care​, ​secondary care​,

and ​tertiary care​, as well as in ​public health​.

Access to health care may vary across countries, communities, and individuals, largely
influenced by social and economic conditions as well as ​health policies​. ​Health care
systems​are organizations established to meet the health needs of targeted populations.
According to the ​World Health Organization (WHO), a well-functioning health care system
requires a financing mechanism, a well-trained and adequately paid ​workforce​, reliable
information on which to base decisions and ​policies​, and well maintained ​health facilities to
deliver quality medicines and technologies

Many types of health care interventions are delivered outside of health facilities. They include
many interventions of ​public health interest, such as ​food safety surveillance, distribution of
condoms​ and ​needle-exchange programs​ for the prevention of transmissible diseases.

They also include the services of professionals in residential and community settings in

support of ​self care​, ​home care​, ​long-term care​, ​assisted living​, treatment for ​substance use
disorders​ among other types of health and social care services.

Community ​rehabilitation services can assist with mobility and independence after loss of
limbs or loss of function. This can include ​prosthesis​, ​orthotics​ or ​wheelchairs​.

Many countries, especially in the west, are dealing with aging populations, so one of the
priorities of the health care system is to help seniors live full, independent lives in the
comfort of their own homes. There is an entire section of health care geared to providing
seniors with help in day-to-day activities at home such as transportation to and from doctor's
appointments along with many other activities that are essential for their health and
well-being. Although they provide home care for older adults in cooperation, family members
and care workers may harbor diverging attitudes and values towards their joint efforts. This
state of affairs presents a challenge for the design of ICT (information and communication
technology) for home care.

Because statistics show that over 80 million Americans have taken time off of their primary
employment to care for a loved one,many countries have begun offering programs such as

Consumer Directed Personal Assistant Program to allow family members to take care of their
loved ones without giving up their entire income.

With obesity in children rapidly becoming a major concern, health services often set up
programs in schools aimed at educating children about nutritional eating habits, making
physical education a requirement and teaching young adolescents to have positive
self-image

The ​health care industry incorporates several sectors that are dedicated to providing health
care services and products. As a basic framework for defining the sector, the United Nations'
International Standard Industrial Classification categorizes health care as generally
consisting of hospital activities, medical and dental practice activities, and "other human
health activities." The last class involves activities of, or under the supervision of, nurses,
midwives, physiotherapists, scientific or diagnostic laboratories, pathology clinics,
residential health facilities, patient advocates or other ​allied health professions​.

In addition, according to industry and market classifications, such as the ​Global Industry
Classification Standard and the ​Industry Classification Benchmark​, health care includes
many categories of medical equipment, instruments and services including ​biotechnology​,
diagnostic laboratories and substances, drug manufacturing and delivery.

For example, pharmaceuticals and other medical devices are the leading high technology
exports of Europe and the United States. The United States dominates the ​biopharmaceutical
field, accounting for three-quarters of the world's biotechnology revenues
VARIOUS PHASES OF CHANGE IN UNFREEZING, CHANGING AND
REFREEZING:-

Healthcare organisations, like some other organisations, are challenged

to define and measure output, where the nature of work is highly
variable, complex, exacting, reactive, urgent and non-deferrable. They
require a complex organisational milieu, to co-ordinate the highly
specialised and differentiated professionals, who, because of the
increasing complexity of healthcare, are required to work
interdependently with each other.Further, healthcare organisations exist
in highly political environments where there is increasing competition
for scarce resources. Patterns of professional political power also
influence the education and socialisation processes of many disciplines.
Professionals’ expertise and reputation influences their authority and

expectation of greater autonomy and control in organisational settings.

As a result, greater emphasis is placed on clinical issues, often at the
expense of managerial efficiency

Unfreeze, Change, Refreeze, also known as the Kurt Lewin Change

Management Model, is a method for managing change within an
organization. The method involves preparing employees for change,
making changes, and finally integrating and normalizing those changes
within the organization.
The name of the Unfreeze, Change, Refreeze model comes from the idea
of an ice block that needs to be transformed into a new shape. The ice
block cannot be forced into the new shape without breaking. Instead, it
must be melted (Unfreeze), poured into a mold (Change) and frozen
again in the new shape (Refreeze).

In the Unfreeze stage of the ​change management​process, there is

usually a motivating event which creates a need for change to occur,
such as falling profits, a lawsuit or simply employee dissatisfaction.
Once the decision has been made that change is needed, a ​change
management strategy has to be communicated throughout the
organization to prepare employees for the change.

In the Change stage, the actual changes to the company’s ​organizational

structure​, business practices, staffing or other areas are determined and
implemented. These changes can be large or small, depending on the
needs of the company, but all changes should be carefully determined
with input from employees and may take time to implement.

In the final stage, the Refreeze stage (sometimes called “Freeze”), the
changes made in the second stage are normalized in the organization’s
day-to-day activities. This process can be very slow, depending on the
scale of the changes being made, because it can take a long time for
members of the company to get used to new practices. Also, because
many organizations are changing constantly, it can be difficult for the
Refreeze stage to be completely successful. However, this stage is very
important for getting the changes to last and making sure that
employees are able to deal with changes efficiently.

The Unfreeze, Change, Refreeze model was created by physicist and

social psychologist Kurt Lewin. Lewin’s background in physics inspired
his illustration of social change using the ice block metaphor.

2.FACTORS OFF EMPLOYEE INVOLVEMENT:-

Factors affecting behaviour

Three factors affecting behaviour in employee involvement can be identified:

1. Predisposing factors
2. Enabling factors
3. Reinforcing factors.

2.1 Predisposing factors

Predisposing factors are those characteristics of a person or population that motivate
behaviour ​before the occurrence of that behaviour. Peoples’ knowledge, beliefs, values and
attitudes are predisposing factors and always affect the way they behave. Predisposing factors
are motivational factors subject to change through direct communication or education. All of
these can be seen as targets for change in health promotion or other public health interventions.
We will look at each of them in turn.
Knowledge
Knowledge is usually needed but is not enough on its own for individuals or groups to change
their behaviour. At least some awareness of health needs and behaviour that would address
that need is required. Usually, however, for behaviour change some additional motivation is
required. For example, even if a mother knows in general about using oral rehydration salts
(ORS) when her child is dehydrated due to diarrhoea, she may need a reinforcing message
from you before she will actually use them.
Beliefs
Beliefs are convictions that something is real or true. Statements of belief about health include
such negative comments as, ‘I don’t believe that exercising daily will improve my health’. More
positive health beliefs might include statements such as, ‘If I use an insecticide treated bed net
at night I will probably not get malaria.’
Often a potent motivator related to beliefs is fear. Fear combines an element of belief with an
element of anxiety. The anxiety results from beliefs about the severity of the health threat and
one’s susceptibility to it, along with a feeling of hopelessness or helplessness to do anything
about the threat.
Values
Values are the moral and ethical reasons or justifications that people use to justify their actions.
They determine whether people consider various health-related behaviours to be right or wrong.
Similar values tend to be held by people who share generation, geography, history or ethnicity.
Values are considered to be more entrenched and thus less open to change than beliefs or
attitudes. Of interest is the fact that people often hold conflicting values. For example, a teenage
male may place a high value on living a long life; at the same time, he may engage in risky
behaviours such as chewing khat and drinking alcohol. Health promotion programmes often
seek to help people see the conflicts in their values, or between their values and their
behaviour.
Attitudes
Attitudes are relatively constant feelings directed toward something or someone that contains a
judgment about whether that something or someone is good or bad. Attitudes can always be
categorised as positive or negative. For example, a woman may feel that using contraception is
unacceptable. Attitudes differ from beliefs in that they always include some evaluation of the
person, object or action.
Self-efficacy
The most important predisposing factor for self-regulating one’s behaviour is seen to be
self-efficacy​, that is the person’s perception of how successful he or she can be in performing a
particular behaviour. Self-efficacy is learning why particular behaviours are harmful or helpful. It
includes learning how to modify one’s behaviour, which is a prerequisite for being able to
undertake or maintain behaviours that are good for your health. Health education and
behavioural change programmes help a person to bring the performance of a particular
behaviour under his or her self-control.

2.2 Enabling factors

Enabling factors are factors that make it possible (or easier) for individuals or populations to
change their behaviour or their environment. Enabling factors include resources (Figure 4.3),
conditions of living, social support and the development of certain skills.

Among the factors that influence use of health services are two categories of enabling
resources: community-enabling resources (health personnel and facilities must be available),
and personal or family-enabling resources (people must know how to access and use the
services and have the means to get to them).
Enabling factors refer to characteristics of the environment that facilitate or impede healthy
behaviour. They also include the ​skills and ​resources required to attain a behaviour. For
example enabling factors for a mother to give oral rehydration salts to her child with diarrhoea
include having time, a suitable container and the salt solution itself.
Skills
A person or population may need to employ a number of skills to carry out all the tasks involved
in changing their behaviour. For some positive health behaviours it might be necessary to learn
new skills. For example if a breast feeding mother is not well trained on positioning and
attachment of her baby she may have difficulty in properly breastfeeding her child. Similarly, if
the mother is not well trained at a later stage on the preparation of complementary feeding, the
child may not get the nutrition they require.
Healthcare resources
A number of healthcare resources may also need to be in place if an individual or population is
to make and sustain a particular health-related behaviour change. The availability, accessibility
and affordability of these resources may either enable or hinder undertaking a particular
behaviour. For example, in a given health post the lack of availability of the family planning
method of choice for a mother may discourage her from utilisation of the service in the future.
Changing behaviour may also be easier if other aspects of one’s environment are supportive of
that change. For example policy initiatives or even laws might be in place that create a positive
atmosphere for change.

4.3.3 Reinforcing Factors

Reinforcing factors ​are the positive or negative influences or feedback from others that
encourage or discourage health-related behaviour change. The most important reinforcing
factors are usually related to social influences from family, peers, teachers or employers.
Social influence
Social influence is the positive or negative influence from those influential people around us
that might encourage or discourage us from performing certain health-related behaviours. For
example a mother who is planning to start family planning (FP) might be influenced by negative
attitudes from her peer group and think, ‘Most of my friends do not use FP methods and I may
lose friends in the neighbourhood if I use the methods’. She might also be influenced by her
family: ‘My family members do not all support the idea of using FP methods, especially my
husband and my mother-in-law. They would really be mad at me if I use FP’. She may also be
aware that her community society or culture generally may not be supportive: ‘Everyone in our
community is against FP and it is seen as a sin in our society’.
An individual’s behaviour and health-related decision making — such as choice of diet, condom
use, quitting smoking and drinking, etc. — might very well be dependent on the social networks
and organisations they relate to. Peer group, family, school (Figure 4.5) and workplace are all
important influences when people make up their minds about their individual health-related
behaviour.
Patient Care is the Priority But Employee Engagement is the Key

You may not immediately see the results of engagement activities, but you need to
remember the ultimate goal: Improved patient care. Building engagement takes time; it
is not a seasonal activity for leadership, management, HR, and Organizational
Development teams to tackle and then forget about. Instead, it should be a slow and
steady build that draws in more and more employees, and you must implement systems
and processes that will maintain your newly engaged culture.

Engaged employees enjoy their work and feel valued, which then translates into better
patient care and this equals financial reward. According to Curaspan Health Group, in ​a
2007 study of a nationwide system of 23 hospitals facilities with more engaged workers
had 8 percent higher net revenue per patient than facilities with lower engagement. I bet
that number and the correlation has only increased since then. With the right systems in
place, an investment in employee engagement now will yield tremendous and
sustainable returns in the future.

3.TEAM BUILDING GAMES WITH PROCEDURES:-

Team building exercises:

Planning/Adapting Exercises
Tag Team Game

Time Required: 20-30 minutes

This adapting exercise requires just a few simple tools, which include large

sheets of paper, writing paper, pens, and markers. In this exercise,

participants are broken up into groups of 4-8 people and instructed to share

with their group their individual strengths and the positive attributes they feel

would lend to the success of their group. They are to write these strengths

and attributes down on a piece of paper. After their group discussion, each

team will be given one large sheet of paper, writing paper, markers, and a

pen. The groups should then be instructed to make the "ultimate team

member" by combining each team member’s strengths and positive attributes

into one imaginary person. This “person” should also receive a name, have a

picture drawn of them, and have their different attributes labeled. The group

should also write a story about this person, highlighting all of the things their

imaginary person can do with all of their amazing characteristics. At the end of

the exercise, each group should share their person with the group and read

the accompanying story. This exercise will help coworkers adapt to weakness

they feel they or a team member may have by understanding that as a group,
they are capable of having more strengths and positive attributes then they

would have working solo.

The Take Away Game

Time Required: 5-10 minutes

This planning game only requires 15 coins of any time, including pennies. To

play, the instructor can create multiple teams of two or have on group play

another, with one representative from each team participating in each game

until everyone has had a turn. The set up is simple: a coin is tossed to decide

who goes first. Each side may remove two coins every time they call the it

(heads or tails) correctly. The winner is the person/team removing that

removes the last coin. The game can be made more complex by upping the

number of coins a team can take when it’s their turn or by allowing coins to be

put back. With increased complexity, the activity allows the teams a strategic

planning stage. The goal is to have the players realize that simpler versions of

the game can easily be planned and controlled by the team/person playing

first.
The Paper Tower

Time Required: 5 minutes

This planning exercise is very simplistic in its approach, but it teaches

participants the importance of planning, timing, and thinking on their feet.

Each participant is given a single sheet of paper and told that it’s absolutely

necessary that they construct the tallest free-standing structure in just five

minutes using no other materials. After the five minutes and a review of the

structures, a discussion can be had concerning who planned out their

structure, who ran out of time, and what could be done differently next time.

Road Map Game

Time Required: 30 minutes

The participants need to be split into two groups with an equal about of

players in each group. This planning exercise also requires that the

participants have paper, pens, and a map. The map can be of the state the

participants are in, of the whole country, or of a specific area. The area the
map covers doesn’t matter as much as the fact that each group needs a copy

of the same map. Instruct the teams to plan a vacation, which must be

planned within certain parameters. Each group should be given a list of what

they have for their trip, how much money they can use, what kind of car they

will have, the size of its gas tank, m.p.g., the price of gas, the beginning and

ending destination, and anything else you can think of. Each group should

write down their travel plans and any group that runs out of money or gas will

be disqualified. Awards can be given to the team that saw and did the most

with what they had or for the most exhausting trip, the most relaxing, etc. The

goal of team building exercises like this is to get coworkers working together

as team with the common purpose of planning this trip in 30 minutes.

Paper and Straws Game

Time Required: 15 minutes

This planning game is ideal for small groups and only requires drinking straws

and some paper. The group leader needs to draw a large circle on a large

piece of paper with concentric circles within it. Then, each circle must be
assigned a score, with the biggest score being saved for the smallest, middle

circle. This paper is taped onto the middle of a large desk. Then, each

participant must gather around the table and be given a drinking straw. The

group leader will make dime-sized balls by wadding up bits of paper. It is up to

the group leader how many balls will be in play. The participants must blow

into their drinking straws to push the balls around. It sounds easy, but as more

balls come into play, the participants must plan with their coworkers how they

will push balls into high-scoring sections without moving balls that are already

in place. This may require re-positioning themselves in different locations

around the table or having different players blow in different directions; it’s up

to the participants to create their plan of attack. The group leader can end the

game once they’ve reached a specific score or once each ball is in the middle.

These simple team building exercises helps coworkers work together to

create and follow through with a plan and it also encourages them to

communicate.

Trust Exercises
Mine Field

Time Required: 20-30 minutes

This trust exercise requires some setting up before it can be executed. It also

requires a large, open area such as a room without furniture or an empty

parking lot. The leader must distribute "mines," which they place haphazardly

around the area. These “mines” can be balls, bowling pins, cones, etc. This

exercise gives coworkers a chance to work on their relationships and trust

issues, which is why they are paired into teams of two. One team member will

be blindfolded and cannot talk and the other can see and talk, but cannot

enter the field or touch their blindfolded teammate. The challenge requires

each blind-folded person to walk from one side of the field to the other,

avoiding the mines by listening to the verbal instructions of their partners.

Penalties can be put in place for each time a blindfolded person hits a mine,

but the real idea behind the game is to get the team members to trust their

partner’s directions and to teach them to communicate in a more effective

way.
Running Free

Time Required: 20 minutes

This trust building exercise requires nothing more than a few blindfolds and a

large, flat area- preferably with grass. The group leader can either team

people up or allow them to pick their own partners. Once everyone is in teams

of two, one team member will be designated as the leader and the other as

the follower. The follower must wear a blindfold. The group leader will instruct

the leaders in each team to hold the hand of their blindfolded partner and take

them on a slow walk around the area for at least 3 minutes. This will allow the

partners to get accustomed to the process and their partner. After three

minutes, instruct the teams to take a normal-paced walk for three minutes.

After those three minutes are up, instruct the leaders to take their blindfolded

partners on a fast walk for thirty seconds. After each turn, the blindfolded

partner is developing more and more trust in their seeing partner. Instruct the

leaders to take their blindfolded partner on a 30 second jog, then a 15 second

run, and lastly, a very fast 15 second run- with breaks in between. After the
last run, the follower can take off their blind fold and rest for a bit with their

partner before the process begins over again and the followers become the

leaders and vice versa. After the last run, a discussion can be had about the

process, whether or not it was difficult for participants to trust their partners

and if so/not, why?

Slice ‘n Dice

Time Required: 15 minutes

This trust building exercise should take place outside and preferably, should

be done with a large group of 20 or more. Participants should be instructed to

form two equal lines facing each other (creating a corridor) and to put their

arms straight out in front of them. Their arms should intersect, overlapping by

about a hand with the arms of the people opposite of them. The person at the

end of the corridor will walk down the corridor of arms. In order to let the

person pass, the other participants will have to raise and lower their arms.

That person will then join the corridor again and then the next person in line

will walk through. This process will continue until everyone has had a turn.
Now that the group is more confident, participants should be instructed to walk

quickly, run, or sprint down the corridor, trusting that the other participants will

let them pass without making them pause. For the last turn, the participants

making the corridor should be instructed to chop their arms up and down as

people run through. This exercise allows participants to build trust in their

teammates while also having fun.

Eye Contact

Time Required: 5 minutes

This trust exercise requires no special equipment, just an even number of

participants. Making eye contact is sometimes difficult for people, as it

requires a certain amount of trust and respect. Some people avoid it, while

others simply aren’t very good at it; they make look away often or appear

awkward or uncomfortable, sometimes fidgeting with other objects. This

exercise, though simple, can help coworkers become more comfortable and

trusting of each other through the practicing of eye contact. For this activity,

have people group into pairs and stand facing each other. The idea is to have
them stare into their partner’s eyes for at least 60 seconds. Neither participant

should be wearing glasses or sunglasses of any kind. There may be some

giggles at first, as it can feel somewhat awkward during the first try, but as

participants get the hang of it, it should become easier for them to make eye

contact for prolonged amounts of time.

Willow in the Wind

Time Required: 20 minutes

This particular trust building exercise goes by different names, but usually

illustrates the same idea. This exercise is best suited for coworkers who

already know each other fairly well. One participant must volunteer or be

chosen to be the “willow.” The willow must stand in the middle of a group with

their eyes closed, their feet together, and body upright. They will perform a

series of “trust leans” against the other participants, whose job is to hold up

the willow and pass them around without allowing them to fall or feel

frightened as if they’re going to fall. Before beginning, the instructor should

discuss “spotting” techniques to all participants. Those who are not the willow
must have one foot in front of the other, have their arms outstretched, elbows

locked, and fingers loose, as well as be ready and alert. This will ensure that

they will successfully pass the willow around without any troubles. Various

co-workers can take turns being the willow. This technique helps coworkers

establish and build trust with each other in an open, fun environment.

4.GROUP DYNAMICS IN HEALTH CARE:-

Group  dynamics  have  broad  and  necessary  applications.  And  there  is  arguably 

no  more  of  a  need  for  such  than  in  a  healthcare  setting  as  a  result  of  the 

fast-paced,  high  pressure,  and  seemingly  always  shifting  focus  from  patient 

need  within  policy  framework.  Nonetheless,  the  abilities  for  clinicians’  to 

successfully  interact  within  a  multidisciplinary  team  is essential for patient care 

outcomes  and  effective  and  efficient  use  of  system  resources.  This  paper  will 

review,  discuss,  and  propose  a  strategic  framework  for  team work development 

and improvement within a healthcare setting.  

Advocacy and Competence 

For  those  situations  when  the  referring  physician  (or  another  healthcare  unit) 

are  unsure  about  the  scope  of  clinical  and/or  health  psychology,  providing  a 

cohesive  introduction  and  utility  of  your  services  may  be  necessary.  (It  is, 
however,  likely  that  the  hospital  may already have a brochure created, if so, skip 

this  section.)  Working  with  your  newly  developed team to create an informative 

packet  would  be  a  nice  way  to  further  establish  rapport  and  trust,  not  just 

among  your  professional  aims  and  skills,  but  it  also  provides  an  opportunity  for 

a  personal  connection  with  each  other After all, the more time invested helps to 

develop  the  shared  identity  as  well  as  increase  the  value  added  proposition  to 

the  overall  business  model  (your  admins will love this). There is always a bottom 

line  to  services  rendered,  and  as  healthcare  policies  continue  to  change, 

providers  and  systems  must  adapt  in  real  time  Having  each  member  create  a 

small biography with a picture would be a nice personalized touch.  

Cultural Competency and Diversity 

Cross-cultural diversity is inevitable in the workplace that demands the need for 

cultural  competency  and  diversity  training.  As  such,  observing  your  team 

members’  interactions  with  each  other  is  crucial  in  order  to  address  potential 

issues  within  the  group.  The  concept  of  microaggressions  is  especially  relevant 

to  this  need  as  they  have  the  potential  to damage the wellbeing of minorities by 

making  one  feel  isolated,  underappreciated,  targeted,  and  inferior  Being  able  to 

understand  the  differences  in  age,  gender,  and  ethnicity  will help tremendously 

with  group  cohesion,  trust,  and  rapport.  This  helps  to  create  a  culturally 

equitable workplace, which is dependent on adopting policies and procedures to 

meet the needs of the diverse individuals in the workplace. 

Adaptation 
Telehealth  is  the  use  of  modern  information  and  communication  technologies 

for  distance-related  health  activities.Telehealth  allows  for  ease  of 

communication  between  health  professionals  and  between  health  professionals 

and  their  patients.  These  services  can  reduce  healthcare  costs,  reduce  travel 

burden,  and  improve  health  outcomes  if  used properly . Alternatively, the use of 

telehealth  services  can  also  create  conflict  and  exacerbate  communication  if 

members  of  the  team  reside  in  different  geographic  locations  where  similar 

resources  are  not  available.  Factors  such as different communication standards, 

cultural norms, and teamwork structure can also impede on collaboration  

Wellness 
Wellness  is  a  balanced  state  of  health  in  both  mind  and  body  This  concept  is 

especially  important  for  both  individual  employees  but  as  well  with  the  group 

members  at  large.  Companies  have  wellness  initiatives  that  promote  physical 

exercise  and  proper  nutrition  to  improve  employees’  physical,  emotional,  and 

psychological  health.  Such  programs  are  proactive  approaches  using 

preventative  measures  to  help  employees  with  lifestyle  changes  as according to 

the  Center  for Disease Control and Prevention, more than 66% of Americans are 

overweight  or  obese  and  nearly  half  reported  to  have  at  least  one  chronic 

medical  condition.  These  impairments  have  indirect  costs to the economy, both 

in  terms  of  financial  loss  and  personal  burnout  and/or  turnover  ​.​In  order  to 
slow  the  rising  healthcare  costs  and  maintain  a  productive  workforce,  wellness 

plans have been developed to prevent these national health problems.