British Journal of Social Work Advance Access published December 30, 2012

British Journal of Social Work (2012) 117

doi:10.1093/bjsw/bcs194

Making Interprofessional Working Work:

Introducing a Groupwork Perspective
Annie Pullen-Sansfacon and Dave Ward

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Dr Annie Pullen-Sansfacon is Associate Professor at the Universite de Montreal, Canada. Her
research interests include social work ethics and professional identity as well as groupwork
and social action. Dave Ward is Professor of Social and Community Studies at De Montfort
University, Leicester, England. His research interests include groupwork, social exclusion, and
probation and criminal justice.

Correspondence to Annie Pullen-Sansfacon, E cole de service social, Universite de Montreal,

CP 6128, succursale Centre-ville, Montreal, QC, H3C 3J7, Canada

Abstract
Teams are an established part of organisations and are, by definition, groupsbut the
business discourse within which they are conceptualised, and within which teamwork
takes place, discounts key aspects of groupwork, essentially related to its values.
Hence, we argue, the true potential of teamwork is stifled. This is compounded in rela-
tion to interprofessional teams, by the top-down, prescriptive, policy drivers which
have led to their setting-up and because of new managerialism embedded in their op-
eration. In other words, they are essentially business teams and, as such, constricted.
Groupwork, we argue, has the potential, first, to liberate interprofessional teams to func-
tion more successfully and hence, second, to deliver better to the service user and, third,
we believe, to contribute to reducing the risks of failure in interprofessional working as
exhibited in recurring tragedies. Social workers, with their values, knowledge and train-
ing in groupwork, have potentially a special role to play in facilitating interprofessional
teamwork. In turn, this role, if they carry it out well, might help improve their status in
the interprofessional team, where currently they often feel marginalised.

Keywords: Group work, interprofessional work, skills, social work, teamwork, values

Accepted: October 2012

Introduction
Inter-agency and interprofessional working and linked terminology such as
partnership, collaboration and teamwork have been buzzwords in the
health and social services throughout the first decade of the twenty-first

# The Author 2012. Published by Oxford University Press on behalf of

The British Association of Social Workers. All rights reserved.
Page 2 of 17 Annie Pullen-Sansfacon and Dave Ward

century. They were core to New Labours aspirations for joined-up policy
making and management to produce more efficient services in terms of
value for money, reach into problems and better access for potential
beneficiaries in social care, mental health and childrens services. This is un-
likely to change under the Coalition governments drive for cost savings and
providing more for less. Although this paper is grounded in the British
context, similar processes can be detected elsewheres, such as in Quebec
Province, Canada (Ministe`re de la sante et des services sociaux, 2010),
the workplace of one of the authors. It is not clear that those charged
with engineering such developments, those tasked with managing resultant
provision and those delivering on the front line are necessarily on the same

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wavelengths when these concepts are deployed.
At the core are people working togethera feature which appears to
have become almost forgotten amidst the overwhelming attention given
to organisational structures and operational procedures:

Policy makers often see organizational change as a solution to improving or

modernizing services and (that) new structures for inter-agency and inter-
professional working and new methods of service delivery can provide
new opportunities for creative developments (Seden, 2007, p. 1).

It seems to have been overlooked that working together is not only what
people have done, long before the inters . . . came to top the agenda. It
is central to what they must do given the complex and multidimensional
natures of service user need.
At the same time that interprofessional and inter-agency working have
gathered pace and prominence, practice has become framed increasingly
within a business discourse, represented by the dominating culture of
new managerialism (OReilly, 2011). This stresses, besides ratcheting up
performance through targets and outputs, a reframing of the characteristics
desirable in individual workers, favouring competitiveness, flexibility and
short-term horizons (Sennett, 2006). Combined with a more prescriptive
approach to management, these features impact on the nature of interper-
sonal relationships in the work setting.
As an alternative, we argue that attention be directed towards an ap-
proach guided by a social groupwork discourse, signified by an explicit
focus on how people work together as group members. Where this works
well, we argue, desired outputs and outcomes can flow from people
working and interacting in groups as a consequence of effective groupwork.
To these ends, we will posit that drawing from group dynamics knowl-
edge and, more broadly, from groupwork theories and experience, we
can strengthen interprofessional working and provide conditions favour-
able for successful working together over and above the structures that
are introduced by agencies and policy makers. Core to this enterprise lies
the team-group. We will conclude by exploring the importance of leader-
ship in such teams and the role social workers can take as facilitators.
 Interprofessional Work and Groupwork Page 3 of 17

The policy context

Inter-disciplinary and interprofessional working has long been embedded in
the work of the health and welfare occupations. We question whether, if at-
tention had been given to this history, the approach that has been taken, in-
volving reorganisation after reorganisation and the disruption and resource
diversion that have been a consequence, would have been so necessary?
Has the structural focus really missed a key issue?
Besides new-managerial concerns for economy, efficiency and greater
effectiveness, the overt driver in developing interprofessional practice has
been to change services for the benefit and protection of service users, includ-

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ing those for whom the state has protective responsibilities, through changing
the way services are delivered and received at the front line (Laming, 2003).
Yet, there are voices questioning whether restructuring and reorganisation
are the only ways to achieve behavioural change at that level (see, e.g. Fitz-
patrick, 2010; Toynbee, 2010). Anning and Edwards (1999, cited in Jelphs
and Dickinson, 2008, p. 32) suggest that often professionals are simply
exhorted to multi-agency team-working with little training or guidancea
situation reported to be similar in North America (Clement et al., 2007).
In our view, then, it is not surprising that successive reviews of service
failures (from Maria Colwell to Baby Peter in childrens services, for
example) consistently identify failures of front line practitioners to commu-
nicate and to work together (Stanley and Manthorpe, 2001; Parton, 2004;
Brandon et al., 2009; Department for Children, Schools and Families,
2010). More frequently, this has been where practitioners have been
working from separate locations and there is evidence that co-location pro-
vides a better context for working together interprofessionally (Gulliver
et al., 2003). Certainly, there is a particular challenge for dispersed
teamsbut, with the adoption of new technology into the methodologies
of groupwork, there is increasing development and recognition of the po-
tential for effective working in groups where members are at a distance
from each other (see Simon and Stauber, 2011).
More generally, examples of good interprofessional practice can be
found in accounts of groupwork (see, e.g. Mullender and Ward, 1991;
Doel, 2006; Lindsay and Orton, 2008; Mullender et al., forthcoming).
Although the interprofessional factor was not their prime consideration,
it is our contention that, if these grounded practices are valued, recognised
and understood, reorganisation should not be the exclusive solution.

Working together: understanding the terminology

Many authors on the topic (e.g. Glasby and Dickinson, 2008) place defin-
itional clarity and mutual understanding as imperatives for successful
Page 4 of 17 Annie Pullen-Sansfacon and Dave Ward

interprofessional working. Whittington (2003) illustrates the differences.

For example, partnership tends to involve formal, institutional-level
working together while collaboration implies something more active.
Multi-disciplinary involves agency team members working in parallel,
maintaining distinctive organisational and professional boundaries, while
Inter-professional working involves greater interaction, integration and
adaptation, merging of ideas and creation of new practice (Whittington,
2003, p. 16). Thus, some forms of working together require minimal consul-
tations, whereas others involve a greater level of interaction. Particularly in
the case of interprofessional working, workers will be asked to work together
more intensively. Here, in our opinion, a greater awareness and application of

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groupwork theory and methods can assist the interprofessional project.
For our purposes, interprofessional working:

. . . involves members of two or more professions working together to

respond more adequately to the needs of individuals, families and commu-
nities and to improve the quality of services provided. It also looks to opti-
mise the use of resources by avoiding duplication (Barr, 2000, p. 176).

In this sense, interprofessional working requires the professional, regardless

of discipline or area of work, such as child or adult care, to analyse situa-
tions from their own professional perspective and define intervention
objectives before, with the other professionals involved, putting them to-
gether and prioritising them. The interprofessional working we refer to in
this paper includes both co-located and dispersed teams, although, as men-
tioned, we acknowledge that dispersed teams have extra challenges for the
group to form and develop. Furthermore, while we will discuss interprofes-
sional work in care management, we consider the underlying principles to
be generic, applicable in a range of interprofessional teams.
However, as noted, the current situation in interprofessional work has
tended to become distanced from this interpersonal context and divested
of its human and interactional content, that is from the processes and
skills involved in achieving and maintaining partnership and working to-
gether (Robson and Kitchen, 2007). Perhaps this is not surprising given
the extent of political interest and the policy drivers forcing its develop-
ment, spurred by the successive reviews of welfare tragedies which have
laid blame on failures of professionals to communicate and work together.
Nevertheless, the top-down approach has been helpful in providing inter-
professional working with a high profile and legitimacy, as the increasing
amount of training about collaborative work for intending health or
social care professionals in part demonstrates (Freeth et al., 2005; Barr
et al., 2011). However, the top-down approach has placed emphasis on pre-
scription and direction in which service-level practitioners and their imme-
diate managers find their own understandings and experience, grounded in
practice, largely passed over. That most practitioners and service-level
managers are well aware of the interfaces, interactions and overlaps
 Interprofessional Work and Groupwork Page 5 of 17

between different areas of activity has not, in our view, been sufficiently
considered, failing to appreciate that awareness of, and interaction with,
other people are basic to social work practice (OLeary et al., 2012) and
human experience. As Sennett (2011b) expresses, it is in interpersonal
interaction or, to put it another way, in being in groups that we form our
identities, we live much of our lives and seek the means of survival and ful-
filment. These characteristics are critical to working together.
To illustrate, examples can be found in which interprofessional working
has developed naturally in settings where it was not part of the professional
discourse, not a priority concern nor a focus imposed from above. For
example, Ward (2012) outlines how this has happened in dentistry, histor-

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ically a self-contained occupational area. Led by bottom-up concerns to
improve services to patients, interprofessional, and inextricably linked
with it, teamwork have evolved without external specification as logical
and professionally responsible responses to changing patient profiles and
needs.
Our argument, therefore, is that emphasis on interprofessional working
should attend not only to structure and organisation, but also to valuing,
nurturing and facilitating processes of people working together. This
implies moving from preoccupation with top-down and outside-in processes
to bottom-up and inside-out ones. The latter engage with local, incremental
and cultural changes disseminated through practitioner networks and
tested, hopefully, through research. Focus moves to micro-level issues of
teamwork and interpersonal communication, negotiation and influence
from macro concerns for structure and change (Gratton, 2007). These
micro issues interlink with the concerns of groupworka discipline
which, conventionally, would be regarded as outside the organisational
domain.

Teamwork and groupwork: moving towards a different

type of interprofessional practice
According to Jelphs and Dickinson (2008, p. 1), teamwork lies at the heart
of effective interprofessional practice. Like others in the management and
organisational literature (West et al., 1998; Robotham, 2008), they assert
that teams and groups are different entities. However, what, for instance,
Jelphs and Dickinson (2008, pp. 8 9) describe as features of teams could
equally apply to groups: shared objectives and goals; interdependence, in
that members work together to achieve goals; recognition by members
and those outside; situated within wider social systems; involving some
degree of leadership. Teams, like groups, can vary widely in size.
Kezsbom (1990, cited by Robotham, 2008, p. 49) argues that team
members are aware of their individual roles and the extent to which their
Page 6 of 17 Annie Pullen-Sansfacon and Dave Ward

respective talents work together. In reviewing social work teams, Parsloe

(1981) suggested that what is projected as a team often resembles a
tennis team, where the collection of individuals are not dependent on
each other to work effectively. Alternatively, she saw advantage in the foot-
ball team model where members bring together differing experiences, skills
and methods of working. In such a team, she argued, group members work
together, are dependent on each others skills and draw strength from their
experiences within the group. Such joint investment in success and in
achieving common goals are key to creating synergy (Eva, 2002,
p. 314)what is often characterised as the special group characteristic of
the whole . . . exceed[ing] the sum of the parts (Eva, 2002, pp. 315 16).

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There is nothing here that would surprise a groupworker. Indeed, Guzzo
and Dickson (1996, cited in Robotham, 2008, p. 48) suggest that it is point-
less to attempt to distinguish between groups and teams. This is echoed by
Trevithick (2005) and Preston-Shoot (2007), who assert that groupwork can
be used to improve the functioning of organisations. In an early paper on
interprofessional work, Kane (1975) maintained that conflicts in interpro-
fessional teamwork may be as much explained by group process as by the
interaction of professional roles and statuses. Cheminais (2009, p. 37)
even applies Tuckmanss classic model of the groupwork process
(forming storming norming and performing) to the phases of interprofes-
sional team development, seeing it as helpful in assisting multi-agency
practitioners to understand the four stages they work through, in order to
become an effective team.
However, Douglas (1983) sees the matter as more complex:
. . . writers seem to indicate that that the dynamics of teams are the dynamics
of groups in general, which is true, and that the different emphases are not
sufficiently different to warrant specific mention, which is not true . . .
(Douglas, 1983, p. 124).

Douglas (1983, p. 122) defines a team as a co-operative group created by a

larger organisation to perform tasks that cannot be attempted by an individ-
ual. While, in essence, all groups are teams and vice versa, the organisation
that constitutes a team is not necessarily found in other forms of group
(Levi, 2011). Although noting this, we believe it is important not to
assume that groups necessarily form voluntarily. Indeed, while interprofes-
sional teams may be constituted by the organisation, so are groups of invol-
untary participants, such as offenders attending a group as part of their
sentence. In this sense, the organisation may be perceived as having the
same role as a groupworker who brings mandated members together into
groupwork.
Davis and Wacker (1987, cited in Robotham, 2008) provide some flavour
of the organisational input. Teams, they say, involve:
. . . a certain level of skill, work is structured in a manner which allows a
balance between individual and team work, the team is clearly recognised
 Interprofessional Work and Groupwork Page 7 of 17

for its contribution in the organisation, management see the need for cross
training, team membership is stable and turnover amongst members is kept
to a minimum, the work requires that individuals work together to success-
fully complete tasks, there are clear criteria to evaluate team performance
and feedback on performance is available (Robotham, 2008, pp. 48 9).

However, we do recognise that there are also some groups within organisa-
tions that are formed to resist organisational pressures which they view
as detrimental to their work. However, for this paper, teams are groups
formed by organisations and encompassed within their purposes and objec-
tives. While the focus is primarily on task achievement, they can also engage
in other activities such as member support, training and development (Gray

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et al., 2008).
Yet, for a team to work, it must draw from the capacities of each member,
as well as the group as a whole. It is this engagement between the member
and member and member and the group to agree, integrate and pursue
common objectives that constitutes the essence of its groupwork.
In comparing teams with groups, organisational literature does appear to
view the latter as rather passive and situational, namely people who happen
to be together compared unfavourably with the dynamic and goal-focused
characteristics of teams (Levi, 2011). In response, we would point out that
groups do have a purpose but that it is unlikely to be focused on business
objectives, in the commercial sense of that term. Indeed, we would argue,
both teams and groups are purposeful; there is much overlap in character-
istics but the contexts are different. Teams are groups in organisational
settings.

Working together in organisations through groupwork

Organisational sponsorship and, particularly, accountability for members
contributions seem to make a team a rather special kind of group. First,
they signpost that teams and teamwork reside within the discourse of busi-
ness rather than that of the liberal social sciences. This is important. Behind
discourses lie questions of values. Ward (2009) points to a close connection
between groupwork and the values of equality and democracy, arguing that,
historically, distinguishing features of groupwork have been its emphasis on
commonalities within problems and collective commitment:
In groupwork each issue that is raised, even when that issue at first glance
seems to have no relevance to others in the group, does have applicability
for all. The worker who practises real groupwork draws out that applicabil-
ity and elicits the commonalities and asks members to examine the issues of
others (Kurland and Salmon, 1993, p. 10).

In parallel, White (2006) explains that, for an interprofessional team to

work, it must integrate in the workplace the notions of shared values and
Page 8 of 17 Annie Pullen-Sansfacon and Dave Ward

of dialogue. Glasby and Dickinson (2008, p. 34) add that effective interpro-
fessional working should involve: recognition and acceptance of the need
for doing things together; clarity and realism of purpose; commitment
and ownership; trust; clear and robust practical arrangements; opportun-
ities to review and learn. To be successful, an interprofessional team must
move from a culture of difference (tennis team) to one of integration (foot-
ball team), from an individual to a team focus; it must develop a culture of
trust as well as a collective system of leadership (DAmour et al., 2005).
However, Douglas (1983) suggests that the behaviour of teams is likely to
be constrained to eliminate actions not essential to task achievement, a high
level of conformity being generally required and sanctions for contraven-

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tions. He also identifies the role of the team leader as having a strong dir-
ective element. Douglas contextualises these features by observing that
teams tend to be embedded in a sponsoring organisation to which the
leader bears accountability for team performance. Similarly, Robotham
(2008, pp. 49 51), in highlighting conditions for successful team perform-
ance, identifies the importance of: upper management support; incentives
(without incentives a team will usually fail); leader-established rules on
how members will work together; and the team leaders responsibility to
inspire. There should be the right match of individuals so that individual
performance and contribution are maximised. All these features, Robot-
ham suggests, are not so prominent in groups, as they are not tied to organ-
isational and commercial goals. In other words, a different set of values to
those associated with groupwork are at play. Nevertheless, through these
nuances, we can still see that a team, as a group with a purpose in an organ-
isational setting, is still a group. To function effectively, attention is needed
to group norms, to nurturing, to encouragement and support, to decision
making and conflict resolution, to communication, to leadership and to
group harmony, as in other kinds of groups (Kane, 1975; Levi, 2011).
Despite the self-evident significance of the group, the literature of inter-
professional working tends not to address micro-level process and interper-
sonal relationship issues through understanding and use of group dynamics
and processes. There is a propensity to frame practice in higher-level stra-
tegic, organisational and structural terms and lose sight of the team as a
group, such as how different roles may affect the way the team works;
how latent conflicts may block the process of working together; or how
poor facilitation skills may contribute to the failing of the team altogether.
This problem of omission is compounded by one of focus: the discourse
which dominates interprofessional practice is instrumental and structural.
For example, Cheminais (2009, p. 26) considering partnership working
under Every Child Matters (HM Treasury, 2003) asserts that it is policy
that drives multi-agency partnerships. Since working together comes
from the top rather than from those directly involved with service users
and clients, it is not surprising that interprofessional teams constructed fol-
lowing reviews and reorganisations frequently struggle to practise
 Interprofessional Work and Groupwork Page 9 of 17

coherently and effectively (see, e.g. Peck et al., 2002). Consequently, there
needs to be, in our view, consideration of a different discourse, one of
understanding people gathered together (Douglas, 1983). Citing Hudson
(2002), Jelphs and Dickinson (2008) describe the problem:

The majority of . . . governments attempts to promote and improve partner-

ship working have focussed on policies, processes and structures, rather than
on the individuals and professionals who are actually interacting with one
another. In other words, the focus on inter-professional working has not
been matched by equal attention to inter-professional relationships
(Jelphs and Dickinson, 2008, p. 52, our emphasis).

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In our view, therefore, it is essential to bring forward the values and pro-
cesses embedded in the discourse of groupwork. It requires looking to
more holistic principles and practices than those revealed in the discourse
of teamwork, as we have found it, with its focus on organisational drivers,
on directive leadership and on the individual. Groupwork, in contrast,
keys into interpersonal relationships and interactions from a different
perspective.
Of course, the very nature of what constitutes groupwork is debated.
For example, Toseland and Rivas (2005) distinguish two different categor-
ies within which different types of groups can be found: treatment groups
(including therapy groups, support groups, education groups, socialisation
groups and growth groups) and task groups (including social action
groups, self-directed groups and multidisciplinary teams). That said, Tur-
cotte and Lindsay (2008) assert that the frontiers between types of groups
are rarely clearly defined. One can move from one to another. In this
sense, we subscribe to Turcotte and Lindsays understanding in that the
groups we are referring to in this paper are not a particular type as identi-
fied by Toseland and Rivas but, instead, are grounded in the generic skills,
knowledge and understanding of groupwork, as identified, for example, in
the Standards for Social Work with Groups (Abels and Garvin, 2010).
In common, across differences, a group can serve to provide a source of
power for members; a place to exchange information; sources of motivation
and hope; opportunities to learn and test interpersonal and other social
skills; a sense of belonging; role models; feedback on behaviour; a chance
to help as well as be helped (Coulshed, 1991, p. 161, summarising Yalom,
1970). In these characteristics, groupwork provides a viable space to actual-
ise essential components of successful interprofessional work which are not
naturally provided through structures.
Thus, in the organisation and management of interprofessional activity,
the problem is not the lack of literature on teams, organisations and man-
agement per se. Rather, it is failing to apply a knowledge and understanding
of group process, and to use groupwork skills, in managing partnerships as
mosaics (Brown, 1989) and front line interprofessional teams as groups. A
culture which is top-down, prescriptive and preoccupied with following
Page 10 of 17 Annie Pullen-Sansfacon and Dave Ward

rules, performance indicators and output measures is the antithesis of

groupwork. One former senior civil servant has described this culture as
leading naturally to narrowing vision, driving out initiative, distorting prior-
ities, flattening performance, conformism, reluctance to question received
ideas and ultimately to secrecy and defensiveness (Faulkner, 1995,
p. 69). The capacity of groupwork to enhance creativity and generate
team spirit and enthusiasm for the tasks in hand goes unconsidered in
such a culture.
Nevertheless, it is important to recognise the challenges faced by workers
who come together to work interprofessionally. There are real personal
challenges when people move from the comfort zone of the familiar uni-

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professional work setting into a maelstrom of new relationships and differ-
ent professional cultures. However, this is exactly where groupwork, with
its focus on interpersonal engagement, can be invaluable. It can offer a plat-
form for connecting members of interprofessional teams, enabling them to
recognise the challenges and opportunities of working together and to
engage more deeply with the complex issues that many service users face.
Indeed, echoing the features outlined above, a team, which is understood
and facilitated within a groupwork frame of reference, can address these
challenges. As Butler and Wintram (1991) describe, in relation to groups
run on feminist principles but clearly of wider applicability, groups can
provide a source of support, where meeting together can offer a safety
net in itself; a place to recognise shared experiences and their value; a
way of breaking down isolation and loneliness in a new environment; a
source of different perspectives; and a place to experience power over situa-
tions with the capacity to have an effect on these. In such an environment, it
should be possible to work upon and develop the specific capacities which
Stevens and Campion (1994, cited in Jelphs and Dickinson, 2008, p. 36) con-
sider necessary for effective teamwork: conflict resolution, collaborative
problem solving, communication, goal setting and performance manage-
ment, and planning and task coordination. It should also help team
members to develop shared goals and commitmentelements seen as
helping to overcome some of the difficulties experienced in interprofes-
sional work (Pittam et al., 2010). A team-group also needs a skilled facilita-
tor/leader, which organisations may not necessarily provide. They may
provide an organisational leader but that does not ensure that group pro-
cesses are developed or followed.
It may be that groupwork in these terms is not readily embraced precisely
because it requires acknowledgement that groups cannot be controlled in
the way that is expected of teams, that groups develop a life and dynamic
of their own over which a groupworkeror manager/team leadercannot
have complete control. In our experience, group members raise what is im-
portant and significant to them, no matter what tasks, ground rules and
boundaries are set. Such characteristics do not fit if the climate emphasises
discipline, individual responsibility, preset objectives and audited outcomes.
 Interprofessional Work and Groupwork Page 11 of 17

The question then becomes: how to integrate groupwork processes,

knowledge and skills into interprofessional teams already in place and
into future ones. The final part of our argument is that, by considering
their values, training and expertise, social workers may already be in a
very good position to take on the challenge and to help the interprofes-
sional teams in which they are working to become more of an interprofes-
sional team-group. This, we propose, is a distinctive contribution that
social workers can make to working together. It might also be significant
in empowering social workers in a context where, all too often, they experi-
ence themselves as the Cinderella profession (Lymbery, 2001).

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Social workers as team-group facilitators
Facilitation is a crucial part of successful groupwork (Lindsay and Orton,
2008). Indeed, literature shows that facilitation by a skilled practitioner is
necessary, from planning through to direct work with members. It
enables the group to develop and progress (Lindsay and Orton, 2008), to
orient to its task and meet its objectives and to generate cohesion among
members (Turcotte and Lindsay, 2008). Translated into a work setting,
this means promoting a better working environment. If the interprofes-
sional team is to meet its objectives and function effectively, we argue
that facilitation skills, knowledge and values need to be used by someone
within the team. Indeed, two recent studies, which have looked into dys-
functional interprofessional teams (Brown et al., 2011; Weller et al.,
2011), have identified problems not only with overarching structures, but
also with in-group interpersonal behaviours. These are eminently the
focus of skilled group facilitation:
Sources of team conflict included: role boundary issues; scope of practice;
and accountability. Barriers to conflict resolution were: lack of time and
workload; people in less powerful positions; lack of recognition or motiv-
ation to address conflict; and avoiding confrontation for fear of causing
emotional discomfort (Brown et al., 2011, p. 4).
. . . new members were not always well oriented to the team. The need to
maintain an environment in which open communication could take place
was acknowledged as important for patient safety, but there were some bar-
riers to achieving this (Weller et al., 2011, p. 478).
Richard Sennett (2006, 1970/2008) is renowned for his studies of people
living and working in proximity. He argues that we must learn the craft of
co-operation to make our complex society prosper. He reassures us that we
can do this, for the capacity for co-operation is embedded in human nature.
The foundations for skilful co-operation lie in learning to listen and discuss.
However, engaging well with others requires skills: of listening well and
working together with those who differ. Getting people to participate
with others unlike themselves, he says, requires well-honed skills of
Page 12 of 17 Annie Pullen-Sansfacon and Dave Ward

facilitation. Sennett identifies such skills within the history of social group
work (Sennett, 2011a). Such, we believe, is the special contribution social
workers can make to the interprofessional team.
Similarly, for Gray et al. (2008), the notion of communities of practice
(Wenger, 2006) provides possibilities of practising to develop learning
organisations (SCIE, 2004) in which a managed yet participatory approach
to interprofessional working in social care can be generated. It would draw
upon groupwork principles and be predicated by the values and cultural
heritage of social work (Gray et al., 2008).
Our next point follows. We contend that social workers, by their values
and training, may be well suited within the interprofessional team to facili-

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tate its success. First, social work, conceptually, seems well fitted for the
task. Indeed, Lymbery (2001) suggests that high among the core tasks of
social work are forming partnerships with other professionals to assess
need and work in partnership to empower users. Practice expertise, he
argues, embraces strategies for working within inter-agency, multiprofes-
sional structures. As we see it, the collaborative nature of the profession,
thus described, places social workers in a unique position to facilitate
group processes within a team. Even if these features are often obscured
by the organisational context that frames social work practice (Pullen Sans-
facon, 2011), it indicates that social work intrinsically leans towards a posture
of collaboration as the context in which social workers accomplish their work.
Furthermore, social work is founded on and informed by a specific value
base (IFSW, 2000) echoed in groupworks own statement of values (Abels
and Garvin, 2010) which specifies the promotion of participation of all, re-
gardless of their background; co-operation and democratic decision
making; solidarity, empowerment, mutual help and understanding. These
values, if applied to interprofessional working, may contribute to the pro-
motion of equal relationships between team members and models of com-
munication that are respectful of different professional knowledge, values
and skills. Indeed, as McGrath (1991, cited in CAIPE, 2007) states:
. . . inter-professional working is not about fudging the boundaries
between the professions and trying to create a generic care worker. It is
instead about developing professionals who are confident in their own
core skills and expertise, who are fully aware of and confident in the
skills and expertise of fellow health and care professionals and who
conduct their own practice in a non-hierarchical and collegiate way with
other members of the working team, so as to continuously improve the
health of their communities and meet the real care needs of individual
patients and clients (McGrath, 1991, cited in CAIPE, 2007, p. 8).
Next, groupwork should be already included in social workers training,
although there is evidence of a tendency for groupwork teaching not to
be prioritised in the curricula of some schools of social work (Trevithick,
2010). However, this not the case everywhere (Pullen Sansfacon et al., forth-
coming) and should not be regarded as immutable. In the UK, for instance,
 Interprofessional Work and Groupwork Page 13 of 17

working with groups is embedded, throughout the National Occupational

Standards for social work, including being able to work within multidiscip-
linary and multi-organisational teams, networks and systems (TOPSS
England, 2002).
Having said this, even though widely accepted definitions and value bases
for practice may provide a foundation for social workers to practise gener-
ally and facilitate groupwork in particular, we are not suggesting that such
skills on their own are a panacea to solve all the failings of interprofessional
collaboration, but rather can make a serious contribution. For example, we
detect positions which organisations require social workers to take, such as
the role of care manager (Postle, 2001), that can be turned into a platform

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from which to develop working together within interprofessional teams,
deploying the particular groupwork contribution social workers can bring.
The rise of the role of care manager within adult and community care
(Department of Health, 1991) has resulted in role changes so that social
workers, although they do not have a monopoly of the role, are increasingly
at the forefront in the assessment of need, identification of risk, and the mo-
bilisation of formal and informal resources. This position, although unwel-
come for many who are resistant to the underlying change from helping
people to resource management and the assessment of eligibility, neverthe-
less, does have potential to place some social workers in a unique position
to facilitate the interprofessional team. While Postle (2001) argues that the
role of care manager often results in staff getting deskilled and placed in an
unclear position, we suggest that this presents also an opportunity in that
care managers often find themselves integral to interprofessional teams.
From this platform, social workers who are skilled in groupwork can poten-
tially facilitate the functioning of the interprofessional team and, in tandem,
improve the work it undertakes and, arguably, contribute to lessening the
risk of tragedies occurring in interprofessional contexts. In so doing, they
will also assist the profession to stand up for, indeed champion, its role in
systems where roles and tasks have become increasingly blurred and where
social work is not always valued or clear (MacDonald et al., 2008).
Combining the position of care manager with the groupwork skills and
tasks we have enunciated may assist social workers to find a more secure
role. Therefore, ensuring that social workers are skilled and trained in
group facilitation therefore assumes a renewed priority for social work edu-
cation. In fact, MacDonald et al. (2008) highlight the importance of consid-
ering anew the form that contemporary social work practice in adult care
should take and how the education of practitioners can support it.

Conclusion
We are well aware that the directions in which we are pointing are going to
pose, however subtly, serious challenges to the conventional structuring of
Page 14 of 17 Annie Pullen-Sansfacon and Dave Ward

interprofessional teamwork and to conventional wisdoms about authority

and the contributions and standing of the professions within it, in which
status and organisational imperatives currently dominate. In practice,
these have meant that medical practitioners, where present, take on leader-
ship roles and, in their absence, professions line up according to the pecking
order of the medical world. However, as argued in this paper, interprofes-
sional teams, no less than any other group, need facilitators and they must
be up to the job. Clearly, it cannot be assumed that this role can be taken by
the team member whose background has the highest status. Such a chal-
lenge to existing assumptions implies, at root, a reconfiguration of power
relationships, but it is grounded on recognition of particular and invaluable

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skills social workers can bring.

References
Abels, P. and Garvin, C. (2010) Standards for Social Work Practice with Groups, 2nd edn,
Alexandria, VA, Association for the Advancement of Social Work with Groups.
Anning, A. and Edwards, A. (1999) Promoting Childrens Learning from Birth to Five:
Developing the New Early Years Professional, Buckingham, UK, Open University
Press.
Barr, H. (2000) Interprofessional working, in M. Davies (ed.), The Blackwell Encyclo-
pedia of Social Work, Oxford, UK, Blackwell.
Barr, H., Helme, M. and DAvery, L. (2011) Developing Interprofessional Education in
Health and Social Care Courses in the United Kingdom: A Progress Report,
London, Health Sciences and Practice Subject Centre, Higher Education Academy.
Brandon, M., Bailey, S., Belderson, P., Gardner, R., Sidebotham, P., Dodsworth, J.,
Warren, C. and Black, J. (2009) Understanding Serious Case Reviews and Their
Impact: A Biennial Analysis of Serious Case Reviews 2005 07, Norwich, UK, Univer-
sity of East Anglia.
Brown, A. (1989) Groupwork with a difference: The group mosaic in residential and
day care settings, in O. Helland, A. Kaansa and K. Leiksett (eds), Together, Oslo,
Norway, Diakonhjemmets Sosialhogskole.
Brown, J., Lewis, L., Ellis, K., Stewart, M., Freeman, T. and Kasperski, M. (2011) Con-
flict on interprofessional primary health care teams: Can it be resolved?, Journal of
Interprofessional Care, 25(1), pp. 4 10.
Butler, S. and Wintram, C. (1991) Feminist Groupwork, London, Sage.
CAIPE (2007) Creating an Interprofessional Workforce: An Education and Training
Framework for Health and Social Care in England, London, Department of Health.
Cheminais, R. (2009) Effective Multi-Agency Partnerships, London, Sage.
Clement, D., Dault, M. and Priest, A. (2007) Effective teamwork in healthcare: Re-
search and reality, Healthcare Papers, 7(Sp), pp. 26 34.
Coulshed, V. (1991) Social Work Practice, 2nd edn, London, Macmillan.
DAmour, D., Ferrada-Videla, M., Rodriguez, L. and Beaulieu, M.-D. (2005) The con-
ceptual basis for interprofessional collaboration: Core concepts and theoretical fra-
meworks, Journal of Interprofessional Care, 19(Suppl. 1), pp. 116 31.
 Interprofessional Work and Groupwork Page 15 of 17

Davis, L. and Wacker, G. (1987) Job design, in G. Salvendy (ed.), Handbook of Human
Factors, New York, Wiley.
Department for Children, Schools and Families (2010) Working Together to Safeguard
Children: A Guide to Inter-Agency Working to Safeguard and Promote the Welfare
of Children, London, Department for Children, Schools and Families.
Department of Health (1991) Care Management and Assessment: Summary of Practice
Guidance, London, HMSO.
Doel, M. (2006) Using Groupwork, Abingdon, UK, Routledge.
Douglas, T. (1983) Groups: Understanding People Gathered Together, London,
Tavistock.
Eva, K. (2002) Teamwork during education: The whole is not always greater than the
sum of the parts, Medical Education, 36 pp. 314 16.

Downloaded from http://bjsw.oxfordjournals.org/ at Universite de Montreal on June 26, 2014

Faulkner, D. (1995) The Criminal Justice Act 1991: Policy, legislation and practice, in
D. Ward and M. Lacey (eds), Probation: Working for Justice, London, Whiting and
Birch.
Fitzpatrick, M. (2010) Dont subject the NHS to the claptrap of business positivity,
Community Care, 4/2/10, p. 31.
Freeth, D., Hammick, M., Reeves, S., Barr, H. and Koppe, I. (2005) Effective Interprofes-
sional Education: Development, Delivery, and Evaluation, Oxford, UK, Blackwell.
Glasby, J. and Dickinson, H. (2008) Partnership Working in Health and Social Care,
Bristol, UK, Policy Press.
Gratton, L. (2007) Hot Spots: Why Some Companies Buzz with Energy and Innovation
and Others Dont, Harlow, UK, Pearson Education.
Gray, I., Parker, J. and Timmins, T. (2008) Leading communities of practice in social
work: Groupwork or management?, Groupwork, 18(2), pp. 26 40.
Gulliver, P., Towell, D. and Peck, E. (2003) Staff morale in the merger of mental health
and social care organizations in England, Journal of Psychiatric and Mental Health
Nursing, 10(1), pp. 101 7.
Guzzo, R. and Dickson, M. (1996) Teams in organisations: Recent research on perform-
ance and effectiveness, Annual Review of Psychology, 47, pp. 307 38.
Treasury, HM. (2003) Every Child Matters, Cm 5680, London, HMSO.
Hudson, B. (2002) Interprofessionality in health and social care: The Achilles heal of
partnership?, Journal of Interprofessional Care, 16, pp. 7 17.
International Federation of Social Workers (IFSW) (2000) Definition of Social Work,
available online at www.ifsw.org/p38000279.html.
Jelphs, K. and Dickinson, H. (2008) Working in Teams, Bristol, UK, Policy Press.
Kane, R. (1975) The interprofessional team as a small group, Social Work in Health
Care, 1(1), pp. 19 32.
Kezsbom, D. (1990) Are you ready to build a project team?, Industrial Engineering,
22(10), pp. 50 5.
Kurland, R. and Salmon, R. (1993) Group work vs. casework in a group, Groupwork,
6(1), pp. 5 16.
Laming, Lord H. (2003) The Victoria Climbie Inquiry, London, HMSO.
Levi, D. (2011) Group Dynamics for Teams, Thousand Oaks, CA, Sage.
Lindsay, T. and Orton, S. (2008) Groupwork Practice in Social Work, Exeter, UK, Learn-
ing Matters.
Lymbery, M. (2001) Social work at the crossroads, British Journal of Social Work, 31(3),
pp. 369 84.
Page 16 of 17 Annie Pullen-Sansfacon and Dave Ward

MacDonald, A., Postle, K. and Dawson, C. (2008) Barriers to retaining and using pro-
fessional knowledge in local authority social work practice with adults in the UK,
British Journal of Social Work, 38(7), pp. 1370 87.
McGrath, M. (1991) Multidisciplinary Teamwork, Aldershot, UK, Avebury.
Ministe`re de la sante et des services sociaux (2010) Plan Strategique 2010 2015, Quebec,
Canada, Gouvernement du Quebec.
Mullender, A. and Ward, D. (1991) Self-Directed Groupwork: Users Take Action for
Empowerment, London, Whiting and Birch.
Mullender, A., Fleming, J. and Ward, D. (Forthcoming) Self-Directed Groupwork
Revisited, Basingstoke, Palgrave-Macmillan.
OLeary, P., Tsui, M. S. and Ruch, G. (2012) The boundaries of the social work relation-
ship revisited: Towards a connected, inclusive and dynamic conceptualisation, British

Downloaded from http://bjsw.oxfordjournals.org/ at Universite de Montreal on June 26, 2014

Journal of Social Work Advance Access published January 10, 2012, 10.1093/bjsw/
bcr181.
OReilly, D. (2011) The grit in the oyster: Professionalism, managerialism and leaderism
as discourses of UK public services modernization, Organization Studies, 32(8),
pp. 1079 101.
Parsloe, P. (1981) Social Services Area Teams, London, Allen and Unwin.
Parton, N. (2004) From Maria Colwell to Victoria Climbie: A generation of public
enquiries into child abuse, Child Abuse Review, 13(2), pp. 80 94.
Peck, E., Gulliver, P. and Towell, D. (2002) Modernising Partnerships: Evaluation of
Somersets Innovations in the Commissioning and Organization of Mental Health Ser-
vicesFinal Report, London, Institute for Applied Health and Social Policy, Kings
College London.
Pittam, G., Secker, J. and Ford, F. (2010) The role of interprofessional working in the
Pathways to Work Condition Management Programmes, Journal of Interprofessional
Care, 24(6), pp. 699 709.
Postle, K. (2001) The social work side is disappearing: I guess it started with us being
called care managers, Practice, 13(1), pp. 13 26.
Preston-Shoot, M. (2007) Effective Groupwork, Basingstoke, UK, Palgrave Macmillan.
Pullen Sansfacon, A. (2011) Ethics and conduct in self-directed groupwork: Some
lessons for the development of a more ethical social work practice, Ethics and
Social Welfare, 5(4), pp. 361 79.
Pullen Sansfacon, A., Roy, V. and Ward, D. (forthcoming) One method, two worlds: An
exploration of groupwork practices in two cultures in North America, Groupwork.
Robotham, D. (2008) From groups to teams to virtual teams, Groupwork, 18(2),
pp. 41 57.
Robson, M. and Kitchen, M. (2007) Exploring physiotherapy students experiences of
interprofessional collaboration in the clinical setting: A critical incident study,
Journal of Interprofessional Care, 21(1), pp. 95 109.
SCIE (2004) Learning Organisations: A Self Assessment Resource Pack, London, Social
Care Institute for Excellence.
Seden, J. (2007) Editorial, British Journal of Social Work, 37(1), pp. 1 4.
Sennett, R. (2006) The Culture of New Capitalism, New Haven, CT, Yale University
Press.
Sennett, R. (1970/2008) The Uses of Disorder: Personal Identity and City Life,
New Haven, CT, Yale University Press.
Sennett, R. (2011a) A Creditable Left, The Nation, August 1st-8th, available online at
http://www.thenation.com/article/162011/creditable-left.
 Interprofessional Work and Groupwork Page 17 of 17

Sennett, R. (2011b) Together: The Rituals, Pleasures and Politics of Cooperation,

New Haven, CT, Yale University Press.
Simon, C. and Stauber, K. (2011) Technology and groupwork: A mandate and an oppor-
tunity, Groupwork, 21(3), pp. 7 21.
Stanley, N. and Manthorpe, J. (2001) Reading mental health inquiries: Messages for
social work, Journal of Social Work, 1(1), pp. 77 99.
Stevens, M. and Campion, M. (1994) The knowledge, skill, and ability requirements for
teamwork: Implications for human resource management, Journal of Management,
20(2), pp. 503 30.
TOPSS England (2002) National Occupational Standards for Social Work, Leeds, UK,
TOPSS.
Toseland, W. and Rivas, F. (2005) An Introduction to Group Work Practice, 5th edn,

Downloaded from http://bjsw.oxfordjournals.org/ at Universite de Montreal on June 26, 2014

Montreal, Canada, Pearson/Allyn and Bacon.
Toynbee, P. (2010) The NHS may not survive this volcano of ideology, The Guardian,
6 July, available online at www.guardian.co.uk/commentisfree/2010/jul/06/nhs-survive-
lansley-volcano-ideology?INTCMP=SRCH.
Trevithick, P. (2005) The knowledge base of groupwork and its importance within social
work, Groupwork, 15(2), pp. 80 107.
Trevithick, P. (2010) Editorial, Groupwork, 20(1), pp. 3 8.
Turcotte, D. and Lindsay, J. (2008) Lintervention sociale aupre`s des groupes, 2nd edn,
Quebec, Canada, Presse de lUniversite du Quebec.
Ward, D. (2009) Groupwork, in Adams, R., Dominelli, L. and Payne, M. (eds), Critical
Practice in Social Work, 2nd edn, London, Palgrave, pp. 115 24.
Ward, P. (2012, in press) Working together in dentistry: Key issues and challenges, in
B. Littlechild and R. Smith (eds), Inter-Professional and Inter-Agency Practice in
the Human Services: Learning to Work Together, Harlow, UK, Pearson Education.
Weller, J., Barrow, M. and Gasquoine, S. (2011) Interprofessional collaboration among
junior doctors and nurses in the hospital setting, Medical Education, 45(5), pp. 478
87.
Wenger, E. (2006) Communities of Practice: A Brief Introduction, available online at
www.ewenger.com/theory/index.htm.
West, M., Borrill, C. and Unsworth, K. (1998) Team effectiveness in organizations, in
Cooper, C. and Robertson, I. (eds), International Review of Industrial and Organiza-
tional Psychology, Vol. 13, Chichester, UK, Wiley.
White, S. (2006) Unsettling reflections: The reflexive practitioner as trickster in inter-
professional work, in White, S., Fook, J. and Gardner, F. (eds), Critical Reflection in
Health and Social Care, Maidenhead, UK, Open University Press.
Whittington, C. (2003) Learning for Collaborative Practice with Other Professions and
Agencies: A Study to Inform Development of the Degree in Social Work: Summary
Report, London, Department of Health.
Yalom, I. (1970) The Theory and Practice of Group Psychotherapy, New York, Basic
Books.