STAFF DEVELOPMENT AND EDUCATION

In die lig van ontwikkelings in die gesondheidsdienste is dit noodsaaklik dat verpleegadministrateurs bekwame bestuurders moet wees. Die gebied van personeelbestuur is van fundamentele beiang en hiervan is personeelontwikkeling en -onderrig ’n belangrike onderdeel. Enkele gebiede van personeelontwikkeling wat op plaaslike vlak meer aandag behoort te kry, word toegelig met spesifieke verwysing na: — oriëntasie as grondslag vir sosialisering van die werknemer binne die organisasie; —personeelontwikkeling vir leierskap, wat onontbeerlik is aangesien die toekoms van die beroep van goeie leierskap afhanklik is; —organisatoriese ontwikkeling ter bevordering van die prosesse waardeur mense met mekaar kommunikeer en saamwerk; —tendense wat in die toekoms veranderinge sal meebring en die noodsaaklikheid daarvan dat opvoeders en bestuurders bewus moet wees van die behoefte aan vernuwing en toegerus moet wees om verandering te kan teweegbring.


INTRODUCTION
Nursing has been greatly influenced by developments within the health services in general.Factors effect ing these changes include increased scientific k n o w led g e, in cre ase d demand for quality health care, and the concept of the hospital being a social institution that provides ser vices to all community members.Because hospitals are becoming in creasingly complex, and because nursing is a key departm ent in any facility that aims to meet the health care needs of the population, it is essential that nursing administrative staff be competent managers.
Previously, nursing managers fo cused almost exclusively on the nursing care provided to patients.They were appointed to adminis trative positions because they had demonstrated a high level of clinical knowledge and skills.While these abilities are important in ensuring the provision of quality nursing care and the credibility and acceptance of the nursing manager by nursing and other hospital personnel, it is evident that the requirem ents of nurse managers today extend far beyond these boundaries.As the nurse moves into higher levels of m anagement, the actual exercise of clinical skills decreases while the demands for knowledge, attitudes and skills related to management principles greatly increase.Nurse administrators are responsible for the management of the nursing care of patients, the management of per sonnel and operational manage ment.
The author believes that the his torical trend in nursing adminis tration has been to focus on manag ing only some aspects of patient care while rarely identifying and fulfilling the roles related to person nel and operational management.This fact is evident in the dearth of South African literature on nursing management and the limited pro grammes available for the training of nurse administrators, which until the last decade have been exclus ively one year diploma courses.The commencement of graduate and p o st-g ra d u a te p ro g ram m es has been a most necessary development but recognition of the need for specialisation has still to gain accep tance both within and outside the profession.
Returning to the three areas of management m entioned, it is be lieved that the area of crucial significance is the management of personnel, for the quality of patient care is directly dependent upon those giving care.Similarly, staff are vital to the successful outcome of operational management.Be cause the writer is convinced of the fundamental importance of person nel administration to the hospital service, and particularly to nursing administration, a study into nursing personnel administration within a hospital was undertaken.Areas which were selected for particular study received attention according to their urgency or their significance in the effective utilisation of person nel resources and others.In this article an overview of staff de velopment and education, as an im portant aspect of nursing personnel administration, is presented.

WHAT IS STAFF DEVELOPMENT?
Staff development is a broad con cept which encompasses the identi fication of the educational needs of individuals, departm ents and the organisation and links these needs to available resources both within and outside the institution1.As such it includes orientation, in-service education, continuing education and m anagem ent/leadership de velopment.The final outcome of staff development should therefore be organisation development.
For nurses, staff development is a function of nursing administration.The quality of the nursing service, and the ability of the nursing per sonnel to provide an effective ser-vice are, in large measure, deter mined by the extent to which administration exercises this func tion both directly and indirectly.A great deal of the success in staff de velopment for any group depends upon the establishment of a climate conducive to education.The chief nursing administrator sets the stage by giving positive support to the staff development programme and those of her programme of nursing service coincide; by her recognition of the educational function as an in dispensable component of adminis tration and, by her personal com mitment to the continuing improve ment of her personnel.
To be effective, therefore, a pro gramme of staff development must support the goals and priorities of the respective organisation and de partm ents.Prior to formulating specific development and education proposals, cognisance must be taken of the current economic, poli tical and medical science trends2.
Although staff development is an integral part of administration, it requires centralised planning, co ordination and evaluation and is thus ideally placed within the per sonnel department, under the direc tion of the Chief Matron person nel3.Such a co-ordinated staff de velopment approach requires the mutual co-operation of the staff of both nursing service and the staff development department.In spite of the fact that the responsibility of staff d ev elo p m en t is centrally based, it is envisaged that unit and ward teaching programmes should, in general, be decentralised with the staff developm ent educator acting in an advisory capacity.
The centralisation of staff de velopment and education does not mean that nurse administrators can abdicate and delegate their respon sibility for coaching, counselling, teaching and staff development to the personnel department, for this is an integral part of their adminis trative function.
Staff development must be an identifiable component within the organisational structure, available in all departments and to all person nel and, therefore, be acqprded value and administrative support along with other components in the DESEM BER 1982 hospital.As such it should be allo cated a budget appropriate to the identified programme objectives, thus ensuring the necessary human and physical resources to achieve these objectives4.Because of the di verse nature of staff development and its potential as a powerful ad ministrative tool, it is necessary that the senior personnel are qualified at graduate level and are knowledge able in the areas of clinical nursing practice, the behavioural sciences (particularly organisational behav iour), adult education and adminis tration.It is somewhat idealistic to envisage all these attributes being vested in one individual and for this reason too it is recommended that staff development and education be cited within the personnel depart ment.Although discussion will be confined to nursing development and education, it in no way implies that the staff development and edu cation department will be unidisciplinary for it must appropriately serve the needs of the entire hospi tal staff.
In approaching this topic, an at tempt has been made to emphasise those aspects which have to date been to a greater or lesser extent neglected in the nursing literature in South Africa and in nursing prac tice, specifically within hospitals; and which are believed to be essen tial to effective practise both in the present and in the future.The dis cussion will, therefore, not be com prehensive nor will it include the varied methodologies which are available, but will instead focus on principles which are considered to be fundamentally important to staff development and, therefore, to education as well.For ease of dis cussion, staff development and edu cation will be considered in three sections: -orientation -leadership development -organisation development

ORIENTATION
What is it about the ways in which employees are recruited into and de veloped within hospital settings that make some new recruits feel compe tent and others helpless . . .some passive and others creative contribu tors to organisational success?5 CURATIONIS These questions are basic to the study of organisational socialisa tion, of which orientation is the in troductory phase.Very few answers exist and research into the ways in which nurses (trainees and profess ionals) are socialised into hospitals is certainly needed.
At the outset, therefore, it is im portant to place orientation in its context as part of a process which must be on-going in the form of continuing education, which in cludes organisational socialisation.The duration of the socialisation process is variable and amongst nurse trainees it can last up to four years6.
Shanks and Kennedy define ori entation as: the introduction o f the employee to his job and its require ments, to his fellow workers, and to the institution as a whole.It is the phase designed to stimulate the em ployee to identify himself with the organisation and its goals?7 If this definition is regarded as acceptable, then it comes as no surprise that Clarke quotes this prolonged period (viz.4 years) before nurses enter the stage of settled connection8.
Orientation starts prior to the commencement of work and is com pleted once the objectives of the specific orientation programme are achieved, which may or may not co incide with the end of the pro gramme.Completion of orientation does certainly not imply socialisa tion.
Feldman proposed that there are three distinct and successive stages of the socialisation process, each of which has its own set of activities9.The first stage, anticipatory social isation, encompasses all the learn ing which occurs before the recruit enters the organisation.This stage is a most important part of orienta tion and includes those activities in which the nurse is engaged in form ing expectations about her new position.It includes such aspects as: -interview/s; -brochures and information sheets giving adequate details of the or ganisation in general and the specific job in particular; -information booklets/brochures, etc. for living-in and up-country staff covering aspects of every day life (such as transport, post-age, banking, library, cultural and recreational facilities) as well as facilities provided within the residence and hospital.
The problem is seldom one of a surfeit of information; rather the re verse.The benefit of sufficient and appropriate information should not be underestim ated for it does much to allay fear and minimise insecur ity10.In addition, it gives to the po tential employee a basis for esta blishing an accurate picture of the or ganisation and, for student and pupil nurse, the educational pro gramme as well.It enables the pro fessional nurse to gauge the degree to which the organisation's re sources and her needs and skills are mutually satisfying, that is, the level of congruence.
The greater the level of realism and congruence the more likely it is that the individual will successfully progress through the two stages which follow.
The second stage is accommoda tion, and is that period in which the individual sees what the organisation is actually like and attempts to become a participating member of i t 1.
This involves learning new tasks, estab lish in g new in te r-p e rso n a l collegial relationships, clarifying their roles and evaluating their pro gress within the hospital.
The objectives for this period can, therefore, be classified into two m ajor categories: organis ational and personal.
W here a staff development and education departm ent exists, it is envisaged that a centralised orienta tion programme would be con ducted prior to a unit/departm ental programme.These two phases need to be carefully planned, imple mented and evaluated according to pre-determ ined objectives which are specific to the particular indi vidual or group.Feedback must be two-way if maximum value is to be achieved, both for the individual and for the organisation.This aspect is often absent in nursing ori entation programmes.
Although many hospitals con sider a fixed number of days or weeks as the orientation period, staff development personnel and nurse adm inistrators in general need constantly to be attuned to the 36 individual nurse.No two people adapt at the same rate, nor does one person make multiple and di verse changes in behaviour patterns concurrently.Thus, while a nurse may have apparently adapted pro fessionally she may well be lagging far behind in emotional or social ad justments.It is the difficult task of the nurse administrator to discern the individual nurse's threshold for change and accordingly to select one or two behaviours for alteration at any one time.
Such sensitivity is not born over night and chief nurse administrators need to set the example, and also ensure that their administrators at all levels are trained and nurtured, in order to develop such assessment skills.
An approach such as this, with regular informal communication, does much to speed up the adapt ation process, minimise strain and improve the standard of work and job satisfaction obtained12.
The third stage of socialisation, role management, is n o t conventionally part of orientation.In this stage the recruit has already come to some resolution of the problems in her own work group and now needs to mediate the con flicts between her group and other groups where these conflicts place demands on her13.Many nurses never reach this stage and, there fore, cannot become leaders.
If nursing administration wants to maximise the outcomes for indi viduals and for the hospital, then their efforts which commence with recruitm ent and selection, must continue not only through training and development of individuals, but also through helping nurses deal with work and home-related con flicts.The current trend of esta blishing posts for nurse counsellors is an encouraging sign in this regard.
Thus, although orientation as it is currently practised only forms a part of the socialisation process, it is important that nurse administrators continue to expand its level of effec tiveness, while at the same time planning, implementing and evalu ating methods for realising the com pletion of the socialisation process amongst all its members.This is made possible by continu ing education for all levels and cate CURATIONIS gories of nursing staff.Continuing education must, however, not be confined to facilitating socialisation but must be viewed within the per spective of staff and career de v e lo p m e n t, m an p o w er plan n in g and quality of patient care and therefore become an integral part of the life of the hospital and indeed of the health care services in ge neral.
The development and education personnel are considered invaluable in facilitating such a process.

Staff development for leader ship
The scope for and need of leader ship in nursing is broad.Leininger said: There is a critical shortage o f capable, well-prepared nursing lead ers and administrators.To deal with the complex and diversified pro blems o f education and service, the nursing profession needs politically and economically astute leaders who are good risk takers, fairly aggres sive, and adept in using a variety o f m anagem ent and interpersonal strategies14.
The future of the nursing profes sion is indeed dependent upon good leadership.
A t the outset it is im portant to state that leadership as a mode of social influence is not the same as authority, which is an attribute of a social position.Those who have authority by virtue of the positions they hold, may or may not also exert leadership.Leadership can be found at every level of an organis ation and involves an interpersonal relationship in which others comply because they want to do so and not because they have to do so.A uthor ity, on the other hand, involves the legitimated rights of a position which requires others to obey.
The nurse in a leadership position requires opportunities for leader ship development.All too often, nurses are promoted into the ranks of management as a reward and as a recognition of the nurse's technical skills.These nurses may be highly skilled and professionally com petent, but they may be unprepared theoretically and practically for management responsibilities.The pattern of promotion therefore fre quently involves the best sister be coming a senior sister, senior matron, principal matron and fi nally a chief matron.Throughout there appears to be a lack of ac knowledgement that each of these steps requires different leadership skills, which, if they are to be learnt necessitates concerted and directed efforts on the part of the individual, her superiors (including the staff development department) and indi rectly, her subordinates as well.
Leadership involves the ability to use different styles to meet chang ing situations; it is dynamic and thus does not, indeed cannot, result merely from the individual traits of leaders; it must also involve attri butes of the transactions between those who lead and those who follow.In other words, the leader is only one component in that complex phenomenon we call leadership15.
Inherent in the concept of leader ship is the premise that role making is a dynam ic and im aginative endeavour.In making this state ment it is assumed that flexibility exists in roles, and that this very flexibility may be utilised creatively and constructively by nurse leaders, particularly senior administrators.It is not an uncommon myth that many roles in nursing are fixed, and that such role fixing results in a re duction in uncertainty and insecu rity.On the contrary, it is suggested that perception of a role as being fixed actually will augment the un certainty that the administrator will experience in certain situations; es pecially if personnel in counter positions engage in the role making process.Furtherm ore, if the role is assumed to be fixed, the role behaviours used are often likely to be inappropriate, thus re ducing the value of their outcom e16.
The belief in a role being fixed is, in essence, a denial of the value of an individual's unique contribution.The existence of this situation in hospitals is evidenced in the excess multiplication of rules which accu mulate to the point of paralysing in novation and the slow progress to wards staff participation in adminis tration.
Basic to the concept of a flexible role for the nurse administrator is the assumption of a process of per sonal and professional change and DECEM BER 1982 this has relevance to training and development.
The King's Fund working party, in their report on the education and training of senior managers in the NHS, state that . . . . . .any training curriculum should be designed around manage ment activities, skills and problem areas and not around the availability o f particular teaching inputs -espe cially when these are undisciplinary . . .The academic inputs must be reassembled around managerial activities and problems11.
The training and development department within a large hospital is ideally placed to design learning experiences to suit individuals and their particular situations.The aim is not only to impart knowledge about organisational matters, im portant as this may be, but rather to enable individuals to gain know ledge and understanding of their own ability to take effective action within their environment.If ap praisal is used as a basis for confi dential counselling, then the train ing needs of respective individuals can readily be assessed, and the ap propriate development opportuni ties can be made available.The methods used may, however, be varied in accordance with the facili ties available -both within and outside the organisation.
It is beyond the scope of this dis cussion to deal with details of methodology and, therefore, atten tion will be focused on certain ob jectives for leadership development and the factors which enhance or detract from the effectivity of train ing courses.The latter is an aspect which has generally been neglected, to the detriment of the individual and the organisation.
In describing leadership, Merton says . .Leadership training may take any of several forms, but almost always implies the need for some change in the knowledge, attitudes, skill or performance of the trainee(s) and may also be used to change entire organisational units.For the trainee (whether a ward sister or a senior nurse administrator) the change is usually intended to improve her performance in her present posi tion, prepare her for the future re quirements of her position or, pre pare her to meet the requirements of promotion to a higher position.

. the overriding functions o f leadership can be instructively re duced to two. The first is the integra tive function providing fo r that socio-emotional support to members o f a group which stabilizes systems o f social relations between them. The second is the instrumental func tion providing fo r effective mobili zation and co-ordination o f activity to enlarge the amount and improve
This necessitates that leaders should discover the extent to which they still think as nurses rather than as managers, as perpetuating be haviours learned in early nursing may well have dysfunctional conse quences.It also requires that they should discover the wider aspects of their respective roles and learn how to take innovative action in order to create conditions which will be m o re s u p p o r t i v e , th o u g h n o t necessarily m ore protective, of those under their charge.This in evitably involves learning to cope with added responsibility and asso ciated anxiety.
Leaders must be agents of change and also changing agents19.In es sence, managing change means changing management from a ma nagement that is a victim o f change to a management that is an instrument o f change20.
Lippit classifies two main types of change: planned change and un planned change21.Nurses are taught how to act in times of unplanned change (disaster and danger) but little if any instruction is given on how to cope with planned change.This is essential if the objectives of the organisation, department or in dividual are to be fulfilled.Some times people find it hard to accept change because they do not do a very good job of accepting them selves as individuals.Carl Rogers said of himself . ..the curious para dox is that when I accept m yself as I am, then I change . .we cannot move away from what we are, until we thoroughly accept what we are.

Then change seems to come about almost unnoticed22.
A key role for development and training personnel is to create an environment which is supportive and in which the individual feels secure for only then will change at a personal level be possible and this is ultimately where all change must occur.
If the leadership role of the administrator consistently provides direction, support and opportuni ties for active participation in admi nistration, then an organisational climate will be established which makes the introduction of change a normal and expected event.
Ultimately the outcome will be a systematic programme o f change that brings with it higher levels o f nursing and hospital achievement through the contributions o f persons who, having the capacity to grow, are given the opportunity to grow23.
In such a supportive environment the anxieties associated with inno vative action can be significantly re duced, consequently enhancing the individual capacity for risk taking in interpersonal relationships.Lead ers need to learn how to check out, or even discover, their ability to engage in pragmatic, relationships with other authority figures to im prove the likelihood of a greater fulfilment of organisational objec tives as they perceive them.In so doing, it is necessary for them to learn to what extent they use organis ational systems and traditions as a protection against coming into too close contact with others, and in stead to learn how to form appro priate relationships in order that, by leaning on them , they can then use systems and procedures to shape, more effectively, their respective roles.
Leadership training, as a method of change, differs from o th er methods in that it relies on learning and attitude formation rather than power, as the m ajor path toward behaviour change and thus, it in volves a commitment on the part of the trainee.Once attained, it is likely to be sustained over a longer period of time and without the use of organisational controls.
In complex organisations, such as the hospital, the social influences that serve to constrain or support leadership training arise from the formal authority system, the exer cise of formal authority by the superiors of the trainee, and the trainees primary work group.Con flict between these influences and the attitudes or behaviour taught in leadership training account for many of the dysfunctional con sequences of training.
The formal authority system is usually expressed in the mechan isms by which this authority is allo cated (such as policies, procedures and position descriptions); and en forced (for example by control sys tems and performance appraisal).These organisational practices in fluence the effectiveness of the hos pital, group cohesion and affect trainee attitudes as well as the out come of leadership training24.
Trainees from highly centralised organisations (such as many hospi tals) who have become predisposed toward delegating authority, are likely to experience a conflict be tween their attitudes and the hospi tal's formal organisation.They may try to modify the prevailing system, but these attem pts imply discontent and may be interpreted as an ex pression of disloyalty or as a threat to the prevailing hierarchy.
When thus interpreted, negative sanctions may be applied to the trainees' superior.Superiors influ ence trainees through their exercise of formal authority and evidence has shown that subordinates tend to act as their superiors act, have atti tudes similar to those of their su periors and behave according to their perception of their superiors' desires25.The outcome of the train ing efforts are, therefore, signifi cantly affected by the superiors' re sponse.Although this may theoreti cally appear to be an over-simplifi cation, this is not entirely so in practice, for how often has one not seen young (or older) professionals w ho h a v e s h o w n e x c e p t io n a l promise and creativity in post-basic education programmes who have returned to their hospital and been engulfed by the system.
However, not all the blame can CURATIONIS be laid at the door of the superiors for the expectations of peers and immediate subordinates affect the trainees attitudes towards her train ing and her ability to transfer her new knowledge and skills to her work environment.W here these conflict with group norms or subor dinate expectations, the chance of success is lowered.
The three sources of social influ ence, viz. the formal authority system, the exercise of formal authority of superiors and the norms and expectations of the pri mary work group can be analysed into their m otivational and re inforcement effects and assessed from: -their congruence with the pre scriptions of the training, -the clarity of their relevance to trainee reward and punishment, and -their tendency to induce anxiety in the trainee.
The consequences of leadership training, therefore, depend on the degree to which the social influ ences in the trainee's work environ ment are viewed by the trainee as motivations to learn and the degree to which they reinforce the learned behaviour during and after training.
The social influences in the work environment which explain why lea dership training produces both functional and dysfunctional con sequences have profound implica tions for nurse educators.When training efforts are designed to meet the specific needs of a particu lar hospital and are administered within the hospital to a large pro portion of its leaders, then changes in group norm s and significant pressures to change the formal structural arrangements for admi nistering the division/unit are more likely to occur.This is not the case when one or two nurses are sent to other organisations, such as hospi tals o r universities for form al courses unless these courses are designed to take account of the trainee's specific situation.The im portance of the role of the de velopment and education depart ment in leadership training within a large hospital is thus evident.

ORGANISATION DE VELOPMENT
Burke defines organisation de velopment as: a planned process of cultural change.It involves change o f an organisation's culture from one which avoids or ignores an examination o f social processes in organisations, especially decision making, planning and communica tion to one which institutionalises and legitimises this examination . . .The culture o f an organisation is a set o f learned and shared assump tions about the norms which regulate member behaviour26.
If one accepts Burke's definition then it becomes imperative that, in any education programme the ap proach must be one which fully re cognises that an organisation evolves with a system o f management and a culture which complement each other, which fo r the members o f the organisation is both the natural order and the reference fo r action and controF1.
Organisation development tech niques, such as team building, role clarification, process consultation, education and management by ob jectives, should be linked to avail able organisational resources and then applied to help solve pro blems.These techniques must be learnt within the context of the specific unit/ward and the role of the nurse administrator (specifically responsible for development and education) in facilitating this is cru cial.If staff are to demonstrate these attitudes and skills they must first be evidenced in the individual nurse administrators and reflected in the organisation and policy making procedures throughout the hospital.Most organisation tech nology deals with improving the processes by which people relate to one another and work together, such as the design of jobs, the struc ture of reporting relationships, formal or informal communication patterns, and clarity of roles.
The purpose of organisation de velopment are growth of people, the fostering of an open problem solving work climate, the improve ment of methods of conflict resolu tion, and the development of more effective c o lla b o ra tio n am ong groups.

FUTURE TRENDS AFFECT ING STAFF DEVELOPMENT AND EDUCATION
Just as bureaucracy emerged as a creative response to a radically new age, so today new organisational shapes and forms are surfacing before our eyes.In fact, Bennis pre dicted in 1967 that: . . . in the next 25 to 50 years we will participate in the end o f bureaucracy as we know it and the rise o f new social systems better suited to 20th Century de mands . .28.
W hether one agrees with the de tails of Bennis's statement or not, one thing is certain, and that is that organisations are changing and will continue to change.The effect of this process on hospitals is already apparent and will become increas ingly evident.The development and education profession must thus design long-term programmes to meet the anticipated trends.
Throughout it is envisaged that there will be an increasing need to emphasise the professional manage ment of social systems for indeed a hospital has a definite social struc ture which is apparent at group, unit, department and organisation levels.One writer refers to the ge neral hospital as a self-contained social universe29.The concept of the hospital or any large organisation as a social system is not new, and yet despite this fact, Bennis writes . . .The reality of the dynamics of the training situation would suggest that there are, at the very mini mum, three parties to the process -the organisation which initiates the training, the course members and the trainers who conduct the program me31.A t present, postbasic education in nursing primarily occurs outside the organisation and, therefore, the educators are not members of the organisation.This is frequently the situation in basic courses as well.The result of the education process is largely deter mined by the extent to which the expectations and assumptions of all three parties concerning the curri culum content and outcomes are made known, for these are essential to the design of any course.The ac curate recognition and successful integration of these expectations, by the educator, is a difficult and complex process, but it is made easier if the educator is working in close contact with the sponsoring organisation/s or a division within it.In this situation, not only can she (he) more accurately determine the training needs and philosophy of the organisation, but she (he) can work within it to help to prepare a supportive climate.This will enable the members to make the transfer of learning back to the work situ ation more easily, and in effect help to remove some of the barriers and obstacles which can exist towards the introduction of any changes they wish to make.
It is apparent, therefore, that nurse educators will be required to increase their knowledge and skills concerning social systems (hospital, community, etc.A nother requirem ent for de velopment and education personnel is to enable staff to become com fortable in the presence of change and to work effectively within or g a n is a tio n s c h a r a c t e r i s e d by continuous change.A key to suc ceeding in this regard and indeed to organisational accomplishment in general, is effective face-to-face groups.Likert comments on the im portance of organisational work units or teams: Each o f us seeks to satisfy our desire fo r a sense o f per sonal worth and importance primar ily by the response we get from people we are close to, in whom we are interested, and whose approval and support we are eager to have.The face-to-face groups with whom we spend the bulk o f our time are, consequently, the most important to us.Our work group is one o f the most important o f our face-to-face groups and one from which we are particularly eager to derive a sense o f personal worth33.This statem ent is corroborated by studies in psychology, sociology and psychiatry and, as a profession, nurses would confirm their belief in the importance and centrality of team work in effective practice.Despite this fact the existence of real teams is the exception and the evidence of training in group dy namics at all professional levels is almost non-existent except within the discipline of psychiatry.
If an organisation, and a hospital in particular, is to make maximum use of its human resources and sa tisfy the highest level of m an's needs, it will come to function best in situations where the individual relates effectively to those organis ational groups of which she is a member and leader.This situation does not occur spontaneously and requires consistent effort and train ing at all levels throughout the or ganisation as well as administrative practices which are in accord with sm all g roup dynam ics.R ensis Likert writes in his New patterns o f management that management will make full use of the potential ca pacities of its human resources only when each person in an organis ation is a member of one or more effectively functioning work groups that have a high degree of group loyalty, effective skills of interac tion and high performance goals34.
The present system of staff rostering which is operative in most large, teaching hospitals and re quires substantial staff changes on a monthly basis mitigates against ef fective small group functioning and therefore retards staff development and also increases wastage levels.A key need in the hospitals of the future will be to utilise small groups effectively for some form o f team organisation promises to be the major innovation in dealing with complexity and change during the coming decades35.
Success starts with awareness36.If the nursing and hospital adminis trators are not aware of the need for renewal, it is foolish to think that the process will ever be achieved.In the future they may see: . . .stag nation and decay as the order o f the day unless they develop socio-technical structures and processes that engender resilience, renewal, and a fearlessness o f revision.This is not easy, but it is a necessary task37.
the quality o f task-performance.Both generic functions are o f course CURATIONIS essential to the operation o f social systems.But phases in a system vary, sometimes requiring more o f the first function, sometimes more o f the second. . .whether encompassed in the same people or allocated to dif ferent people, these functions are basic to the effective working o f social systems18.
) and the process of change.Educators can be key per sons in bringing about organis ational change and renewal, and, t h e r e f o r e , o r g a n i s a ti o n d e velopment must become part of the role of the educator.Conversely, . . .m anagem ent training p r o grams are so frequently found to be associated with periods o f orga nisation change as to suggest the exis tence o f a strong belief in the efficacy o f the training process in helping an organisation to adapt to change and pursue newly chosen directions32.