Dr. Robert Rossa

 

Overview
Working on a psychiatric ward demands high levels of situational elasticity to meet the variable presentations and needs of patients. Usually, each highly-qualified professional communicates within their own specialty-group in a solution-focused and clear manner. However, communication between professional groups can be far more difficult. Trad­itionalism and hierarchical mindsets often stand in the way of the key concept of multidisciplinary care. This can hinder the development of more construc­tive, comprehensive, “multi-perspective views,” that are essential for understanding complex sets of symptoms. It’s far too common for each professional group to focus more on setting boundaries than on overcoming existing communication pitfalls. This often results in tedious and damaging “trench warfare,” causing high rates of absenteeism and a huge drain on resources.
On the initiative of a senior physician, a renowned psychiatric hospital in the Hanover area invited all the members of staff from one ward to participate in two concept-days. The participants were physicians, psychotherapists, physiotherap­ists, occupational therapists, speech therapists, art therap­ists and sports therapists, as well as all care services and training staff. The main goal was to jointly develop a forward-looking treatment concept. In addition, interactions relating to group dynamics were to be carried out to foster the participants’ communicative readiness, to bolster the “we-feeling” and to overcome any reservations they may have.
The organization, planning, and selection of the appropriate tool began with two shadowing-days to provide insight into existing tasks, focal points of activ­ity, processes, and communication structures. Ess­ential information to create the staging and perform­ance of the learning project, possible interventions, and the evaluation. A particular chall­enge was faced by the general resistance of individual employees from different occupational groups and would be addressed in the final evaluation.

 

Topic
The focus of the CultuRallye learning project was to raise awareness of the mechanisms affecting interpersonal relationships and individuals themselves, the behavioral norms and roles of communication between the professional groups, and of the associated codes of conduct. In addition, the aim was to encourage “out of the box” thinking in each individual employee and the relevant profession­al groups. The shared goal was to be developed and firmly anchored.

 

Staging
a. Preparation
A separate workroom was prepared for each of the professional groups. When setting up the individ­ual rooms, we paid attention not only to the tables and chairs but also to typical tools of the trade: such as stethoscopes and medical journals for the physicians, or paints and brushes for the art therapists. The rooms were labeled to match the occupational groups, e.g. “ward” or “physiotherapy department.” The aim was to encourage identification with the task, roles, and language patterns specific to the occupational group.

 

Transfer to the real World

Elements in the learning project	Elements in the real world
Workrooms	Activation of role-related/professional communication
Chips	Performance in the context of work
Full beaker	Individual success vs. collective outcomes
Empty beaker	Indication of lack of integration into the overall process
Different rules	Represent the social norms, expectations, and identification typical of the profession
Symbol/number dice	Rules and standards/impact
Nonverbal	Represents both the hierarchy of communication and the power structure
Alternating participants	Changing requirements and changing workplace constellations; shift work

 

b. Performance
“Hello everyone. We are delighted to have you here today. Before we jump into the contents of what we have planned for you today, we would like to invite you to participate in your first learning project. Now that you have had a cup of coffee and a tasty sandwich to fortify yourselves, we are sure you are really curious to find out what’s in store for you. Please form groups according to your profession, then go and look for your designated workspace in the hallway. Once you have done that, you will receive more information about the upcoming task.”
The setting for the participants in all the work­rooms was that, at the end of their working day, they were to use the remaining time to share ideas and play a very popular game. “The rules are very simple. You only need two dice. You all also get some chips to play with so there is a winner at the end.”
After the acclimatization phase, the instruction sheets were taken away and the players were told that from now on they were not allowed to speak until the task was completed. At regular intervals of ten minutes, individual players would switch from one professional group to another according to diff­erent criteria. Only those who had not yet changed tables were allowed to switch.
After a total of 4 work phases, the individual professional groups were brought together again, but now in a room belonging to a different profession. Another three-minute lightning round was played before all participants gathered again to talk in the main group room.

 

c. Progression
The individual professional groups initially received the CultuRallye learning project with spontaneity and good humor. The participants demonstrated a high level of acceptance of the rules and appeared to really enjoy the game, particularly until the first changeover.
As the activity continued, the switching increas­ingly triggered emotional responses such as loss of enjoyment, defiance, anger, and refusal/rejection, which could not at first be resolved due to the ban on speaking and, at times, also due to a lack of motivation. The participants described the change­over as being difficult for them because they did not want to leave their own groups and did not feel welcome in the new professional groups. No one seemed to want to explain what were for them new rules, which ultimately led to internal resistance and refusal to cooperate. Only step by step, after each change, did this feeling somewhat improve, culminating in the lightning round at the end being perceived as fun.
When asked about the rules of the lightning round, it appeared that although six of the eight professional groups had returned to the initial lineup of their own professional groups, they did not play by the original rules, but by the rules that were played in that room.

 

Reflection
They were able to draw on the experience to work out the extent to which the behavior shown could also be transferred to everyday life on the ward, and thus to a multi-perspective, multi-professional view of the patients, the symptoms, and the opportunities for treatment. The participants developed proposals for solutions and communication processes that they could use in their professional lives to work together in a more unreserved and constructive manner. Through discussing specific situations they had all experienced, which had also been colored by different expectations, they were able to initiate a focused clarification process. They used the break following the learning project to intensively and enthusiastically share their experiences.

 

Conclusion
CultuRallye enabled the participants to draw on their own experience to truly understand that diff­erent professional groups can have different rules and standards, and that their personal ideas, expect­ations, and wishes do not necessarily correspond to those of their colleagues. This made it possible for them to work together as peers to develop possible solutions for their everyday working lives.