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HME 2301 TOPIC 2

TRANSACTIONAL ANALYSIS HUMAN RELATIONS IN HOSPITAL

INTRODUCTION
The study of human behavior is very complex and complicated concept. It is affected by the
psychological factors such as perception, learning, personality and motivation. One of the major
problems in the study of organizational behavior is to analyze and improve the interpersonal
relationships. One basic approach to study interpersonal relations in an organizational system is
transactional analysis. This analysis deals with understanding, predicting and controlling
interpersonal relationships.
WHAT IS TRANSACTIONAL ANALYSIS?
It was introduced by Eric Berne in the 1950s. Transactional analysis is a technique used to help
people better understands their own and other’s behavior, especially in interpersonal
relationships. It is a good method for understanding interpersonal behavior. It offers a model of
personality and the dynamics of self and its relationship to others that makes possible a clear
and meaningful discussion of behavior.
Transactional Analysis is primarily concerned with following:
1. ● Analysis of self-awareness
2. ● Analysis of ego states
3. ● Analysis of transactions
4. ● Analysis of life positions
5. ● Script Analysis
6. ● Game analysis
7. ● Stroking

1. ANALYSIS OF SELF-AWARENESS
It’s the core of personality pattern which provides integration. Self-awareness is an important
concept; it describes the self in terms of image, both conscious and unconscious. In JOHARI
WINDOW self-comprises of 4 parts. The OPEN/BLIND (known to others and also self)
(unknown to self but known to others) HIDDEN /UNKNOWN (known to self but unknown to
others) (unknown to self and unknown to others)
2. ANALYSIS OF EGO STATES
The ego plays an important role in human behavior. People interact with each other in terms of
psychological positions or behavioral patterns known as ego states. Ego states are person’s way
of thinking, feeling and behaving at any time. There are 3 important ego states. The Child, Adult
and Parent.
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THE EGO STATES: PARENT, ADULT and CHILD

Personality
1. Parent Ego State - The parent part is what every person inherits from his parents in
the form of commands, rules, do’s and don'ts. It is usually authoritative and
preservative.
2. Adult Ego State- The adult ego state is authentic, direct, reality based, fact seeking
and problem solving. They assume that human beings as equal, worthy and
responsible. The process of adult ego state formation goes through one’s own
experiences and continuously updating attitudes left over from childhood. People
with adult ego state, gather relevant information, carefully analyses it, generate
alternatives and make logical choices.
3. Child Ego State -The child part consists of the emotions, feelings and perceptions
of people experience in their childhood as a result of parental and peer
control. And usually emotional and creative and vulnerable to parental controls and
in memory.

3. ANALYSIS OF TRANSACTIONS
A transaction is a basic unit of social interaction. Where a verbal or nonverbal stimulus
from one person is being responded by another person a transaction occurs. Transactional
analysis can help us to determine which ego state is most heavily influencing our behavior
and the behavior of the other people with whom we interact.

There may be three types of transactions:

1. Complementary transaction: Both people are operating from the same ego state. There
can be nine complementary transactions. They are given below:  Adult-Adult
transactions  Adult-Parent transactions  Adult-Child transactions  Parent-Parent
transactions  Parent-Adult transactions  Parent-Child transactions  Child-Parent
transactions  Child-Adult transactions  Child-Child transactions
2. Crossed transaction: A crossed transaction is one in which the sender sends message a
behavior on the basis of his ego state, but this message is reacted to by an unexpected
ego state on the part of the receiver.
3. Ulterior transaction: two ego states within the same person but one disguises the other
one.

4. SCRIPT ANALYSIS
A script is the text of play or TV programmed. In transactional analysis a person’s life is
compared to a play and the script is the text of the play. According to Eric Berne, a script is
an ongoing programmed, developed in early childhood under parental influence which
directs the individual behavior in the most important aspects of his life. A script is a
complete plan of living, offering prescriptions, permissions and structure.
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5. ANALYSIS OF LIFE POSITIONS

In the process of growing up people make basic assumptions about their own self-worth as
well as about the worth of significant people in their environment. The combination of
assumptions about self and the other person called as life position. Transactional analysis
constructs the following classifications of the four possible life positions or psychological
positions: • I am OK, you are OK. • I am OK, you are not OK. • I am not OK, you are OK. • I
am not OK, you are not OK
1. I am OK, you are OK - It appears to be an ideal life position. People with this type
of life position have confidence in themselves as well as trust and confidence in
others.
2. I am OK, you are not OK -This is a distrustful psychological position. This is the
attitude of those people, who think that whatever they do is correct.
3. I am not OK, you are OK -This is a common position for those people who feel
powerless when they compare themselves to others.
4. I am not OK, you are not OK -People in this position tend to feel bad about
themselves and see the whole world as miserable. They do not trust others and have
no confidence in themselves.

6. STROKING
Stroking is an important aspect of the transactional analysis. The term stroke refers to
“giving some kind of recognition to others. People need strokes for their sense of survival
and wellbeing on the job. Lack of stroking can have negative consequences both on
physiological and psychological wellbeing of a person.
There are types of strokes:

a) ✔ Positive Stroke: the stroke one feels good. Recognition, approval are
some of the examples.
b) ✔ Negative Stroke: a stroke one feels bad or not good. Negative stroke can
hurt physically or psychologically.

7. GAME ANALYSIS
When people fail to get enough strokes at work they try a variety of things. One of the most
important things is that they play psychological games.
Types of games:
a) A first-degree game is one which is socially acceptable in the agent’s circle.
b) A second-degree game is one which more intimate end up with bad feelings.
c) A third-degree game is one which usually involve physical injury.
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BENEFITS OF TRANSACATIONAL ANALYSIS

• Improved interpersonal communication.
• Source of positive energy.
• Understanding ego state.
• Motivation.
• Organizational development

TOPIC 2 B

IMPORTANCE OF TEAM WORK

INTRODUCTION
An effective teamwork is now globally recognized as an essential tool for constructing a more
effective and patient-centred health care delivery system. Identifying best practices through
rigorous research, which can provide data on optimal processes for team-based care, is subject
to identification of the core elements of this system. Once the underlying principles and core
values are agreed and shared, researchers will be able to more easily compare team-based care
models and commissioners will be able to promote effective practices [1]. Therefore, a number
of designated health professional bodies worldwide have come out with recent statements to
define teams and their roles and the characteristics of a successful team [1-4]. They elaborated
on essential values and principles of a team based health care, to share a common ground on
this very hot topic. These have all been highlighted in this article. The potential challenges, and
practical tips on how to successfully approach the task, have also been explored and included
alongside proposed implementation strategies.

DEFINITIONS AND IMPORTANCE

The nature of a team is varied and complex. Though many patients may think that the most
effective team is the multidisciplinary team, however, teams may be drawn from a single
professional group.
Definitions:
A team can be defined as a distinguishable set of two or more people who interact
dynamically, interdependently and adaptively towards a common and valued
goal/objective/mission, who have been assigned specific roles or functions to perform and
who have a limited lifespan of membership [2].
Team-based health care is the provision of health services to individuals, families, and/or
their communities by at least two health providers who work collaboratively with patients and
their caregivers—to the extent preferred by each patient - to accomplish shared goals within
and across settings to achieve coordinated, high-quality care [5]. The incorporation of sharing
responsibilities with accountability between team members in health care systems offers great
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benefit. However, in practice, shared responsibility without high-quality teamwork can result
in immediate risks for patients. For example, poor communication between health-care
professionals, patients and their caregivers, has emerged as a common reason for
patients taking legal action against health-care providers [2]. Medical errors, ―near misses‖
and other adverse events may also occur due to inadequacy of communication among team
members even in a well coherent team [6-10]. Moreover, lack of purposeful team care can
also lead to unnecessary waste [11]. Therefore, identification of best practices may help
avoiding some of these dangers, and may help to control costs [12,13].
An effective team is a one where the team members, including the patients, communicate with
each other, as well as merging their observations, expertise and decision-making
responsibilities to optimize patients’ care [2]. Understanding the culture of the workplace and
its impact on team dynamics and functioning will make a team member a good team player.

IMPORTANCE:
Nowadays, patients are rarely looked after by just one health professional. In the context of a
complex health- care system, an effective teamwork is essential for patient safety as it
minimizes adverse events caused by miscommunication with others caring for the patient, and
misunderstandings of roles and responsibilities [2]. Patients are undoubtedly interested in their
own care and must be part of the communication process too; their early and throughout
involvement has been also shown to minimise errors and potential adverse events [2].

The Development and Characteristics of a Successful Health Care Team

Different types of teams can be identified in healthcare systems:

1. Core teams:
These are directly involved in caring for the patient.
They usually consist of team leaders and members who are direct-care providers such as
nurses, dentists, pharmacists, doctors, assistants...etc. They also include case managers.
2. Coordinating teams:
The group responsible for operational management, coordinating functions and resource
management for core teams.
3. Contingency teams:
Formed to deal with emergencies or specific events (e.g. cardiac-arrest teams,
disaster-response teams, .etc).
4. Ancillary teams/services:
The group supports services that facilitate patient care such as cleaners or domestic staff.
5. Support services and administration:
Those who provide indirect, task-specific services in a health-care facility support services. It
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includes secretaries and the executive leadership of a unit or facility. This team has 24-hour
accountability for the overall functioning of the organization.
In order for any team to form and develop in a way that makes it coherent, effective and
strong enough to face future challenges, research have shown that it usually passes through
the following stages [2]:
1. Forming: Typically characterized by ambiguity and confusion. Team members
may be unclear about tasks at this stage. They have not yet chosen to work together
and may communicate in a superficial and impersonal manner.
2. Storming: A difficult stage when there may be conflict between team members
and some rebellion against the assigned tasks. Team members may get frustrated here
when do not progress well in the tasks.
3. Norming: Open communication between team members is established and the team
starts to confront
the task at hand. Generally accepted procedures and communication patterns are
established.
4. Performing: The team focuses all of its attention on achieving the goals. The
team is now close and supportive, open and trusting, resourceful and effective.
After being formed and continue to develop, Health- care teams interact dynamically and have
the common goal of delivering health services to patients. In order to succeed, the team
members need to share certain characteristics, which include [2]:

1. Possess specialized knowledge and skills and often function under high-workload
conditions.
2. Know their role and the roles of others in the team(s) and interact with one
another to achieve a common goal.
3. Act as a collective unit, as a result of the interdependency of the tasks
performed by team members.
4. Possess specialized and complementary knowledge and skills.
5. Take decisions.

VALUES, PRINCIPLES AND BENEFITS

The values needed in an effective team member harmonize with the core competency domain
of ―Values/Ethics‖ put forward in the meeting sponsored by Inter-professional Education
Collaborative (IPEC) entitled ―Team-Based Competencies”. The following are five personal
values that characterize the most effective members of high-functioning teams in health care
[1]:
1. Honesty: A high value is put on effective communication within the team, including
transparency about aims, decisions, uncertainty, and mistakes. Honesty is critical
to continuous development and for maintaining the mutual trust, which is
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prerequisite for a high-functioning team.

2. Discipline: Team members carry out their roles and responsibilities with discipline,
even when it seems inconvenient. Such discipline allows teams to develop and stick to
their standards and protocols even as they seek ways to improve.
3. Creativity: Team members are excited and motivated to tackle emerging problems
creatively. They see even errors and some unanticipated bad outcomes as potential
opportunities for improvement.
4. Humility: Team members do not believe that one type of training or perspective is
uniformly superior to the training of others, though they recognize differences in
training. They also recognize that they are human and will make mistakes. Hence, a
key value of working in a team is that fellow team members can rely on each other to
help recognize and avert failures, regardless of where they are in the hierarchy.
5. Curiosity: Team members are dedicated to reflecting upon the lessons they learned in
their daily activities and using this reflective experience in continuous professional
development and the functioning of the team.

Principles of Team-Based Health Care:

There are many models to describe effective teamwork. Historically, these have come from
other industries, such as the aviation’s crew resource management (CRM) [2]. The principles
that characterize a successful team based health care include [1]:
1. Shared goals: The team, including the patient and, where appropriate, family
members or other support persons, generate a common and clearly defined purpose
that includes collective interests and demonstrates shared ownership.
2. Clear roles: There are clear expectations for each team member’s
functions, responsibilities, and a c c o u n t a b i l i t i e s , w h i c h o p t i m i z e t h e
t e a m ’ s efficiency and often make it possible for the team to take advantage of
division of labour, thereby accomplishing more than the sum of its parts.
3. Mutual trust and respect: Team members earn each other’s trust, creating strong
norms of reciprocity and greater opportunities for shared achievement. They respect and
appreciate the role of each other. They also respect each other’s talents and beliefs, in
addition to their professional contributions. Effective teams also accept and encourage a
diversity of opinions among members.
4. Effective communication: This is crucial for the teamwork success. The team
prioritizes and continuously refines its communication skills. It has consistent and
accessible channels for complete communication, and used by all team members across
5. Measurable processes and outcomes: Reliable and timely feedback on successes and
failures should be agreed and implemented by the team. These are used to track and
improve performance immediately and put strategies for the future.
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6. Leadership: Effective team leaders facilitate, coach and coordinate the activities of
other team members. Effective leadership is a key characteristic of an effective team.

CHALLENGES TO EFFECTIVE TEAMWORK

Several barriers exist to establishing and maintaining effective teamwork in health care [2]:
1. Changing roles:
In many health-care teams, there is considerable change and overlap in the roles played by
different health-care professionals. These changing roles can present challenges to
teams, in terms of acknowledgement and role allocation.
2. Changing settings:
Some changes in the nature of health care such as increased delivery of care for chronic
conditions require the development of new teams and the modification of existing teams.
3. Health-care hierarchies:
The strongly hierarchical structure of health care can be counterproductive to well-functioning
and effective teams where all members’ views are considered.
4. Individualistic nature of health care:
Many health-care professions, such as nursing, dentistry and medicine, are based on the
autonomous one-to-one relationship between the health care provider and patient. While this
relationship remains a core value, it is challenged by many concepts of teamwork and shared
care.
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5. Instability of teams:
Some health-care teams are transitory in nature, coming together for a specific task or
event (e.g. Trauma team).
6. Failing teamwork leads to accidents:
Reviews of high-profile incidents have identified three main types of teamwork failings,
namely, unclear definition of roles, lack of explicit coordination and other
miscommunication.
7. Resolving disagreement and conflict:
The ability to resolve conflict or disagreement in the team is crucial to successful teamwork.
This can be especially challenging for junior members of the team or in teams that are highly
hierarchical in nature.

PRACTICAL TIPS
How to apply teamwork principles?
Here are some tips to help health care teams to head towards successful achievements, which
include:
A. A life example of a strategic plan.
B. Practical tips for health care team members.
C. Monitoring progress through patients’ satisfaction.
Practical tips for health-care professionals [2]:

1. Always introduce yourself to the team

2. Clarify your role
3. Use objective (not subjective) language
4. Learn and use people’s names
5. Be assertive when required
6. Read back/close the communication loop
7. State the obvious to avoid assumptions
8. Ask questions, check and clarify
9. Delegate tasks to specific people, not to the air
10. If something doesn’t make sense, find out the other person’s perspective
11. Always do a team briefing before starting a team activity and a debrief afterwards
12. When in conflict, concentrate on ―what‖ is right for the patient, not ―who‖ is
right/wrong?
13. And remember: ―Teamwork doesn’t just happen‖. It requires [2]:
- An understanding of the characteristics of successful teams
- Knowledge of how teams function and of ways to maintain effective teams.
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Patient satisfaction:
A sensitive indicator for a successful health delivered teamwork is Patient satisfaction, which
requires: C.P.R.
C: Compassionate Communication

P: Patient information/Pain management

R: Response

For a high patient satisfaction, the delivery of the following is critical [4]:
1. Communicate to the patient who you are, what you do and who are the members of
the team.
2. Inform the patient daily what their plan is for the day and set expectations – write
on the whiteboard so they can see it and revise as they need.
3. Inform the patient and family if they have any questions, concerns to call - you are
there to help.
4. Encourage the patient to communicate how they are doing in managing their
pain – their comfort is vital!
5. Include the patient - tell them what you are doing in the room, even the simple
things like adjusting IV’s or taking a vital sign. The more you communicate about
what you are doing, the more comfortable they will be with asking questions.
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REFERENCES
1. Mitchell P, Wynia M, Golden R, McNellis B, Okun S, Webb CE, et al. Core Principles
and Values of Effective Team- Based Health Care. Discussion Paper. Washington, DC:
Institute of Medicine; 2012.
2. Anderson, J. E., Ross, A. J., Lim, R., Kodate, N., Thompson, K., Jensen, H., &
Cooney, K. (2019). Nursing teamwork in the care of older people: A mixed methods
study. Applied Ergonomics, 80, 119-129.
https://doi.org/10.1016/j.apergo.2019.05.012
3. Brommelsiek, M., Graybill, T. L., & Gotham, H. J. (2019). Improving
communication, teamwork and situation awareness in nurse-led primary care
clinics of a rural healthcare system. Journal of Interprofessional Education &
Practice, https://doi.org/10.1016/j.xjep.2019.100268
4. Walker, F. A., Ball, M., Cleary, S., & Pisani, H. (2021). Transparent teamwork: The
practice of supervision and delegation within the multi-tiered nursing team. Nursing
Inquiry, https://doi.org/10.1111/nin.12413
2. World Health Organization. Being an effective team player. Available from:
URL:http://www.who.int/patientsafety/education/curriculum/who_mc_topic-4.pdf.
Accessed 2 Decemeber 2014.
3. Compassion in practice – nursing, midwifery and care staff – our vision and strategy, the
Chief Nursing Officer for England’s Conference. 4 December 2012. Available from:
http://www.england.nhs.uk/wp-content/uploads/2012/12/ compassion-in-practice.pdf .
Accessed 19 Aug 2013.
4. Frampton S, Guastello S, Brady C, et al. Patient centered care improvement guide. VII.A.
Communicating effectively with patients and families. Boston: Planetree, Inc. and Picker
institute 2008. pp 77-199. Available from:URL: http://www.patient-
centeredcare.org/chapters/chapter7a.pdf. Accessed 19 Aug 2013.
5. Naylor MD, Coburn KD, Kurtzman ET, Prvu Bettger JA, Buck H, Van Cleave J. et
al. Inter-professional team- based primary care for chronically ill adults: State of the
science. Unpublished white paper presented at the ABIM Foundation meeting to
Advance Team-Based Care for the Chronically Ill in Ambulatory Settings. Philadelphia,
PA; March 24-25, 2010.