|ORIGINAL RESEARCH ARTICLE
|Year : 2016 | Volume
| Issue : 3 | Page : 179-185
Emotional intelligence: A unique group training in a hematology-oncology unit
Tamar Tadmor1, Niva Dolev2, Dina Attias1, Ayalla Reuven Lelong3, Amnon Rofe4
1 Bnai Zion Medical Center, Haematology Division; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
2 EI-el Company; Department of Interdisciplinary Studies, Kinneret Academic College, Tiberias, Israel
3 EI-el Company, Tiberias, Israel
4 The Ruth and Bruce Rappaport Faculty of Medicine, Technion; Bnai Zion Medical Center, Haifa, Israel
|Date of Web Publication||11-Apr-2017|
Bnai Zion Medical Center, Haematology Unit, 47, Golomb Street, Haifa 31048
Source of Support: None, Conflict of Interest: None
Background: Emotional intelligence (EI) is increasingly viewed as one of the important skills required for a successful career and personal life. Consequently, efforts have been made to improve personal and group performance in EI, mostly in commercial organizations. However, these programs have not been widely applied in the health field. The aim of this study is to assess the impact of a unique special EI interventional process within the framework of an active hematology-oncology unit in a general hospital. Methods: This investigation employed a pre- and post-training design using the Bar-On Emotional Quotient Inventory (EQ-i) measure of EI, both before and after completion of training 10 months later. The training included personal and group EI assessments and 10 EI workshops, each 2 weeks apart and each lasting approximately 2 h. Results were compared to a control group of medical staff who did not undergo any EI training program during the same time period. Results: Average total Bar-On EQ-i level at baseline for the group was 97.9, which increased significantly after the interventional process to a score of 105.6 (P = 0.001). There were also significant increases in all five main EQ-i scales, as well as for 12 of the 15 subscales. In contrast, the control group showed no significant differences in general EI level, in any of the five main scales or 15 EI subscale areas. Discussion: This pilot study demonstrated the capability of a group intervention to improve EI of medical staff working in a hematology-oncological unit. The results are encouraging and suggest that the model program could be successfully applied in a large-scale interventional program.
Keywords: Emotional intelligence, emotional quotient, hematology, oncology, success, 21st century
|How to cite this article:|
Tadmor T, Dolev N, Attias D, Lelong AR, Rofe A. Emotional intelligence: A unique group training in a hematology-oncology unit. Educ Health 2016;29:179-85
| Background|| |
Emotional intelligence (EI) can be defined as the capacity to reason about emotions and of emotions to enhance thinking. The introduction of the concept of EI resulted from the awareness that standard measures of general intelligence quotient (IQ) are unable to convincingly explain individual overall ability, performance, and success. Although the concept of social intelligence was presented in earlier reports by other researchers,,, it was Salovey and Mayer who first highlighted the relationship between emotion and cognition. They proposed that EI is composed of the ability to identify, understand, and manage our emotions as well as those of others. The concept won public recognition in 1995, after Goleman published his book, “Emotional Intelligence-Why it can matter more than IQ,” where he argued that noncognitive skills may be as important as IQ for success at work.
Bar-On  proposed that EI is “a cross section of interrelated emotional and social competencies, skills, and facilitators that determine how effectively we cope with daily demands.” He suggested that EI embraces five major areas: intrapersonal, interpersonal, stress management, adaptability, and general mood. Each of these areas contain a number of skills, up to a total of 15 skills [Table 1].
|Table 1: Bar-on emotional intelligence-inventory model that includes five major areas and 15 skills|
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From its onset, the concept of EI has been accompanied by attempts to generate valid assessment measures, aiming to estimate individual emotional skills.,,, One of the most widely used measures is the Bar-On Emotional Quotient Inventory (EQ-i), a self-report assessment tool which measures the set of skills included in the Bar-On model. It provides a reliable and valid measure of social and emotional competence and individual behavior, and it was reported by Pérez et al. to have an average alpha of 0.85. Studies using this tool have established the contribution of EI to different life and work areas, and in particular, to effectiveness and success at work, across different professions, medicine among them.
One of the main advantages of EI is that it can be intentionally developed at any age following individual or group intervention programs. In this respect, training processes designed to enhance EI have shown to increase EI levels and to result in enhanced personal, professional, and organizational effectiveness. However, while EI training is increasingly used in business organizations, it has been utilized far less in medical settings, and it is mostly restricted to the framework of medical or nursing schools. EI has not yet been integrated into daily practice of hospital work and development programs. Routine experience within an active medical hematology-oncology unit has not yet been reported.
The aim of this study was to assess the impact of an active interventional process attempting to improve the entire “Hematology-Oncology Unit EI” as well as the EI of individual team members, using a pre- and post-intervention assessment of EI levels of the training participants.
| Methods|| |
Sample and study design
The study was performed in the Hematology-Oncology Unit of a general hospital in Haifa, northern Israel. The team consisted of 16 individuals including six doctors, five nurses, four administration staff, and one social worker, all of whom voluntarily participated in the training program; all but one participated in the current program evaluation (one doctor was not interested in participating for personal reasons). Therefore, no participation bias was unlikely. The medical center's Helsinki Ethics Committee approved the study, and written informed consent was obtained from all participants.
The study used a pre- and post-training design, in which all participants completed the Bar-On EQ-i questionnaire at the initiation and the conclusion of the program 10 months later (intervention sample).
An additional 15 medical staff members from the same hospital who did not undergo any specific EI training activity completed the identical EI questionnaire (EQ-i) during the same time interval and served as a control group. The control group consisted of hospital staff members: ten doctors and five nurses. Both the training and control groups were similar in terms of age, number of working hours, and number of years spent working in this hospital. However, the control group included personnel with more average years of education (P = 0.05).
The training program was conducted with all team members and was led by an external team specializing in EI development. The training began by an introductory session in which the concept of EI, using the Bar-On framework, was presented, and the participants completed the EQ-i questionnaire. Thereafter, they met individually with an EI specialist for a feedback session where their personal EQ-i profile was presented, interpreted, and discussed. In addition to individual profiles, a team profile was also presented and explained to the entire team in a group session and its relevance and potential implications for the entire unit were discussed.
The training included ten EI workshops, each 2 weeks apart and each lasting for approximately 2 h. Attendance in the workshops was full, and the majority of the Hematology-Oncology staff participated in all sessions (one doctor had to miss one session for an emergency case). Workshops included topics such as the nature and definition of EI and its link to medical work; its general importance and possible impact on the quality of medical work and well-being of the entire medical staff; empathy, interpersonal relations and communication skills, stress management, emotional self-awareness and impulse control, positive feelings, and optimism. Some of these workshops were designed to meet the needs emerging from the team EI profile and the nature of the tasks involved at work in the Hematology-Oncological Unit. The training program was interactive and utilized a variety of methods such as presentations, group discussions and personal self-exploratory exercises, watching movies, case studies, and reading background material. As part of the training program, the participants identified a number of specific areas for improvement within the Hematology-Oncology Unit, created a work plan that illustrates the project schedule for the main elements of the program (Gantt Chart), and worked in groups to decide on what actions to adopt in order to execute these plans and on their actual execution [Figure 1].
|Figure 1: Process design: A multi-step analysis, intervention, and leading activity|
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The training program had a number of unique features: All team members participated in the same training sessions together, learning and discussing issues related to the unit together. Individual assessments allowed the participants to become aware of their own skills, and participants played an active role in the design and development of the training and leading consequent changes in the unit. The training was designed for the unique needs of the unit, and responsibility was then transferred before its completion to the unit, in order to keep the program ongoing and viable unaccompanied by EI experts. At the end of the training program, team members completed a second (posttraining) EQ-i assessment and thereafter participated in a second feedback session so as to explore their individual EI score shifts [Figure 1].
EI levels were evaluated using the Bar-On EQ-i scale, a self-report assessment tool which measures the set of skills included in the Bar-On model [Table 1]. The questionnaire includes 133 short questions and employs a 5-point Likert scale with textual response formats ranging from “not true” or “very seldom true of me” to “always or very often true of me” and takes approximately 20–40 min to complete. EQ-i raw data are then processed by the publisher (MHS) and automatically tabulated and converted into standard scores, using a mean of 100 and a standard deviation of 15. A score of 90–110 is regarded as an effective functioning skill, while a score of below 90 is regarded as too low and indicative of an area needing improvement. Scores of 110–120 are regarded as an enhanced skill, while values above 120 constitute an unusually high skill which may have a negative impact on functioning and also represent an area for possible improvement (MHS, 2006).
Differences between pre- and post-intervention EQ-i scores were evaluated by t-test. Differences were assessed for the department as a whole, as well as on an individual basis. Changes recorded in EQ-i scores were compared to control group scores using ANOVA, in order to analyze the differences between the means of the two groups. Statistical significance was defined as P< 0.05. Interviews were analyzed using a thematic content analysis following clearly defined and methodical procedures. Each interview transcript was analyzed and coded separately, using open coding. Cross-interview categories, or families, were then constructed and codes were again compared to ensure that items were properly sorted and coded.
| Results|| |
Of the 16 team members of the Hematology-Oncology Unit, all except one eventually participated in the evaluation study. The baseline EI scores of the cohort were recorded and compared to their post training scores. Pre, post and differences were compared to those of the control group. We summarize the results obtained with 15 members of the Hematology-Oncology team and 15 controls as follows.
Results of emotional intelligence profile at baseline in the Hematology-Oncology Unit
The average total EI score for the Hematology-Oncology Unit team, before starting the program, was 97.9 points (89.4–106.3 range). Average scores on the five major scales were as follows: intrapersonal, 97.9 (92.0–103.8); interpersonal, 101.6 (91.5–111.7); stress management, 98.3 (87.7–109.0); adaptability, 98.1 (88.5–107.7); and general mood, 98.3 (92.3–104.4). The results of the 15 EQ-i subscales [Figure 2] identified the specific areas of the team's strength as well as areas for possible improvement. The highest scores were reported for emotional self-awareness 102.3 (96.0–108.5), social responsibility 103 (92.6–113.4), stress tolerance 104.1 (96.2–111.9), and empathy 105.9 (93.6–118.1); the latter, having the highest score recorded. On the other hand, the group's lowest scores included impulse control 93.0 (78.7–107.3) and self-actualization 94.5 (84.6–104.4). Other results are also shown in [Figure 2].
|Figure 2: Comparison of hematology-oncology team scores in five major areas for the intervention cohort before and after the emotional intelligence interventional program|
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Choosing goals and building a working plan (Gantt)
Based on the established EQ-i team profile and workshops, the Hematology-Oncology Unit set for itself a goal of how to improve the team EI, identified areas to target for improvement, and set up a working Gantt Chart which included goals and timetables. Working teams were identified and invested time in the following areas: defining a vision and mission statement, improving the Hematology-Oncology Unit's efficiency, improving the team's well-being, and creating a unique value proposition for the Hematology-Oncology Unit [Table 2].
|Table 2: Ten steps involved in how to build a team emotional intelligence program|
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Differences of Emotional Quotient Inventory scores in the experiment cohort during the period of 2013–2014
The pre- and post-analysis revealed a significant improvement in general EI, scores for the five main areas, and all 15 EQ-i skills within the intervention group. First, we identified an improvement in the general EI profile for the Hematology-Oncology team overall. Average total EQ-i level at baseline was scored as 97.9, while after intervention, it was higher with a significant increase to 105.6 (P = 0.001) which is well above the average. Furthermore, all five main EQ-i scales also showed a significant improvement. Intrapersonal skills showed the greatest improvement increasing from 97.9 to 105.9 (P = 0.001), followed by interpersonal skills (101.6–106.9, P = 0.001), general mood (98.3–103.8; P = 0.008), adaptability (98.1–103.1; P = 0.009), and stress management (98.3–102.3; P = 0.089). In contrast to pretraining, in which only one of the main scales was slightly above average (101.6), at posttraining, all five main scales were higher than the average values which is 100 (105.9, 106.9, 103.8, 103.1, and 102.3). Intrapersonal skills were the lowest at pre = interventional stage and showed the greatest increase,. Significant positive shifts were also found in 12 of the 15 subscales as shown in [Figure 3]. The highest shifts were encountered in self-actualization (7.9), interpersonal relations (6.7), assertiveness (6.4), flexibility (6.1), and self-regard (5.9). Posttraining, 14 of 15 EI skills were above the average (in contrast to one at pretraining).
|Figure 3: Comparison of hematology-oncology team scores in 15 emotional intelligence skills for the intervention cohort before and after the emotional intelligence interventional program|
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Differences of emotional intelligence-inventory scores between the experimental group and the control cohort
As noted above, results of EQ-i test were compared at baseline and after a 10-month interval both in the control as well as the study groups. The significant shifts the experimental group was identify in total EI 5 main scales and 13 of the subscales [Figures 2 and 3], while the control group showed no statistical significant difference in any of the areas tested.
The participants were interviewed a few weeks after the completion of the training and were asked about the perceived impact of the training on the unit. The main themes that emerged were improved relationships within the team, improved teamwork and unit atmosphere, improved personal well-being, and work-related changes. The participants described greater tolerance, more consideration toward each other, expressed in being more patient with each other, better conflict resolution, being more attentive to other staff needs, and offering help more often. Many said that it contributed to a better capability to work as a team, to a feeling of togetherness, and enhanced unit pride: “It is more of a team now, rather than a group of professionals.” Nurses, in particular, described a greater feeling of inclusion and feeling more respected by the doctors: “Not everywhere doctors sit with nurses and aids and talk about their feelings, about life. It made us feel equal… and it carried on to the day-to-day work.” Another noted change was investment in team well-being, including a unit trip and other activities. On the more operational side, some participants described improvement in daily meeting order and better daily work planning which positively impacted patient care. Some improvements in routines were mentioned as “on the way” and were related to greater awareness and proactive thinking. On a personal level, the participants described varying levels of EI improvements, and in a wide array of skills, mainly in areas of personal challenges. Some of the participants reported improved well-being, resulting from enhanced awareness to emotions and personal strengths, and improved skills to overcome difficulties and enhance positive mood. Due to the short time since the end of the training, external measures of team performance were not yet available.
| Discussion|| |
This study describes a pioneer model of EI assessment and an interventional program in a Hematology-Oncology Unit of a busy hospital. We demonstrated that an active EI intervention improved EI skills of the entire unit, as well as of the participating individuals, resulting in improved work relationships and team atmosphere.
The first question that may come to mind for hematologists might be: “Why should I dedicate time and effort to improving my personal EI and my team's EI?”
During the past decade, hematology-oncology, like many other specialized units, is characterized by emerging new technologies, the entry of a new generation of trained workers who have different general views and personal characteristics than previous generations and the introduction of stricter regulations and accreditation procedures. Facing these challenges, medical teams undoubtedly need a wider set of skills which are critical for their continued success in the 21st century. These skills must include flexibility and the ability to adapt to changing environments, to maintain work efficiency under stress, to develop and maintain positive work relationships and personal well-being while providing professional service to patients, and at the same time to guide and lead others in a changing medical environment. Studies have shown that EI skills are indeed related to work effectiveness and well-being, including medical staff, and these skills have been discussed in our program.
It is also shown here that EI could be an important tool in medicine, particularly in the 21st century. EI has been shown to be associated with improved individual performance and positive outcomes at work, as well as to reduced occupational stress, enhanced interpersonal relations, higher quality leadership, and better team performance. It has also been applied widely in commercial organizations,,, and studies have shown that in contrast to IQ, it can be developed at individual, group, and even organization levels, thereby generating a model for team interventions.
EI has been shown to play an important role in the improved function and success of medical staff. Patient–doctor interactions constitute an important component of patient care and appear to be related to EI and to provide empathic care,,, teamwork, patient trust and satisfaction, and also with lower rates of malpractice claims. All the above issues have contributed to the integration of EI as one of the six competencies included in the Accreditation Council for Graduate Medical Education  in the USA and to its introduction as a program in nursing and medical schools.,,
It may be, in particular, an important set of skills for Hematology and Oncology staff, where we expect staff and patients to be under even greater emotional stress and to experience a wide range of emotions. Thus, while the pretraining scores were already in the effective zone, they were slightly below the average. In the light of the challenging and demanding reality of Hematology-Oncology staff, higher than the average EI skills are needed to overcome difficulties, maintain and enhance effectiveness, and maintain well-being and effectiveness. Thus, the shift to higher than the average total EI group score is of real-world importance.
Thus, the observations reported here provide further support for earlier investigations showing that EI can indeed be further developed through an interventional training program at work and can also be applied to a medical setting within hospitals, specifically a hematology-oncology unit. These findings demonstrate that there are positive shifts in competence, which are important given the demanding nature of work in hematology-oncology unit and the high intensity of emotions of patients, their families, and treating staff, who consistently need to show empathy and emotional control to collaborate and be a lifelong learner. Furthermore, our findings suggest that the specific training design utilized during this study may be well suitable for developing the EI of the entire hematology-oncology staff.
Advantage of the training
This training is a design which included the whole team working together and designing a training schedule which would cater for the treating unit's specific needs, combining workshops with teamwork allowing them to take control themselves, as well as to focus on areas identified by the team appear to be relevant for improvement of the unit's future function.
We are aware of the fact that our study has several limitations. First, the sample size was small, as the cohort hematology-oncology team consisted of only 15 persons, making external validity less certain. Furthermore, including the entire team did not allow for randomized sampling within a unit. On the other hand, working with a smaller cohort had the advantage of including most of the existing staff of the unit thereby reducing selection bias while catering at the same time for a more personal and intensive type of interventional experience.
Second, the control cohort consisted of a greater number of doctors, for whom the initial average EQ-i score was comparatively higher than the training group. However, changes in EI scores were found in cohorts of different initial EI scores, thus allowing the data obtained from the control group to be used. Third, data relating to the improvement in terms of patients' satisfaction and other measures of effectiveness, which may shed light on the advantages gained from the intervention, had not yet been collected due to the short time interval from the completion of the training program Ideally, a longer period of follow-up would perhaps have been more beneficial in terms of summarizing the results.
| Conclusion|| |
This pilot study of the use of a group intervention in an attempt to improve EQ-i within the framework of a busy medical center and an active hematology-oncology unit showed positive results. Although preliminary, the experience obtained in this study indicates that it is not only possible to include such training in the busy setting of hematology-oncology unit but also highly beneficial. We suggest that others must further explore EI training in the medical setting, replicating the design used in this study or in others. Increasing evidence will allow the field to better understand the impact of EI training in medical settings, identify the features of programs that lead to success, and assess the long-term impact of EI training on medical staff, patients, and families.
Financial support and sponsorship
ARL is the owner and director of EQ-el; ND is the head of training and development in EQ-el.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mayer JD, Caruso DR, Salovey P. Emotional intelligence meets traditional standards for an intelligence. Intelligence 1999;27:267-98.
Thorndike RL, Stein S. An evaluation of the attempts to measure social intelligence. Psychol Bull 1937;34:275.
Sternberg RJ. Components of human intelligence. Cognition 1983;15:1-48.
Gardner H. Frames of Mind: The Theory of Multiple Intelligences. New York: Basic Books; 2011.
Salovey P, Mayer JD. Emotional intelligence. Imagin Cogn Pers 1990;9:185-211.
Goleman D. Learning. Emotional Intelligence. Why It Can Matter More than IQ. Vol. 24. United States and Canada: Bantam Books; 1996. p. 49-50.
Bar-On R. The Bar-On model of emotional-social intelligence (ESI). Psicothema 2006;18:13-25.
Brackett MA, Salovey P. Measuring emotional intelligence with the Mayer-Salovery-Caruso Emotional Intelligence Test (MSCEIT). Psicothema 2006;18 Supl: pp; 34-41.
Boyatzis RE, Goleman D, Rhee K. Clustering competence in emotional intelligence: Insights from the emotional competence inventory (ECI). Appeared in Reuven Bar-On and James D.A. Parker (editors)(2000), Handbook of Emotional Intelligence, San Francisco: Jossey-Bass, p. 343-62.
10 Bar-On R. The Bar-On Emotional Quotient Inventory (EQ-i): Rationale, description and summary of psychometric properties. In G. Geher (Ed.), Measuring emotional intelligence: Common ground and controversy.
Hauppauge, NY: Nova Science.; 2004.
Lennick D. Emotional competence development and the bottom line: Lessons from American Express financial advisors. Educating People to be Emotionally Intelligent. Westport, CT: Praeger; 2007. p. 199-210.
Van Rooy DL, Chockalingam V. Assessing emotional intelligence in adults: A review of the most popular measures. Educating People to be Emotionally Intelligent. Westport; CT; Praeger publisher 2007. p. 259-72.
Pérez JC, Petrides KV, Furnham A. Measuring trait emotional intelligence. Emotional Intelligence: An International Handbook. Gottingen, Hogrefe; 2005. p. 181-201.
Cote S, Miners CT. Emotional intelligence, cognitive intelligence, and job performance. Adm Sci Q 2006;51:1-28.
Mikolajczak M, Menil C, Luminet O. Explaining the protective effect of trait emotional intelligence regarding occupational stress: Exploration of emotional labour processes. J Res Pers 2007;41:1107-17.
Carmeli A. The relationship between emotional intelligence and work attitudes, behavior and outcomes: An examination among senior managers. J Manag Psychol 2003;18:788-813.
Borges NJ, Kirkham K, Deardorff AS, Moore JA. Development of emotional intelligence in a team-based learning internal medicine clerkship. Med Teach 2012;34:802-6.
Gardner L, Con S. Examining the relationship between leadership and emotional intelligence in senior level managers. Leadersh Organ Dev J 2002;23:68-78.
Barling J, Slater F, Kelloway EK. Transformational leadership and emotional intelligence: An exploratory study. Leadersh Organ Dev J 2000;21:157-61.
Druskat VU, Wolff SB. Building the emotional intelligence of groups. Harv Bus Rev 2001;79:80-90, 164.
Birks YF, Watt IS. Emotional intelligence and patient-centred care. J R Soc Med 2007;100:368-74.
Austin EJ, Evans P, Magnus B, O'Hanlon K. A preliminary study of empathy, emotional intelligence and examination performance in MBChB students. Med Educ 2007;41:684-9.
Austin EJ, Evans P, Goldwater P, Potter V. A preliminary study of emotional intelligence, empathy and exam performance in first year medical students. Pers Individ Dif 2005;39:1395-405.
McCallin A, Bamford A. Interdisciplinary teamwork: Is the influence of emotional intelligence fully appreciated? J Nurs Manag 2007;15:386-91.
Weng HC. Does the physician's emotional intelligence matter? Impacts of the physician's emotional intelligence on the trust, patient-physician relationship, and satisfaction. Health Care Manage Rev 2008;33:280-8.
Arora S, Ashrafian H, Davis R, Athanasiou T, Darzi A, Sevdalis N. Emotional intelligence in medicine: A systematic review through the context of the ACGME competencies. Med Educ 2010;44:749-64.
Libbrecht N, Lievens F, Carette B, Côté S. Emotional intelligence predicts success in medical school. Emotion 2014;14:64-73.
Sa B, Baboolal N, Williams S, Ramsewak S. Exploring emotional intelligence in a Caribbean medical school. West Indian Med J 2014;63:159-66.
Beauvais AM, Brady N, O'Shea ER, Griffin MT. Emotional intelligence and nursing performance among nursing students. Nurse Educ Today 2011;31:396-401.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]