Effective Management Is Key to Successful Meetings

This checklist of how to run successful meetings could help health care organizations use meeting time more efficiently.

The meeting is over. You walk down the hall shaking your head. "What went wrong?" you wonder. "It should have been so easy. The ideas presented were great. All these people are bright. They all want to do the right thing. But all we did was waste time and frustrate most of the participants."

Unfortunately, this is the consensus after many business meetings. When clinicians become managers and administrators in organizations, meetings can be particularly challenging because nonacademic physicians have had little experience as either meeting managers or attendees.

Clinician input, however, is crucial to the success of the organization. Therefore, it is vitally important that they actively participate in meetings and sometimes manage them. Also, when busy physicians forgo patient care time to attend meetings, it is important that meetings be productive if participation is to remain high.

The meeting manager has responsibilities beyond calling the meeting, i.e., keeping it moving and writing up the minutes. Equally important is increasing the effectiveness of a meeting.

Almost everyone comes to a meeting with expectations. Each person has a different history with the group and different concerns. To be effective, a manager must understand these differences and set up the meeting so that they are accommodated.

Managing meetings is not easy, and until recently it was not taught in medical school. However, it is a skill that can be learned. By following these guidelines, you can make your meetings interesting, productive and time efficient.

Publish and follow an agenda.

The easiest way to get a meeting off to a productive start is to include time frames for each agenda item. That way you can specify who needs to be at each part of the meeting. Nothing frustrates busy professionals more than sitting through parts of a meeting that do not concern them.

Meetings take time to arrange, skill to manage and the mature participation of everyone involved. Nevertheless, distribution of an agenda to attendees before the meeting reduces the problems of no shows and late starts and virtually eliminates disruptive group members.

Develop and post a set of norms for the behavior of meeting attendees. How is the meeting going to function? What will the attendees try to accomplish?

Start on time.

Physicians often have interruptions and schedule changes that are beyond their control. Starting on time can be tough, but every attempt should be made to stay on the established schedule. Everyone suffers when members arrive late. The quality and effectiveness of the meeting declines precipitously. Conversely, when meetings start on time, cover scheduled topics efficiently and end on time, people are more likely to arrive on time.

Give periodic summaries.

During the meeting, occasionally review what has been covered by asking group members to summarize the discussion up to that point. Check frequently to be sure everyone understands which issue or agenda item is under discussion. This process lets people know the meeting has some chance of ending.

Assign tasks to participants.

Good meeting managers often assign different tasks to group members. Usually these are formal assignments that take advantage of the participant's natural skills and abilities. There are numerous additional roles for members such as facilitating, summarizing, consensus building, checking and clarifying that may never appear on the list of assignments but are important to effectively managing a meeting.

Insist that vague statements be clarified.

Dropping vague, unclear and poorly thought out statements into the discussion is one-way dissidents and attention grabbers muddy the waters. Do not overreact, however. Many great thoughts begin as poorly developed ideas. Clarification can help nourish nascent thoughts into great ideas, gain support for the leader from the person whose ideas are being improved and ferret out a disruptive person. Clarification is a task best performed by someone other than the leader; other group members should be encouraged to perform this function.

Test all generalizations.

Whenever you hear comments such as "Everyone knows..." or “Of course, we all agree that..." your ears should perk up. Using generalizations is a technique that many of us used as children. However, it is a technique that meeting managers should watch for, particularly during emotionally charged meetings.

Ask questions.

When you check for understanding, agreement and clarity, do not ask only your supporters and confidants. Develop the uncomfortable but productive habit of asking antagonists, those less talkative, and those most likely to be affected adversely by the group's decisions.

Use open-ended questions if you want useful input from participants. Ask questions that cannot be answered with "yes" or "no." When you ask for someone's opinion, listen carefully and acknowledge that you heard and understood what was said.

Protect and defend minority opinions.

Many good ideas that emerge during meetings are contributed by individuals or small subgroups. These ideas are minority positions. If not encouraged, they are often abandoned out of frustration or intimidation.

Keep outside issues outside.

Focus the meeting on the agenda. Try to keep outside issues and personality conflicts from intruding. For example, schedule another meeting to resolve issues that arise which are not on the current meeting's agenda. Schedule private conferences with members who are openly hostile toward one another or the group.

Know when to fold 'em.

Keep a list of issues that are not resolved during the current meeting. At the end of the meeting, go over the list to assure attendees that these items will be dealt with later. Some topics seem to have eternal life.

Many successfully resolved issues come back to haunt a meeting because no one asked, "Does that finish the discussion?" or "We're all in agreement in that, aren't we?" Put a stake through the hearts of these vampire issues by insisting that they not be brought up anymore once they are resolved.

Always debrief.

After a good meeting it is important to acknowledge what went right, just as after a less-than-perfect meeting, it is vital to identify what went wrong. The last item on your agenda should always be team analysis and group self-assessment.

A "check-up" can encourage recalcitrant and resisting people to participate. Solicit input from those who are having a difficult time with the group decision on an item. This technique has helped turn around many nonproductive group members.

Focus the meeting on the agenda.

Combat negative behaviors.

Occasionally, a group member's negative behavior can derail a meeting. Reasons for negative behavior may include a meeting climate that avoids confrontation, personal style, or even the "rush" that such actions cause. Understanding these negative behaviors and how to deal with them can help you turn around potentially disastrous situations.

Curtail dominance.

Some people always need the spotlight. They solicit attention with nonverbal behavior as well as with words. They have a comment on everything, relevant or not, and always try to have the last word.

Meeting managers need to have a private chat with such people and let them know that their behavior gets in the way of the group's progress. It may take several discussions to get their behavior under control. Develop a code or a signal between the manager and the dominator so that the latter knows when to stop.

Avoid tunnel vision.

Positing ideas as if there are no alternatives tends to polarize issues between opposing viewpoints. An either/or attitude hardens positions and closes out alternatives. In reality, alternatives, concessions, compromises and new directions almost always exist. If you see polarization happening, begin emphasizing alternatives to these more extreme positions. Ask group members for new ideas.

Minimize silence.

It is possible to exert considerable influence through silence. Some people use silence to try to attract attention; others use this technique to disrupt the meeting flow. Watch particularly for people who are strong contributors, then suddenly become quiet.

Silence is difficult to spot because it is what many meetings managers really want, but it can be a strong clue that things are not going well. Periodically ask everyone, individually, for input, observations and thoughts.

Watch for subgroups or cliques.

Sometimes group members find people who are unaligned or undecided and try to recruit them. Done in a positive manner, this alignment can be helpful. Too often, however, the result is counterproductive and simply hardens positions. Publicly question the instigator about his or her concerns and then try to bring the instigator and his or her subgroup members back into the group.

Seek out hidden agendas.

The intent of hidden agendas may be to increase personal power, or decrease the power of the meeting leader. At other times, the goal is to get the group to agree to something that is beyond its scope, counter to its real purpose or a reversal of a previous decision.

Test comments and pronouncements against the published agenda by asking, "Is this what we are meeting about today?"

Monitor agreement.

When everyone agrees too quickly and with too little discussion, it can be a problem. Individuals start to act as if each knows what everyone else thinks, and they can fall into the habit of being "yes men and women.” Encourage discussion of issues, particularly when agreement seems to be too easy.

Find the right style.

To successfully manage meetings, physicians need to learn a "dance" that begins with control and direction, proceeds to opening the meeting and encouraging participation, and closes with a soft consensus- building style.

During the meeting, the role of the manager will change many times. At the beginning, you probably will be in control of the agenda. Later your role may be facilitating a discussion. Even later, your role may be one of encouraging discussion. Still later, your role may be one of seeking consensus. Your role may shift again to that of clarifier, or parliamentarian, or back to controller.

The key to good meeting management is to recognize when each role is appropriate, to feel comfortable in shifting into your various roles, and to understand that role changing does not imply you are indecisive, insecure or manipulative. The keys to being an effective meeting manager are flexible thinking and knowing when to put on which hat.

Finally, for clinicians in general, it is often difficult to manage meetings in which there are various professionals with different areas of expertise, such as physicians and nonphysicians. The perceived status differences can be a serious obstacle.

Furthermore, the independent way that physicians have been taught to think and work sometimes makes it difficult to create an atmosphere in which people feel free to participate fully. Two approaches are recommended:

1. Take on the role of a facilitator rather than a controller.

2. Structure the meeting so that contributions from everyone are considered the norm and full participation is encouraged.

Encourage participation.

Even physicians who do not manage meetings can contribute to the advancement and success of their organization by becoming skilled participants. Being a productive meeting participant has other rewards besides helping a meeting run efficiently. The benefits include:

• Less time spent in the meeting.

• Increased influence, and the likelihood of your opinions being heard, and your positions being accepted.

• Increased skills in meeting management.

• Decreased boredom.

Clarify points.

One of the most important roles that meeting participants can perform is helping others make their points in a clear and concise manner. Some people have difficulty speaking clearly to a group. It is also difficult for some to see how their ideas can benefit or influence others or how others will be affected by issues under discussion.

You will discover that when you help clarify someone's points it improves your understanding of the issue as well. You may also gain new respect for the other person's point of view, especially important in areas where you disagree, or your reaction is more emotional than logical.

Restate the issue.

How many times have you wondered, "How did we get here? This discussion has nothing to do with our original direction." When things are not going well, restate the issues on the table. This helps people refocus, defuse an emotional moment, or take the pressure off a group member who has elicited an unwarranted hostile response from the group.

Ask probing questions.

The use of well-thought-out serious questions can help divulge what someone is really thinking. Use questions for enlightenment or clarification, not as battering rams. Meetings should not be adversarial games of one-upmanship.

Act as a mediator.

When the group is stuck and no one will concede a point, it is time for action, preferably by a nonaligned person—someone not in any camp. Offer suggestions such as accepting a previously stated idea or introduce a new idea. Sometimes a previously stated idea will be a combination of ideas, a composite super idea. If all else fails, suggest that the issue be put off until another meeting or referred to a committee.

Facilitate the meeting.

Consider these useful comments to get people to agree:

• "What I think you are saying is..."

• "What I see happening is..."

• "What I feel is..."

• "I wish you would tell us more about that..."

• "It seems to me that we have these two positions..."

Sometimes these comments are aimed at the proceedings (What is going on?), sometimes they are aimed at the participants (What are we doing?), and sometimes they are self-directed (What do I feel, see, think, believe?). Whatever the motivation, the effect of facilitation or intervention is that things begin to flow again. The best facilitator has a genuine interest in other people in the group and their goals.

Express support.

Even when you disagree with what someone is saying or dislike the speaker, you can still support the person's right to an opinion and the importance of his or her being heard.

Invite participation.

Nonparticipation can be one of the most manipulative techniques in the world. For example, for three meetings Jack has just been sitting there. He has not said a word, has not gone to sleep, has not shown a strong emotional reaction. He merely sits. Eventually everyone starts to watch him, trying to elicit some response, trying to read the mind behind the great "stone" face. Bingo! Jack has achieved exactly what he wanted: undue influence.

Too often in health care, we assume that no response is a "yes" response. Check frequently to ensure that everyone has been heard or has been invited to comment. A good team member is genuinely interested in the other members' opinions on the issues.

Check for consensus.

The group has reached consensus when you have found a solution that everyone can live with. Consensus is not complete agreement; it is not a majority opinion; it is not a plurality. Consensus might arrive before you expect it to or it might never arrive. That is why good meeting participants from time to time check to see where everyone stands. It is senseless to waste time beating a dead horse.

Appeal to higher goals.

Petty differences, minor power plays, hidden agendas and personality issues can fade when participants rediscover the real reason for a group's existence. It is a wise and powerful group member who can refocus a meeting by judiciously emphasizing the group's higher goals and thus the members' areas of agreement.

Changing the state of meetings takes time, dedication and focus. Begin by considering what is causing your meetings to be less efficient than you want, then review these techniques and select the ones that will help your meetings.

If you try some of the techniques described, you may walk out of your next meeting shaking your head and thinking "Hey, that went really well! We have a great group of people! Everyone had something to contribute today!"

Ronald B. Pickett is an organization effectiveness consultant in Escondido, CA.

This article first appeared in the Physician Leadership Journal.