Oplinc

Managing Your Practice

As another weekly meeting comes to an end, you find yourself leaving the room wondering, “What did we accomplish?” “Do we have a plan of action?” or “What agreements have been made?” Does this sound familiar?

Running an effective meeting requires more than simply gathering a team together in the same room week after week. Furthermore, inefficient use of the time set aside for meetings can actually compound the stress felt by individual employees, as well as weaken the overall efficiency and success of your practice.

Telltale signs that meeting structures can be improved include:

  • The lack of agendas, or agendas that simply contain a long list of topics
  • A pattern of never getting through the agenda in the time allotted
  • A tendency to revisit the same topics or issues without coming to resolution
  • Participant reluctance to engage in dialogue during the meeting, and a propensity for the “real” meeting to take place later in the break room or parking lot
  • A pattern of specific individuals monopolizing and/or stalling dialogue
  • Confusion about what decisions have been made after the meeting is over
  • Uncertainty about individual roles and responsibilities relative to any planned actions or implementation of changes
  • Lack of clarity regarding the decision-making process
  • Absence of follow-up or systematic evaluation of the impact of decisions made

If you recognize any of these symptoms, chances are that improvements to your meeting planning and processes can make a difference. While the practice of medicine is highly technical and requires a broad knowledge base, good management is more of an art form that works best when simple, systematic steps are implemented. Managing your practice well is of professional importance because of the degree to which it affects your bottom line and the lives of human beings. This article outlines some specific strategies that can go a long way toward improving the productivity and efficiency of your meetings.

Why do we meet?

The first step toward improving the effectiveness of your meetings is to have a clear purpose in mind for the gathering. A good starting place is to take the time to think about the overarching purpose for the group. Does your practice have a mission statement or statement of vision about its objectives? If so, it probably includes language about high quality care, appropriate and current diagnostic and therapeutic methods, and respectful and compassionate communication amongst patients, staff and physicians. These statements are meant to communicate the shared values that form the basis of your clinic or department.

However, we all know that stated values are meaningless if not supported by behaviors that put them into practice. Using a systems approach to meet your stated objectives requires that all activities and interactions be viewed and evaluated based on these statements. How do meetings serve the purpose of your practice, improve services to patients, and contribute to employee productivity and job satisfaction? Revisiting your larger purpose and applying that to your meetings can help to ensure that they do not become aimless or counter-productive.

“No one wants to go to the meetings” comments a nurse working in an intensive care unit, “People get frustrated because nothing ever gets accomplished. Those who do attend spend a lot of time complaining, often misunderstand what is said and then spread misinformation among those who weren’t there.” Comments like these illustrate the impact that poorly planned meetings can have on a practice or department.

In general, we meet for the purpose of:

  • Sharing information
  • Learning
  • Planning
  • Problem solving/decision-making
  • Accomplishing other group tasks

communication

If the purpose of the meeting is to disseminate fairly straight-forward information that does not require two-way communication, consider not meeting at all. The judicious use of meeting by memo, weekly staff bulletins, email distribution lists, or postings on employee bulletin boards for one-way communication of information will reduce wasted meeting time and convey the message that meetings will be called only when necessary.

Clearly articulating the purpose for your meeting will help to establish whether a meeting is the best way to meet the objective, and if so, who needs to be included (and who does not), how the agenda should be shaped and how much time should be scheduled, and the types of processes you will want to use to accomplish your goals. One way to distill your objective(s) is to complete the sentence, “By the end of this session, participants will…”

Examples might be “…be able to use our new patient information software, ...agree on three strategies to more efficiently manage patient flow in the office,…each have a personal action plan to improve interpersonal communications.” Specificity of objectives contributes to a more focused agenda.

In addition to your intended outcomes, the planning and management of the meeting will be influenced by the size of your group, the degree of trust and collaboration that has been established, and the role of the meeting chair or facilitator.

Identify participants and roles

Once you have established the purpose and objective(s) of a meeting, you are ready to determine who should participate. You should include only the people who can benefit from and contribute to the meeting’s goals. Whenever possible, send out information about the goal of the meeting ahead of time so that participants understand why they will want to attend and how they can expect to benefit.

If your meeting involves planning or problem-solving, you should ensure that you have included those responsible for implementation as well as those who have something to contribute to the process of determining action.

Each participant in a meeting has a role to play. Even if the meeting is simply for the presentation of information, there are expectations for the presenter and the receivers of that information. Only when roles and expectations have been clarified can participants be held accountable for achieving the intended outcomes.

When information sharing is the primary purpose, there is likely to be an authoritative presenter of information, whose role it may also be to give direction, delegate, set goals, and answer questions. Informational meetings are often minimally interactive, however receivers of the information are most often expected to apply the information in some way after leaving the meeting. If application of the information involves a significant change in practice or level of complexity, it is wise to allow for more engagement and interaction to accomplish enough planning or problem solving so that participants feel confident about implementation.

spheres

When the meeting is held for the purpose of planning, problem solving or decision- making, the meeting chair or facilitator should be expected to review the objective(s), monitor and moderate participation by ensuring psychological safety, and asking probing questions, summarize and synthesize to build consensus, and keep the group on task. There are several options to consider when designating a facilitator.

If your team meets regularly to work on projects, planning and problem-solving, you might consider having several individuals trained to facilitate, or depending on the size of the group, you may want to have the group participate in training together, so that the role can be rotated among team members. In either case, it benefits the group to know the rationale behind the use of facilitation and group process protocols. First, in terms of how the technique helps the group to meet task outcomes, and secondly, in terms of how the strategy supports the development of the group itself. We will discuss group process strategies a little later.

Significantly complex or controversial issues benefit from the utilization of an outside facilitator. This is especially important when a series of meetings, a full day meeting or a retreat will be focused on tackling thorny issues or engaging in long-term planning. Having an outside facilitator allows for each member of the group to participate fully while the facilitator maintains objectivity and ensures a participatory process.

If the usual mode of operation for your group is to have the senior member, or person with role authority facilitate meetings, be aware that candid and productive discussions of significant issues can be difficult to achieve when there is a perception that the group leader is advocating for a particular point of view.

Whether you opt for the use of an internal or external facilitator for your meetings, the entire group will benefit from the experience of having trained persons practice and model the skills of effective facilitation. Meetings will become increasingly focused and productive as a result.

Other group member roles to consider include: recorder, charter, and timekeeper. Whether or not you choose to assign each of these tasks depends to some degree on the size and formality of your group, as well as the purpose for the meeting.

A recorder documents the main points that are discussed, and any actions that are planned, including who is responsible within what timeline. Keeping meeting notes can be a tool for increasing efficiency by verifying decisions, providing information to those who were not in attendance, helping to keep the meeting on track, and acknowledging ideas and contributions to discussions. One effective way of taking meeting notes is to use the agenda as an outline to summarize the main points of each discussion topic, including any agreements and/or next steps for each item.

Some group process strategies, such as brainstorming, require the recording of ideas on charts. It is good practice to establish who will perform this task prior to the meeting whenever possible. Unless he or she is highly trained, it can be quite difficult for the facilitator to also be responsible for charting.

timekeeper

A timekeeper may not be necessary for short, informal meetings of a few people – but if there is any danger of group members wandering off task or of the discussion getting usurped, then having someone assigned to mind the clock and offer gentle reminders can be invaluable.

Finally, all participants should arrive knowing the overall reason for their attendance and as the agenda is reviewed, understanding the level of participation that will be expected of them. Reviewing the topics or steps, and foreshadowing the kinds of processes that will be used, helps to prepare members of the group to engage fully and increases overall productivity.

Use the agenda as a tool to improve efficiency

Establishing a process for building the agenda can help to clarify what will and will not be addressed during each meeting. In addition, communicating clear expectations about the parameters of a meeting assists participants in staying focused on the topic at hand.

If one main topic is being addressed, such as information or training about a new departmental process – then it makes sense to have the agenda outline the steps of the process in sequential order. When deciding how the agenda will be built for weekly staff meetings that often address a variety of topics, determine the role participants will play in creating the agenda and how items will be prioritized.

Will there be a single facilitator or presenter who identifies the topics, or will there be a call for agenda items from the group? If you plan to invite participants to submit items, be sure to provide a deadline for submissions, and ask that presenters indicate the amount of time that will be needed for each item.

In order to have a well-developed agenda, the person responsible for the planning must clarify that items meet the overall goals of the meeting, that reasonable timeframes have been established to meet the objectives for each topic, and that participants and presenters receive the agenda far enough in advance to confirm and plan for the presentation and/or discussion of each item.

Weekly Staff Meeting – March 13, 2008 – 7:30-8:30 a.m.
I. Nurses Congress 15 mins Sharon Update the group on new information from February Congress
II. Phone System 10 mins Lee Share timeline for system replacement – identify any potential issues
III. Patient Surveys 25 mins Chris Review and discuss data from patient surveys
IV. Next Steps 10 mins Group Evaluate meeting, identify agenda items for next week

The agenda for a brief, information sharing meeting is content-based and may not require the identification of an objective for each item, but rather an overall objective for the meeting that relates to the topic at hand:

New Patient Record Filing System

Objective: By the end of the meeting, staff will be familiar with, and able to use the newly organized patient record filing system.

I. Introduction 15 mins Linda
II. Access and process for ongoing file maintenance 20 mins Chris
III. Questions 10 mins Group
IV. Meeting Evaluation and Close 4 mins Linda

On the other hand, in-depth training, decision-making, problem-solving and planning meetings are interactive and process-based. A skilled facilitator will know a variety of strategies to use for each phase of the work. The development of an agenda for these types of meetings requires that the facilitator or planning team carefully consider, select and plan for each activity that will be completed during the meeting. A separate facilitator’s (working) agenda can be used as a script to ensure that detailed information and clear direction is given about each activity used throughout the meeting or series of meetings.

Apply group process techniques to enhance productivity

Have you ever been to a training where the presenter stood at the front, clicked through one after another of text-heavy slides that he or she read to you word for word? Were you engaged with the material or looking for ways to distract yourself until you could make your way to the nearest exit? Using appropriate strategies to help participants engage with the material and one another, increases retention and improves application of the learned skills. Skilled presenters know that information needs to be delivered and “processed” in portions. If you are regularly called upon to facilitate these types of sessions, you will want to use some processing strategies throughout the meeting such as:

  • Starting by having participants tell a partner about a time when… (choose a prompt that relates to the topic to get them quickly prepared to hear what you have to say)
  • Every ten to fifteen minutes, have participants talk with a partner, a small group, or write down ideas about how they might apply what they have just learned
  • At the end of the meeting, ask participants to share with a partner or write down and exchange an idea about a “next step” they will take within the week

Simply allowing time for participants to respond to reflective questions related to the topic will yield great returns.

What kind of decision-making process is used in your clinic? Do participants arrive at the meeting with the solutions in mind, and armed with arguments to persuade the group to adopt their ideas? Does the debate go on throughout the meeting, only to have the decision be made by a select few in a nearby restaurant that evening?

Maybe you don’t meet at all -
“We don’t need to have meetings because our clinic is small, and we talk all the time,” explains the newest nurse in the practice. “If I have an idea about something we can do to improve our services, I tell Clara because she and her husband play bridge with Dr. Nash every week. She tells him about the idea and then the next day she tells us what he has decided.” This example of a decision-making “work-around” is not all that uncommon and to some degree, it is working.

However, engaging in a structured decision-making process with a variety of participants has multiple benefits. Cumulative knowledge and facts are increased, broader perspectives and alternatives are considered, employees are more satisfied and likely to support the decision, and communication is improved.

chess

Decision-making models generally include strategies for:

  • Definition or clarification of the issue, problem or opportunity
  • Collection and analysis of facts or data relevant to the issue
  • Generation of options, solutions or alternatives
  • Comparison and/or evaluation of the pros and cons of various alternatives
  • Decision for a course of action
  • Plan for the communication and implementation of the chosen option(s)
  • Identification of a process or method to evaluate the success of the implementation

If your group meets regularly to make decisions, it is wise to identify a decision-making model that will be used consistently. Additionally, each step in the decision-making process comes with its own issues and challenges depending upon the experience and culture of your group. Although there are many activities and protocols from which to choose, it is important to note that each is best suited to a specific stage of the work.

In every group, there are members who have a preference for “process” and others who are more “task” oriented. One common misconception is that a group must choose between process or task, and another is that process is used primarily to provide a “warm and fuzzy” environment.

balanceIn reality, a balance of task and process is the most efficient way to manage group productivity. Attention to task is of obvious necessity. Attention to process is important whenever a topic is controversial, complex or emotionally charged. Consideration of process strategies depends upon group size, time allocated and the experience of the group.

Valuable process strategies that give attention to relational outcomes are not simply “icebreakers” or team-building activities that stand apart from the work at hand. Rather, they are activities that allow for participants to engage with one another in a productive way around the important, relevant topics that need attention from multiple members of the group.

There are many resources available for identifying and describing group process techniques and strategies. Choose those that are relatively easy to implement for each step, and practice them regularly until your team becomes familiar with your decision-making or problem-solving model. With continued practice, you can expect productivity and satisfaction levels to increase over time.

Whenever your group meets for the purpose of discussing potential change, you can assume that there will be differences of opinion. Conflict within the group is not only to be expected, but if handled properly can be productive. Disagreement can lead to creative problem-solving and innovative ideas when the group stays focused on addressing issues with the agreed upon goal in mind.

One way to keep the focus of the disagreement on the issues rather than on individuals, is to use a “third point” in the room such as a flipchart, a data display, or a handout of information. Some illustrations:

  • A group is brainstorming ideas that will improve patient flow. (The brainstorming process is intended to allow ideas to be surfaced without judgment or advocacy in order to maximize the possibility of increasingly creative thoughts being generated.) Various ideas are generated about the waiting room, lab, exam room and infusion room procedures. By recording the ideas onto a chart for later consideration via a structured process, members of the group are better able to keep their attention focused on the ideas rather than the people attached to them.
  • Staff is reviewing data that seems to indicate a need to improve maintenance of accurate patient demographics. In order to clarify the scope and source of the problem, a wall chart shows statistical and/or descriptive data about the situation, and related processes based on records, denials, etc. In this way, underlying assumptions about what the problem is, and differing opinions about what the data show, can be surfaced through a structured dialogue prior to jumping to a solution.
  • The nurses have just returned from their annual congress with information about the utilization of standardized protocols. They have a collection of materials describing various strategies of implementation, the benefits and challenges. By having the members of a larger team read and engage in dialogue about the case studies in pairs, prior to large group discussion – the information can be processed in an interactive and focused way by all participants. Using the text as the third point gives a jump start to in-depth processing of the new ideas by the larger group.

Regardless of the focus of the meeting, choosing activities to accomplish your goals and objectives is a function of agenda development, and leads to decisions about room and materials preparation.

Prepare space and materials

Whatever the purpose of your meeting, you will want to ensure that the room and the materials promote rather than inhibit accomplishment of the goals. If the primary purpose is to share information and little interaction is planned, arrange the room so that receivers of the information are facing the speaker and make pertinent information available in handouts. If the presenter will be using a PowerPoint presentation, check for lines of visibility and audibility from all areas of the audience.

If your meeting will involve more interaction by participants, use circular tables, U-shaped arrangements, or other configurations that allow people to hear one another even when there are other groups working simultaneously. Provide flipcharts, index cards, handouts and other materials that support the group process techniques being used. Use PowerPoint slides selectively to maintain attention, pose questions and reinforce activity directions.

For maximum productivity, pay attention to room temperature, acoustics, personal and group space, and placement of support materials (such as charts).

Manage time and resources

When you begin your meeting, review and ask for a commitment to the agenda. Consider keeping the agenda posted in the room where it is visible to all participants. Clarify your role (facilitator, collaborator, etc.) and explain what will and will not be accomplished by the end of the meeting. Identify the timekeeper and note-taker. Define the decision-making (or other) process that will be used including time allocation for discussion.

Throughout the meeting help the group to focus on one topic at a time. Consider keeping a chart to the side for “parking lot” issues. This chart is for issues that are off-topic, involve only a few people, or are too difficult to address at the time. By listing them to the side, participants will know that their issues will be addressed eventually and that they are now in the group memory. If your meeting is going to run beyond 90 minutes, be sure to include a break.

Close with clarity and assess to improve

A productive meeting is one that leads to action. At the end of each meeting, review any actions that have been agreed upon, including who is responsible and the timeline. Clarify whether minutes or agreements will be reported back to participants or others. Set the time for the next meeting if there is not a standing appointment, and ask for potential agenda items or list items that need to be carried over to the next meeting.

Finally, if your goal is to continually improve the effective use of meetings, you will want to consistently engage in a quick process to evaluate your meeting. Create a simple T-chart with Positives/Improvements headings. Ask participants to name things that worked well and things that could be improved for next time. Have the note-taker include the evaluation in the meeting notes. Keep these comments in mind when planning for the next meeting.

Well-managed meetings can be an important tool for improving the efficiency of your office, increasing your bottom line, and improving employee satisfaction and overall communication. In order to make the most of meeting time, be sure you know the purpose for meeting, you have included the appropriate persons, and that an agenda is carefully developed and followed. Plan your space and materials to support process and meeting objectives. Engage participants in an evaluation of meetings in order to continually improve outcomes and to develop the skills of your team.

 


Pamela Comfort, Ed.D. is a leader of professional and organizational learning, specializing in group facilitation and collaborative decision-making, interest-based problem solving and negotiations, and organizational planning. She can be contacted at pam@pamelacomfort.com.

 


“Running an effective meeting requires more than simply gathering a team together in the same room week after week. ”

 


“The first step ... is to have a clear purpose in mind ...”

 


“Whenever possible, send out information about the meeting ahead of time ...”

 


“Revisiting your larger purpose and applying that to your meetings can help to ensure that they do not become aimless or counter-productive.”

 


“If the purpose of the meeting is to disseminate fairly straight-forward information ... consider not meeting at all. ”

 


“If application of the information involves a significant change ... it is wise to allow for more engagement and interaction ...”

 


“If your team meets regularly to work on projects, planning and problem-solving, you might consider having several individuals trained to facilitate, or depending on the size of the group, you may want to have the group participate in training together ...”

 


“Some group process strategies, such as brainstorming, require the recording of ideas on charts.”

 


“... all participants should arrive knowing the overall reason for their attendance ...”

 


“... communicating clear expectations about the parameters of a meeting assists participants in staying focused on the topic at hand ...”

 


“A skilled facilitator will know a variety of strategies to use for each phase ...”

 


“... [Use] appropriate strategies to help participants engage with the material and one another ... ”

 


“... engaging in a structured decision-making process ... has multiple benefits ... ”

 


“... a balance of task and process is the most efficient way to manage group productivity. ”

 

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CONTACT US
Risë Marie Cleland
Rise@Oplinc.com

Oplinc, Inc.
315 W. Mill Plain Blvd.,
Suite 204
Vancouver, WA 98660
360.695.1608 office
360.695.6937 fax
www.Oplinc.com
Rise@Oplinc.com

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UPCOMING ISSUE
Comments and suggestions for future issues are welcome, please forward correspondence to Risë Marie Cleland by email at: Rise@Oplinc.com

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NEWSLETTER ARCHIVES
Volume 3 Issue 7
Volume 3 Issue 6
Volume 3 Issue 5
Volume 3 Issue 4
Volume 3 Issue 3
Volume 3 Issue 2
Volume 3 Issue 1
Volume 2 Issue 7
Volume 2 Issue 6
Resource Guide Issue 5
Volume 2 Issue 4
Volume 2 Issue 3
Volume 2 Issue 2
Volume 2 Issue 1

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ABOUT THE EDITOR
Risë Marie Cleland is the founder and President of Oplinc, Inc., a national organization of oncology professionals. Through Oplinc, Inc. Ms. Cleland publishes the weekly Oplinc Fax Tracts focusing on the timely dissemination of information pertaining to billing, reimbursement and practice management in the oncology office and Oplinc’s Best Practices Review, which provides a more in-depth look at the issues and challenges facing oncology practices. Ms. Cleland also works as a consultant and advisor for physician practices, pharmaceutical companies and distributors.

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IMPORTANT NOTICES
Please note that this newsletter is presented for informational purposes only. It is not intended to provide coding, billing or legal advice. Regulations and policies concerning Medicare reimbursement are a rapidly changing area of the law. While we have made every effort to be current as of the issue date, the information may not be as current or comprehensive when you review it. Please consult with your legal counsel for any specific reimbursement information. For Medicare regulations visit: www.cms.hhs.gov.

 

CPT® is a Trademark of the American Medical Association Current Procedural Terminology (CPT) is copyright 2007 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein.

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