Becoming a meetings maestro: Dispensing information and boosting morale

Doctors and staff are not usually big fans of meetings. Doctors hate to take time away from patients or their families. Staff hate coming in early or on their days off. So practices have to offset these negatives by making meetings meaningful, productive and efficient.

In virtually all practices, there are two types of meetings: one for physicians and one for staff. Each has its own nuances, so each requires different techniques to ensure the meetings are effective. Here are some guidelines from physicians and others to make either kind of meeting work well for everyone in the room.

Physician meetings

The biggest problem physicians and consultants mention about doctor meetings is getting everyone in the same place at the same time. That's why many groups have instituted various incentives -- both positive and negative -- to encourage attendance. Without incentives, "forcing doctors into meetings will just end up irritating them. And they may not really participate in a helpful way," says Roger Shenkel, MD, a family physician and executive director of Primary Care Partners, a 32-doctor group of family physicians and pediatricians in Grand Junction, Colo.

Time of meeting is an important factor in improving participation. Unfortunately, there's really no good time to hold a meeting. Few groups can afford to hold meetings in the middle of the day, when doctors could be seeing patients. And it's difficult to get everyone to come early or stay later. So groups need to choose the least bad time to meet.

Dr. Shenkel has found that when there's a choice between arriving to work early or leaving late, the majority in his group prefers the former. "After work, most doctors are [eager] to get back to their families," he said. But he adds that it's important for groups to vote on a meeting time. Doctors with differing life situations might vary in their preferences. If necessary, stagger meetings: half in the early morning, half after office hours.

But whenever meetings are held, try to plan them for short days, experts say. "Doctors don't want to come in at 7 [a.m.] for a meeting on a day when they'll be seeing patients until 8 at night," said Larry Dressler, president of Boulder, Colo.-based Blue Wing Consulting, which advises businesses and organizations on, among other things, how to structure meetings.

Whether the meeting is pre- or post-office hours, make sure there's refreshment. That's not much of an enticement, "But it will keep the doctors' grumbling stomachs from distracting them," says Will Latham, president of Latham Consulting Group in Charlotte, N.C.

Some groups do try to provide meaningful incentives. For example, a small number "capitate" doctors for their time at meetings. Keith Borglum, a consultant with Professional Management & Marketing in Santa Rosa, Calif., believes a one-hour meeting is probably worth around $100 to $300, depending on the group and its reimbursement from payers. "If doctors are paid, they're more likely to attend and to take the meetings seriously," Borglum says.

Some consultants suggest fining doctors for missed meetings or tardiness. A $100 fee for each missed meeting or a couple of dollars for each missed minute will often suffice to improve attendance and reduce tardiness.

"People hate to pull out their wallets and pay a fine," says Borglum. Contributing the fine to a local charity will often reduce its sting.

James O'Malley, MD, an internist and president of New Hartford, N.Y.-based Slocum-Dickson Medical Group, a 68-physician multispecialty group, says that getting doctors to attend shareholder meetings was so important, he instituted a major fine to those who don't attend regularly. He says each year, doctors receive an approximate $20,000 bonus as compensation for various ancillary services.

"We decided that only doctors who attend at least half the partners' meetings would be eligible for that compensation," he says. Virtually all partners are very diligent about attending.

In general, the severity of any fine or the value of any enticement should be proportionate to the importance placed on attendance. Some groups may decide that pressuring all doctors to attend every meeting is unnecessary and ultimately not productive.

"We leave it to each doctor to decide for himself or herself if there is a need to attend any particular meeting," says Thomas Royer, a general surgeon and CEO of Irving, Texas-based Christus Health, which has 200 doctors on staff and contracts with more than 1,000 more.

Dr. Royer says that many doctors depend on their leadership to attend and report back results of meetings. Others look at the agenda and attend only if there's an issue they feel strongly about.

Dr. Royer helps doctors who do want to participate but who can't physically make it by providing telephone conferencing access to the meeting.

Spelling out a meeting's agenda is also an effective way to get doctors, because the agenda gives notice of what will be discussed. More importantly, the agenda helps the leader run a successful meeting.

The agenda items should be decided upon ahead of time and the document distributed to doctors at least a week prior to the meeting. Ideally, agenda items should be accompanied by supporting data.

If the supporting information is sufficiently comprehensive, "Doctors can talk about [the issues] in the hallway; no one is out of the loop when they attend the meeting,'' says Bruce Stevens, MD, an anesthesiologist with 16-doctor Unifour Anesthesia Associates in Hickory, N.C.

Dr. Stevens says his group sends out proposed agendas two to three weeks ahead of time. Doctors can make recommendations for additions, and the final agenda is distributed shortly before the meeting.

The comprehensive agenda reduces the need for potentially long-winded discussions at meetings. "By the time we get together, most doctors not only understand the topics we'll be covering, but many have already made up their minds," Dr. Stevens says.

But the most carefully considered and scrupulously worded agenda won't do the group much good if it isn't followed. Accordingly, the meeting leader may have to apply a bit of muscle to keep participants on track. "It's OK to be a bit of a benevolent dictator," says Dr. Shenkel.

He points out that without strong governance, presenters might drone on too long, one doctor may dominate the meeting, and the chronic complainers might try to change the subject to their pet peeves of the week. "The meeting leader has to be the voice of the silent majority who wants to complete the agenda items in as short a period of time as possible," Dr. Shenkel says.

But because even carefully run meetings might not have time to cover all agenda items, those items should be prioritized in order of importance. "There are things you have to accomplish, things you should accomplish and things you'd like to accomplish. Agendas should be organized in that order," says Dressler.

Along with the agenda, the most important meeting document is the record of the proceedings, or the minutes.

"If you don't record what you decided, who is responsible for what, and what has been tabled for the next meetings, you're setting yourself up for a lot of disagreements," says Latham.

Once minutes are drawn up by the meeting leader or secretary, they should be reviewed by the president and possibly the board, and then sent to all doctors in the group.

The first item of business at the following meeting should be a vote on acceptance of the previous meeting's minutes.

Latham believes that an administrator should read through the minutes every three months or so and record policy changes and other long-term decisions in a separate manual. "If someone has a question about a policy instituted ten years back, you don't want to have to shuffle though hundreds of sheets of minutes to find it," Latham says.

Staff meetings

Staff meetings differ from physician meetings in a number of important ways. But to be effective, they require almost as much care and feeding as doctor meetings.

One difference between staff and doctor meetings is that staff members do not have to be induced to attend. "Our staff meetings are mandatory," says Dr. Shenkel, echoing the sentiment at many practices. But Dr. Shenkel is quick to add that just because you can lay down the law doesn't mean you have to be insensitive to the needs of staff.

"We recognize that having staff come in early -- some on their day off -- is a hardship. And we try to accommodate them as much as possible," Dr. Shenkel says. For example, parents who have child care issues can bring their kids with them. And those who come in on their day off can dress casually. That allows them to do their errands without having to return home to change their clothes.

Unlike doctor meetings, where strategic decisions are made, staff meetings tend to be more informational and morale-boosting. However experts say groups should not ignore the value of staff brainstorming and problem solving.

Most experts say that staff meetings, held weekly or monthly, provide the most effective way to communicate important information such as policy changes. "When you try to inform people individually, you run the risk of a dozen different people hearing you in a dozen different ways," warns ArLyne Diamond, a consultant with Diamond Associates in Santa Clara, Calif. She points out that when information is imparted at meetings, everyone hears the same message at the same time. In addition, staff can benefit from each other's questions, and no one can later claim that he or she never received the memo. Minutes distributed after the meeting can help reinforce what was discussed.

However, groups should avoid the temptation to render staff meetings as strictly informational. "The staff are often the first people in the group to become aware of problems," says Nick Fabrizio, PhD, a former practice administrator who is now a consultant with Medical Group Management Assn. Consulting Group in Englewood, Colo.

For example, staff may know that patient wait time has been inching up, or that someone recently tripped on a tear in the rug. Fabrizio suggests reserving five minutes or so at each meeting for people to bring up such issues.

But staff input doesn't have to be dominated by problems. Linda Leake, president of Raleigh, N.C.-based execUchange, a business management consulting company, suggests starting meetings by allotting every person 30 seconds to discuss what he or she or the group as a whole has accomplished. She also believes just the fact that the entire group comes together on a regular basis can create a sense of community. "Face time is very valuable," she says.

Finally, Fabrizio says that staff meetings can be used to make recommendations to the group's decision-makers. For example, when he was an administrator of a group that wanted to expand evening hours, he asked the staff during a meeting which would be the best nights to remain open. He attributes that discussion to fewer defections, because staff had an opportunity to select evenings that fit better with their personal schedules.