Anesthesia Group Meetings: Madness or Method—the Choice is Yours

Will Latham, MBA
President, Latham Consulting Group, Inc., Chattanooga, TN

Meetings?

With so many things going on in your practice, why read an article about a topic as mundane as “meetings?”

Here’s why:

1. Regardless of size, meetings are an important governance tool for all groups. Much of the work of governance is done in group meetings. Yes, often a lot of background work is done outside of meetings, but the real discussions, debate and decision-making typically take place in group meetings.
2. I have observed that many medical group meetings are chaotic and unproductive. Much time is wasted. And if meetings don’t work well, practice governance doesn’t work well. The wrong issues are discussed, reasonable conclusions are not reached and decisions are not made.

Some of you won’t pay attention to these ideas because either “we don’t need to do that” or “we don’t want to do that.” However, keep in mind that, to paraphrase Albert Einstein, “Insanity is doing the same thing and expecting a different result.” The bottom line is that successful anesthesia group governance requires successful meetings.

The following steps can help you dramatically improve the effectiveness of your group meetings, save time and actually get things done.

Set a Meeting Schedule

Many groups have problems with meeting attendance. One way to increase meeting attendance is to establish a schedule of meeting dates well in advance.

The most effective anesthesia groups set up their meetings on a particular date each month (e.g., the second Tuesday) or select specific dates. The important thing is to develop this schedule well ahead of time (I suggest 12 months out) so that individuals can consider these dates as they set their own schedules.

Each group will need to determine the best time to meet, but be realistic about the start time for the meeting. Unfortunately, some individuals feel they have “won” if they are the last person to show up to a meeting, because then they don’t have to sit around and wait for others to arrive. In other instances, groups will “pad” the start time of meetings, hoping that setting a 5:30 meeting time means a meeting will actually start at 6:00. The bottom line is that this is disrespectful to the people who do show up on time and can often result in a game of “who can be last.”

If you know that most of the time people will be late, move the meeting start time to a reasonable time. Attendance at group meetings will improve if individuals know that meetings will start and end on time. You appreciation of their time will result in consideration from them.

Set a Meeting Duration

Many anesthesia groups have lapsed into poor meeting behaviors that result in very long meetings. I have heard that some groups endure four- to five-hour meetings.

Other poor meeting behaviors include:

• Arriving late
• Arriving unprepared
• Too many issues for discussion
• No prioritization of issues
• Discussion that strays off track
• Using meeting time to present reports that could be sent in written form

The rest of this article will address these issues in turn. However, the first step to make meetings more efficient is to set a goal for how long you would like to meet, and then do what you have to do in the chosen time frame to achieve that goal.

Setting a time goal forces you to consider ways to jettison inefficient parts of the meeting and put into place good meeting techniques that you might not otherwise implement.

For regularly scheduled meetings, my recommendation is to set a goal to keep meetings to two hours or less. After two hours, participants are usually exhausted and little is accomplished.

There will be times when the time goal cannot be achieved, but most groups are surprised that when they use good meeting management tools and techniques they finish more quickly. Set a meeting duration goal and meet that goal.

Establish and Use Ground Rules

Think about your most recent group meeting. Did the attendees exhibit any of the following behaviors?

• Multiple people talking at the same time
• The discussion drifting off topic
• Distracting phone calls taken in the meeting room
• Participants arrive late
• Low physician attendance
• Some participate in the discussions, while others don’t (until the “after-the-meeting meeting”)
• Individuals raise many problems but do not pose solutions
• Participants engage in many sidebar discussions, either by talking to the person seated next to them or through texting.

Establish and use ground rules to prevent these negative meeting behaviors.

Ground rules delineate the observable behaviors that group members expect from every attendee. The focus is on observable behaviors.

To clarify, let me provide an example of an unobservable behavior. A ground rule that states that everyone is expected to “be open-minded” is subject to dispute, depending on an individual’s viewpoint. Why? Because being “open-minded” occurs inside the brain and is not an undisputable observable behavior.

It’s best to set ground rules as a group. In other words, have the attendees develop the ground rules together rather than copy the list below and say “here are our new ground rules.” Individuals are more likely to adhere to the ground rules if they have had a hand in developing them.

Focus on Observable Behaviors

Ask attendees “what observable behaviors should be expected of each attendee?” Their responses should cover the following key ground rules:

1. One person speaks at a time and everyone else listens.
2. Arrive on time.
3. Stay on topic.
4. All are expected to participate in the discussion.
5. No sidebar discussions—oral or texting.
6. If you must take a call, leave the room so work can continue.
7. Everything we discuss is confidential unless we specifically agree otherwise.

During the discussion to develop ground rules, you might have someone suggest an unobservable behavior such as “we should all focus on what’s best for the group.” This is not truly observable because it is happening inside an individual’s brain, and each individual can claim to be acting in the best interests of the group. Thank them for their contribution (and maybe even write it down), but keep coming back to observable behaviors like those noted earlier.

Once the ground rules are created, each attendee should be asked if they will abide by the proposed ground rules.

The best performing groups take a few minutes to review the ground rules at the beginning of every meeting. This doesn’t take long and the pay-off is huge. Some groups publish the ground rules at the top of their meeting agendas, while others post them on a cardboard sign displayed at each meeting.

Most groups find that group meeting performance will improve simply by verbalizing the ground rules. Attendance will likely increase as individuals begin to experience more organized and effective meetings.

The ground rules will take on even more importance when they are utilized by the group’s meeting manager, which will be discussed later in this article.

Prepare and Commmmunicate Agendas

The anesthesia groups that have more effective meetings devote time to planning their meetings. The best way to ensure that those attending a meeting are sure about its purpose is to send them a clear agenda well in advance.

An agenda for a meeting is a list of items or issues that need to be raised and debated. It should be short, simple and clear.

Creating and using an agenda can cut down on meeting time, improve communication and serve as a useful tool for the meeting manager.

Developing Agenda Items

Where do agenda items come from? For most anesthesia groups, the best process is for each shareholder or board member to submit an issue they would like to be discussed to the group’s administrative manager. The manager may want to send out a reminder to all shareholders about the due date for agenda items.

At the appropriate time, the manager and president should meet to develop and finalize the agenda. Many groups give their president the authority to develop and set the agenda. However, those same groups typically allow a shareholder or board member to raise an issue at the meeting if it is not included on the agenda. Those issues usually drop to the end of the meeting.

To prepare the agenda, the manager and president should review potential agenda items, select those that are most important, develop an order of discussion and estimate the amount of time each discussion should take. Be generous in estimating the time. Yes, an issue can take five minutes if only one person talks, but an interactive discussion takes longer.

An important tip: nothing makes a board member or shareholder angrier than seeing that an item they proposed is not on the agenda, with no explanation. Therefore, I suggest that the president be charged with the task of contacting those whose submitted agenda items are not included and telling them why.

The president and manager should then total the estimated time to see if the meeting can be completed within the meeting time goal. If not, they must pare away the lower priority issues, or warn the other attendees that the meeting might last a little longer than the goal.

Agenda Guidelines

Following are guidelines for setting an effective agenda:

• Try to restrict the agenda to one sheet of paper.
• Include details of the meeting’s date, time and place.
• Specify the main purpose of the meeting.
• The time devoted to each item should reflect its priority. As previously noted, try to allocate time reasonably. Err on the generous side. Nobody minds if a meeting ends early, but overrunning is unpopular.
• If the total of the time allocation exceeds a reasonable meeting length, revise your plans.
• Some groups use a timekeeper. If an issue exceeds its expected time, the meeting manager should stop the discussion and ask whether the group prefers to continue the discussion or defer the remaining time to the end of the meeting or another date.
• It is unreasonable to present participants with a revised agenda as they arrive at a meeting unless last-minute events have made it necessary, for example, if a participant is not available because of illness or there is a sudden change in financial circumstances.
• Much time is chewed up in meetings with individuals providing reports from certain departments or committees. I suggest that such reports be delivered in writing before the meeting, and that oral reports be limited to asking whether participants have any questions. This, in and of itself, can save hours of meeting time yearly.

Information to Send with the Agenda

One of a shareholder’s or board member’s most important responsibilities is to come to meetings prepared. Therefore, the agenda should be sent out several days in advance. Along with the agenda, any relevant backup information also should be sent, such as:

• Minutes of the last meeting
• Department or committee reports
• Information related to an agenda topic, such as a cost/benefit analysis
• Financial reports
• Market intelligence

Some groups find it effective to categorize this information as follows:

• Monitoring information
• Decision information
• Educational information
• Market Intelligence information

Agenda Distribution

If the agenda is for the board meeting, I recommend that you also send it to the shareholders as well as to meeting attendees. This will allow shareholders to provide board members with feedback about the issues to be addressed prior to the meeting.

Utilize a Meeting Manager

A meeting manager can be instrumental in ensuring that a meeting runs smoothly. This person should be responsible for:

• Enforcing the ground rules
• Keeping order
• Ensuring that any discussion is relevant to the points on the agenda and that time is not wasted on irrelevant debate
• Repeating any motion proposed by attendees to ensure that everyone has heard and understood it
• The successful completion of business
• Summing up the discussion at the end of the meeting

In addition, it often falls to the meeting manager to remind attendees to make their decisions based on what is best for the entire organization as defined in the group’s mission statement, vision, values and strategic plan.

The ideal meeting manager should have a wide range of personal skills, such as:

• Firmness in running the meetings on time and dealing with problems
• Ability to summarize points succinctly
• Flexibility when dealing with attendees’ different tones and styles
• Openness and receptiveness to differing opinions
• Fair-mindedness in ensuring that all views are aired and given equal consideration

In cases in which the group expects the meeting manager to appear unbiased, the manager should not join fully in the discussion and should not vote unless a deciding vote is needed.

Qualities of the Meeting Manager

The meeting manager is often the group chairman or president, but does not have to be. For example, several years ago I worked with an anesthesia group that had a president who performed most of his functions excellently. However, he was unable to keep the discussion on track and moving forward. This group kept him as president and elected another physician to serve as meeting manager.

I believe that it is best for a physician rather than the group’s administrative manager to serve in this role. Sometimes the meeting manager must confront a shareholder or board member about their meeting behavior. That can be a career limiting move for a group administrator.

Implementing a Meeting Manager

Many groups find it difficult to implement the use of a meeting manager. Some practices don’t want one. In other groups, no one wants to take on this role, because they are unsure whether they will receive the support they need.

Here’s how I suggest you approach implementing a meeting manager:

1. First, ask group members if they believe that their group meetings are ineffective.
2.  Then, ask group members if they think that group meetings will be more effective if they have someone who serves as a meeting manager.
3. If they say yes to #2, ask them if they are personally willing to be managed. For example, are they willing to be told, from time to time, that they have spoken on an issue multiple times and that it is time to let others speak?
   
   Be careful here. Many physicians will say “yes,” meaning they are happy to have a meeting manager manage someone else in the group, but they themselves don’t need to be managed (because, of course, they think they are never a part of the problem). So ask this question a second time to make sure that they are personally willing to be subject to the meeting manager’s efforts to keep meetings on track.
4. If the answers to all of the above questions are “yes,” then, and only then, is it time to ask someone if they would be willing to serve as meeting manager.

Tips for a Meeting Manager

Pacing the meeting correctly is an important part of the meeting manager’s role.

The meeting manager should always make sure that an agenda is provided and followed, and that the speakers have enough time to make their points without the meeting overrunning its schedule.

Here are some additional tips:

• Always make a point of starting the meetings on time. If some participants are late, start the meeting without them.
• Do not waste time recapping for late arrivals unless it is vital that they possess information to make a quick decision.
• Keep things moving briskly by adhering strictly to the agenda and enforcing a strict time limit for each topic. This establishes and maintains a sense of urgency and momentum.
• Do not allow participants to waste time by wandering from the point. If the discussion does begin to stray, bring the discussion back to the main issue by saying, for example, “We are not here to discuss that today. Let’s get back to the point.”
• Keep tight control over proceedings, direct any debate and encourage attendees to participate.
• When people take divergent positions, remind the participants that the purpose of the meeting is to reach agreement.
• It is the meeting manager’s responsibility to ensure that individual participants appreciate the interests of the whole group, that personal interests are set aside when necessary and that everyone is working toward the same aim.
• The meeting manager should close the meetings by:
  • Summarizing discussions and recapping agreements
  • Informing participants of the time, date and location of the next meeting
  • Ensuring that outstanding items are noted for inclusion at the next meeting

Make Decisions by Voting

When the members of an anesthesia group meet (at either shareholder or board meetings) they typically deal with issues that require a decision. Unfortunately, discussion and voting don’t work well in many anesthesia groups for the following reasons:

1. Some group members feel that voting is too “formal.”
2. Some groups think they have a consensus because no one speaks up (or only a few speak up and the assumption is that the rest are willing to go along). These groups are fooling themselves because when people don’t speak up, it typically means they disagree. In addition, if you think you have a consensus, why not vote to make sure you do?
3. Physicians tend to be conflict avoiders. Sometimes discussions go on and on because people don’t want to raise their hands to vote and possibly enter into conflict with those who don’t agree with them. This can make meetings last much longer than they need to.

The result of this is often the presentation of too many options and discussion that goes around and around. While it is appropriate that a group consider a variety of options to deal with an issue, at some point, a decision needs to be made. Therefore, I suggest that the meeting manager should always be pushing for someone to make a motion on the issue. In fact, some groups have such a problem with overly long discussions that I suggest they not allow discussion on an issue until someone makes a motion!

The following practices can be helpful in this regard:

• Introduce the issue.
• Allow some time for general discussion while encouraging someone to make a motion and someone to second the motion. The meeting manager should clarify the motion, make sure it is complete and repeat the motion so that all understand it.
• At that point the motion should be discussed. The meeting manager should keep discussion focused on the motion at hand.
• At some point, someone should call for a vote, and the group members should vote with a show of hands or by using secret ballots (discussed below).

Yes, this process is a little more formal than the one many groups currently utilize. However, it can lead to a level of clarity in decision-making that many groups have not seen for years.

Secret Ballots

To avoid conflict, more groups have moved to voting with secret ballots. Most groups use secret ballots to elect their board and officers, but some groups use them when they need to vote on controversial issues, or, in some cases, on all issues.

Why are secret ballots useful?

• They allow individuals to “vote their conscience” with less fear of retribution. .
• They avoid the opportunity for one physician to bully another physician into changing their vote.
• They often speed up a meeting because people don’t delay voting to put off conflict.

There are several ways to implement secret ballots. Here are two: 

1. Use 3 x 5 cards as the secret ballots.
2. I have observed some groups starting to use “audience response systems.” Such systems are either stand-alone devices, such as those produced by Turning Technologies www.turningtechnologies.com or apps such as Poll Everywhere www.polleverywhere.com. (I have no relationship with either of these firms.) I spoke with a medical group president at a recent conference whose group had moved to using such a system for all votes. He said the system had cut meeting time by about 25 percent.

Groups that use secret ballot for all of their issues have told me that there is only one potentially negative outcome: people will push too quickly for a vote. Therefore, it is up to the meeting manager to make sure that the group has had a full discussion of the issue prior to voting.

Avoiding Re-discussion Torture

Many anesthesia groups make a decision and then revisit it over and over again. This happens when a few group members do not get their way in the first vote. They use this strategy to try to torture the group into changing its decision or to paralyze it.

When other group members express their frustration about the problems that revisiting an issue will cause, the dissenting physicians often argue that additional information has come to light that should be considered. This can go on ad infinitum and the ability to pursue key opportunities (or the ability to avoid key threats) can be lost.

Many organizations suffer from this problem, but the situation is more challenging for anesthesia groups where the shareholder physicians are equal owners of the practice. Some physician shareholders believe that equal ownership gives them the right to have a say about every issue at any time (and often to waste precious group meeting time in the process).

Speed Bumps

Anesthesia groups can prevent this perceived “right” on the part of the shareholders from being used to torture the other group members into voting their way.

One way to reduce the use of this torture technique of revisiting issues over and over again is to use a “speed bump” to return the discussion back to the agenda.

For example, the group might consider implementing a policy that requires 30 percent of the shareholders to sign a document asking to bring an item back to the floor for re-discussion once a decision has been made.

It is important to have shareholders sign an actual document, rather than have someone say “30 percent of the group says they’d like to re-discuss this issue.” This policy doesn’t close the door to re-discussing an issue. If more than 30 percent want to re-discuss an issue, the group probably should. However, it can reduce the incidence of torture. A

Super-majority to Overturn Board Votes

Anesthesia groups that have a board of directors (composed of a subset of shareholders) sometimes face the problem of individual shareholders wanting to re-discuss board decisions that are clearly within the board’s authority.

You can use the speed bump strategy discussed above for board decisions. Alternatively, you can create a policy in which a super-majority vote of the shareholders is required to overturn a board decision that is within their level of authority. Such a policy can strengthen your board and increase their confidence in making decisions for the group’s benefit.

A third solution is to empower the president or the Executive Committee to decide what to include and what not to include in the agenda of larger group meetings.

Put These Ideas to Work

There are two main ways to implement the ideas covered in this article:

1. Choose two or three ideas above and implement them as soon as possible.
2. Devote one of your upcoming meetings to reviewing the ideas and agree to immediately implement as many of the recommendations as possible.

Some group members probably will fight against such changes, arguing that they won’t work or that they are too formal for a group of your size. Expect such resistance, but realize that the reason they are fighting change is that they are getting something out of the status quo.

To overcome this resistance, suggest trying the new approach in the next few meetings and then re-evaluating. Soon these changes will become a part of your process.

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Will Latham, MBA, is president of Latham Consulting Group, Inc., which helps medical group physicians make decisions, resolve conflict and move forward. For more than 25 years, Mr. Latham has assisted medical groups in the areas of strategy and planning, governance and organizational effectiveness, and mergers, alliances and networks. During this time he has facilitated over 900 meetings or retreats for medical groups; helped hundreds of medical groups develop strategic plans to guide their growth and development; helped over 130 medical groups improve their governance systems and change their compensation plans; and advised and facilitated the mergers of over 120 medical practices representing over 1,200 physicians. Mr. Latham has an MBA from the University of North Carolina in Charlotte. He is a frequent speaker at local, state, national and specialty-specific healthcare conferences. Mr. Latham can be reached at (704) 365-8889 or wlatham@lathamconsulting.com.