How to Run a Meeting.

Abstract

Why do we have so many meetings? Furthermore, why have meetings at all? Chances are that the mere mention of the word “meeting” triggers negative feelings drawn from past experiences of inefficient, poorly run gatherings at some point in your life. We all have busy schedules trying to find work-family balance and juggling our clinical workload, research, teaching, and administrative tasks. The last thing anyone needs is to fit in another useless meeting. What about the monetary costs? Taking into account the lost revenue from time away from work, it has been estimated that meetings cost $1.4 trillion per year.1 As if that was not enough, Steven Rogelberg describes a “meeting recovery syndrome” where attendees lose additional time and productivity recovering from a bad meeting.2 Thus, is the answer to just get rid of meetings altogether? Not so fast. Although there is little to gain from an unplanned, disorganized meeting, noted workplace communications expert Antony Jay describes six important functions of meetings.3 The first is that a meeting defines the group. For instance, you attend the American Society of Plastic Surgeons annual meeting where you share a collective identity with your fellow plastic surgeons. The second function is a place for the group to share knowledge and creative power. The term “social mind” has been used to describe the capacity to share information and experience as a single mind dispersed among many people.3 Advances and updates are presented at Plastic Surgery The Meeting to help all members improve their practice and patient outcomes. Third, a meeting helps individuals understand the collective aim of the group and how everyone individually fits into it. The American Association of Plastic Surgeons program committee selects abstracts for presentation at its national meeting, and each committee member participates by rating the abstracts. Next, a group decision carries commitment from individuals and has greater authority. Recommendations from the Venous Thromboembolism Task Force for the prevention of deep venous thrombosis are more likely to be followed in practice compared to recommendations from a single-surgeon experience. The group decision also dilutes individual authority and responsibility. Hospital protocols are designed to foster improved patient outcomes, but they may also serve to protect physicians who follow the protocols in the case of an adverse event. The fifth function is for democratization. Everyone in the group has a voice. A plethora of articles can be found outlining the importance of empowering individual group members to achieve buy-in and therefore survival and success of the group. Finally, the meeting serves as a status arena where members assess their relative standing. Thus, if we agree there seems to be a meaningful need to continue meetings, we can shift the focus to how to run a meeting efficiently and effectively. Not surprisingly, most of the research in this area relates to business. Although there is a paucity of literature in PubMed related to the topic, a quick Google search yields 1,720,000 results. Robert’s Rules of Order, which was originally published in 1876, is one of the oldest authorities on the subject, and the principles are still relevant.4 In particular, the rules permit the minority to have a voice, but the majority acts and makes collective decisions. Steven Rogelberg describes some key points in a manner to which surgeons can relate in The Surprising Science of Meetings.5 Meeting science is defined as the study of meetings themselves, and everything and everyone involved. It should not come as a surprise to this audience that field studies and laboratory experiments have helped answer questions and generate knowledge about every component of meetings. So how do we know whether we need to have a meeting? First, we must make a diagnosis.3 What seems to be the problem? Why are we having the meeting? Move on to the physical examination. What is the current status of the situation at hand? Make your assessment and plan. What do we expect to accomplish with the meeting? Once a legitimate need for a meeting has been established, it is essential to prepare ahead of time. As Ben Franklin eloquently stated: “By failing to prepare, you are preparing to fail.” Without question, the most important task is creating an agenda3 to define the objectives for the meeting. An agenda facilitates clarity and flow. Each item on the agenda should have a specific purpose that either requires input from the group, or is information best delivered in the group setting. Contrary to what we have learned from giving presentations, a detailed and descriptive agenda is far more beneficial than a generic agenda with few words. Once the content of the agenda has been set, it should be strategically ordered. Important discussion items should be set relatively early in the meeting and those that could wait—or those that could be saved for a future meeting—should go late. The most important item should be placed second or third on the agenda by permitting communication of all essential components of the meeting, which also permits time, if warranted, for additional discussion on the star item. If desired, agendas can be timed, permitting a specific duration per agenda item and avoiding excessive focus on minutiae. Once prepared, the agenda is circulated 2 to 3 days in advance to permit for attendee preparation. Outside of the agenda, the most important component of the meeting is the chair.5 An effective leader will visualize and anticipate key needs and challenges ahead of time. He or she prepares the agenda, considers the attendees, and designates meeting time and length. The mindset of the leader is a key predictor of success. Dominant leaders seek to derive power from controlling the meeting and feature themselves in nearly all the discussions and interactions. In contrast, a servant-and-giver mindset acts to engage all attendees, actively listen, manage conflict, and ask the right questions. This in turn builds trust, safety, and buy-in from the group, fostering an environment of input and innovation. The chair’s self-indulgence is the greatest barrier to the success of a meeting.3 Classic studies show there is human bias in how we perceive ourselves and our leadership skills. To put this in simple language, we overestimate our leadership skills. One of these leadership studies attached a survey to the Scholastic Assessment Text examination.5 It showed that 70 percent of applicants rated themselves above median leadership skills and 25 percent rated themselves in the top 1 percent. Although there are several interventions that can cultivate leadership skills and self-awareness, experts in the field strongly suggest that the chair should aspire to be a servant leader, which shares power and gains satisfaction when others prosper. In helping others rise to their potential, the collective talent of the group is unleashed, and the group thrives. Adam Grant describes a “giver mindset” in his book Give and Take as a key to leadership success.6 A giver is described as someone who prefers to give more than he or she takes, whereas a taker likes to get more than to give. You might be thinking that the “givers” end up at the bottom of the success ladder. You are right—they do. However, the interesting twist is that givers end up at the top of the success ladder as well, leaving the takers more in the middle. Example after example in this book shows how a giver mindset can lead not only to success of the individual but also to those around him or her. “When givers succeed, it spreads and cascades.”6 Once the agenda has been set and circulated and the chairperson established, it is time to conduct the meeting. All meetings should have a set time to start and stop. Adam Bryant of The New York Times suggests starting and ending on time as one of three essential rules to running a meeting.7 If meetings chronically start 10 minutes late, soon the participants will arrive late by taking their cues from leadership. The next thing to decide is meeting duration. Traditionally, the most common timeframe is 60 minutes. Larry Page of Google suggests a 50/25 rule for meeting duration.5 Instead of 60 minutes, try 50 minutes, instead of 30 minutes try 25. The concept is based on Parkinson’s law: work expands to fill the time available. By decreasing the time, it can lead to more focused discussions and return time to the attendees. The Yerkes-Dodson law suggests that performance is optimal with a modest amount of stress which, in this case, relates to time available for coverage of the topics at hand. The chair is ultimately responsible for conducting the meeting, but in some instances, more than one leader may be needed. Often, there is a social leader of the group, and a task leader who is second in command.3 The task leader presents the topic for discussion, whereas the chair preserves his or her role as social leader, listening to all the viewpoints of the group before summarizing his or her personal view. Importantly, the chair avoids what Peter Bregman describes as the number one killer of meetings: a PowerPoint presentation.8 Surprised? Here is the rationale: a PowerPoint presentation is typically a polished monologue focusing on answers and updates during which the attendees tune out because nothing is required of them. Instead, a meeting should have participants facing one another, engaging in conversations, and focusing on questions and issues. Jay helps us break down the duties of the chair into two parts: dealing with the subject/agenda and dealing with the people.3 In dealing with each agenda item, the chair may first set a goal for the end of the discussion. With the goal in mind, he or she listens carefully and steers the group toward the objective. The chair makes sure the group fully understands the issue by asking for clarification when needed and providing interim summaries. Arguably the most challenging aspect may be in determining when to close discussion. A discussion should be closed without reaching a conclusion when more facts are needed, more input is needed from people outside the current group, members need more time to think it over, events are changing that may alter the outcomes, there is not enough time to come to a decision, or a few members can handle the issue outside the current meeting. Dealing with the meeting participants requires active facilitation of opinions to encourage a crossflow of discussion and debate. The chair actively mediates, probes, stimulates, and summarizes ideas and conclusions. As part of chair’s duties, he or she is able to control the garrulous and draw out the silent members of the group. Typically, senior members are called on last to encourage more junior members to give an opinion. In closing the meeting, an action plan is determined and summarized for each agenda item. If you are so inclined, this is where a PowerPoint slide or two can prove useful. Apple coined the term “DRI” for the Directly Responsible Individual for managing a particular task.5 Similarly, Mark Toro coined the abbreviation “WWDWBW”: who will do what by when.7 Assigning responsibility and ownership to an individual can foster confidence and leadership while at the same time it is something that can be monitored and followed for future endeavors. Finally, the meeting is closed on a note of achievement, a positive outcome from the meeting that members can take away and feel a sense of accomplishment. This reinforces a sense of purpose and necessity for … can you guess? Yes, that is right: the next meeting. ACKNOWLEDGMENTS The authors appreciate the peer-review and edits from Mike Stokes, staff Vice-President of Communications at ASPS.