Your Staff Meetings Are Broken. Here’s How to Fix Them.

Dear Director: I’ve taken over a department that didn’t really do staff meetings. Can you suggest a format I can use? What about virtual meetings?

“If you had to identify, in one word, the reason why the human race has not achieved, and never will achieve, its full potential, that word would be ‘meetings’.”  -Dave Barry

Despite what we may think of their utility, having staff meetings is a must, especially with all the changing protocols and high-stakes decisions made by medical personnel. It’s the best way to share your vision with your department and have discussions on how best to implement plans to keep the department optimally successful and efficient. It can also be a great team building opportunity! As docs come together, have some time to socialize outside of the clinical area, and actually talk about things outside of medicine, they will naturally develop better rapport with one another. After all, if your team isn’t particularly close, it’s unlikely they’ll be comfortable enough to ask for help on difficult cases, be keen on making trades that don’t benefit themselves, or be willing to cover for each other when someone is sick.

First Steps
As you get started, there’s a variety of points to consider:

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• Frequency: The departments I’ve worked in have always had monthly meetings.  While I have some colleagues that have theirs every other month, I find there’s too much going on to wait that long between meetings.
• Duration: I generally target about two hours. I know some groups have longer meetings, but I’d rather maintain stronger interest for a shorter period of time.  However, if the meetings are short (<1 hour), I’ve found docs won’t find them worthwhile enough to spend the time driving round trip.
• Location: I prefer a hospital conference/meeting room (but not the ED breakroom), as being in the hospital allows for some flexibility of people who are working but might be able to come to the meeting (albeit for a brief time) if the shift is slow. It also allows for some additional people who might attend (nurse manager, a doc from a different specialty who’s doing a lecture, etc…). If you have a budget, meeting at a restaurant with some good food or going to someone’s house intermittently throughout the year, also sounds like a good time.
• Time of day: We’re in a 24/7 business, so there’s always people working. Honestly, I’ve always preferred the 7 or 8 a.m. start time because there’s typically more docs available (catch the overnight doc and maybe still single coverage), but traffic stinks where I am now so anything with rush hour is off the table. We do an early lunch meeting so people can have an easier commute.
• Attendance Expectations: My personal expectation is that people attend 50% of staff meetings with no excused absences. You’re either absent or present, but need to be there for 50% of them. Typically, people don’t attend meetings held after a night shift unless the meeting is at 7a.m., but I do expect docs to come in if you’re working a shift later that day. Some hospital bylaws may require a certain level of attendance to attain the highest level of medical staff membership, which may be required to vote at general medical staff meetings or chair a hospital committee. CME: A couple facilities I worked in were able to obtain CME hours for the meetings, which usually contained a lecture as well. I think a 20-30 minute update on a specific topic can be great, but it’s better if CME credits can be awarded.

As you consider all these variables, start by knowing your staff and your site. You’ll need to plan around the restrictions that are specific to your site. For instance, if you have a large staff and everyone lives close by, you’ll likely always have a critical mass to make your meetings worthwhile. However, if you’re in a rural area that uses moonlighters or the docs live far away, you may not have sufficient turnout to justify a monthly in-person meeting.

Format
As you consider your format, consider who is attending your meeting and who will be seeing the minutes of the meeting. Although I’ll occasionally have a closed, physician-only session, in general, my meetings include at least my nurse manager, the ED administrative assistant (who does the minutes and also benefits by knowing what’s going on), and our lead scribe.

Admittedly, adding my lead scribe wasn’t inherently obvious to me. Then I realized, many of our issues had to do with documentation (or lack there of). Since our scribes do most of our documentation, under the direction of the docs, why not include them so they can be more proactive and aware of the issues? Your hospital bylaws may dictate that your meeting minutes are sent to the medical staff office for review and perhaps may make their way to the hospital board of directors. More importantly than who may or may not read them, however, is who might come in to review them as part of an inspection.

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We had an EMTALA complaint and CMS came in to review my meeting minutes to see what regular discussions took place regarding medical screening exams and other EMTALA-related issues. That was scary. But it taught me the importance of having a handful of monthly metric-based slides that included a little bit of everything (volume, admissions, left without being seen, transfers, core measure metrics, etc…).

An ED dashboard facilitates discussion regarding almost every topic that CMS may want to ask you about. It’s essentially the first real slide of my meeting now. While my slides are thorough, my minutes are fairly brief and generally include big picture components, next steps, and any other action items or follow up.

Meetings are more interesting when there’s discussion. While not every aspect of the meeting requires discussion, as you plan you agenda, do your best to make sure there are areas where you’ll be seeking input. My agenda is pretty straightforward. After our dashboard, we’ll get in to quality reviews and M and M cases, which can definitely lend themselves well to discussion, (i.e., What would you do in this situation?). I can’t stand it when my name is all over the agenda. It’s definitely a more interesting meeting when others do some of the presenting. I have a handful of docs who do quality reviews or sit on committees that need to provide regular updates at the meeting. These docs have a schedule, so they’ll know when to be prepared to have a few slides to report to the group. After all, one of the most important parts of a quality assurance program is to be able to report back to the group observable trends. This is also important when Joint Commission comes to inspect and starts asking questions about things like propofol and moderate to deep sedation.

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I then try to have a section that lends itself to discussion. Over the years, we’ve had some good ones, ranging from how we divide up patients in our chest pain ED (balancing flow, acuity, and critical care), tips on increasing productivity or reducing length of stay, how to handle “drug-seekers” and standardizing how we use opiates in the ED, and the pros and cons of different staffing patterns. There’s always a block of time for the nurse manager and lead scribe and then an open session.

Because the agenda is similar from month to month, the docs know they’ll have an opportunity to bring something up for discussion. One reason I like using a meeting room instead of a restaurant is I think meetings flow better when you have slides to guide the discussion. Although I don’t typically edit slides that are sent to me, I do prefer that all slides being presented are sent to me ahead of time to be included in the PowerPoint set. This also saves time, as people don’t need to load thumb drives or hook up their computers for their presentation.

A word on virtual meetings
I’ve seen sites go to virtual meetings to increase attendance. I’ve generally been against them, because, as I said, I think there is value in getting together with your colleagues for discussions. Moreover, virtual meetings usually end up with one person talking and not everyone listening or participating. I think it’s particularly true when there are big groups on the call. When people are there in person, I’m also sure they’re not surfing Facebook or checking email. However, virtual meetings can save travel time and help people attend who may otherwise not be able to (vacation, child care issues). So there is a trade off between the flexibility associated with virtual attendance and the real value of face-to-face interaction. This comes back to knowing your staff. Perhaps you’ll want to build in virtual meetings intermittently throughout the year, develop an agenda that may be more lecture than discussion based, and take advantage of technology that fits your group. While sharing a screen of PowerPoint slides is great, I’ve also been on meetings where you could literally see everyone participating and that certainly felt more like a face-to-face meeting. I’ve done that with six to eight people on calls, but it might be challenging with many more than that (images become too small).

Conclusions
I’m always amazed when I meet chairs who don’t hold regular staff meetings. I feel like there’s a lot of information to be shared and discussed. Meeting in person can facilitate discussion and team bonding, but there is an increasing place for virtual meetings. Having a regular format and customizing aspects based on individual characteristics of your group is critical. In the end, we need a format that will share information, align and educate the team, and help move the department forward.

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