Part 5 in a 5-part series on facilitation skills for physician leaders — an emerging necessity in a complex health system

 

Whether facing a new team or an established one, facilitative leaders can prevent difficult behaviour among its members by ensuring clear communication, an open environment, and effective meetings. In this article, we provide a number of tips for accomplishing these goals and intervening when poor behaviour demands it.

 

KEY WORDS:  facilitative leadership, teams, challenging behaviour, meetings

 

In his national bestseller, Patrick Lencioni1 clearly states: “No action, activity, or process is more central to a healthy organization than the meeting…. Bad meetings are the birthplace of unhealthy organizations and good meetings are the origin of cohesion, clarity and communication.” In this last article in our facilitative leader series, we stress the need for leaders to master challenging behaviour in meetings that otherwise squanders enormous talent and precious energy every day. We describe approaches

for meetings of both new and existing teams. Top

 

New teams

 

Physician leaders sometimes have the benefit of leading meetings in which team members are coming together for the first time to take on new work. In this case, they have the advantage of putting processes in place to prevent or reduce the incidence of challenging behaviour. It is always easier to prevent such behaviour than to manage it; although the following recommendations take time to implement, the investment is worthwhile.

 

Create an environment of psychological safety

 

Challenging behaviour often occurs when decisions do not reflect the priorities of the team members. To mitigate this, physician leaders are urged to create an atmosphere that encourages team members to share, not only facts and data, but also their biases, perspectives, values, and assumptions. Top

 

Clarify the context

 

Challenging behaviour may occur when team members are not clear on the context or the background for the team’s work. Each member may have different information about why the team is coming together, some having “inside” information and others knowing very little. At best, this situation will create confusion and, at worst, it will result in an “us versus them” scenario, both of which can precipitate challenging behaviour.

 

Physician leaders who take time to clarify the context are less likely to have to deal with challenging behaviour, as all team members will be working with the same information to solve problems and, subsequently, make decisions. Top

 

Clarifying the context means addressing the following questions and issues:

 

• Why this change? Why this change now?
• What’s going on “out there” that compels us to think about   doing our work differently? What’s going on out there that will impact the work we do overthe next 2–3 years?
• Here’s what we know (about this change and the impact of this change).
• Here are some of things we don’t know (about this change and the impact of this change), and here are some things I will need your feedback on.

 

Clarify goals, roles, interpersonal relations, and processes

 

Similarly, physician leaders are advised to clarify team goals (what the team is trying to accomplish, the results they expect to achieve), roles (what team leaders and team members will do to ensure that results are achieved), and meeting processes (how team goals will be accomplished, how the team will share information, solve problems, and make decisions). (See part 2 of this series for details.2) The more clarity the team members have with respect to team goals, roles, and processes, the less likely challenging behaviour will occur. Top

 

Create and refer to team meeting guidelines

 

One of the first items on the agenda for the first meeting of the new team is the creation of meeting guidelines or rules of engagement. These agreements provide clarity regarding optimal interpersonal relations among team members during team meetings. Top

 

Meeting guidelines can be established by the team leader or by the team members. If the team is coming together for just a few meetings, it is quite appropriate for the leader to suggest guidelines. Examples include “tell the truth,” “listen hard and be decent,” and “ROPES (respect, openness, participation, experimentation and safety).” In this case, the physician leader should explicitly propose the team meeting guidelines and spend a few minutes at the beginning of the first meeting explaining what he or she expects of team members.

 

If team members will be working together over a long period, the best approach is to engage them in creating their own meeting guidelines. When team members are consulted about their expectations, they are more likely to “own” their team meeting guidelines and follow them. Top

 

Early in the first team meeting, the physician leader is advised to ask the team members to reflect on and discuss responses to the following questions:

 

• What two or three things can the team leader do that will contribute to the success of our team’s work?
• What two or three things might the team leader do that will interfere with the success of our team’s work?
• What two or three things  can team members do that will contribute to the success of our team’s work?
• What two or three things  might team members do that will interfere with the success of our team’s work?

 

The responses are then compiled to create a list of five to seven meeting guidelines that are posted and reviewed during each team meeting.

 

Use a check-in

 

A check-in2 is a brief activity designed to enhance the climate by helping team members get to know one another and focusing attention on the work of the team. Team leaders who use check-ins help create a meeting environment that encourages team members to have positive relations with one another resulting in a lower incidence of disruptive, challenging behaviour. Top

 

Provide a language for team members to describe dysfunctional meeting behaviour

 

Often, team members will leave a meeting feeling vaguely annoyed; they know the meeting did not go well but are unable to identify just what went wrong. Providing a language that helps them describe dysfunctional meeting behaviour makes team members more likely to voice their observations and experience during the meeting. This practice also empowers the team members to take responsibility for managing the meeting experience rather than expecting the team leader to be solely accountable.

 

The physician leader is advised to propose the following language to team members to describe dysfunctional meeting behaviours: hogging, flogging, bogging, fogging, frogging, dead buffalo (see part 3 of this series1). Since the language is humorous, team members are likely to use it. Top

 

Optimize team size

 

The best size for a team is seven plus or minus two. Teams with fewer than five members may not have the cognitive diversity to make a good decision, whereas decision-making can be more difficult in teams with more than nine members, as balancing participation becomes more challenging. If the number of team members exceeds nine, ensure that the right people are included. Consider who needs to be at each team meeting (core team members) and who can attend team meetings on a consulting basis (subject matter experts) depending on the agenda. Top

 

Ensure team meetings start and finish on time

 

Team members, who consistently show up on time only to have the meeting begin 10 minutes late, are likely to become annoyed and disengaged. Similarly, team meetings that go on later than the agenda indicates will also cause irritation. A commitment to starting and finishing on time will help to reduce challenging behaviour, caused by team members feeling their time is not valued.

 

Distribute minutes before meetings and include next steps

 

This practice allows team members to prepare for and focus on the business of the team meeting and can reduce unrelated and often challenging behaviour. Top

 

Ensure fair distribution of work and recognize team member contributions

 

Challenging behaviour can occur when one or two team members feel that the bulk of the work is delegated to them. Physician leaders should ensure that work is evenly distributed and show appreciation for work done. Often, the work team members do on behalf of the team is “above and beyond,” and recognition from the team leader can help keep them committed and appreciated.

 

Ensure members are clear on the team’s decision-making processes

 

Challenging behaviour may occur when team members are unclear about how decisions will be made. Teams often assume that this will be done by consensus, and when decisions do not reflect the wants and needs of all members dissatisfaction may result (see part 4 in this series4). Top

 

“Park” questions and ideas not related to the agenda

 

Record questions and ideas that arise during a team meeting but are unrelated to the agenda, but keep the discussion on track so that it ends on time.3 The “parking lot” is helpful for recognizing team member contributions and ensuring that members are focused on what is relevant and important to them. Parked items often inform development of the agenda for the next meeting. Top

 

Take time to make decisions

 

Physician leaders are reminded of the “inverted triangle” (Figure 1 in part 4 of this series4), which indicates that 80% of decision-making time should be spent gathering and sharing information; only 20% is used to make the decision. Challenging behaviour can occur when teams try to make decisions too quickly, with the result that they do not adequately reflect the needs of the team members. Physician leaders are advised to intentionally work through the information-sharing, problem-solving, and decision-making stages, purposely dedicating a good deal of time to sharing information and generating options. Top

 

Existing teams

 

Often physician leaders “inherit” teams with long-standing, challenging behaviour that discourages optimal engagement and productivity. In this case, preparation is as critical as facilitation of the meeting itself. We suggest that leaders take the following steps before facilitating their first meeting and then on an ongoing basis.5 Top

 

Before the first meeting

 

Assess the needs of the group using one or more of the following approaches:

• One-on-one interviews allow you to question members about the state of the team  and their interactions. This is the best approach to help people be candid if there are sensitive issues in the group.
• Group interviews or focus groups work well when  there are no overly sensitive  issues or there are too many people to interview. This technique also allows observation of group dynamics before the actual meeting.
• Surveys offer an opportunity to gather anonymous information and generate quantifiable data.
• Observation of the group in action (ideally strictly as an observer, before formally leading the group) helps you grasp the interpersonal dynamics; assess the roles being played out and how members relate to each other.

 

Here are some sample questions5,6 that can be tailored to fit your particular assessment approach (Table 1). Some of these were highlighted in part 2 of this series.2

After the leader has gathered information about the group, a summary should be distributed to the members — either written or key points on a flip chart — and it should be reviewed at the start of the first meeting. Ensure that time is set aside on the agenda to review and discuss this information, prioritize key issues to be addressed, and begin working on the most critical concern. We have found that, typically, it is best to begin addressing concerns that fall under context, followed by goals, roles, and procedures before resolving any issues under relationships. Top

 

During meetings

 

During any meeting, periodically conduct the following four process checks5:

 

• Check the purpose to ensure   that everyone is still clear on the   focus of the conversation; e.g., “Are we still discussing our topic or have we shifted our focus?”
• Check the process to see if the approach used is working; e.g., “We agreed to work through this issue as a large group rather   than subgroups. Is this approach working or should we try something else?”
• Check the time and ask members how the pace feels to them; e.g., “Is this discussion dragging or are you feeling rushed? What can we do to improve the pace?”
• Take the pulse of members by constantly reading faces and   body language; e.g., “Where   are you at? Is anyone feeling like they’ve dropped out? How can we get our energy levels up again?” Top

 

Intervention

 

There will be times when meeting leaders need to make an intervention — a set of actions deliberately taken to improve the function of the group — particularly if:

 

• Members are having a side conversation
• People are interrupting and not hearing each other’s points
• People become inappropriately emotional
• The discussion is stuck or off track

 

If the leader notices any of these problems, he or she should ask, what will happen if I do nothing? If the answer is that the group will be less effective, then the leader is obliged to take action. This can be done either in the group or “off-line,” e.g., after the meeting or during a break if that would be more beneficial.

 

The wording used for intervention must be carefully crafted; do not assume or judge. Here are three distinct components to guide the creation of your statement with an example for illustration (Table 2). Top

 

Intervention wording for common challenging situations

 

Using the above guidelines, here are some appropriate interventions that facilitative leaders may want to incorporate into their toolkit.5

 

When one person dominates the discussion: “Pat, I notice that we’ve heard many ideas from you. I’m concerned that we may not get to hear from others. Please hold the rest of your comments until the end so that other people can be heard.” Top

 

When two people are arguing and not listening to each other: “I’m noticing that you are each repeating your points. I’m concerned that you’re not hearing each other’s ideas. I’m going to ask you both to first paraphrase what the other has said before you make your own comment.”

 

Members are disregarding their previously set guidelines: “I’m noticing that you’re ignoring several of our guidelines. Let’s stop and look back at the guidelines we set last month. What do we need to do to ensure they’re being followed?” Top

 

When someone is being sarcastic: “Landry, I’m noticing that your good ideas aren’t being heard because of the tone of voice you’re using. How about stating that again, only in a more neutral way?”

 

When one person is putting down the ideas of another: “Joe, you’ve been ‘yeah butting’ every suggestion Gwen has put on the table. I’m going to ask you to tell us the pros and cons of each of the ideas. I want to make sure Gwen feels like she’s being heard.” When people run in and out of a meeting: “In the last 10 minutes, I’ve noticed several people going in and out of the meeting. I’m concerned that this is disrupting the discussion. What do we need to do about this?” Top

 

Summary

When dealing with challenging behaviour in meetings, leaders have four main options: ideally, prevent the behaviour in the first place; intervene during the meeting; intervene following the meeting; or do not intervene. Even when confronted with challenging behaviour, facilitative leaders must be mindful that their intentions are to learn, to strengthen relationships, and to produce results.

 

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” ― Maya Angelou Top

 

References

1. Lencioni P. The advantage – why organizational health trumps everything else in business. San Francisco: Jossey-Bass; 2012.

2. Olsen M, Yates M. Designing engaging and productive meetings. Can J Physician Leadersh 2015;Winter:16–9.

3. Olsen M, Yates M. Keeping the discussion on track. Can J Physician Leadersh 2015;1(4):table 3. 14–9.

4. Olsen M, Yates M. Group decision-making. Can J Physician Leadersh 2015;2(1):14–7.

5. Bens I. Facilitating with ease! Core skills for facilitators, team leaders and members, managers, consultants, and trainers (2nd ed.). San Francisco: Jossey-Bass; 2005.

6. Beckhard R. Optimizing team building effort. J Contemp Bus 1972;1(3):23-32.

 

Authors

Monica Olsen, MHRD, is principal of Olsen and Associates Consulting. Her current focus is on leadership development in the health care sector through customized education programs, facilitation, and coaching. She has been a long-standing faculty member of the CMA’s Physician Leadership Institute.

 

Mary Yates, MEd, is principal of Align Associates, offering expertise in the areas of leadership development, team effectiveness, performance management, meeting and retreat facilitation, human resources management, curriculum design, and quality improvement. She has been on the faculty of the CMA’s Physician Leadership Institute for the last 16 years.

 

Correspondence to: olsenandassociatesconsulting@rogers.com or marytyates@alignassociates.com

 

This article has been reviewed by a panel of physician leaders.

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