The facilitative leader

Designing engaging and productive meetings

Part 2 in a 5-part series on Facilitation skills for physician leaders — an emerging necessity in a complex health system

Mary Yates, MEd and

Monica Olsen, MHRD


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In part 1 of this series, we described how a facilitative approach is replacing the directive or autocratic style among physician leaders. In this article, we focus on a key skill that facilitative leaders need: the ability to hold effective meetings. We encourage leaders to let go of past assumptions and, instead, create context; do a check-in; and clarify goals, roles, relationships, and processes.


In an introductory article,1 we differentiated between the approaches used by traditional and facilitative leaders and stressed the necessity for leaders to acquire facilitation skills. In this and three future articles, we focus on “basic facilitation skills” — those skills that are useful for dealing with predetermined issues requiring an improvement in the status quo. The practice of basic facilitation focuses the leader’s attention on guiding the group through the following three processes: Top


  • Sharing relevant information
  • Problem-solving
  • Decision-making that builds long-term commitment


Developing these basic facilitation skills is prudent before a leader embarks on acquiring the advanced facilitation skills essential for more complex situations focused on transforming the health care system. At the conclusion of this 5-part series, we will shift the focus to those advanced facilitation skills required for systems thinking. Top


Assumptions about meetings

The first element for consideration is determining what model or framework you follow for creating engaging and productive meetings. In most instances, physician leaders simply default to past meeting practices, even though they have found them ineffective. After facilitating numerous physician leadership courses on Managing People Effectively, where good meeting practices are both discussed and modeled, we have discovered many assumptions that physician leaders have about meetings. It is critical to reveal and examine these assumptions, which often operate at a subconscious level, as they keep leaders thinking and acting in ways that may no longer serve a useful purpose (e.g., reacting vs. acting) and, thus, hold them back from exploring new ways of doing things. Here is a sample of some commonly held assumptions about meetings.


  • Must be 1 hour in length
  • Must include everyone in the department/group
  • Everyone is seated
  • It is acceptable for some people to monopolize the meeting
  • Agenda items must be discussed by everyone all together at the same time
  • It is the chair’s fault if the meeting is ineffective
  • The chair is solely responsible for time-keeping, gate-keeping   (ensuring everyone has a chance to speak), and the meeting environment
  • Endless status reports are the norm
  • Recycling agenda items is considered acceptable, if not preferred, over accepting a change to the status quo
  • Majority vote is the best decision-making process as it is transparent and efficient


A model for better meetings

The following three steps will contribute to more engaging and productive meetings: create context; do a check-in; clarify and agree to the goals, roles, interpersonal relationships, and processes (GRIP).2 Top


Create context

Engagement, in part, depends on creating context. Leaders must be clear about what is compelling for the group to come together, before calling the meeting. Many meeting participants report confusion about why they are meeting. It is not at all unusual for each participant to come to the meeting with a completely different understanding of why the meeting is being held, and these misunderstandings can create unnecessary conflict. Understanding the “backdrop” for the meeting conversations is essential for engagement.


Leaders should think about the following questions before organizing the meeting:


  • What issues compel us to meet now?
  • What is going on in the internal and external environment that requires our attention?
  • How will the compelling issues affect our conversations and decisions?


The ideal way to create context is for the leader to begin the meeting by describing it. Doing so requires answering the questions, “Why are we here?” and “Why are we here now?” Depending on the topic of the meeting and how long ago participants last met, asking the meeting participants to answer the question, “What’s happened since we last met that may influence our conversations and decisions today?” is an ideal way to ensure that the context is fully clarified and to increase engagement of the group members. If the group has never met before, this question can be modified to, “What has happened in the last 2 weeks (insert any relevant time period here) that may influence our conversations and decisions today?” Top


Another essential element in creating context is clarifying the boundaries of the problem-solving space: those features of the system that would be considered constraints (such as budget and time) and decisions that have already been made. Meeting leaders often find themselves attempting to manage conflict among participants when constraints and previously made decisions are not communicated clearly at the beginning of the meeting. Before going into a meeting, leaders should ask themselves: “What are the known constraints affecting our decision-making?” and “What decisions have already been made?” And make sure they communicate the answers to the participants before moving forward with the meeting.


What happens if the meeting leader does not know the boundaries of the problem-solving space? It could be argued that, in this case, the meeting should not take place until this information is clarified. Alternatively, the meeting leader may know some of the boundaries or constraints but not all. In this case, it is perfectly acceptable to ask the participants to identify additional constraints. In fact, asking participants to identify boundaries or constraints could serve as a meeting “check-in.” Top


Do a check-in

A check-in is a best practice for creating engagement. It serves three important functions. First, it orients participants to the business of the meeting by serving as a transfer in or bridging function: from where participants have been, to where they need to be now. Participants come to meetings with many things on their minds, most of which have nothing to do with the meeting. A check-in provides participants with an opportunity to “take a breath” and focus their attention on the business of the meeting.


Second, the check-in is an important tool for building relationships among members of the team. People who know one another as people, rather than as boxes on an organizational chart, tend to have more productive and respectful conversations, which, in turn, lead to more informed problem-solving and better decision-making. The check-in provides an opportunity to get to know one another. Top


Finally, the check-in can help both the meeting leader and participants more clearly understand their needs with respect to the meeting agenda and use this information to ensure that the meeting conversation reflects those needs. The check-in can also be used to create an agenda in cases where the meeting is scheduled at the last minute.


Although check-ins need not take a lot of time (5–10 minutes depending on the length of the meeting and how frequently the group members meet), the time they do take is valuable in terms of helping to create the psychological safety necessary for group members to share information effectively, solve problems, and make decisions.


A check-in that achieves all three of the purposes mentioned above could consist of asking participants to state: one thing on their mind that has nothing to do with the meeting today and one thing on their mind that has something to do with the meeting today. Top


Clarify and agree to the GRIP

The meeting leader is responsible for ensuring clarity and agreement regarding:


  • Goals — what we are trying to accomplish
  • Roles — who will do what to accomplish our goals
  • Interpersonal relationships — explicit agreements about how participants will engage in the meeting conversation
  • Processes — how we will accomplish our goals


Goals: The overarching goals for the initiative or project should be stated at the beginning of the first meeting. The goals for subsequent meetings should be stated at the beginning of each meeting and included in the agenda. Meeting goals should focus on the results the group is trying to achieve. Top


A word of caution: all too often, both meeting leaders and meeting participants are overly ambitious in terms of what might be accomplished in any given meeting. Many meetings are scheduled for only 1 hour. If leaders want to create an environment of psychological safety, which is critical for healthy dialogue, and ensure that all participants have an opportunity to contribute their perspective, then they must build adequate time into the design. Participants often feel discouraged when agreements for moving forward (a.k.a. “decisions”) never seem to get made. Engagement is more likely to occur when participants feel that meaningful progress is being made. When setting meeting goals, less is almost always better than more.


Roles: Meeting leaders often assume that they need to do everything themselves. However, when meeting participants assume some responsibility for meeting effectiveness, the level of engagement tends to increase and the role of the leader is less onerous. Meeting roles can include: time keeper; recorder; someone to alert the group when the conversation is going off track; someone who keeps track of decisions that the team has made; someone who keeps track of questions for which the team members do not have answers; someone who drafts the agenda for the next meeting (the agenda should include “great ideas” that came up during the meeting but were not explored and questions for which no one at the meeting had an answer). Top


Processes: The meeting leader should clearly state how the group will do its work. Some examples include:


  • How many meetings the participants will be required to attend
  • How long the meetings will last
  • How decisions will be made
  • How the team will keep the discussion moving along
  • What will need to happen to encourage participants to “tell the truth” about what is important to them


As a facilitative leader, the meeting leader must strike a balance between telling meeting participants about meeting processes (i.e., how many meetings and how long the meetings will last) and asking participants for input (i.e., “How will we keep the discussion moving along?”).


The agenda should reflect which of the three meeting processes (sharing information, solving problems, and making decisions) will be the focus of the meeting. In the early stages, not all meetings have to result in decisions. It is perfectly acceptable, for instance, to focus on sharing information with no attempt to solve the problem or make a decision about moving forward. Top


Interpersonal relationships: Engagement is directly affected by how the meeting leader and meeting participants interact. Facilitative leaders focus on creating an environment of psychological safety and they are responsible (along with the team members) for maintaining it.


Meeting guidelines (also known as ground rules and team charters) must be explicit. Options for creating meeting guidelines are determined by the type, frequency, and goals of the meeting.


If a meeting has been called to deal with an emergency or crisis or if the meeting is a one-time occurrence to deal with an unusual circumstance, there will probably not be enough time to engage the group in agreeing to meeting guidelines. In this case, the leader should state the meeting guidelines at the beginning of the meeting; for example, “tell the truth, listen hard, and be decent.”3 It should be noted that just because a meeting is called to respond to a crisis or a special set of circumstances, it does not negate the responsibility of the meeting leader to state the meeting guidelines. Top


Typically, however, the group will be meeting over time. In this case, the participants should be included in creating the meeting guidelines, as this will contribute to their sense of engagement. One way to do so is to ask meeting participants:


  • What can the meeting leader do to help us have productive and engaging meetings?
  • What can the meeting leader do to hinder having productive and engaging meetings?
  • What can the meeting participants do to help us have productive and engaging meetings?
  • What can the meeting  participants do to hinder  having productive and engaging meetings?


The responses to these questions should be compiled to create a set of five to seven meeting guidelines that are reviewed at the beginning of each meeting and included in the meeting agenda.


Meeting guidelines enable the meeting leader and meeting participants to “intervene” respectfully when the behaviour of participants interferes with sharing information, solving problems, and making decisions. Although the development of meeting guidelines is considered an essential practice of the facilitative leader, the extent to which meeting participants interact respectfully with one another during meetings is also determined by the extent to which meeting goals, roles, and processes are clarified and agreed to.


A resource for further reading

A wonderful resource for designing engaging meetings is Liberating Structures: Including and Unleashing Everyone.4 It provides a menu of 33 free, easy-to-learn “liberating structures” or microstructures that enhance relationships and trust. Instructions and video demonstrations are provided for each approach to replace or complement conventional practices. Top



1.Olsen M, Yates M. Facilitation skills for physician leaders — an emerging necessity in a complex health system. Can J Physician Leadership 2014;fall:23.

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

3.Dr. B, @HelpMyDoctor, Twitter, 16 Nov. 2013.

4.Lipmanowicz H, McCandless K. Liberating structures: including and unleashing everyone.



Monica Olsen, MHRD, is an independent organization development consultant (Olsen and Associates Consulting Inc., Richmond Hill, Ontario). Her current focus is on leadership development in the health care sector through customized education programs, facilitation, and coaching. She is a long-standing faculty member of the PMI Physician Leadership Program.


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 PMI Physician Leadership Program for the last 16 years.


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