Rural Physician Leadership CurriculumRural Physician Leadership Curriculum

West Virginia UniversityWest Virginia University

Rural Family Medicine Residency ProgramRural Family Medicine Residency Program

Rural Physician Leadership CurriculumRural Physician Leadership Curriculum

Module 4

Hospital Committees,Teams & Hospital Committees,Teams & MeetingsMeetings

DescriptionDescription

Funded by HRSA Grant D22HP00306 Objective 1– Develop a competency based

longitudinal curriculum in Rural Physician Leadership

Konrad C. Nau, MDPrinciple Investigator

Chair, Dept of Family Medicine-Eastern Division

WVU Rural Family Medicine Residency Program

Rural Physician Leadership CurriculumRural Physician Leadership Curriculum

Learning Objectives : Module 4Learning Objectives : Module 4

Understand the differences between Understand the differences between hospital committees and teams hospital committees and teams

Identify factors to consider when Identify factors to consider when participating on a committeeparticipating on a committee

Understand meeting types and Understand meeting types and etiquetteetiquette

Identify signs that it may be time to Identify signs that it may be time to leave a committeeleave a committee

Rural Physician Leadership CurriculumRural Physician Leadership Curriculum

FunctionsFunctions

Crayton Fargason,MDCurbside Consult on Hospital Committees and Teams , 2001, American College of Physician Executives.

Committees Teams

- Permanent- Permanent

- See the forest- See the forest

- Oversee activities- Oversee activities

- - Supervise PeersSupervise Peers

- Strategic Policy- Strategic Policy

- Temporary- Temporary

- See the trees- See the trees

- Operational issues- Operational issues

- Multi-disciplinary- Multi-disciplinary

- Tactical operations- Tactical operations

Committees and Team Committees and Team InteractionsInteractionsCommittees delegate work to TeamsCommittees delegate work to Teams– But not visa versa– Usually process focused work

exampleCredentials Committee appoints team to

recommend critical care credentialing criteria

Committees and Team Committees and Team InteractionsInteractionsCommittees delegate work to TeamsCommittees delegate work to Teams– But not visa versa– Usually process focused work

exampleCredentials Committee appoints team to

recommend critical care credentialing criteria

Committees and Team InteractionsCommittees and Team Interactions

• Teams report to CommitteesTeams report to Committees– But not visa versa– Usually for policy recommendations

example Alcohol Detoxification Team recommends

standing orders for identifying, preventing, and treating alcohol withdrawal in hospitalized acute care medical and surgical patients

Don’t Confuse Your TeamsDon’t Confuse Your Teams

• Patient Care TeamsPatient Care Teams

•Focus on individual patients

•Care for one patient at a time

• Hospital Committees/TeamsHospital Committees/Teams

•Focus on groups of patients

•Care for the organization

•Care for the processes of the organization

Group Decision-MakingGroup Decision-Making

• Applies to Teams and CommitteesApplies to Teams and Committees• Best for 2 types of decisionsBest for 2 types of decisions

• Information-Dense Decisions

•Decisions that Require Team Implementation

• Power SourcePower Source

•Ability to consider multiple potentially competing perspectives

Group Decision-MakingGroup Decision-Making

• Address complex decisionsAddress complex decisions• Make decisions where diffusion of Make decisions where diffusion of

responsibility is appropriateresponsibility is appropriate

•CEO / Committee relationship vs

•Attending /consultant relationship

• Make decisions over a period of timeMake decisions over a period of time

Strengths : Group Decision MakingStrengths : Group Decision Making

Information-Dense DecisionsInformation-Dense Decisions– Information from multiple parties required– Take time to seat the right people– Promote dynamics that will allow all

relevant information to be • extracted • incorporated

Strengths : Group Decision MakingStrengths : Group Decision Making

Implementation Requiring CooperationImplementation Requiring Cooperation– Seat all key participants in the process– Facilitates initial buy-in– Participants can sculpt decisions that they

will have to implement– Participants can vent negative feelings

and put them in perspective • Best done BEFORE the work is to be

done

Weakness : Group Decision MakingWeakness : Group Decision Making

Passing the BuckPassing the Buck - Tendency to decrease amount of work done by any one individual

False assumption that group decisions False assumption that group decisions are more balancedare more balanced– Dominant physician decides on end result

of committee without eliciting relevant information from team members.

Team feels that they have no real input Team feels that they have no real input or authorityor authority

Weakness : Group Decision MakingWeakness : Group Decision Making

Team asked to make decision that is clearly a management responsibility

Team composition can be stacked in favor of only one side of an issue or lack key operational leaders

Creativity requires at least some individual work effort for maximal option creation

When asked to serve on a CommitteeWhen asked to serve on a Committee

Why me ?Why me ?Why the Committee ?Why the Committee ?What is the Time commitment ?What is the Time commitment ?What is my Role ?What is my Role ?

Why me ?Why me ?

ExpertiseExpertisePowerPowerPersonality Personality JCAHO MandatedJCAHO MandatedPotentialPotentialProblem Problem

Why me ? Why me ? ExpertiseExpertise

Unique operational perspective of Unique operational perspective of physiciansphysicians

Quality of Care knowledgeQuality of Care knowledge

““Power of Persuasion”Power of Persuasion”

Why me ? Why me ? PowerPower

Income contribution to the hospitalIncome contribution to the hospital““Mission Critical” servicesMission Critical” servicesExpense contribution to the hospitalExpense contribution to the hospitalDANGER : Your comments will tend to DANGER : Your comments will tend to

be interpreted as self-servingbe interpreted as self-servingADVICE : Focus on the interests of the ADVICE : Focus on the interests of the

other committee members (Servant other committee members (Servant Leadership)Leadership)

Why me ? Why me ? PersonalityPersonality

Your ability to contribute to the group Your ability to contribute to the group maintenance activity of the committeemaintenance activity of the committee

High Emotional IQ physicians are High Emotional IQ physicians are valuablevaluable– Self-awareSelf-aware– MotivatedMotivated– Self-regulatedSelf-regulated– EmpathicEmpathic– Adept in relationshipsAdept in relationships

Why me ? Why me ? PersonalityPersonality

““And when we do not know, or when we And when we do not know, or when we do not know enough, we tend always do not know enough, we tend always to substitute emotions for thoughts.”to substitute emotions for thoughts.”

T.S. EliotT.S. Eliot

The Sacred WoodThe Sacred Wood

Why me ? Why me ? MandateMandate

Executive CommitteeExecutive CommitteeDepartment or Service ChairsDepartment or Service ChairsMedical Staff OfficersMedical Staff OfficersCredentials CommitteeCredentials CommitteeQuality Assurance/Performance Quality Assurance/Performance

Improvement/Peer ReviewImprovement/Peer Review

Why me ? Why me ? PotentialPotential

Organizations must develop their Organizations must develop their human capitalhuman capital

Management can evaluate and develop Management can evaluate and develop your non-clinical decision making your non-clinical decision making abilities abilities

Opportunity for you to develop skills Opportunity for you to develop skills and create a reputation beyond your and create a reputation beyond your clinical competenciesclinical competencies

Why me ? Why me ? ProblemProblem

Bombastic and obstructionist Bombastic and obstructionist physicians can be appointed to a physicians can be appointed to a committee as a means of managing committee as a means of managing their unpleasantnesstheir unpleasantness

Unproductive and powerless Unproductive and powerless physicians have lots of spare time to physicians have lots of spare time to serve on committeesserve on committees

Why the Committee ?Why the Committee ?

Who initiated the committee/teamWho initiated the committee/teamAuthority boundariesAuthority boundariesResourcesResourcesProbability of SuccessProbability of Success– Clarity of goalsClarity of goals– Political factorsPolitical factors

Time Commitment ?Time Commitment ?

All other businesses readily accept All other businesses readily accept this professional imperativethis professional imperative

Build in in your scheduleBuild in in your scheduleHow often , how longHow often , how longPreparation time neededPreparation time neededCommittee service builds valuable Committee service builds valuable

long term relationship capital for your long term relationship capital for your practicepractice

What is my Role ?What is my Role ?

Active ParticipantActive Participant– Regularly attendsRegularly attends– Respectful communicatorRespectful communicator– Follows group agendaFollows group agenda

Group LeaderGroup Leader– Attend to group cohesionAttend to group cohesion– Help set agenda and maintain focusHelp set agenda and maintain focus– Ready to assume RiskReady to assume Risk

What is my Role ?What is my Role ?

Group Leader RolesGroup Leader Roles– Opinion leaderOpinion leader– FacilitatorFacilitator– Arbitrator/NegotiatorArbitrator/Negotiator– Keeper of the Discussion RulesKeeper of the Discussion Rules– Devils AdvocateDevils Advocate– Keeper of the Voting RulesKeeper of the Voting Rules

Types of MeetingsTypes of Meetings

““Bad meetings, and what they indicate Bad meetings, and what they indicate and provoke in an organization, generate and provoke in an organization, generate real human suffering in the form of real human suffering in the form of anger, lethargy, and cynicism…it anger, lethargy, and cynicism…it impacts people’s self esteem, their impacts people’s self esteem, their families, and their outlook on life.”families, and their outlook on life.”

Patrick LencioniDeath by Meeting : A leadership fable about solving the most painful problem in business

Jossey-Bass, 2004

Types of MeetingsTypes of Meetings

Daily Check-InDaily Check-InWeekly TacticalWeekly TacticalMonthly (or Ad Hoc) StrategicMonthly (or Ad Hoc) StrategicQuarterly Off-Site ReviewQuarterly Off-Site Review

Types of Meetings : Daily Check-InTypes of Meetings : Daily Check-In

Time: 5 minutesTime: 5 minutesPurpose/Format:Purpose/Format:– Share daily schedules and activitiesShare daily schedules and activities

Keys to SuccessKeys to Success– Don’t sit downDon’t sit down– Keep it administrativeKeep it administrative– Don’t cancel even when some people Don’t cancel even when some people

can’t attendcan’t attend

Types of Meetings : Weekly TacticalTypes of Meetings : Weekly Tactical

Time: 45 - 90 minutesTime: 45 - 90 minutesPurpose/Format:Purpose/Format:– Review weekly activities and metricsReview weekly activities and metrics– Resolve tactical obstacles and issuesResolve tactical obstacles and issues

Keys to SuccessKeys to Success– Set agenda after initial reportingSet agenda after initial reporting– Postpone strategic discussionsPostpone strategic discussions

Types of Meetings : Monthly StrategicTypes of Meetings : Monthly Strategic

Time: 1-4 hoursTime: 1-4 hoursPurpose/Format:Purpose/Format:– Discuss, analyze, brainstormDiscuss, analyze, brainstorm– Decide on Critical Issues affecting long Decide on Critical Issues affecting long

term successterm successKeys to SuccessKeys to Success– Limit agenda to one or two topicsLimit agenda to one or two topics– Prepare and do researchPrepare and do research– Engage in good conflictEngage in good conflict

Types of Meetings : Quarterly ReviewTypes of Meetings : Quarterly ReviewTime: ½ - 2 daysTime: ½ - 2 daysPurpose/Format:Purpose/Format:– Review strategy, industry trends, competitive Review strategy, industry trends, competitive

landscape, team developmentlandscape, team development– Decide on Critical Issues affecting long term Decide on Critical Issues affecting long term

successsuccessKeys to SuccessKeys to Success– Get out of the officeGet out of the office– Focus on workFocus on work– Don’t overburden the scheduleDon’t overburden the schedule

Types of Meetings : Medical MixupTypes of Meetings : Medical Mixup

All four types are separately held in the All four types are separately held in the most successful private/group practicesmost successful private/group practices

Hospital administration and management Hospital administration and management tend to hold all four meeting types tend to hold all four meeting types separatelyseparately

Hospital/Medical Staff Committees tend to Hospital/Medical Staff Committees tend to mix all 4 types into once a month meetingsmix all 4 types into once a month meetings

Types of Meetings : Medical MixupTypes of Meetings : Medical Mixup

Results of the Medical Meeting MixResults of the Medical Meeting Mix

tactical > strategictactical > strategicacute problems > chronic problemsacute problems > chronic problemsfatigued participants leave meeting fatigued participants leave meeting

towards the end towards the end – right when most decisions get maderight when most decisions get made

Types of Meetings : Medical MixupTypes of Meetings : Medical Mixup

If several meeting types If several meeting types mustmust be held be held in one sittingin one sitting

Strictly allocate time for each type/functionStrictly allocate time for each type/functionAgenda setting and adherence is criticalAgenda setting and adherence is criticalTry not to mix more than 2 meeting typesTry not to mix more than 2 meeting types

Meetings : Prepare/Prepare/PrepareMeetings : Prepare/Prepare/Prepare

AgendaAgenda– Start with specific goals/objectivesStart with specific goals/objectives– WhenWhen– WhereWhere– WhoWho

Size of MeetingsSize of Meetings

““Size Matters”Size Matters”Group dynamics change at various sizesGroup dynamics change at various sizes

• 2 – 7 participants2 – 7 participants• 7 – 15 participants7 – 15 participants• 15 – 30 participants15 – 30 participants• Over 30 participantsOver 30 participants

M. Doyle & D. StrausHow to Make Meetings Work

Jove Books, NY: 1982

Size of Meetings :Size of Meetings : 2 –7 2 –7

everyone can play multiple roleseveryone can play multiple roles– FacilitatorFacilitator - Recorder- Recorder–ChairChair - Group Member- Group Member

Good size forGood size for–All types of meetings esp. process detailAll types of meetings esp. process detail

DetractorsDetractors– ? Critical mass for best creativity? Critical mass for best creativity– Decision quality may be questionedDecision quality may be questioned

Size of Meetings :Size of Meetings : 7 - 15 7 - 15

Good size forGood size for–Problem solving meetingsProblem solving meetings–Decision making meetingsDecision making meetings–Best size for creative synergyBest size for creative synergy

WarningWarning–Need separate Facilitator and Recorder Need separate Facilitator and Recorder – Complexity requires attention to Complexity requires attention to

structure and agendastructure and agenda

Size of Meetings :Restaurant Lessons Size of Meetings :Restaurant Lessons

“ “Groups of 6 or more will have an Groups of 6 or more will have an automatic gratuity of 15% applied to automatic gratuity of 15% applied to the billthe bill””–Everyone feels they overpaidEveryone feels they overpaid

Nega-synergyNega-synergy– The probability is high that 1 or 2 “low The probability is high that 1 or 2 “low

tippers” will adversely effect the tippers” will adversely effect the contribution of otherscontribution of others

Size of Meetings :Size of Meetings : 15 - 30 15 - 30 Good size forGood size for– Information sharing meetingsInformation sharing meetings–Creates feeling of being part of large Creates feeling of being part of large

teamteamWarningWarning–Use smaller ( 7-15) sub-groups that Use smaller ( 7-15) sub-groups that

report to larger group if problem solvingreport to larger group if problem solving–Hidden sub-group agendas and win/lose Hidden sub-group agendas and win/lose

mentality can easily emergementality can easily emerge

Size of Meetings :Size of Meetings : over 30 over 30 Good size forGood size for– Lectures, panel discussionsLectures, panel discussions–VotingVoting–Creates feeling of being part of large Creates feeling of being part of large

teamteamWarningWarning–Clear speaking and voting rules neededClear speaking and voting rules needed–Hidden sub-group agendas and win/lose Hidden sub-group agendas and win/lose

mentality can easily emergementality can easily emerge

Shapes of MeetingsShapes of Meetings

““Shape Matters”Shape Matters”

M. Doyle & D. StrausHow to Make Meetings Work

Jove Books, NY: 1982

Shapes of MeetingsShapes of Meetings

““Shape Matters”Shape Matters”

M. Doyle & D. StrausHow to Make Meetings Work

Jove Books, NY: 1982

Shapes of MeetingsShapes of Meetings

““Shape Matters”Shape Matters”

M. Doyle & D. StrausHow to Make Meetings Work

Jove Books, NY: 1982

Shapes of MeetingsShapes of Meetings

““Shape Matters”Shape Matters”

M. Doyle & D. StrausHow to Make Meetings Work

Jove Books, NY: 1982

Shapes of MeetingsShapes of Meetings

““Shape Matters”Shape Matters”

M. Doyle & D. StrausHow to Make Meetings Work

Jove Books, NY: 1982

Shapes of MeetingsShapes of Meetings

““Shape Matters”Shape Matters”

M. Doyle & D. Straus

How to Make Meetings Work

Jove Books, NY: 1982

Meeting EtiquetteMeeting Etiquette

Attend regularlyAttend regularlyCome preparedCome preparedBe an active listenerBe an active listenerDon’t overuse your statusDon’t overuse your statusRespect group consensus decision Respect group consensus decision

making – this is not clinical medicinemaking – this is not clinical medicineCrayton Fargason Jr MD

Hospital Committees and Teams

ACPE, 2001

Time to Leave Time to Leave

Change in InterestChange in InterestChange in AvailabilityChange in AvailabilityConflicts of InterestConflicts of InterestDetrimental to your relationshipsDetrimental to your relationships–With physician colleaguesWith physician colleagues

–With hospital staffWith hospital staff

Time to Leave Time to Leave

Inability for CommitteeInability for Committee to have good meetingsto have good meetings

“ “ The hard truth is, bad meetings almost always The hard truth is, bad meetings almost always lead to bad decisions, which is the best recipe lead to bad decisions, which is the best recipe for mediocrity”for mediocrity”

Patrick LencioniPatrick Lencioni

Death by MeetingDeath by Meeting

Hospital Committees,Teams Hospital Committees,Teams & Meetings& Meetings

While medicine is largely a one-on-one While medicine is largely a one-on-one practice of the healing artspractice of the healing artsPhysicians have a citizenship duty to Physicians have a citizenship duty to contribute to the infrastructure that contribute to the infrastructure that enables them to sustain their practice enables them to sustain their practice of medicineof medicine

Hospital Committees,Teams & MeetingsHospital Committees,Teams & Meetings Summary:You now know Summary:You now know

the difference between the difference between committees and teamscommittees and teams why physicians should serve on why physicians should serve on committeescommittees about the most effective types, about the most effective types, size, and shapes of meetingssize, and shapes of meetings how to effectively serve or lead a how to effectively serve or lead a committee committee