Bethany Rogers, BSN, RN, LSSMBB, CPHQ, CPHRM

Director of Performance Improvement, St. Luke’s Health System

Building Effective Teams and

Running Effective Meetings

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Objectives

Building an Effective Team

– The Seven Essential Team Functions

Leading an Efficient and Effective Meeting

– Understanding the Five Essential Meeting Roles

– The Kickoff Meeting

– The Three Meeting Phases

The 7-Step Meeting Process

– Facilitating Group Decision-Making

– Managing Group Dynamics

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Building an Effective Team

Ownership / Motivation

Content Expertise

Authority

Influence

Structure / Process

Accountability

Team Leadership

The team has collective responsibility

for the success or failure of the

project.

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Form Follows Function

Team members should be selected based on their ability to

fulfill one or more of these functions– Who is our LEADER?

Able to create energy and enthusiasm for the topic; able to get others to follow

– Who OWNS the outcome of this team’s efforts?

Motivated to see the project succeed, engaged in the work of improvement

– Who are our CONTENT EXPERTS?

Insight into actual workflows, barriers, competing priorities, etc.

– Who is our INFLUENCER?

Can persuade others to change behaviors

– Who will keep us ACCOUNTABLE to produce results?

Formal leader authorizing the team deployment resources

– Under whose AUTHORITY will we conduct tests of change? Who has the

AUTHORITY to enforce the standard, once set?

Formal leader who oversees workflows and has power to compel others to change

behaviors

– Who can help us succeed by providing STRUCTURE to our improvement

efforts?

Expert in evidence-based improvement science

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Essential and Distinctive

In the right quantities,

combining…

Flour Texture

Water Moisture

Salt Flavor

Time Lift

Heat Structure

…will produce a specific

and predictable outcome…

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Essential and Distinctive

In the right quantities,

combining…

Ownership / Motivation

Team Leadership

Accountability

Structure / Process

Influence

Authority

Content Expertise

…will produce a specific

and predictable outcome…

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Potential Sources

Frontline Staff (e.g., RN, CNA, tech,

physician, therapist,

EVS tech, etc.)

Unit Director PI Coordinator

Specialty

SMEs(e.g., IP, Educator,

Nurse Specialist,

Reg / Accred, etc.)

Team Leadership

Ownership /

Motivation

Content Expertise

Influence

Accountability

Authority

Structure / Process

= most effective = it could work = possible, but ill-advised

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Roles– Team roles and Meeting roles are frequently the same

…but they do not have to be the same

– Appreciate the value that each role brings to the meeting

Leader

Facilitator

Recorder

Timekeeper

Member(s)

Leading an Efficient & Effective Meeting

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Leader

– Sets the attitude, motivation, and effectiveness of the Team

– Has a communication plan with department leadership andfrontline staff

– Involves and engages stakeholders

– Retains records of the Team’s work

– Ensures that the work of the team moves forward during and between meetings

– Assigns and delegates the work of the Team to Team members and stakeholders

– Helps the Team resolve its problems, including going “up the chain”

Meeting Roles

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Facilitator

– Focuses more on the Team’s process than its product

– Guides the Team in selecting and using the most appropriate tools for process evaluation and improvement

– Monitors and manages group dynamics

– Assists and advises the Team Lead in structuring and breaking down tasks into reasonable portions

– Advises on, and teaches, data collection and analysis techniques

– Helps the Team with visual presentation of data and information

Meeting Roles

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Recorder

– Keeps a visual record of:

Important discussion points

Team decisions

Assignments (who, what, and by when)

Parking Lot items

Meeting Roles

What is the value of

a visual record?

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Timekeeper

– Monitors the team’s progress through the timed Agenda

– Notifies the Meeting Leader at 3, 1, and 0 minutes left

Interruption of discussion can be a challenge for some team

members – consider using non-verbal cues (holding up signs,

using an audible timer, or making hand gestures)

It is the Meeting Leader’s responsibility to ask the Team if they

would like to extend the discussion time on a particular topic,

and from what other topic they would like to remove equal time

Meeting Roles

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Team Member(s)

– Provide content expertise into the process or workflow

under review

All stakeholder roles should be generally

represented

– Build enthusiasm and engagement in the improvement

effort within the work area

– Serve as the “communication bridge” to others in their

same role

Meeting Roles As appropriate, the meeting Leader and Recorder

should participate in all of these functions, but

assignments should generally go to Team Members

who are NOT acting as meeting Leader or Recorder

Communication

Bridge

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The TEAM Leader doesn’t always have to be the

MEETING Leader

The meeting Facilitator may change as long as the

individuals have the skill set to fulfill the role

The Recorder role may rotate each meeting, or the

role may be shared

The Timekeeper role may rotate each meeting

The Team Member(s) may rotate on and off the

team, if approved by the TEAM Leader

Rotating Meeting Roles

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Ineffective Meetings

DYSFUNCTION DISENGAGEMENT

What are the Signs and Symptoms

of an ineffective meeting?

Uncontrolled, tangential discussion

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Ineffective MeetingsPeople don’t come at all

People don’t come prepared

for the discussion

On their phones (email,

texting)

Assignments are not done

Little forward movement,

despite significant resource

allocation

Effective meeting

skills can correct

the balance

Unclear / uncompellingpurpose

Starting late or going overtime

Unclear / misunderstood assignments

Repetitive discussion from one meeting to the

next

Uncontrolled, tangential discussion

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Define the project:– Problem statement, Aim statement, charter, etc.

– Parameters, scope, process start and end points

– Deliverables, goals, Critical to Quality (CTQ) characteristics

Define the team:– Team roles and stakeholder assessment

– Ground rules, meeting format, team member expectations

– Communication plan

Define the approach:– Outline the process (Lean, Six Sigma,

Microsystems, FOCUS PDSA, etc.)

– Plan the next meeting

Answer questions and reach agreement

The Kickoff Meeting

Fa

cili

tato

r

Le

ad

er

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Should generally cover:– How disagreement is handled

– How the team makes decisions

– Communication plan (high level)

– Behavior expectations

Timeliness / attendance

Completion of assignments

Engagement

Ground Rules

Common Ground Rules1. Start on time, end on time2. If you oppose, you must

propose3. Be present; excuse yourself

when interruptions are necessary

4. No “meetings after the meeting”

5. Team members support team decisions, regardless of personal opinion

What ground rules do you like to use?

Why do ground rules frequently fail?

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Voting

– Decision point: Simple majority? 2/3 majority? Unanimous? Multi-

voting?

– Voting membership: Quorum? Members present? Do all members

have a vote?

Consensus

– Does not mean all in agreement – means no strongly held

disagreement

– Establish safety for dissention: Give everyone a chance to express

their opinion

Leader (independent decision with group input)

– Must be established at the first as the decision-making mechanism

– Useful for controversial decisions

Decisions made at the meeting stand

– Must be brought back to the team for reconsideration if new information

surfaces

Facilitating Group Decision-Making

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Set the tone– Send out meeting materials in advance, so time at the

meeting can be spent on content rather than orientation

– Start on time and end on time

– Enforce your ground rules

Get it all on the table – Discuss and document assumptions and beliefs about the

process in question

– Establish safety and open communication

Create a shared vision– Identify measurable objectives and success factors

Keep the momentum– Schedule the first team meeting about a week after the kickoff

Tips for a Successful Kickoff Meeting

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The Three Meeting Phases

• Pre-Meeting1. Identify the AIM of the

upcoming meeting • Don’t ever have a meeting just

because it’s on the calendar

• Ensure that all stakeholders have been invited

2. Review assignments from the last meeting

• Is any follow up or loop-closing needed?

3. Create a timed Agenda

4. Share the Agenda with the Team

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The Three Meeting Phases

• Meeting (7-Step Meeting Process)

1. Clarify / agree upon Aim(s)• What we intend to accomplish with our

time

2. Review meeting roles• Leader, Facilitator, Recorder, Timekeeper

3. Review agenda• Determine or agree upon time allocations

for each agenda item

4. Work through agenda items• Keep active, visual meeting records

5. Review the meeting records• Make revisions

• Agree upon assignments

6. Plan the next meeting’s agenda• Aim(s) and agenda items

7. Evaluate the meeting• “Went Well / Next Time”

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The Three Meeting Phases

• Post-Meeting1. Communicate meeting

decisions to stakeholders

• Up Team Leader

• Across Team Members

2. Carry out Action Items

• Action Items drive meeting frequency

• “Working Teams” should meet frequently to drive forward movement

• “Reporting Teams” should meet based on cadence availability of new information

3. Identify new issues that need to be brought to the next meeting

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Action ItemsWho What When

Joe P.

Find

policy on

SAEs

Next

mtg

Sarah

H.

Find out

drsg par

level

Next

mtg

Meeting Records - Flipcharts

Discussion Record

Write highlights of

discussion, including

any decisions that were

made by the group

Parking Lot

Write down the

thoughts,

comments, or ideas that

people offer that don’t

directly relate to the

discussion at hand

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Meeting Records – Computer/Projector

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The Meeting Facilitator is

responsible for monitoring and

managing group dynamics– Supported by the Meeting Leader

Essential Tools for Managing

Group Dynamics:– Ground Rules document

– Parking Lot

– Aim Statement / charter, etc.

– Timed Agenda

– Meeting Evaluations

Managing Group Dynamics

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Attacks the product or the people

“This is stupid.”

“We’ve tried this before and it

didn’t work.”

“You’ll never get people to agree

to that.”

The Nay-Sayer

Management Strategies

• Remind the team of the

ground rules

• “We’re interested in your

improvement ideas”

• “How was this implemented

when it was done before?”

• “What were the lessons

learned last time, so we

don’t make the same

mistakes?”

• “How do you think we could

influence change with this

group?”

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Doesn’t want to be there

Attacks the process

“This is stupid.”

“Can’t we just skip this step?”

“Do we have to do this?”

“This is a waste of time.”

The Heckler

Management Strategies• “Tell me why you are frustrated

by this part of the process.”

• “Tell me why you find this hard.”

• “Tell me what part of the process is not working for you.”

• “Tell me why you are on this team.”

• Work with the Team Leader to reassess this person’s functional contribution to the team

– Are they a strong influencer?

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Dominates the conversation

Likes to hear the sound of their

own voice

Never shuts up

Doesn’t listen to what others

have to say

The Me Monster

Management Strategies• Structured conversation

– Round-robin for comments

– Written comments

– Timed comments

• Remind the team of the ground

rules

• Enforce the timed agenda

• Make them the Recorder

• “So, to sum up…”

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Does not speak up

Spends meeting time on mobile

device

May appear disengaged, or

may be highly engaged, but

silent

The Wallflower

Management Strategies

• “We haven’t heard from you

in a while – what are your

thoughts on X?”

• Structured conversation

– Round-robin for comments

– Written comments

– Timed comments

• Evaluate the safety of the

environment

• Control the Me Monsters –

Wallflowers don’t talk over

people

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Offers off-the-wall comments

Goes off on tangents in the

conversation

Ends up with a lot of

comments in the Parking Lot

The Space Cadet

Management Strategies

• “Tell me more about what

you’re thinking with that.”

• Reorient to the Aim of the

meeting

• Reorient to the scope of the

project

• Make them the Recorder

• If comments are disruptive,

consider using Structured

Conversation

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Jumps to solution

“All you need to do is X, and it’ll be no problem.”

“At my other hospital, we did it this way.”

Offers primarily “sucker solutions”

– New policy

– New form

– More staff

– Education

– Etc.

The Meddler

Management Strategies• Remind the team of the value

of following a structured improvement process in order to get lasting results

• Thank them for their suggestions, and let them know that we’ll need those when we get to the point of talking about change concepts

– Use the Parking Lot

• Reemphasize the need for data to inform our improvement efforts

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Handling Disagreements

Clarify – Try to identify the source of the assumption or belief that is driving the

opinion Query the participants about the accuracy of your perception of their belief

Identify how you can determine if the belief is valid

– Offer to restate the differing opinions Restating can give a participant insight into how their message is coming across

Restating can give a frustrated participant the sense that they are being heard

Redirect– Ask people to bring information / data to the next meeting for further

discussion

Reorient– Find common ground

Refer back to the Aim statement, problem statement, charter, etc.

If there is high emotion…– Take the discussion offline (eliminate the audience)

– Refer back to the team’s ground rules for behavior

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Questions and Answers