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Cutting Meetings Down to Size
As part of a broad safety initiative, meetings get the ax

Last summer, we got word that something was going to be done about the problem of meetings.

We made a few calls. One source was “back-to-back until 6 o’clock.” Another had a 15-minute “window” later that day. When we eventually reached someone, we discovered that a meeting to discuss the problem of meetings was actually in the works. No one had managed to schedule it, however, because everyone was always “in a meeting.”

Now, though, meetings are front and center on the radar screen. In a letter dated Oct. 6 and sent to all clinical chiefs, directors of nursing, administrators and clinical officers, Dean Edward Miller and Hospital President Ronald Peterson put forth several recommendations involving meetings—chief among them that there be no multidepartmental meetings on Fridays, and that all meetings start on time and end within 45 minutes. Furthermore, some meetings will be evaluated. Those found to have little value will be eliminated.

Cutting back on business meetings is nothing new. Plenty of companies have resorted to tactics that run the gamut—from training people how to run effective meetings, to forbidding food and drink in meetings, to even furnishing conference rooms with hard, uncomfortable chairs. Some, including a large, nonprofit health care system in Minnesota not unlike Hopkins, have also set aside one meeting-less day a week.

What makes the Hopkins initiative a real original is that the cutback in meetings is designed not only to improve productivity but also free up time to spend on a single, enterprise-wide goal: making Hopkins safer by a factor of 10. It’s all part of a broad plan that seeks to create a culture of safety by offering leaders the time, the tools and the incentives to make it happen.

Supported by the Center for Innovation in Quality Patient Care, the plan, says Renee Demski, director of operations integration and program development, “is all part of an attempt to build an organizational structure that promotes a commitment to safety. We know there will be some trial and error, but we want to try different things.”

How bad is the meetings problem? Some administrators, says Richard “Chip” Davis, executive director of the Center for Innovation, run from meeting to meeting all day long. It’s a practice, he says, that’s ingrained in the culture. “If there’s a problem, we have a meeting. Then we accept the fact that we can’t get everyone together, that it takes weeks to schedule the meeting, that some arrive late from their last meeting, that people get beeped and take phone calls. In the end, the actual productive time spent is 15 to 20 minutes.”

One morning at around 11 a.m., Lisa Rowen was “between meetings.” The director of surgical nursing had already been through five. “From 7 to 7:30, I was in M&M [Morbidity and Mortality]. Then there was OR Management, a meeting with Nelson 6 nursing staff, and two ‘one-on-ones’ with direct reports.” Rowen had no fewer than five more to go: nursing students on Nelson 8, departmental administrators, a surgeon, OR Support Services, and another direct report. Plus, she’d been on e-mail starting at 4:50 that morning, and the night before until 10:40 p.m.

It’s not easy to keep track of all this. To do so, some rely on PDAs. Others, like Davis, carry their schedules on index cards in their shirt pockets. Rowen gets beeped 15 minutes before her next meeting and told where she should go next. Demski, who estimates she spends six to eight hours a day in meetings, carries a print-out of her GroupWise calendar. “If I didn’t have that, I’d be dead in the water.”

Medical Board or Management Forum? To keep track of all their meetings, some administrators carry cards like these wherever they go.

All this takes its toll on administrative assistants. “We struggle to have a day to get other things done besides scheduling meetings,” said Monica Henry, senior administrative assistant in JHOC administration. She often takes her meeting book home and schedules, cancels and reschedules at night. “When you’re trying to come up with a date, you have to know who’s flexible and who’s not,” she explains. “There’s a certain art to getting meetings on the calendar.”

“We get paid a lot of money for what we do. We shouldn’t be sitting in meetings and listening all day long,” says Michele Lagana, Bayview’s senior vice president of administration. Some meetings, she acknowledges, are key, particularly the small, interactive ones. “But if you’re just sitting there being spoken to, you’re not getting anything done.”

The meetings plan is part of a three-pronged effort launched at a recent retreat on patient safety. One group of participants came up with an array of system management tools to help people work smarter. A second group looked at ways to compensate leaders for quantifiable improvements in safety measures. A third group, the Time for Improvement Committee, led by Demski and Bill Baumgartner, chief of cardiac surgery, worked on ways to give people more time to focus on safety and quality.

In addition to having no multidisciplinary meetings on Fridays and ending meetings 15 minutes early to allow for travel time, the “time group” recommended that multidepartmental standing meetings (Management Forum, Management Committee, Emergency Preparedness and the like) be evaluated by their participants, and that leaders participate in a 30-minute session reviewing effective meeting techniques. The use of alternative methods of communication, such as conference calls, videoconferencing, Web conferencing and e-mail, also was recommended. Information Services will assist with these efforts.

To be sure, there have already been changes. Rowen now splits many of her meetings with her department’s administrator. For her own meetings, safety tops the agenda. At Bayview, there has been some consolidation, says Lagana. The Emergency Preparedness Committee, established after Sept. 11, overlapped with the longstanding Safety Committee, which focuses on the environment of care. The two committees recently combined into one Safety and Emergency Management Committee.

Consolidating, as well as eliminating meetings found to have little value, will free up more time early in the week for those meetings that would have been on Friday, Davis predicts. “Then, with no big multidisciplinary meeting on Friday,” he says, “people can use that time to get together within their departments on issues of safety and quality. Folks are here not because they want to sit in meetings, but because they want to contribute to the care of patients.”

“We have set our expectations very high: Safer by a factor of 10,” Miller and Peterson wrote in their letter. “We simply cannot achieve this without changing our organization and our expectations of each other to create a culture of safety and quality.” The framework is still imperfect, they acknowledged, but “we must be guided by the belief that it is possible to promise that no patients will be harmed at Hopkins, and we will truly be ‘Best of the Best’ in safety.”

—Anne Bennett Swingle




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