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Assignment 05: Generalized Quality Problem

Should you address this continuing problem with the group at large at your August meeting?

Assignment 05: Generalized Quality Problem Instructions Directions Read “The Generalized Quality Problem” Case Study in Chapter 32, pages 481-482. In two pages, not counting the title page, respond to the following questions: Should you address this continuing problem with the group at large at your August meeting? Explain. Should you do some research aimed at identifying the more troublesome employees and address their quality problems at the August meeting? Explain. How would you mobilize your transcription group to address the quality problem and recommend solutions? Give an example of how the supervisor’s communication skills could help this department achieve its mission and increase productivity. CHAPTER 32 Holding Effective Meetings One secret of successful conversation is learning to disagree without being disagreeable. It isn’t what but how you speak that makes all the difference. Ben Franklin used to remark diplomatically, “On this point I agree. But on the other, if you don’t mind, may I take exception?” —Jack Harrison Pollack CHAPTER OBJECTIVES ? Review the primary purposes of meetings. ? Identify the principal components of a properly structured meeting. ? Review the necessary preparations to be made in advance by the individual who is to chair the meeting. ? Recommend a procedure for the conduct of a meeting. ? Provide advice for meeting attendees to apply as constructive participants. ? Review the various kinds of problem attendees whose behavior threatens to disrupt the meeting, and suggest how the chairperson may cope with nonconstructive behavior. KEY TERMS Abilene Paradox: The inability to manage agreement, occurring when members approve an action contrary to what they really want, because they fail to express their true opinions and vote for something to which they object but which they believe the group favors. ? Getting Together to Solve a Problem A scenario: A problem developed within the hospital’s finance division in the processing of receiving reports, from the receipt of incoming material to the completion of payment. The purchasing manager, Mr. Sampson, recognized the problem and pointed it out to his immediate superior. Sampson said he understood the situation and knew how it should be corrected, but to do it right would involve five different departments. Sampson was directed to “get together with the other four supervisors and work out a solution.” On short notice Sampson called a meeting of the affected supervisors. Only two of the other four were able to attend; of the other two, one was ill, and the other was on vacation. So the three persons who were available went to work on the problem. They developed a workable solution that required little implementation effort on their part but called upon the two missing supervisors to take nearly all of the required action. Sampson put the results of their decision in a memo to the two supervisors who were expected to implement the decision. Assuming that what Sampson and his companions arrived at was the most reasonable solution possible, could there be any legitimate reasons for resistance from the two supervisors who were expected to carry it out? If you were one of the two supervisors left out of the meeting, how would you react to the “directive” from Sampson and what would you do about it? Think about this while going through the next few pages. ? A Necessity Despite their tainted reputation, meetings remain one of our most valuable communication tools. We use them for team building and coordination, cross-functional activities, dissemination of information, training, problem solving, and decision making. Committees, task forces, and focus groups could not function without meetings. Ad hoc problem-solving meetings conducted in a brainstorming mode are often among the most valuable of meetings. We must, of course, not forget departmental and staff meetings. Essentially every department or departmental subgroup holds regular staff meetings. Indeed, there may be few if any healthcare institutions that do not encounter a shortage of places to meet. It seems that only vehicle parking space is in greater demand than meeting space. The amount of information flowing out of computers has made meetings even more important because there is an ever-increasing amount of information to be shared and discussed. Many managers believe they spend too much time in meetings and that a great many meetings are a waste of time. They are correct on both points. Nevertheless, the higher people rise in the organization, the more time they spend in conferences. Insecure managers call meetings for the sole purpose of getting moral support or sharing responsibility. Perhaps the biggest time waster is the regularly scheduled meeting, often held even when there is nothing important to discuss. ? Major Purposes of Meetings Meetings as we know them in organizational life are held to share, exchange, or disseminate information. Specific purposes for holding meetings are as follows: ? To explain new policies, laws, services, protocols, systems, or restructuring activities; in general, anything that involves change ? To accept reports or recommendations ? To make decisions, solve problems, allocate resources, prepare plans, establish priorities, generate ideas, or assign tasks ? To persuade or obtain commitment for an idea, program, or proposal ? To teach, train, demonstrate, or explain tasks and procedures ? To congratulate or reward ? Components of a Meeting All properly structured and conducted meetings include the following essential components: ? Purpose: the reason for the meeting ? Input and content: leader, attendees, agendas, visual aids, handouts, meeting room facilities, objectives, facts, and opinions ? Process: presentation, discussion, consensus, voting, negotiation, information exchange, expression of feelings, planning, problem solving, and decision making ? Product: problems solved, decisions made, compromises reached, commitments obtained, schedules, assignments, priorities, resources allocated, and action plans ? Responses and follow-up: actions taken, information provided to meeting constituents and other people affected by the decisions ? Advance Preparations by the Chairperson In addition to preparing an agenda and ensuring that meeting space and resources are available, chairpersons improve their effectiveness by soliciting ideas, opinions, and information before the session. They encourage attendees to submit suggestions for topics. Talking to attendees before a meeting often eliminates the need for that meeting. This is also a technique for getting opinions from passive individuals who may be reluctant to speak up at the meeting. Let the participants know what you expect of them. Designate whom you will call on to discuss certain points. Morning meetings when everyone is awake and fresh are ideal. After lunch, some people get sleepy. Many people find it productive to hold meetings at 4 p.m. By that hour they have ideally taken care of most of their major daily problems and still have a little time to return to their offices for last-minute details after the session. The selection of attendees is important. You can reduce costs and avoid displeasure if you limit attendance to people you absolutely need and who are willing to serve. The attendees should collectively have the necessary knowledge and experience. They should be the kind of people you can depend on to show up and participate. The larger the number of attendees, the slower the meeting progress and the more difficult it is to stick to the agenda. A group of five to eight people is ideal for most action meetings. To help reduce meeting size, consider part-time attendance; that is, ask people to be present only when you need them. Encourage them to leave when they have made their contributions (busy people are grateful for this). If your meetings tend to run too long with little being accomplished, schedule them to take place just before quitting time. Many supervisors prefer Friday afternoons because they can review the week’s progress. They also prevent the premature departure of folks who like to leave work early on Fridays. A CAVEAT You do not win popularity contests with this practice. Select a Competent and Conscientious Recorder Meeting records are important, so you want a recorder who takes clear and concise notes. The recorder summarizes and condenses the information into the minutes and submits them to the chairperson for review and approval. Recorders (or chairpersons) often use flip charts to record progress or to check off agenda items as they are dispatched. Seating Arrangements Most meetings are held around a rectangular table. A circular one is preferable, especially if there is no designated leader. Classroom or auditorium arrangements are fine for distributing information with little or no interchange but not for problem-solving or committee meetings. Circular, semicircular, and U-shaped configurations of chairs have their advocates. Seminar leaders and leaders of discussion panels prefer hollow square groupings with the leader or panel on one side. Do not seat antagonists facing each other at rectangular tables (typical union-management arrangements) where they can glare across the table at each other. If you can, seat them on the same side of the table. Agenda Think of the agenda as the rudder of your discussion boat. The agenda is to a chairperson what a recipe is to a cook. Encapsulate the topics in action- or goal-oriented statements. Avoid the word “discuss” when the purpose of the meeting is to recommend action. Discussions that do not lead to actions are usually little more than hot air. After each item on the agenda, show the expected kind of result (for example, “to prepare the final draft of our mission statement”). Indicate the time allocated for each topic and the names of the people you expect to report. Use a computer to prepare your personal copy of the agenda. You can leave enough space between each item for notes so you eliminate puzzling over your scribbling in the margins. List everything you want to cover and then cut the agenda in half, either combining items or eliminating those of lesser importance. Always include a start and end time for each topic. Use action phrases like “to recommend” or “to make a final decision” rather than “to discuss” or “to consider.” Distribute the agenda several days before the meeting. If you issue the agenda too long before the meeting, some people may lose their copies and forget the contents. But if you do not give them enough time to read and digest the content, they lack time to prepare for the session. You must know where to send each copy. Some people, like members of a board of directors, for example, often prefer to get their agendas at home, whereas others wish to receive such material only at work. Reviewing the Sampson Scenario Even if the solution developed by Sampson and his two colleagues was the most reasonable available, there remains legitimate reason for resistance from the two supervisors who were expected to carry it out. These two are not in a position to feel any sense of ownership in the solution, and since they did not participate in the process they are not guaranteed to see the result as “the most reasonable answer available.” No one is likely to react completely favorably to the “directive” from Sampson. If we were the absentees, we may well see the result as piling the work onto those who weren’t at the meeting. The perception of anyone outside of the decision-making threesome is likely to be that Sampson and company railroaded the decision through to their own advantage. Anyone who had been left out of the process might well ask for another meeting at which the five can work toward a solution that all can accept—even though it may still look much like the Sampson-and-company solution. It is absolutely fundamental to problem-solving and decision-making meetings that those who will in any way be affected by the results have a voice in developing a solution. ? The Meeting Get Started Arrive early to ensure that everything is ready. For quick sessions, remove the chairs and hold stand-up meetings. Consider memorizing your opening statement, making it clear, concise, and to the point. The opening statement establishes the direction for the meeting. If this is the first meeting of a particular group, establish some ground rules before any discussions start. Here are some usable guidelines: ? We will begin and end the meetings on time. ? We will listen to others without interrupting. ? We will not allow sarcasm, ridicule, or intimidation. ? Everyone gets a chance to talk and is expected to do so. ? We will seek consensus rather than a majority vote. Sound and look enthusiastic as you review the highlights of the previous meeting and ask for any comments or corrections. Note any progress made since that meeting. How to Encourage Participation ? Go around the table, calling on each member by name. ? Respond enthusiastically to all suggestions. ? Split into breakaway groups. ? Let others lead some questioning or chair the session. ? Reinforce participation from reserved members, for example: “Thanks, Erica, for speaking so candidly.” ? Use nonthreatening, open-ended questions, such as “How do you think someone opposed to that idea will respond?” ? Withhold your opinion until everyone else has spoken. ? If a person’s suggestion cannot be accepted in full, try using part of it. ? Encourage members to build on the ideas of others. ? Preserve the egos of all members. Avoid the Abilene Paradox The Abilene Paradox is the inability to manage agreement.1 It occurs when members approve an action contrary to what they really want. This occurs because they fail to express their true opinions and vote for something to which they object but which they believe the group favors. This scenario is common when chairpersons are domineering. When the result turns out unfavorably, members either accuse each other or make lame excuses for not speaking up. This paradox can be avoided when participants have the courage to speak their minds honestly or when a devil’s advocate is present. Maintain Control Keep people from going off on tangents. When they stray, say something like, “Jessica, that’s interesting. We’ll consider that at another time. Now about ….” Summarize progress periodically by using a flip chart or whiteboard. Call for a break when things stall. Force Decisions Ask if anyone needs more data before a decision can be made. Ask a proponent to sum up his or her opinion or perspective. Do the same for an opponent. Go around the table and ask each person for his or her position and then try to achieve a unanimous decision. Call for a vote only when a serious effort for a consensus has failed or you need a record of how each member has voted. Ensure that recommendations are phrased in specific terminology. For example, “to improve emergency room service” is too general. “Decrease average waiting time in the pediatric clinic to less than 15 minutes” is more specific. Close the Meeting To avoid confusion, summarize the discussion and decisions. Indicate the areas still requiring consideration. Review assignments and select the date for the next meeting. When you must leave a meeting still in progress, provide a brief explanation and turn the chair over to an alternate who is prepared to take over. Important “Do Nots” for Chairpersons ? Do not try to dominate the meeting. ? Do not state your opinion before others have given theirs. ? Do not tell a participant that he or she is wrong. ? Do not instruct or lecture unless that is the purpose of the meeting. ? Do not argue (disagreeing is acceptable). ? Do not ridicule, kid, or use sarcasm. ? Do not take sides early in the discussion. ? Do not fail to control problem members. ? Do not allow the meeting to run overtime. ? Do not try to accomplish too much at one meeting. After the Meeting Notify the convening authority of the outcome, if appropriate. Send thank-you notes to individuals who made outstanding presentations, clarified remarks, supported you, or agreed to carry out post-meeting tasks. Prepare meeting minutes without delay. Have meeting minutes prepared and ready for distribution within 24 to 48 hours. The minutes should include the following: ? Time started, time adjourned ? Who was present and who was absent ? Statement that previous minutes were read and approved ? Brief discussion or presentation of each item on agenda ? Record of agreement or disagreement, record of vote, or decisions made ? Follow-up actions to be taken ? Date, place, and time of next meeting ? Tips for Meeting Attendees ? Ask yourself why you have been invited, and come prepared to participate. ? Arrive on time. ? Listen thoughtfully to others and try to understand their points of view. ? Look for hidden agendas. ? Ask for clarifications. ? Respect the opinions of those with whom you disagree. ? Offer honest opinions, even when these are unpopular. ? Try to separate facts from perceptions, assumptions, or opinions. ? Disagree without being disagreeable. ? Remain rational and assertive, even when harassed. ? Seek win–win solutions, and be willing to compromise. ? Accept special assignments such as searching the literature or serving as recorder. ? Avoid being a problem attendee. For Nonassertive Attendees Some individuals hesitate to speak up at meetings, thus depriving the group of their knowledge and opinions. Ideally, these people should obtain assertiveness training via seminars, workshops, or books. There are also tactics for bolstering one’s courage to speak up. One of the best approaches is to come fully prepared. Another is to use escalating dialogue. Here, you break your silence by asking questions, starting with benign requests for information or clarification, followed by more challenging queries. Finally, you start to express your opinion. Another technique is to maintain a state of interest and active neutrality during controversies. Opposing members try to convince fence sitters, who then become centers of attention. Simply listening to both sides and asking appropriate questions provides the neutral observer with clout. Use power language by avoiding discounters like “I know this sounds silly, but ….” Do not use clichés like “It goes without saying ….” Eliminate those dreadful fillers such as “Ya know” or “Uhhhhhh.” Sound enthusiastic, speaking clearly and forcefully. Do not tolerate interruptions. Say, for example, “I wasn’t finished, Lou.” Then go on without waiting for an apology. Support your vocal expressions with appropriate body language. When a speaker looks at you, give a head signal that shows your reaction. If you nod agreement or shake your head, the person will give you more attention. ? Problem Attendees There are all kinds of participants: incisive thinkers, impatient doers, chronic objectors, speech-makers, shoot-from-the-hip decision makers, and ultraconservatives; you can probably name others. Following are descriptions of several who tend to give chairpersons the most difficulty. Latecomers Encourage chronically tardy members to arrive on time. Do not reward their tardiness by reviewing what transpired before they appeared; this only encourages more tardiness. If all of your meetings start at the stated time even though all attendees are not present, most of the chronic latecomers will get the message and begin arriving on time. Attendees Who Offend Others No attendee has the right to mock or insult others. The leader should immediately interrupt the errant behavior and apologize to the person who has been ridiculed. Admonish the offender (for example, “Jack, that is uncalled for, and I’m sure the rest here agree. Let’s keep this on a professional level”). Intimidators Intimidation is a common method used to force opinions. The three primary intimidation tactics are appearing to be angry, assuming a superior attitude, or using ridicule. The chair must stop this quickly. Hostile or Angry Attendees If you know who these people are, plan what you will say to them if necessary. Practice by saying it aloud several times before the meeting; visualize a successful confrontation. At the meeting, encourage venting. The more anger that pours out, the less there is left. Do not interrupt the person, and insist that he or she not interrupt you. Nonparticipants Nonparticipants’ thoughts are elsewhere; you will soon learn that you should not have invited some of these people. Bring their minds back on track by posing questions directly to them or asking for their opinions. Side Conversationalists Some private conversation is natural. Timid members may be afraid to speak up, so they whisper to each other. These attendees may be bored or may just be discourteous. If you stop in the middle of a sentence and glare at them, this may work. If not, ask them to share their conversation with the group. Comics We all enjoy a little humor, but individuals who overdo this can be disruptive. Stop them in their tracks by not laughing, giving a wry smile as you shake your head, and say that you want to get on with the business. The most appropriate humor arises from the material and the discussion; forced humor more often than not falls flat with some attendees. Motor Mouths These people are enthralled by their own voices and never seem to run out of gas. Their comments are endless, and their questions are really just more comments. Jump in when they pause for breath. Say, for example, “Just a minute, Rita, let’s hear what others have to say,” “We’re getting bogged down, Rita, please make your point,” or “Please put that in the form of a motion.” Some of these folks cannot get enough air time. They try to engage you in repeated one-on-one conversations, usually by asking many questions. Ask them to stay after the meeting to discuss these; they rarely do. Destroyers Some participants become emotionally rather than rationally involved. They play psychological war games and demand attention by criticizing, interrupting, or taking offense at innocent remarks. One of them may say something on the order of “I resent that” or “If you people approve that, I’m walking out.” Ignore their outbursts. Do not argue or get excited. Let them say their piece, and then move on. ? Committee Meetings Committee meetings are subject to the same rules and conduct as other meetings. Standing committees are permanent and meet regularly. The Joint Commission (TJC) [formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)] requires a number of such committees. Standing committees deal with matters such as quality, safety, infections, ethics, and credentials. Bylaws, union contracts, and operational procedures or protocols list the functions and responsibilities of standing committees. Ad hoc committees are temporary, created to deal with a single issue such as a threat of unionization or a one-time problem. A task force is a special kind of ad hoc committee created for a specific purpose. It is unfortunate that so many healthcare workers dislike committee assignments because committees are constantly growing in number and importance. Managers at any level can appoint ad hoc committees. When you appoint a committee, be specific about what you expect. Answer the following questions: ? Who is to chair the meetings, and does that person have the power to appoint members, schedule meetings, and prepare agendas? Select the chairperson carefully. ? Is membership voluntary? ? What is the goal or mission of the committee? ? When is a report due? Are there to be interim reports? If so, at what intervals? ? If it is a decision-making committee, what are the alternatives to be considered? ? If it is a problem-solving committee, do you want only what is deemed to be the best solution or do you want a list of all the alternatives? ? Will you carry out whatever the committee recommends, or only the parts you like? ? What facilities and fiscal support are available? ? If the committee is to serve permanently, have terms of tenure and plans for rotation of membership been provided? ? Telephone Conference Calls Although they are sometimes necessary, conference calls present some particular disadvantages. It may be difficult to identify all the voices. Participants lack the opportunity to observe body language, and it is easier for certain individuals to dominate the conversation. Finally, some people are simply not comfortable with this form of communication. Despite all these disadvantages, the use of conference calls has been increasing because of their convenience and the saving of time and expense. They are ideal for obtaining a vote or getting quick opinions from key people. THINK ABOUT IT The most important single point about convening and conducting meetings is one to be considered before any of the advice contained in this chapter is applied: Is this meeting really necessary? Any time a meeting can be avoided with no harm to organizational communication, problem solving, or decision making, it should not be held. What gives meetings their generally bad reputation is the number of them that are unnecessary. QUESTIONS FOR REVIEW AND DISCUSSION Why should there be a separate recorder appointed for a meeting? Why not have the chairperson fulfill this function and thus keep down the number of essential attendees? Why should we not seat antagonists facing each other across a conference table? Why and how can the active presence of a devil’s advocate help avoid falling prey to the “Abilene Paradox”? What is one form of meeting for which it is appropriate to expect everyone present to actively participate? And one form of meeting where little or no attendee participation is expected? If five to eight people is the ideal range of membership for a group considering various actions, how can a board of, for example, 30 persons effectively do business? When you are convening a meeting, why not make your position, opinion, or recommendation clear at the outset to let attendees know where you stand? Why are so many regularly scheduled meetings wasteful and inefficient? What is the purpose of the practice of setting meeting times at odd hours, for example 9:06 a.m.? How would you handle a meeting participant who behaves as though he or she knows considerably more about the subject of the meeting than you, the chairperson? Do you believe that meetings in general have a tainted reputation as claimed in the chapter? Why or why not? ? Case: The Generalized Quality Problem You are supervisor of the central transcription service at City Hospital. Your group includes several transcriptionists who handle all the dictation from laboratory and radiology and the typing for several department managers as well as all medical record transcription. You are in the habit of holding a brief informational meeting with your staff early each month. At your June meeting you felt obliged to point out that quality was slipping, errors were on the increase, and more care had to be taken with transcription. (Straight

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