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Partner Meetings, Physician Outbursts, and Dale Carnegie

MD Monthly Magazine, October 2016

Earlier this month I went on a walking meeting with a good physician friend along the lakes of beautiful Ladybird Lake in downtown Austin. During our walk, she expressed her surprise when, during a partner meeting one of the physician owners rolled her eyes dramatically and mouthed disgust over the ensuing discussion. I wasn't as surprised given my experience in physician partner meetings and the -- how can I phrase this -- near Tony-award-winning expressions and performances I have witnessed. Because these "performances" seem so commonplace in the medical industry, I thought I would dedicate a few words to it this month.

I'm not a psychologist, but I can't help but hypothesize that the frequency of this problem among you 'doctor types' might have something to do with your unbelievable heart, passion, and concern for humanity combined with a lifetime of education learning to identify, diagnose, and “fix” (aka - make decisions promptly, authoritatively, and in a silo). Further, as a kid, you were likely so bright that your good grades made it possible to skim right through some of the more qualitative subjects, such as those proffered by the likes of Dale Carnegie and Daniel Goleman.

As a b-school junkie, the quaint smells and hands-on atmosphere in the biology lab where you excelled left me in the hallway hunched over and green-faced. Learning "how to win friends and influence people" was going to be a necessity in my life. So today I wanted to share with you a few lessons, using the scientific method, of course, that I would like for you to "experiment" with for greater success in getting your point across, expressing dissention, and achieving measurable outcomes in partner meetings

OBSERVATION:

Your physician partner meetings are inefficient and rarely productive. If you express displeasure or disagreement, people get offended. Discussions on important matters either become over-heated or are avoided, impairing the decision-making process. Complaints tend to be re-hashed at every meeting with very little resolution.

HYPOTHESIS:

With the addition of a few tools on your Mayo Stand, you can:

  • Have productive partner meetings with clear decisions finalized at each meeting
  • Comfortably express differing opinions
  • Avoid re-discussing the same “problems” at every meeting

EXPERIMENT:

Step 1: Realize that multiple insights yields better results

Understand that there is a lot of scientific evidence supporting the theory that collective intelligence yields better outcomes than individual opinion. So much so, in fact, that MIT now has an entire Center for Collective Intelligence. "When there are many who contribute to the process of deliberation," states Aristotle so eloquently, "each can bring his share of goodness and moral prudence…some appreciate one part, some another, and all together appreciate all".

If you aren’t a theorist, however, let’s look at some real-world data. Google, Wikipedia, and Amazon are all designed for key decisions to be made through banter and group discussion. Amazon even takes it a step further - not only do they make all key decisions within teams, but they also have a specific program in place to revere those within the group who break convention with "peculiar", or differing, perspectives. So how do they do it without killing each other? It starts with their mindset.

If we can start by going into partner meetings with the mindset that "peculiar" (note the use of a non-offensive word here) yields better outcomes, suggesting the "peculiar" doesn't have to get your blood boiling (or anyone else's, for that matter).

Step 2: Learn to banter

Practice banter in a safe environment first (perhaps in a class or with a trusted friend) and heed Part Four of Dale Carnegie's famous "How to Win Friends and Influence People" (this is the section with guidance on changing people's attitudes and behavior) by (1) beginning with praise and honest appreciation, (2) calling attention to people's mistakes indirectly, (3) talking about your own mistakes before criticizing another person, (4) asking questions instead of giving direct opinions, and (5) always letting others save face.

Step 3: Stick to the same agenda

Use the following agenda for every meeting:

  1. Decisions to Make
  2. Issues
  3. Goals to Achieve

Step 4: Assign a timekeeper

Beginning with Agenda Item #1, go around the table and give everyone a maximum of 30 seconds to add discussion items to the list. Assign a timekeeper to time 30-second increments. This is not a time to pitch arguments or prove points; it is only a time to add decisions, issues, and goals. Write all items added to a whiteboard visible to all. Continue this process with Agenda Items #2 & #3.

Step 5: Follow a system

Ask the following questions for each item on the list:

  1. Decisions to Make
    1. Does the decision need to be made in the next 30 days?
      1. If yes, circle it (these decisions will get addresses in today's meeting).
      2. If no, document and pre-place on the board for the next meeting.
  2. Issues
    1. Does this issue need to be fixed within the next 30 days?
      1. If yes, circle it (this will be decided on in today's meeting).
      2. If no, document and pre-place on the board for the next meeting.
  3. Goals to Achieve
    1. Are there any actions we need to take over the next 30 days to assure we achieve this goal on time?
      1. If yes, circle it (this will be decided on in today's meeting)
      2. If no, document and pre-place on the board for the next meeting

Step 6: Assign & make decisions

For the circled items on the list ONLY (ignore all non-circled items; they will not be discussed today), ask the following:

  1. Who needs to be involved when making this decision? Moreover, who are the lowest-level people in the organization who can make this decision and achieve an outcome that is wise and well thought-out? (Keep in mind that it is unwise, time-consuming, and very expensive to have every partner involved in making every decision. Often managers and other staff members are more suited for certain decisions.)
    1. For any item that can be decided by someone other than the partners, define:
      1. Which partner will accept accountability for ensuring this is assigned to the appropriate manager and report back to the group during in the next meeting.
      2. End discussions.
    2. For any items that can be decided by a subset of the partner physicians, define:
      1. Exactly what partners should be involved.
      2. Those partners will stay after the meeting and, following the guidelines in Step 2 above and Step 6C below, will make the decision.
    3. For any items that need to be decided on by 100% of the partner physicians (or decided by vote), do the following:
      1. Present the item.
      2. Go around the room and give every partner 1 minute to present their 'case' (no one else is allowed to speak).
      3. Once all opinions have been heard, go around the room again and give each partner 30 seconds to 'banter' someone else's case.
      4. If the issue is significant or heated, take a 10-minute break here for people to gather their thoughts.
      5. Once back together, a 3rd and final cycle of arguments will be heard (final 'presenters' will register during the break, and then will have 2 minutes each to present their argument).
      6. Take a written, silent vote.
      7. Announce the outcome.
      8. Move on to the next item on the list.

The process outlined above may seem elementary and beneath you at first, but many of the world's most successful companies use a similar structure because it is efficient, quantifiable, creates accountability, and gives everyone a chance to be heard. Group "peculiarities" should ultimately encourage positive, lively, inoffensive debate that leads to either the initial desired outcome; an undesired outcome that you understand and feel comfortable with given that everyone was 'heard' and all opinions were voted on in a logical, fair manner; or a new outcome that is by far better than anyone thought possible going in because the discussions led to the creation of new possibilities.

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