Meetings, meetings, meetings
It’s nice to have a meeting. It gives people the chance to chat, catch up on the gossip and pick up the buzz. It is also an ace way of avoiding seeing any patients. The mark of seniority and importance in the NHS is spending less and less time on direct patient contact and more and more time in meetings. Of course, clinical work is extremely tiring and we can’t do it *all* the time…………..we do need to lift our noses from the grindstone occasionally and scan the horizon to see what’s coming, as well as taking time to teach, network, educate ourselves and think about stuff. Having been unexpectedly co-opted into a little bit of medical politics, I can see why people get hooked on it. Stalking the polished floors of BMA House in Tavistock Square, being waved in by the minions and helping yourself to the posh biscuits and fizzy water from the BMA-logoed bottle makes you feel really important. The national headquarters of the health service unions and Royal Colleges are huge classic buildings that reek of power, although I do find myself wondering how much of our membership subs goes on keeping such white elephants going and how effective is the activity that takes place therein. Has the huffing and puffing from the BMA and the RCN had any effect whatsoever on the relentless progress of Mr Lansley’s “reforms”? – well, quite. Did the recent symposium on flexible working delivered by eminent professors and government medics actually change anything? We all had a nice chat and I suppose came away a bit better informed, but what action took place as a result?
Meetings in GP-land were generally stuffed in between surgeries, interrupted by phone calls, and conducted with the practice accounts in one hand and a sandwich in the other. So when I moved to a salaried job with the local Trust I was quite startled at the leisurely pace at which meetings were conducted, the number of meetings there were, and the lack of clarity as to what they were actually for. They hoovered up a massive amount of what would otherwise have been clinical time, thereby rendering all the clinical staff unavailable to their patients for an entire morning or afternoon. No wonder the waiting-lists were so long. But it reflected a culture in which “management” was seen as more important than direct patient care. Managers do not see patients: they have meetings. Clinicians are expected to do both, but cannot do both simultaneously, and the meetings take priority. Let’s look at how this works in practice…………….
In an NHS workplace that shall be nameless, the “management meeting” took place on a Friday afternoon. Many people might well feel that the end of the week when people were a.) tired and b.) wanting to tie up loose ends before the weekend was not the best time for all the senior clinical staff to be trapped in a meeting for three hours. It took the only doctor on-site away from the patients and left the admin staff battling with prescription requests and sudden crises without anyone to resolve them. In fact the real purpose of it was to stop anyone from leaving before five o’clock, as the manager was obsessed with the notion that the clinical staff were lazy naughty children who had to be kept firmly in check. The agenda ran to two A4 pages containing about 35 items (with sub-clauses), with the important things at the end, by which time everyone had lost the will to live and would have agreed to selling their mothers to be made into cat food if it meant the meeting could at last come to an end. Much time would be spent on debating things on which there was no actual decision to be made – for example, the visit of a government minister recurred on the agenda for weeks. First we talked about how nice it was that the minister was coming, then we talked about how nice it was that he had come, and then we talked about how nice it was for him to have sent a letter saying what a good time he’d had, while issues like staffing levels, salaries etc remained firmly at the bottom of the agenda and somehow never came up for discussion. I earned the manager’s undying enmity by suggesting that perhaps we could circulate the minutes and agenda in advance, and divide items into “for information” and “for decision” so that we didn’t spend endless time going round in circles and could finish earlier to have time for pre-weekend mopping-up. I had misunderstood. This workplace was a dictatorship, not a democracy, and the management handbook says “have meetings”. The fact that the meetings were actually getting in the way of our primary purpose of delivering care to our patients was completely irrelevant. It was an absolutely classic example of how *not* to run a meeting, assuming that your intention is to deploy your resources wisely and efficiently rather than bully, control and waste the time of your senior staff – which, of course, it wasn’t.
Meeting games include the manipulation of agendas and circulation lists so that some people mysteriously always get left out and don’t get the minutes or even hear about the meeting in the first place, rewriting minutes so that they bear no resemblace to what was actually said or decided, or not taking minutes at all. Witness another “medics meeting” that collected eight consultants and two senior GP’s on a Wednesday afternoon for purposes unknown, apart from the one person who was never informed about it and the one who had said they really wanted to come but couldn’t do Wednesday. While it was nice for us all to have “face time” with each other, it was never entirely clear why we were there – some people wanted to discuss difficult cases and seek advice, some wanted to discuss holiday cover and admin issues, some wanted a journal club. Whatever the purpose of the meeting, the boss forgot the first rule of chairmanship, which is to switch off your mobile phone. However there is no point in being the boss if you can’t be so terribly busy and important that you must always take the call – which is why a whole room full of senior medical staff sat in patient silence while the boss had a discussion about dog fostering. It’s always useful to remind your subordinates where they stand in the animal hierarchy. After a while , of course, the patient silence disintegrated as a small sub-meeting broke out at one end of the table, an argument at the other, and the rest started wandering off to get cups of tea. Calling the meeting back to order after that little lot took some time…………..
I have been at meetings which were cordial, efficient and expertly chaired, but they were generally not within the NHS. They were in organisations that treated the participants with respect, valued their time and their contributions, and had clear ideas of why the meeting was taking place and what the outcomes and objectives were. They were vehicles for achieving the primary purpose of the organisation, not avoiding it. In the Workplace from Hell nothing would have been any different if the meetings had all suddenly stopped happening, apart from the fact that the staff would have had more time with the patients. So is your meeting really necessary?
You could be writing about universities here too – the lack of time available for students and research because we have to be in “important” meetings…
I used to work for an organisation where the finance director did not attend staff meetings because, as he literally said to everyone, including his line manager (and convener of the staff meetings), he had work to do. He was a very nice colleague, and nobody dared argue with him. Perhaps that is something to emulate!
Michael Marten
November 25, 2011