Meetings: bane of a hospitalist's existence? Not necessarily

One hospitalist gives advice on making the most of work gatherings.

New hospitalists will soon learn that they and their colleagues have many occasions to confer, some of which entail a more formal meeting structure. In particular, the meetings called “deliberative assemblies” require special skills. Awareness of the rules by which they operate is critical to being effective, avoiding time-sinks, and making opinions heard (the proper way).

This more formal modus operandi for meetings is characteristic of self-governing medical staffs, which are required by The Joint Commission to account to their boards for quality of care. The rules of deliberative assemblies also apply to other large or important meetings: practice organizations, medical societies, charitable organizations (e.g., health or educational institutions) and voluntary associations.

Deliberative assemblies derive their rules from stipulations in the organization's bylaws. Many organizations specify Robert's Rules of Order. Resources describing these rules can be found online at the National Association of Parliamentarians website. When hospitalists need action en bloc, an understanding of the rules can be gold.

Ever exit an important meeting steaming and fuming? General Henry M. Robert devised his friendly rules circa 1876, and ever since many well-meaning equals have used them to collaborate and make decisions without losing composure or friends. Deliberative assemblies are guided by the wisdom of the group, and avoid any tyranny though an ingeniously designed choreography of thought and expression.

Such structure could be denigrated as “political” with its ensuing negative connotation. But more often it resembles a good political process, for example, when a medical staff executive committee makes a wise decision for the good of the patients, families and staff.

So if you landed on a planet where meetings are conducted by Robert's Rules of Order, how would it look?

First, you'd receive a meeting notice well in advance. It would contain a meeting call, agenda, and motions with supporting documents. The advance material would afford you plenty of time to consider the motions, research their merits or demerits, contemplate alternative motions, and decide if you really want to juggle your schedule to be present. If you have a strongly-held view contrary, you might craft an alternative motion in the concise format Whereas…. (reason for your motion), and Whereas… (more rationale), Therefore be it resolved that….(your motion).

Or, if you favor a proposed motion, but want it to be tweaked, you might draft an amendment to be offered during debate. Counter-intuitively, your amendment will take precedence over the main motion. This sequence is intended to allow improvements to the main motion—to cobble together the best main motion for the good of the organization's mission—before it is eventually voted upon. Before consideration of amendments the main motion is “stated” and becomes property of the assembly, not private property of the original proponent. The assembly then determines whether to improve and adopt it, or dispose of it.

Another profound aspect of Robert's world is that a motion is always “on the table.” No, or at least minimal, time is burned by “information only” presentations. Deliberative assemblies are decision-making animals, single-minded workhorses getting things done. No time for “Blah, blah, etc.” Robert's system gets to the point. How's that sound to you, busy hospitalist?

Folks accustomed to vaguely sharing and ruminating during a meeting are flummoxed by General Robert. If you value your time, however, you'll be cheering when the Chair asks for clarity, “That's interesting, but are you speaking for or against the motion? If not, do you have a new motion that's in order?” To which Dr. Longwinded replies, “No. But I just think…blah, blah …”. The courteous Chair chirps, “Sorry, the member's comment is out of order, and we'll return to debate on the motion.”

You, harried hospitalist, joyously levitate as the Chair concludes debate—both sides having exhausted counterpoints—by calling the question and taking an immediate vote.

You'll appreciate the orderliness when Dr. Important attempts to monopolize debate and belittle opponents with ad hominem attacks. In Robert's world, Dr. I is thwarted after his first wisecrack. The Chair reminds the speaker he must confine remarks to the merits of the pending question, address all remarks to the chair, and avoid questioning motives. Robert's 19th century admonition: No nipping or biting words must be used! Other potential nippers (or biters) now conform to decorum, even in disagreement.

In the crisp debate, the Chair alternative recognizes supporters and opponents of the pending motion—before debate becomes needlessly duplicative. A vote (by ballot, if contentious) decides the question. The assembly moves on to the next motion, or adjourns. When debate is controlled in this fair-handed manner, all are heard respectfully. Rights of the minority, and the individual, are preserved. Members deliberate and depart without rancor. Comity is preserved. Clinicians, who seriously disagreed, have expressed themselves and exerted proper influence—yet find they can still work amicably together at a patient's bedside. Once, at a 600-bed hospital, we conducted old and new business of a quarterly medical staff meeting in 18 minutes. All were satisfied.

In the spirit of General Robert's Rules I've opined in <900 words. Enjoy your un-used reading time.