Latest / The Operator | Healthcare Business / Your Meetings Already Confessed

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Your Meetings Already Confessed · The Operator | Healthcare Business

0:01
All right, let's go.
0:02
All right,
0:03
most healthcare organizations have the
0:05
same response when they think they have a
0:07
meeting problem.
0:08
They launch a survey.
0:10
You've taken one, I've taken one.
0:12
You form a task force,
0:14
they create the committee,
0:15
and maybe they even schedule, wait for it,
0:18
a meeting about meetings.
0:20
In Larry's latest article on The Operator,
0:22
it makes a pretty uncomfortable argument.
0:24
You don't need any of that.
0:26
You don't need to attend a single meeting.
0:29
You don't need another survey that you're
0:30
just going to get a three point four
0:31
back anyway.
0:32
The artifacts have already confessed.
0:36
Let's find out what we mean by that.
0:37
Larry, let's start there.
0:38
How can someone figure out what's wrong
0:40
with an entire organization without going
0:43
to one meeting?
0:46
Well,
0:47
let's just start out with the basics that
0:52
I spent a lot of time on meetings.
0:53
This is the sixth article because I think
0:55
it's so important in an environment where
0:58
many people are working remotely to get
1:00
really inefficient about meetings.
1:03
And when you put a framework around them,
1:07
It helps.
1:08
And you can see the artifacts.
1:11
I know we'll get into this as we
1:13
go along there.
1:14
But I wanted folks to understand that the
1:20
uglier the product that you're seeing,
1:23
the decisions,
1:24
the things that are written down,
1:25
the things that actually come out of
1:26
meetings,
1:27
those are the compelling parts of what you
1:30
do.
1:31
CEOs make two or three decisions a week
1:34
that are big.
1:35
Teams make dozens and dozens.
1:39
Daily huddles can make even more than
1:41
that.
1:42
They're smaller decisions,
1:43
but they're really critical and they have
1:45
to emanate out of our process.
1:47
And that process is the meetings and the
1:49
byproducts that they produce that I'm sure
1:52
we're going to talk about here.
1:53
Yeah.
1:53
All right.
1:54
So you opened up in your article with
1:56
a VP sitting down with four artifacts.
1:59
And by four forty five that day,
2:00
that first day,
2:02
they could know more about the
2:03
organization than the annual engagement
2:06
survey learned in a year,
2:07
which you also go into saying you're not
2:09
really learning a whole lot.
2:11
Why start there?
2:11
Why start with that first day and what
2:14
they can learn?
2:15
Yeah.
2:15
So what I was trying to do here
2:17
is I want to put the whole argument
2:19
of the entire five-part series on one desk
2:23
and one afternoon and let you watch it
2:26
sort of work.
2:26
So the article, she lays out four things,
2:30
a photo of the morning's huddle board,
2:32
the deck from Tuesday's weekly tactical.
2:35
Again, those are two meeting contexts,
2:37
daily huddle, weekly tactical.
2:39
The third is the strategic,
2:41
so the pre-read and the minutes from last
2:44
month's strategic, and then the all-hands.
2:47
with the Slido log.
2:48
One artifact per tier.
2:51
The entire stack on a single desk in
2:53
front of one person who has not attended
2:55
a single meeting and has not interviewed
2:58
anybody.
3:00
And by quarter five,
3:01
she knows more than the annual survey
3:03
learned in twelve months.
3:04
These surveys take a long time.
3:06
They're expensive.
3:08
They're overdone.
3:09
You're usually using a third party.
3:11
People generally have survey fatigue and
3:16
it just gets long.
3:18
And then there's usually a campaign around
3:20
the survey.
3:21
And so there's a lot of artificial noise
3:22
around it as well.
3:25
But she took the four documents in the
3:27
afternoon and really produced the truth.
3:30
so i started the article there on purpose
3:32
because every operator's instinct is when
3:35
the ceo or the ceo says figure out
3:38
our meeting culture everybody tries to
3:41
reach a survey or god forbid a task
3:44
force or a committee that reports up okay
3:47
that's just poor and professional
3:48
management and that was her first instinct
3:52
was a survey her second was a task
3:54
force her third instinct was the right one
3:56
read what the meetings
3:59
actually wrote down and if you notice the
4:01
detail that the artifacts came to her the
4:04
huddle photo got texted to her by a
4:07
site lead she didn't requisition anything
4:11
the evidence you know was already there
4:13
inside the building and so that's the part
4:15
operators miss you're not missing the data
4:18
you're not reading it it's been hitting
4:20
your inbox the whole time those are really
4:22
what insights are
4:24
So what is that line in the article
4:25
which stood out,
4:26
which was the artifacts had already
4:28
confessed?
4:29
What does that mean if someone's reading
4:31
this and going, wait,
4:32
I think I know what that means,
4:33
but how can they be sure?
4:35
Yeah,
4:35
so what it really means is that every
4:37
meeting in your stack leaves a paper
4:39
trail,
4:40
and that paper trail is the meeting with
4:42
the performance stripped off.
4:45
And here's the thing about a confession.
4:47
It's involuntary and it's specific.
4:51
The deck from Tuesday is the deck whether
4:53
or not anybody audits it.
4:55
Nobody dressed it up for you.
4:56
The Q&A log from the all hands shows
4:59
exactly what questions got submitted and
5:01
exactly which ones got answered,
5:03
not the uncomfortable summary,
5:06
the actual list.
5:07
So the huddle checklist on the clipboard
5:08
shows what actually got raised at
5:15
So the artifacts,
5:16
they can't lie because they weren't
5:18
produced to be looked at.
5:19
That's the whole trick.
5:21
The moment you announce an audit and go
5:23
sit in the back of the huddle,
5:25
the huddle performs.
5:26
The board gets run properly for the first
5:27
time in months.
5:28
The tactical suddenly has all kinds of
5:30
good crisp action details to it.
5:33
And that's the Hawthorne effect and
5:35
exactly why watching tells you the least.
5:38
The observed meeting is on its best
5:40
behavior.
5:41
It's the artifacts that come out of it.
5:44
that you're caught off guard.
5:45
So when I say they confessed,
5:46
I mean the evidence of what your stack
5:48
actually does versus what it claims to do
5:51
is already written down, timestamped,
5:54
sitting in a folder.
5:55
You don't need a wire.
5:56
You don't need to read the file.
5:58
And here's an interesting tidbit.
6:00
The most damning confession is usually the
6:02
one that isn't there.
6:03
The tier that produces no artifacts or no
6:06
notes, no logs, no commitment records,
6:08
just told you something.
6:10
A meeting that leaves no trace was never
6:12
in operating.
6:13
mechanism it was a conversation that
6:15
recurs and so everybody now in a lot
6:18
of meetings and i do this um for
6:20
accountability reasons uses a meeting
6:23
software there's a million of them plod uh
6:26
you know zoom has its own everybody has
6:29
it so you know there's just a ton
6:31
of those they can be used extremely
6:33
effectively
6:34
for accountability to run through AI to
6:37
determine there to post, you know,
6:40
the documentation.
6:41
These things,
6:42
these are good tools to help you.
6:44
They're not replacements.
6:45
And that's what I'm seeing tending to
6:47
happen now.
6:48
Well, so far, just in this conversation,
6:50
I got a few artifacts of saying you're
6:51
not a hugest fan of surveys.
6:54
Why are organizations so attracted to
6:56
surveys when the answers,
6:58
as you just highlighted,
6:58
are often sitting right in front of them
7:01
somewhere else?
7:02
Yeah, surveys are excuse, you know,
7:04
they feel like there's some action going
7:06
on,
7:06
it produces a number that you can put
7:08
on a slide.
7:10
And, and, you know, that's,
7:12
that's just almost irresistible to a
7:14
leadership team.
7:15
By the way, just as a side note,
7:18
I'm a fan of one question surveys that
7:21
go to the stakeholders of a particular
7:24
department that evaluate that department.
7:28
How is our accounting group performing?
7:31
and have a Likert scale.
7:33
Why did you answer it that way?
7:34
That's it.
7:36
If you do that appropriately,
7:38
surveys could be good.
7:39
But what we tend to do is use
7:40
them as excuses.
7:43
It say we listen to you,
7:45
but it never really brought anything up
7:47
uncomfortable.
7:48
If it did,
7:48
you did it in writing and you didn't
7:50
have a conversation about it.
7:52
And so it outsources discomfort to a
7:54
vendor, you know,
7:55
usually a very expensive vendor.
7:57
But, you know,
7:57
there's also a deeper problem.
7:59
The survey measures mood, not function.
8:02
A meeting could feel perfectly pleasant
8:04
and produce nothing.
8:06
Right.
8:06
So the mood didn't matter.
8:08
The dashboard recital is comfortable.
8:11
The pre-screen Q&A is comfortable and
8:14
polished.
8:15
You never assess your revenue cycle by
8:17
asking the billing team how they feel
8:18
about it, right?
8:19
You pull the aging report.
8:21
Mark Benthien, SCEC,
8:21
meetings deserve the same discipline,
8:23
the question is never how the meeting
8:25
feels it's what the problem produces so we
8:26
like kpis because their objective,
8:29
but we don't like kpis.
8:30
Mark Benthien, SCEC,
8:31
or results or outcomes of meetings i'm not
8:33
sure why and that's why i've tried to
8:36
differentiate between management
8:37
leadership and operations.
8:40
Because operators want that discipline,
8:42
whether you're talking about an outcome
8:44
from a KPI or how do you keep
8:46
a meeting accountable or how do you keep
8:48
people autonomous but accountability
8:51
within structure.
8:53
And to me, that's what it's all about.
8:54
So just another little tidbit for you.
8:56
Survey asked the floor to describe the
8:58
building.
8:59
The artifacts are the building.
9:01
Why interview the witness when the
9:03
security footage is already running?
9:04
Right, right, right.
9:06
Also,
9:06
you highlighted that a lot of times you
9:08
get a three point four because no one
9:10
wants to be the squeaky wheel.
9:11
No one wants to be the thing that
9:13
says it out loud because as anonymous as
9:14
a lot of surveys are.
9:17
We all kind of doubt that or there's
9:18
ways to figure that out.
9:19
So no one wants to be,
9:20
that's why you get to a three point,
9:22
a three point four out of five.
9:25
You identified three failed approaches.
9:28
The sentiment survey,
9:30
just sort of talked about that.
9:31
The calendar cleanse,
9:32
which I alluded to earlier,
9:33
and the meeting about meetings.
9:36
Which one do you see most often and
9:38
which one is the most damaging?
9:42
Well,
9:42
most often by a wide margin is a
9:45
sentiment survey.
9:46
You get a three point four and you
9:47
file it.
9:48
It's the cheapest possible motion that
9:50
still looks like leadership and acts like
9:52
you're caring.
9:53
But the one that does the most damage
9:55
in my view is the meeting about meetings.
9:57
And I've watched platforms
9:59
you know,
9:59
try to do this with complete sincerity,
10:02
but you know,
10:03
which is what makes it so, you know,
10:04
brutal.
10:05
And so, you know,
10:06
so here's how it kind of lays out.
10:07
The COO commissions a task force to fix
10:12
the meeting problem or a committee that
10:13
reports up.
10:15
The task force schedules a working
10:17
session.
10:17
You're burning up all this time.
10:19
The working session produces, you know,
10:21
in business speak,
10:22
we call it a charter or a RACI,
10:24
R-A-C-I, and a sub team.
10:27
And within two quarters,
10:28
your meeting audit has become a fifth tier
10:30
in the meeting stack with its own deck,
10:32
its own trailing metrics,
10:34
and its own follow-ups, you know,
10:36
dietly quiet, you know,
10:37
dietly in the same follow-up, you know,
10:40
offline cemetery I wrote about in the
10:43
weekly tactical piece.
10:44
You set out to cure the disease,
10:46
and you incubated another strain of it.
10:49
And that's why it does the most damage.
10:51
The survey wastes a quarter of your time
10:54
and a lot of money.
10:55
The calendar cleanse maybe wastes a
10:56
couple.
10:57
You delete the meetings.
10:58
But both are recoverable.
11:00
But the meeting about meetings adds more
11:03
work while claiming to remove it.
11:05
And it does so with a straight face
11:08
and a project plan.
11:09
It's the only one of the three that
11:11
makes the stack even heavier.
11:12
You're just adding more stacks to a
11:15
meeting.
11:16
so the audit has to be the literal
11:18
opposite of those three which is why i
11:20
saved it for article six one person one
11:23
afternoon artifacts only one page out the
11:27
second it needs to be a committee or
11:29
a sub team you've lost it yeah
11:33
When I read meeting about meetings,
11:34
it made me think about George Costanza.
11:37
It felt very Seinfeld.
11:38
It felt very when Costanza was working for
11:41
the New York Yankees.
11:42
It sounds like something Costanza would
11:43
come up with, which is probably Gilbert,
11:44
right?
11:45
Exactly.
11:47
So talk more about those artifacts.
11:49
If someone's a health care leader
11:50
listening now,
11:51
let's go the opposite route.
11:53
Normally, I would ask,
11:54
what's the most important thing to pay
11:56
attention to?
11:56
How about this?
11:57
What's the artifact that they're probably
12:00
underestimating and should pay attention
12:02
to more?
12:04
Yeah,
12:05
the ones you're underestimating are sort
12:07
of the boring operational exhaust you
12:09
don't think of as documents at all.
12:11
So let me name them.
12:15
So the huddle board photo or the clipboard
12:17
checklist.
12:18
Operators dismiss this as too low or too
12:22
low hanging fruit that it doesn't matter,
12:24
but it's the most honest artifact that you
12:27
own because it's filled out at seven fifty
12:28
five in the morning by someone who has
12:30
no idea anyone important will ever read
12:33
it.
12:34
They're doing it for their sole purpose of
12:36
what I call working in the team.
12:37
You don't work for a company,
12:38
you work within the team.
12:41
The commitment record from the weekly
12:43
tactical
12:45
or far more often the absence of one.
12:47
So that would be a second one.
12:48
Fourteen slides and no record of a single
12:51
decision with an owner or a date,
12:54
anything.
12:55
The strategic pre-read,
12:58
the decision documentation does show
13:01
dissent on the record it literally does
13:04
and the three decisions and zero recorded
13:07
disagreements you know all of those kind
13:09
of things and it's the all hands you
13:11
know q a submission long so it really
13:13
would be you know sort of those the
13:15
the those four come to mind initially but
13:18
what ties them all together is that none
13:20
of them
13:21
was written to impress you, the CEO.
13:23
They were written as a function of the
13:24
outcome of the meeting itself,
13:26
which is what meetings are really about.
13:28
That's the filter.
13:29
Any artifacts produced for leadership,
13:32
the QBR, the leadership deck,
13:35
has already been laundered.
13:37
That's not where real action goes.
13:40
It goes by those who are closest to
13:42
the decision-making and closest to the
13:44
action.
13:46
So the artifacts that tell the truth are
13:47
the ones that are produced sideways as a
13:50
byproduct of the work.
13:51
I have a kind of rule of thumb
13:53
for this, by the way.
13:54
The truthfulness of a document is
13:56
inversely proportional to how good it
13:58
looks.
13:59
The prettier the deck,
14:01
the more hand smooth it is on the
14:02
way up to the CEO or the COO,
14:05
the less valuable it is.
14:06
If you want to know what's really going
14:08
on in the platform,
14:09
don't read any deck that was built for
14:11
the board.
14:12
You know,
14:12
read the thing that somebody scrawled on a
14:14
clipboard at seven fifty five in the
14:15
morning and mentioned to their team.
14:17
Yep.
14:18
The ugliness of that is the effectiveness
14:20
of a great organization.
14:21
Yeah.
14:22
The real stuff, the stuff you mentioned,
14:24
like the Hawthorne effect,
14:25
the stuff that can skip and bypass that
14:27
Hawthorne effect.
14:29
You suggest that organizations can
14:30
actually hold hundreds of meeting hours
14:33
but make only a handful of what we
14:36
call actual decisions.
14:37
You mentioned a couple of times in the
14:38
article,
14:39
was this a decision made in that meeting
14:41
or was this decided two weeks ago and
14:43
then sort of sourced or presented at the
14:45
meeting?
14:46
Why do leaders overestimate how many
14:48
decisions their organizations are actually
14:50
making?
14:53
So I think it's because we conflate or
14:55
confuse or count discussions as decisions.
14:59
They're not.
15:00
They feel identical in a room and they're
15:02
completely different on the artifact.
15:04
And discussions make you happy.
15:06
Decisions drive actions and success.
15:10
Run the census,
15:11
and it's violently short how well the list
15:15
actually gets.
15:17
You go through every artifact for thirty
15:20
days and write down every decision
15:22
actually made.
15:23
A resource moved, a policy changed,
15:25
a hire approved,
15:26
a pilot got launched or killed.
15:29
You had real discussion about your
15:31
marketing campaign and whether it was
15:33
effective or not.
15:35
And you're looking at this and all the
15:37
while you're counting and you're making
15:39
about six real decisions,
15:41
four of which you can trace.
15:43
And they were actually made in the
15:45
hallways and ratified by email.
15:47
Meetings didn't decide them.
15:48
The meeting witnessed them.
15:50
They discussed them.
15:51
So the reasons leaders overestimate is
15:54
that a good decision feels productive.
15:57
Everybody talked.
15:58
Everybody was engaged.
16:00
But nothing crossed the line from discuss
16:03
to decided.
16:05
No honor, no action, no date.
16:07
Who's the responsible party?
16:08
When is this due?
16:09
What are we doing here?
16:11
And so the feeling of productivity is
16:14
conflated by discussion,
16:17
and nobody wins in those situations.
16:22
What I look for is the verb.
16:24
Listen to how leaders describe their
16:26
meetings.
16:27
We discussed, we reviewed, we aligned,
16:30
we touched base.
16:31
Notice what's missing.
16:33
We decided, we came up with.
16:36
When the whole vocabulary of your
16:38
operating cadence is discussing verbs,
16:41
you've answered the question even before
16:42
the census started.
16:43
It's okay to do updates.
16:45
Like I'll have one here in a half
16:46
hour with my executive team.
16:47
They're update meetings.
16:48
It's not a decision meeting.
16:51
It's more of a huddle and keeping
16:52
everybody abreast.
16:54
And so understanding the function of the
16:56
meeting and when it's okay to have updates
16:59
and discussion,
17:01
but what is driving decisions and all the
17:04
transparency around what's actually going
17:06
on in the organization.
17:07
That's the tough work of an operator.
17:10
I think if someone's been reading,
17:12
listening to this series about meetings,
17:14
they have to understand they should be
17:15
taking away that there's four different
17:17
meetings and they have distinct, very,
17:20
very distinct purposes.
17:21
If you're running a meeting,
17:22
you don't know the purpose of that
17:23
meeting, that's bad.
17:25
If you aren't reviewing,
17:27
was this meeting purposeful, that's bad.
17:29
And you had a line in this article,
17:31
you're not running a meeting stack,
17:32
you're running one meeting in four
17:35
costumes.
17:36
So how do organizations accidentally
17:38
collapse fourfold?
17:39
four different meetings into the same
17:41
meeting that happens over and over again.
17:43
Yeah,
17:44
it happens through the path of least
17:46
resistance, one trailing metric at a time.
17:50
Nobody decides to collapse the deck.
17:52
They collapse it by accident by letting
17:55
the same, you know, comfortable number,
17:58
you know, colonize every tier.
17:59
So here's the mechanism.
18:01
Same store production is the number of the
18:02
CEO checks first.
18:04
That's what I want to know.
18:05
What is the same store production?
18:06
So it shows up on the huddle board
18:08
in the morning.
18:09
Then it anchors the weekly tactical deck.
18:11
It becomes a priority because that's what
18:13
they think the CEO wants or that is
18:15
what the CEO wants.
18:16
Then it leads to the monthly strategic
18:18
pre-read.
18:19
Then it's the late opening slide at the
18:21
all hands.
18:23
It's been reviewed four times.
18:25
No decisions.
18:26
It's just been reported.
18:27
Four meetings that were each built to do
18:29
a different job surface everything.
18:32
decide, debate, connect.
18:34
Surface, decide, debate,
18:36
connect are now all doing the same job,
18:38
looking at the same trailing metric,
18:40
and nothing has changed.
18:41
And that's the redundancy map,
18:43
and that's the whole series was based on
18:45
that thesis on one sheet of paper.
18:48
You mark every metric that appears at
18:50
three or more tiers,
18:51
and the costumes come off.
18:53
The huddle was supposed to surface what
18:55
the floor knows,
18:56
but nobody was discussing.
18:58
The tactical was supposed to produce this
19:00
week's decision.
19:01
That's what a tactical means.
19:04
The strategic was supposed to host the
19:06
five questions and have dissent and
19:08
debate.
19:09
How are we going to do this marketing
19:11
campaign?
19:11
How are we going to get more lead
19:13
generation?
19:14
How are we going to work with retention?
19:16
Okay,
19:17
the all hands was supposed to let the
19:18
platform talk to itself.
19:20
It's a culture meeting.
19:22
When all four have quietly become the
19:24
metric review of same store sales,
19:26
you've had one meeting wearing four
19:29
different outfits and a calendar that
19:31
looks very, very busy.
19:33
And the fix isn't deleting the meetings.
19:35
That's the calendar cleanse and the work
19:37
grows back.
19:38
The fix is reassigning the jobs,
19:40
having assignable parties that are
19:41
accountable.
19:42
Give each tier one job alone that it's
19:45
allowed to do and name what specifically
19:47
does not get discussed there.
19:49
That's why you have to have a meeting
19:50
czar.
19:51
The discipline lives in the execution of
19:53
that meeting czar.
19:55
A tier can't name what it refuses to
19:57
discuss when it's been separated from the
20:00
others.
20:00
It's just the same meeting in a new
20:03
wine costume, right?
20:04
An old wine bottle with the same wine
20:09
label.
20:09
So you have to be very,
20:11
very careful around all these things.
20:12
And what I hope comes out of this
20:15
is a lot of discipline.
20:16
When I moved the series from a lot
20:19
of physical therapy topics to more
20:21
business-y, operational,
20:22
it was intentional.
20:24
And attacking meetings was, you know,
20:26
something I needed to write about for my
20:28
own edification,
20:29
for our own organizational cleanse,
20:32
because I started to see these same
20:33
patterns in several healthcare platforms
20:35
that I work with.
20:36
So I hope people got a lot out
20:38
of it.
20:38
Now we're going to, you know,
20:39
migrate and transition to a lot more fun
20:41
topic.
20:42
We're going to go back to call to
20:43
care and talk a little bit more about
20:46
not clinical excellence,
20:47
which is understood not customer service
20:49
excellence,
20:49
but compassion and care excellence and how
20:51
that can have operational impact on a
20:53
company.
20:54
Good forward tease.
20:55
I like it.
20:56
Big finish.
20:57
Tactics.
20:58
If someone's going to walk out of the
20:59
door today,
20:59
if they're listening to this on the way
21:00
into the office and they had one hour,
21:04
what's the single audit you'd tell them to
21:07
run today or Monday morning to review
21:10
everything you talked about,
21:11
not just in this article,
21:12
but in this series of articles?
21:14
Yeah, I would go both bookends.
21:16
If they only had an hour,
21:17
I'd say visit a few clinics and ask
21:19
to look at the scribbled notes of the
21:21
daily huddle.
21:22
That'll tell you a lot.
21:24
And then I'd look at the agenda and
21:25
I'd look at the outcome,
21:27
maybe even listen to part of it on
21:29
something you recorded on the all hands.
21:33
What percentage of the people actually
21:35
showed up?
21:36
How many of the questions were unfiltered
21:37
and unscripted?
21:39
Did the meeting take its entire half hour,
21:41
hour, whatever it was allotted to?
21:43
Or did you give time back?
21:45
That's what I would look at.
21:46
Yeah.
21:47
All right.
21:47
Most organizations think fixing meetings
21:51
starts with another survey or committee or
21:54
another meeting about meetings.
21:56
This article hopefully goes into detail
21:58
and shows you why that evidence already
22:00
exists.
22:01
The artifacts already know what's wrong.
22:02
The question is whether you're looking for
22:05
them or if you're willing to, I think,
22:06
also pause and take a look at yourself
22:08
and say,
22:10
the thing we're doing is part of the
22:12
problem as well.
22:12
And that's not usually an easy
22:14
conversation.
22:15
But if it made you uncomfortable and
22:16
rethink how your organization operates,
22:18
that's sort of the point.
22:19
Subscribe to The Operator on Substack
22:21
using the link in the show notes.
22:22
And if you're about to schedule a meeting
22:23
to figure out why there are so many
22:25
meetings,
22:26
maybe send that person this episode.
22:28
Maybe do it anonymously,
22:29
but don't have a survey about it.
22:31
Subscribe on Substack.
22:33
Larry,
22:33
thanks so much for the time and doing
22:34
this.
22:34
Absolutely, Jim.