Most medical offices hold regular meetings for who to attend?

Do you cringe when you hear the phrase “office meeting”? Some medical practices meet too frequently and some seldom meet, but others have it just right – routine meetings with preparation, an agenda, and follow-up. Your practice can get it right, too.

And make no mistake, meetings are important. Medical practices, regardless of size, have a variety of positions that are not interchangeable, but do interact throughout the day.

To make sure interactions go smoothly you need to meet with the staff to identify issues and slowdowns and to develop solutions to meet the needs of the patients, the providers, and the employees.

Many medical practices also complain about a “lack of communication” in their office.

Office meetings satisfy both needs – they can improve communications and serve as a forum for problem solving.

So, why don’t more medical practices regularly hold office meetings?

Probably because past meetings have failed miserably. The usual reason that a meeting fails is because it hasn’t been well planned.

We’ve all attended meetings that became gripe sessions without any problem-solving or resolutions for the issues raised.

We learn quickly from bad meetings that it’s best to just not hold any meeting! But that’s not an appropriate response.

The best response is to resolve to hold better meetings. Doing so is not that hard.

Running an effective meeting requires advance planning. You’ll want your meeting to run on time, to minimize wasted effort in the meeting, to advance the improvement process, provide clarity, and obtain agreement and buy-in to change.

Preparation is more than setting an agenda. The agenda represents those items that must be worked through to achieve the objective for having the meeting.

Let’s look at the agenda format with two sample agenda items below:

The first item on the agenda focuses on getting patients roomed for the provider as quickly as possible. The goal is to engage everyone in the discussion so that recommended changes are widely understood and accepted among the staff.

In planning the meeting, decide on a reasonable time period to allot to the topic – that should include reasonable estimates for the length of time it will take for reporting, discussion, and decision-making.

The final column on this format is used to manage follow-up activities so that items do not simply continue on from meeting to meeting, and to develop the next meeting agenda.

A good meeting will also have a leader and a facilitator, although sometimes one person fills both roles.

The facilitator makes it possible for a group of people to communicate and to accomplish their task. A facilitator is neutral relative to content, but in charge of the process. He or she makes sure the meeting stays on topic, moves along at a reasonable pace, doesn’t get hung up for too long on one aspect of the topic under discussion, and makes sure the discussion doesn’t get “personal” and that tempers are kept in check.

The meeting leader is the person who calls the meeting, runs the meeting , and contributes content. In most offices, the physician is the meeting leader, although sometimes it is the office manager.

For some meetings you may decide to take a directive approach as leader; for others, you may decide to simply serve a consultative role as facilitator and let someone else run the meeting. Often that decision will depend on what the meeting is about. It’s also possible that in a meeting with more than one agenda item, you’ll switch between roles.

In our sample agenda item about copay collection, as leader you will have decided to accept debit cards and assign the follow-up to get enrolled with your bank to one of your staff members. You may find a consultative approach will work best to resolve the front-back teamwork around the item about check-in process, and therefore you’ll facilitate a discussion that is led by the front desk supervisor and nurse manager.

Successful meetings result in a more informed and engaged staff, and with documented action items that can be followed to the next meeting.

So stop cringing and schedule your next office meeting!

Rosemarie Nelson is a principal with the MGMA Health Care Consulting Group.

Originally published in MedPage Today. Visit MedPageToday.com for more practice management news.

This paper uses a series of exercises and practical examples to assist individuals and groups of doctors in training to gain skills in a critical area of management: conducting and participating in effective meetings. Through this paper, readers will be shown how to recognise and manage situations as they occur in meetings to work towards appropriate outcomes. By understanding the elements of conducting a meeting from preparation through to follow up, doctors will be able to conduct and participate more effectively in meetings that arise in their workplaces.

Keywords: education

In 1999 a survey of USA physician leaders identified three sets of practical skills with the highest importance for emerging medical leaders: they were time management, communicating effectively, and managing meetings.1 Several successful programmes were subsequently developed to improve these skills, particularly for junior academic faculty. As a result of one programme, improved retention rates resulted in savings in recruitment that were greater than the cost of that programme.2 In recent times, the view that management skills were largely the domain of doctors seeking to be leaders or academics has shifted. The principles of the managerial sciences are now applied more broadly to the delivery of health care.3 In addition, the growing accountability that has accompanied quality and safety agendas in health care has changed the operating environments of most health care institutions around the world.4 Effective managerial skills have confirmed links to improved patient safety, health care quality, organisational effectiveness, and clinical decision making.5,6,7,8,9,10,11

It has also been recognised that acquiring these skills can occur at varying stages of a doctor's career.12 Basic managerial skills have been recognised as core competencies for doctors in training in the UK. For example, hospital doctors are expected in the first two years of work to “demonstrate leadership skills where appropriate but at the same time works effectively with others towards a common goal” and “encourage an atmosphere of open communication and appropriate directed communication within teams”.13

This article uses a series of exercises and practical examples to assist individuals and groups of doctors to gain skills in conducting and participating in effective meetings. Readers will be shown how to recognise and manage situations as they occur in meetings to work towards appropriate outcomes. By understanding the elements of conducting a meeting from preparation through to follow up, doctors will be able to conduct and participate more effectively in meetings that arise in their workplaces.

A meeting can be defined as a “goal or outcome‐directed interaction between two or more people that can take place in any of four ways: same time/same place; same time/different place; different time/same place; different time/different place”. Same time/same place meetings are the most common in health care settings. They can be large (such as conventions), small (for example, ward rounds), formal (such as committee meetings), or informal (as in the case of corridor chats). The main feature of this type of meeting is that all participants are in the same place and the interaction is immediate and face to face. Participants are usually highly focused and the meeting runs to tight deadlines. Verbal interaction is an important component.14,15

The chairman of a meeting is responsible for a number of activities; some of which must be attended to before the meeting can be arranged. Before any meeting, a chairman must:

• identify and invite the appropriate participants

• familiarise themself with any relevant history of previous meetings

• construct aims for the meeting

• conceptualise a framework for addressing issues coming to and arising from the meeting

• clarify roles of participants

• gather and circulate well ahead of time any pertinent existing data

• prepare meeting logistics (place, time, and resources)

• draft and circulate an agenda.16

The purpose of the meeting should be clear to the chairman before agreeing to arrange or chair a meeting.

Ideally, all the intended participants should be contacted by the chairman well in advance of the meeting and invited to attend after the purpose of the meeting has been explained to them. In subsequent meetings other meeting participants can be delegated to perform some of these responsibilities. In addition, there are several roles in a meeting that the chairman should delegate to other participants. These roles include: note taker and timekeeper. Depending on the situation and style of the meeting, one person may perform more than one role. Table 1​ highlights the key meeting essentials.

Table 1 Meeting essentials

Agendas may vary depending on the purpose of the meeting and its level of formality. Generally speaking, a typical agenda should contain;

• the name of the group that is meeting

• the date of the meeting

• the name of the venue

• contact person (for registering intent to attend, apologies, or items for inclusion)

• apologies from people unable to attend

• introductions

• approval of previous meeting's minutes

• review of matters arising from previous meetings

• new business

• reports

• other business

• evaluation

• date of next meeting

• close

The order of items should be based on ensuring that the controversial and non‐controversial items are interspersed. Starting with a few short and less important issues at the top of the agenda often allows the participants to settle into the meeting before tackling the more contentious items. If possible controversial items should be just before or just after scheduled breaks in the meeting. Establish time limits for each item on the agenda. Decide the length of the meeting and allocate a realistic time slot for each item. Do not try to do too much in a meeting. Generally speaking, items in meetings take longer than you expect so allow plenty of time.

An effective meeting has a structured order. It should start with introductions. A chairman should introduce themself first and set the tone for the rest of the introductions. For example:

“Hello, my name is Dr Lee and I'm your chairman for this meeting. I've asked you to come and meet here today to discuss a topic that I believe is very important to the effective running of our organisation. What I hope to achieve from this meeting is an understanding of the issues and to develop a series of steps we can take individually and as a committee to work towards the outcomes we wish to achieve. This meeting is scheduled for 1 hour and will finish exactly on time. At the end of the meeting we will decide if we should meet again and when. Could we now go around the room quite quickly and would everyone be prepared to tell us a bit about themselves, why you are here and what you might want to achieve in this meeting?”

Apologies should be noted and then a quick review of the agenda and minutes of any prior meetings should be undertaken. Items requiring modification should be assessed to see whether they are procedural or substantive. If they are procedural they should be dealt with immediately and quickly. For example:

It is not uncommon for some people to say they have not received the agenda or previous minutes. Copies of both should be available at the meeting, but discussion of how that occurred should be deferred until after the meeting as it is usually an administrative issue that often requires individual not group attention.

Substantive issues, where they are relevant, may be referred to a particular item in the agenda. Otherwise they can be relegated to “Other Business” at the end of the meeting. It is important not to have a meeting hijacked by trivial issues on commencement. Conversely, trivialising someone's concerns at the outset may then make them less prepared to be an effective contributor to the meeting. It is a delicate balance. Understanding the way people operate in groups often helps. (See section on Behavioural Styles in Meetings).

Technical rules for the meeting are the most important routine items and should always follow the introductions. Some issues need to be clarified at the outset, such as; what to do about mobile telephones and pagers; ensuring that participants on videoconferencing or teleconferencing are included; and how consensus will be achieved.

Major portions of most meetings are time sequenced and filled with routine announcements of past progress, decisions on current issues, and discussions of future prospects.17 Topics should be covered one at a time, starting with routine progress reports on ongoing projects. A participant who has particular expertise, or who has been assigned the task of presenting a topic, should do so first. Group discussion and a collective decision, if warranted, should follow.

Near the end of the meeting, to ensure that subsequent meetings are of high quality, the chairman should ask all participants at the meeting what they thought was effective and therefore repeated in future meetings; and what could be improved and changed for future meetings. As the meeting comes to a close the chairman should summarise areas of agreement and decisions that have been made, assign action items for group members, and highlight areas where consensus could not be reached. Follow up arrangements, such as circulation of minutes, review of action items, or details for another meeting should be made explicit at this time.

It is the responsibility of the chairman and the note taker to ensure that the minutes are completed and circulated within a reasonable time frame. The minutes may be written in a variety of ways, for example in point form or discursive paragraphs. Verbatim minutes are only used in formal situations. Modern meeting notes should concentrate on actions and agreements.18 However, all minutes should include the following:

• date, time, place of meeting, and list of participants present

• information that was shared at the meeting

• decisions that were made along with alternatives that were not chosen (without mentioning which attendees advocated each position), together with a brief summary of the main points for and against the decisions

• action items with each item assigned to one or more members and an expected completion date.19

It is not easy to find a time for busy people to meet. Often, finding a meeting date and time is the most difficult part of the whole meeting process. For regular meetings, the easiest way is to set dates on a particular day of the month, for example 8 30 am on the first Tuesday of the month, and have the participants agree to the schedule at the first meeting. Pre‐planning meeting dates and times is a way of maintaining control to ensure well organised and well attended meetings.

When participants have to travel long distances to attend meetings it is useful to have pre‐meeting refreshments available about 30 minutes before the actual meeting is due to start. Concentration begins to wane after about 45 minutes into meeting so frequent breaks should be scheduled into long meetings. Breaks do not need to be of equal length. Drink breaks and comfort stops can last anywhere from 5 to 20 minutes. Allow at least 45 minutes for the lunch break.

Times to start and finish a meeting depend on the type and duration of the meeting and the attendees' availability. In general, try to avoid times that can lead to problems. For example, meetings held in the middle of the day or at peak hour can result in participants spending a lot of their day travelling to and from the meeting. Similarly, breakfast and evening meetings are only a good idea if participants do not have family or other external commitments.

Venue choice is critical for sensitive meetings, but far less so for routine gatherings. Wherever the meeting is held, the chairman should ensure that the venue is adequately prepared. If the venue has a venue manager or conference organiser it is important to talk with them about your needs before the meeting and even send them a written list of requirements. Arriving well before a meeting allows the chairman to check the set up. Conference organisers and audiovisual experts at the venue, even when well briefed, cannot know exactly what is required. Have the person responsible for the venue confirm your booking in writing. Always check and re‐confirm the booking, providing final numbers, a few days before the meeting.

The set up of the room for the meeting will also have an impact on how the meeting runs. Positioning of tables and chairs is crucial to ensure that the chairman and all participants have the capacity to contribute when appropriate. If the purpose of the meeting is mainly to deliver presentations to a large group of people (over 20 people), a theatre style set up with the audience in rows facing where the speakers and audiovisual equipment will be situated is best. For a medium sized group (10–20 people) where the attention needs to be focused towards the front of the room a “mullet” (long back, short sides in a U shape) style may be most appropriate. Where the group is smaller in size (up to 10 people) and interaction is critical, a horseshoe (U shape) table layout with the open part of the “U” facing the chairman's table is best. For even smaller meetings, one rectangular table with the chairman in the middle of one of the longer sides will suffice.

The positioning of the chairman in relation to the group is important. If you are feeling confident and comfortable as a chairman and your authority is in no doubt, sitting close to or among the other participants is best. If the meeting is going to be challenging or has the potential to be out of control, your physical position as chairman should be separate to emphasise your authority. You might even choose to organise the placement of the participants beforehand by setting out place cards, this way you can influence the personal dynamic of the meeting.

Known adversaries are best placed where they will cause the least disruption, for example next to the chairman (where they can be overshadowed if necessary) or next to a “team player” (to settle them down). Opponents should never be allowed to occupy the confrontational position; that is directly opposite the chairman as it may result in a destructive splitting of power and control.20

Computers, data projectors, screens, and flip charts should be positioned where they can be used comfortably without obscuring the participants' view. Sitting in a selection of seats before the meeting allows the chairman to gauge the visibility for all the participants. Sometimes there are strong lights above the projection screen that cannot be switched off independently and due to glare may make visual material difficult to see. In such cases a plain white wall may be better than a poorly positioned screen. Extension leads and loose wiring should be taped to the floor or otherwise covered to prevent mishaps.

When two or more people come together for the purpose of accomplishing a task, a range of behavioural variables come into play and problems may arise.21 By looking at different behavioural styles participants adopt in meetings, various ways of communicating can be understood. Behaviour is the “tip of the iceberg”. It is what we see of other people. Under the surface lies much more; genetic traits, personality, life experiences, and attitudes. These aspects are less dynamic than behaviour. Behaviour is changeable according to the situation. However, we all have a preferred style of behaviour that we routinely and comfortably adopt in certain settings. Through recognising our own needs and the needs of others as well as understanding how different behaviours may be perceived, we can modify our own approach to communicate more effectively.22

A number of tools have been developed to describe different behavioural styles. The Myers Briggs model, for example, identifies a person's preferences for certain ways of thinking and behaving.23 This model assesses personality types, which in turn affect behavioural styles. It is not very easy to determine which of the 16 Myers Briggs personality types fellow meeting participants fall into without a detailed conversation or completion of the Myers Briggs questionnaire.

A frequently used behavioural styles model is DISC, an acronym for the four styles it describes (Direct, Influencing, Steady, Conscientious). It can be used to help understand a person's preferred behavioural style and the interplay between the preferred focus (task or relationship) and the preferred pace at which a person operates (fast or considered). Based on the work of Marston and Geier,24 DISC is quick and simple instrument to apply and is therefore described in more detail here. There is a DISC questionnaire that can be used to determine preferred behavioural styles, however by interacting with others in a meeting, their preferred style soon becomes evident.

Table 2​ gives an overview of each of the DISC behavioural styles.

Table 2 DISC behavioural styles

Participants adopting a direct style prefer open and straightforward meetings to satisfy their need for quick results. Participants more comfortable with an influencing style, on the other hand, prefer a friendly, emotionally honest environment that recognises their achievements. Steady style participants seek group harmony and prefer meetings to be run at a more relaxed pace and in an agreeable and cooperative manner. Conscientious style participants are most comfortable with detailed, accurate information and need the time to consider all the information. Recognising the preferred behavioural style of participants can help a chairman overcome potential blocks in discussion. Work through the following examples:

A person displaying direct (task focus, fast pace) behaviour in a meeting may: be agitated if the meeting has not started on time and they have had to wait for others to arrive; want to “get straight to the point” and want the group to make immediate and binding decisions on what needs to be done next.

When direct style participants become agitated in a meeting, they should be reassured that the meeting is sticking to the topic and time wasting is being kept to a minimum. They should be given straight forward answers that are clear, brief, and to the point. The chairman should try to make everything task based, even if the issue concerns people. For example: turn the desire for involved group discussion into the task of making sure everyone's opinion is heard.

A group member displaying influencing (people focus, fast pace) behaviour in a meeting may: have already socialised with everyone in the room and is continuing to do so even after the meeting has started; want to talk about tangential issues rather than directly addressing the agenda item; and may have difficulty focusing on one particular item at a time.

When influencing style participants become distracted in a meeting, they should be allowed to verbalise their thoughts briefly and then be guided back to the topic. The facilitator should attempt to be as informal and sociable as possible but still provide them with written details and try to keep them focused.

A participant displaying steady (people focus, considered pace) behaviour in a meeting may: not mind waiting for the late comers to arrive; avoid confrontation or discussions involving conflict; want to know how the decisions made may affect others or how many other groups have been consulted and what was the outcome of those consultations?

If the chairman's approach is too direct and hurried, this may be perceived by the steady style participant as bossy and unfeeling. This participant needs time to adjust to what is being discussed. Often they will remain quiet during a meeting but contribute to discussions held during meeting breaks such as morning or afternoon teas or they may stay around after a meeting to talk with the chairman.

A participant displaying conscientious (task focus, considered pace) behaviour in a meeting may: have read all the agenda items and appendices; have a comprehensive list of issues they want to discuss in detail; bring information from other sources such as the internet; not be willing to make a decision without sufficient information.

If the meeting does not answer this participant's issues in sufficient detail, they may find the interaction scatty and uncomprehensive. What they require is as much detail as possible, preferably before the meeting. They are the type of participant who needs to receive a detailed agenda and background papers well before the meeting. Similarly, at the end of a meeting, they will need to know the follow up procedures and time frames involved. A clear structure to the meeting and methodical approach gives the conscientious participant comfort.

The direct style like others to be direct, straightforward, and open to their need for results

Try to:

• Make communication brief and to the point

• Respect their need for autonomy

• Be clear about rules and expectations

• Let them initiate

• Show your competence

• Stick to the topic

• Show independence

• Eliminate time wasters

Be prepared for:

• A blunt and demanding approach

• Lack of empathy

• Lack of sensitivity

• Little social interaction

The influencing style like others to be friendly, emotionally honest, and to recognise their contributions

Try to:

• Approach them informally

• Be relaxed and sociable

• Let them verbalise thoughts and feelings

• Keep the conversation light

• Provide written details

• Give public recognition for individual accomplishments

• Use humour

Be prepared for:

• Attempts to persuade or influence others

• Need for the “lime light”

• Over‐estimating self and others

• Over‐selling ideas

• Vulnerability to perceived rejection

The steady style like others to be relaxed, agreeable, cooperative, and show appreciation

Try to:

• Be logical and systematic in your approach

• Provide a consistent and secure environment

• Let them know how things will be done

• Use sincere appreciation

• Show their importance to organisational good

• Let them move slowly into change

Be prepared for:

• A friendly approach to colleagues and supervisors

• Resistance to change

• Difficulty prioritising

• Difficulty with deadlines

The conscientious style like others to minimise socialising, give details, and value accuracy

Try to:

• Give clear expectations and deadlines

• Show dependability

• Show loyalty

• Be tactful and emotionally reserved

• Allow precedent to be a guide

• Be precise and focused

• Value high standards

Be prepared for:

• Discomfort with ambiguity

• Resistance to vague or general information

• Desire to double check

• Little need to affiliate with people

As a chairman, you will need to address the various behavioural styles within a meeting to achieve the best process and outcome for all participants. Although you will have your own preferred behavioural style, you will also need to move freely between each of the other styles as the meeting requirements vary. The different behavioural styles required by a chairman according to the demands of a meeting are illustrated in boxes 2 and 3.

It is the responsibility of the chairman of a meeting to ensure that appropriate follow up occurs. Proceedings of the meeting or minutes are the most common way to circulate a summary of what has transpired. A meeting's note taker may be appointed to the group to undertake this task but it is always up to the chairman to ensure that the minutes are accurate to the best of their knowledge and recall before they are circulated to the other participants as soon as possible. When a note taker is unclear about an issue or decision, they should seek clarification within the meeting if possible or with the chairman before the minutes are distributed.

Minutes are the written record of what transpires during a meeting and may be used later as a legal document during a dispute or for clarification. They should be written in an accurate and concise style. Note takers need to balance the need for brevity against the desire for completeness during a meeting. Typically they include: a list of people who attended the meeting, a record of apologies for absentees, and a description in prose or point form of the major issues raised, and the discussion that ensued. In an objective, unbiased, and non‐judgemental way the minutes should also summarise areas of agreement and disagreement and consensus decisions on a way forward, including who is responsible for what action and in what timeframe. This prevents members from later claiming that they were unaware of their responsibilities, and it also prevents more than one person undertaking the same role.26

Even when a meeting seems successful, participants can still experience a sense of dissatisfaction after the meeting. Often, post‐meeting inactivity leads to the same ground being covered in the following meetings. Three areas can make the period between meetings more productive, and prepare the ground for subsequent meetings:

• Task: Make the agenda and objectives for the meeting clear. (Direct behaviour)

Example: What we will cover today is……

• Task: Ensure that your meeting starts and finishes on time. (Direct behaviour)

Example: As we have a lot to cover today, I think it's time we moved on to the next agenda item. Can we wrap up this issue now?

• Task: Make latecomers welcome, and bring them up to date. (Influencing behaviour)

Example:Thanks for joining us. So far we have covered……

• Task: Gain group involvement—draw out the quiet members and tone down the loud members. (Steady behaviour)

Example:Does anyone have any suggestions? We have been hearing a lot from this side of the room—what comments or suggestions does the other side of the room have?

• Task: Bring distracted participants back into the group discussion. (Influencing behaviour)

Example: It looks like you two have come up with something interesting. Can you share your thoughts with us?

• Task: Remain unbiased and not drive a personal agenda. (Steady behaviour)

Example: I hadn't thought about it like that before. What does the rest of the group think?

• Task: Accept questions and encourage discussion (Steady behaviour).

Example: That's a very thoughtful question, does anyone have any ideas?

• Task: Clarify group decisions or individual input. (Conscientious behaviour)

Example: So, as you've just stated, the...

• Task: Take a note of participants' non‐verbal input. (Influencing behaviour)

Example: People are getting restless; it looks like we could all do with a 5 minute break.

• Task: Mediate conflicting opinions. (Steady behaviour)

Example:There are a lot of different views being expressed. Let's review what we've agreed on so far…

• Task: Without actually providing all the answers, know what resources are available to find the answers. (Conscientious behaviour)

Example:I can look that up and get back to you.

• Task: Incorporate varied opinions into the group's discussion. (Steady behaviour)

Example: How would you relate that into the current discussion of the group?

• Task: Defer new issues to another time. (Direct behaviour)

Example: You may have a point, but it's not for this meeting. We'll discuss it another time.

• Issue: The meeting seems to have developed a life of its own and may not achieve what you wanted or expected. What can you do?

Strategy: Ground the meeting in the background detail you have prepared. For example: “Let's revisit what we decided at the beginning of the meeting were the key issues we wanted to cover.” (Direct behavioural approach)

• Issue: Warring participants seem to be continuing their ongoing battle in the meeting.

Strategy: Look at problems using your intuition and emotion to help you work out why the combatants are acting in that way. Also try to think how other people in the meeting are reacting. Revisit the behavioural styles of your participants and try to match your style to the one that will be most effective in resolving this block. (Surfing all four styles)

• Issue: You are unsure about whether a consensus decision reached in the meeting is appropriate.

Strategy: Make a mental list of all the less than optimal features of the decision. Examine the points defensively and cautiously. Try to see why it might not work. Consider what outcome you think is best and achievable: eliminate the decision, alter it, or prepare contingency plans to counter it at a later date. (Conscientious behavioural approach)

• Issue: The mood of the meeting has become quite sombre and nihilistic.

Strategy: Recall your meeting preparation to find the positive outcomes that you envisaged could come from the meeting and the value of them. Conscript the more supportive members of the group into action to find a way to keep the meeting going when everything looks gloomy and difficult. Use your own enthusiasm to persuade others. (Influencing behavioural approach)

• circulating a record of the meeting is important because it identifies actions to be taken, who has the responsibility for those actions and in what time frame.

• the chairperson has other responsibilities in taking an interest in what happens between meetings by asking for progress reports and ensuring that matters are progressing. This can also have an influence on the development of the next agenda.

• reporting post‐meeting progress to all concerned can encourage others to believe in the importance of the tasks involved and enhance the status of the meetings.27

The key to running an effective meeting in a health care setting is keeping control from the first moment the idea the meeting is mooted right up until the minutes of the meeting are ratified. This is achieved by extensive pre‐meeting planning, effective use of the meeting environment, and optimal management of the meeting participants. The objectives of the meeting must be in everyone's thoughts during the meeting to achieve optimal outcomes.

Funding: none.

Conflicts of interest: none declared.

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