Facilitation: Making Meetings a Productive Experience

H. Dominic Covvey, National Institutes of Health Informatics

I am sure all of us have participated in (or, god forbid, led) meetings that simply didn’t go well due to the lack of skill of the chair, the leader or the facilitator. Expressions like painful, frustrating, demeaning, waste of time and ‘never again!’ come to mind. Recently, I was subjected to one of these Trials by Hire when I attended a multi-day project review.

To protect the guilty, I will provide a pseudonym with a randomly selected gender for the chair: ‘Conan’. Conan viewed the assembled experts as his means of putting his report together. The team had been selected from 4 countries and all were experts in eHealth, but accessing and making the best use of that expertise was secondary to completing his (not our) report. Conan gave domination a meaner meaning. Things like recognizing members’ value, engaging all team members, seeking input and listening to and adopting suggestions were absent without leave. Several times Conan made clear that it was his way or the highway, and even pointed out to one participant where the highway was. What a warm and welcoming event! Sort of like dinner at Dracula’s castle, where we were the meal.

However, the situation did serve as a powerful object lesson and made me want to write about group management process. I see this as a crucial skill for health informaticians that is often AWOL.

I have learned that the role of a chair or facilitator is to be things like: (1) An impresario, who brings together the best people who can accomplish some job and then gets mostly out of their way; (2) A conductor, who provides an organizing and converging influence and helps the players to perform their best in ‘concert’ with each other; and (3) A coach, who works to elicit the greatest possible contributions from participants. The facilitator also needs to be quite invisible and relatively quiet, and to make the team the shining light. The role is never to dominate, never to use others to get your job done, never to prove how capable you are or to demonstrate your manipulation skills.

I got into facilitation long ago, honestly, because of my own character and my frustration with meetings that led to my over-inserting myself into the proceedings. My behavior was the disease and the formal discipline of facilitation was the therapy!

I should also mention that formal facilitation doesn’t just apply to formal settings like think-tank sessions. It applies to all meetings, even if the process needs to be minimally obvious so the session remains perceivably informal.

How does one go about facilitating meetings in a way that really works and avoids the negatives I’ve mentioned? In other words, if we sent Conan to school to help him to become competent at facilitation, what would he learn there?

Perhaps first, Conan would learn how to identify candidates for the session and then how to select an appropriate line-up. Conan already has some skill in this area and put together an excellent team that certainly had the needed competencies for an effective meeting. However, he would learn to go through a formal process to identify the purpose and deliverables of the meeting, then to identify the types of participants needed (criteria might include needed expertise, representativeness of stakeholders, etc.), and, only finally, to select specific people. Documenting selection criteria would be important.

Next, Conan would learn some crucial attitudes and a set of skills to help him exhibit and personify these attitudes. The attitudes would include: recognizing that the team is the precious resource, realizing that the team (not the facilitator) is the source of value, being flexible and provoking the team’s contributions so that the team can exhibit its value, being as invisible as possible, and always, always listening and being adaptable.

During his education, Conan would learn a ‘theory’ of meetings – a psychosocial framework that helps him understand the social and personal dynamics of participants, and his own role. This would provide a mental model to guide him in real time under the pressure of the clock. He’d also learn to consult a checklist periodically to see if he was touching all the bases – even if later in his career he could mostly do without this. Conan would come to understand that there is a bit of science involved here and that alignment on purpose, engagement, support of the team’s thinking and actions and management of personal idiosyncrasies requires a lot of thinking, planning and careful, gentle manipulation. Surely too he’d learn never to do harm!

It would important for Conan to study and master methods of facilitation, such as Nominal Group Technique, Consensus Mapping and Delphi method (an online surveying technique especially useful for following up on meetings). There are some great books on facilitation, but book learning must be augmented by actual experience – preferably being videoed while performing and being critiqued post-session. I’ve always held that ‘post mortems’ (reviews of what did and didn’t work) after meetings dramatically reduce the chance of ‘dying’ during meetings!

It would be essential that Conan understand some of the personal and social pathologies that emerge in meetings, like members’ failure to participate, or the opposite, domination. It would be wise to understand also how important it is for participants to see their contributions recognized and included in summaries and post-meeting presentations and reports. Almost any sin can be forgiven except the sin of ignoring or failing to include the members’ contributions. Conan has a real problem with this that he exhibited by being reticent to include and deal with one participant’s contributions he himself had requested.

Part of Conan’s education would address the mechanics of meetings and how to function successfully despite process dislocations. He would learn what can go wrong, how it can go wrong, how to get things smoothly back on track, how distractions can emerge and how to sidestep them. One example is learning a multi-step process for dealing with difficult people without summarily ejecting (or publicly demeaning or executing) them, but not allowing difficult people to take the meeting down with them. Conan would particularly learn techniques that naturally prevent domination and yet make everyone feel their contributions were heard and recorded.

Perhaps most importantly, Conan would learn a bit of humility – recognizing that the greatness of what he accomplished was based on the efforts of the entire team, with the emphasis on the rest of the team. He’d learn that the chair is not a position of power, but rather a position of responsibility and of accountability to the team. He would learn to perceivably respect team members and hold his ego under control.

There is much written about this topic, but a lot of crucial knowledge is tacit, heard only by the meeting-room walls of countless gatherings of humans convened to deal with myriad issues. From my experience, one of these tacit learnings is that the real value of meetings emerges from the collective consciousness and intelligence of those gathered. It is only partially predictable, never fully controllable and never, never forced. A meeting is, in fact, a complex, adaptive system. It is also like having talented musicians in a room, providing a framework, and then allowing great music to emerge.

Facilitation is definitely an art, but it is an art guided by science. If he is lucky, Conan will learn the science and practice of the art of facilitation until it becomes second nature. If he is unlucky, he will continue to bumble along adding unpleasant days to the lives of those he assembles.

Once he is in a committed relationship with this powerful discipline, he would probably also gain from changing his name so it is more in keeping with his new spouse!


Dominic Covvey (FACMI, FHIMSS, FCIPS, SMIEEE, ITCP) is an Adjunct Professor at the University of Waterloo and the University of Ontario Institute of Technology. He is also the President and Director of the National Institutes of Health Informatics. He was the Founding Director of the Waterloo Institute for Health Informatics Research at the University of Waterloo (2003-2010). His research is in the representation and analysis of healthcare workflow, the definition of competencies and curricula in Health Informatics and the design of the Electronic Health Record.

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