Scope of Practice

Make the most out of meetings to improve practice teamwork

Kevin B. O'Reilly , Senior News Editor

Regularly held, properly run team meetings can help physician practices solve workflow problems, build camaraderie and improve patient care. A group of internal medicine practices in Boston explains how it has used effective team meetings to achieve these goals and more.

The internist practice teams at Boston Medical Center meet for an hour each Friday at 8 a.m. Once a month, all six practice teams gather for big announcements and to celebrate practice successes, highlighted in an AMA STEPS Forward™ module on effective team meetings. These large meetings then break into smaller groups, where the individual practice teams of between six and eight physicians, nurses, medical assistants, front-desk staff and others meet.

The Friday meetings allow the individual practice teams to work on projects specific to their areas, such as exam-room stocking or creating a wait-time notification board for the waiting area.

The practice of holding regular physician practice meetings “has allowed the multidisciplinary team members to get to know each other in a more personal way, which breaks down hierarchies and silos and improves communication,” said Charlotte Wu, MD, director of the medical center’s General Internal Medicine Primary Care Clinic.

“It also helps move quality improvement projects forward in part because they stem from the ground up. It gives each team member a voice,” Dr. Wu said. “We've found that hot topics have engaged people on areas that they are particularly passionate about and help identify on-the-ground champions. Through integration of ideas from each team, these team meetings have helped us get buy-in and consensus on practicewide workflows that could be standardized.”

The practice-oriented solutions that have emerged out of these team meetings include:

  • Writing down, on a white board in a common area, the daily roles to which nurses are assigned so that the clinic’s communication, flow and efficiency are improved
  • Learning about need-to-know health topics, such as how to respond if a patient presents with Ebola symptoms
  • Creating specific lanes for certain patient needs at the front desk, alleviating stress for patients and staff

“I have taken feedback discussed during team meetings back to my colleagues to address on a broader scale,” said practice manager Briana Dukas. “With email or face-to-face conversations, I've communicated to my team how we are working to address those line-clogging issues. I think the team appreciates having a forum to discuss challenges we encounter in our practice.”

“The other benefit to the meetings is that it gives all team members a chance to show why certain changes are necessary,” Dukas added. “It's not always obvious to the physician why the front desk does something a certain way, or vice versa. The team meetings are a chance to clear up some of that mystery.”

The STEPS Forward module provides detailed guidance on how to incorporate regular team meetings into practice and how to make them effective. Practices seeking to make the most of their team meetings should, among other things:

  • Schedule meetings regularly, during “on-the-clock” times when patient care demands are unlikely to interfere
  • Limit them to between four and 12 people so each person can participate meaningfully
  • Start and end meetings on time and keep them focused on tasks and issues to be resolved
  • Use a consistent meeting agenda
  • Take a group-oriented approach to solving problems
  • Record each task’s assignee and deadline for follow-up
  • Give participants a chance to get to know each other and their roles using ice-breakers, and encourage them to offer appreciative comments on good work

On this last point, one of the managers at the Boston Medical Center, Ashlyn Tate, said meetings have helped the team members “bond together in a way we didn’t before.” She added, “All aspects of our lives, including our family lives, benefit from this experience. We learn what we can do to support each other with patients and things that make us tick.”

The STEPS Forward module may be completed for continuing medical education credit. There are seven new modules now available from the AMA’s STEPS Forward collection, bringing the total number of practice improvement strategies to 43; several thanks to a grant from, and collaboration with, the Transforming Clinical Practices Initiative.