Physician leaders know how to run great meetings.
You run one every time there’s a code. Someone leads. Everyone has a role. There’s one goal, and everyone in the room knows what it is. Nobody checks their phone. When it’s over, no matter what the outcome, multiple decisions have been made, and everyone knows what happens next.
You do it at morning rounds. You do it at the tumor board. You do it every time a group of clinicians gathers around a hard case and works it until there’s a plan.
Then you walk into a 2 p.m. meeting about the parking policy, and you forget every bit of it.
I know I did.
The Committee That Grew and Grew
Once, I worked at a clinic that had an executive committee.
When I got there, it was a small group. A handful of the senior physicians and the administrator who ran the place. After I had been there a year, some members of the committee said it wasn’t accomplishing much. So they made a proposal. Instead of a select few, why not open it up? Let everyone come. Make it a committee of the whole.
We did. We started meeting once a month for sixty minutes, after work.
We always went over.
So someone proposed we extend the meeting. We bumped it to ninety minutes. And we still felt rushed. We still ran out of time.
Looking back, that should have told me something. When a meeting keeps spilling past its walls, no matter how much room you give it, the problem usually isn’t the clock. The problem is that the meeting doesn’t know what it’s for. And a meeting that doesn’t know what it’s for will expand to fill any amount of time you hand it. There’s no bottom to it.
Here’s the part that’s a little embarrassing to admit. That committee was still meeting the same way, with the same problems, when I left a few years later.
And I never once asked the question that would have cracked it open.
If you don’t know where you’re going, you’ll end up someplace else.
— Yogi Berra
The Questions Nobody Asked
I can ask them now. I wish I’d asked them then.
What governance structure is this committee part of? I didn’t know. The committee did not appear to report to anyone in any formal way.
Who takes the minutes? Where do the minutes go? The doctor who led the meeting took a few notes. I don’t remember ever getting them afterward. I know for certain we never opened a meeting by approving the minutes from the last one, the way a real governing body does. There were no minutes to approve.
What decisions does this committee actually make? Almost none. We’d propose which educational events to host, and when. Those got approved, more or less every time, sometimes with a different date. That was about it.
Could a smaller group make those decisions? Easily. You didn’t need fifteen people after a long clinic day to pick a seminar date.
Every one of those questions has an obvious answer now.
Back then, I didn’t even know they were the questions.
What Meetings Are Actually For
Here’s what I didn’t understand at the time. There are only so many good reasons to put people in a room.
Steven Rogelberg, a researcher at UNC Charlotte, has spent a career studying this. If you read one thing on why meetings fail, read his short Harvard Business Review piece, “Why Your Meetings Stink — and What to Do About It.” And when you look across the people who study and run meetings for a living, they tend to converge on the same idea: a meeting only earns its place on the calendar when it’s there to do one of a handful of real jobs.
To make a decision. A real choice, one that needs more than one perspective to get right, or needs a group to buy in so it actually sticks. It’s a code with a clear leader.
To coordinate work that overlaps. People who depend on each other, getting lined up. Who’s handing off to whom? What falls through the cracks if we don’t talk?
To solve a problem together. The kind of thinking a group can do that no one person can do alone. A case conference, basically. Many minds on one hard thing.
To surface honest disagreement. This one surprises people. Patrick Lencioni, who makes the case in story form rather than studies in his book Death by Meeting, argues that sometimes the point of a meeting is to get the argument out in the open — because people support a decision they helped shape and quietly resist one that was handed to them. A meeting with no tension often just means the real conversation is happening later in the hallway.
To share information that can’t just be sent. And notice the fine print. Most information can just be sent. A regular update is an email. The exception is news that’s sensitive, or emotional, or needs discussion to land. You don’t announce a layoff in a memo.
And then there’s a sixth reason, the one almost nobody counts. To build connective tissue of the team itself — the trust, the feeling of belonging, the feeling that this is a group of people and not just a list of names on an invite.
Hold onto that sixth one. We will come back to it in the next post.
Now measure our committee against that list. It made no real decisions. It coordinated no overlapping work. It solved no problems that a smaller group couldn’t have solved faster. It shared nothing that couldn’t have gone out in an email. By that list, our meeting served none of its purposes.
Or so I believed. For years.
A well-stated problem is half solved.
— Charles Kettering
What We Were Actually Doing
So what was that meeting?
It was a venting session. That’s the honest word for it. A room full of tired physicians, once a month, after a full day of patients, saying out loud the things that were bothering them.
There was even a witness. Sometimes, a manager from the system that owned the clinic would join us. He’d listen. He’d nod. He never once said what someone in his position might have said: Why are you all here? What is this meeting for?
I think he looked around at all the physicians in the room, all that training, all those years of expertise, and assumed we must know what we were doing.
We didn’t. We were smart people running a meeting on autopilot. And the fact that we were smart made it worse, not better. Nobody questions a room full of doctors. Not even the doctors.
You’d Never Do This With a Patient
Here’s what gets me, looking back.
You would never order a test without knowing what decision the result would change. You’d never start a treatment without a diagnosis. You’d never run one protocol for four different presentations and hope it works out.
But we ran that meeting the way you’d run a standing order that nobody ever reviews. It was on the calendar, so it happened. Month after month. Year after year.
And Rogelberg’s research points to why that’s so costly. A meeting is one of the most expensive things an organization does. Add up the salaries in the room. Add up the work not getting done while everyone sits there. A meeting should exist only when it produces something you couldn’t get any cheaper way — from an email, a phone call, a smaller group, or the one person who should simply make the call.
Most meetings fail that test. Ours failed it for years.
Except Once
By every measure that matters, that committee was a failure. No structure. No decisions. No purpose anyone could name. And it was still failing when I walked out the door for the last time.
Except once.
Once, that broken room did something that no well-run meeting in the whole clinic could have done. Something that mattered. Something that outlasted the administrator it was aimed at — and taught me, years too late, what that meeting had quietly been for all along.
It was that sixth reason. The one I told you to hold onto. The one almost nobody counts.
I didn’t understand it then. I’m not sure I understood it until I sat down to write this.
That’s what we will visit in the next post.
The One Practice
Before your next regular meeting, ask one question and make everyone in the room answer it: What is this meeting for?
Not the topic. The purpose. Rogelberg suggests a sharp version of this: write your agenda items as questions to be answered, not topics to be discussed. “Improve door-to-doctor time” is a topic that could wander for an hour. Instead, ask, “What are the three biggest causes of our door-to-doctor delays, and which one do we fix first?” That tells you who needs to be in the room and leads everyone to the desired outcome.
So pick your purpose. Say it out loud at the top. Write it where everyone can see it.
If the room can’t name a purpose, you’ve learned something important. You might not need the meeting. You might need an email instead. Or you might need to redesign the whole thing from the ground up.
That’s the discipline. Name the purpose before you gather the people. It’s the same discipline you already use every time you decide whether a symptom needs a test. You just have to remember to bring it through the conference room door.
P.s. Come back next week for Part 2: The Most Important, Invisible Thing Regular Meetings Do
