Patient Safety / Quality

Adventures in virtual meetings

“Staff meeting at Wednesday afternoon, Conference Room C. Subject: Improving the unit’s compliance with JCAHO patient safety goals.”
You’ve probably seen—or posted—memos like this on your unit’s bulletin board many times. Although the meeting specifics will differ, the need for meetings seems to be eternal.
To keep the climate of care congruent with the current best nursing practices, your nursing unit may need to hold frequent staff meetings. Or perhaps your facility has interdisciplinary groups that need to meet often to discuss wider issues.
Constructive meetings promote an environment of shared governance, which helps boost staff morale and reduce turnover. Shared governance is a key indicator of excellence in nursing practice. Over the past decade, many nurses and nursing organizations have identified it as crucial to maintaining nursing job satisfaction, high-quality patient care, and fiscal viability of healthcare facilities.

Conflicting priorities
But even if you’re eager to offer your ideas and to share in unit governance, your schedule may bar you from attending some meetings. You may feel pressured to make extra time for them, to fit them into your schedule between normal job duties, or even to sacrifice some of your time off.
In many busy units, where a cadre of nurses is responsible for 24-hour coverage, meetings inevitably occur on someone’s day off or during periods when several nurses are scheduled to staff the unit. Needless to say, taking time away from patient care—the nurse’s primary role—is risky. And sacrificing your personal time off to attend a meeting can contribute to job dissatisfaction and burnout.

Progression to a letdown?
On our unit, we needed to revise a crucial patient care protocol and create two new protocols. We knew that doing this the usual way would take much effort and time—and many meetings. First, we’d have to assemble a work group of three to six members. Next, we’d have to coordinate group members’ schedules to find a mutually acceptable meeting time and interval—a daunting task. Eventually, a group of six nurses would start the project, meeting monthly to discuss and resolve issues.
But using past experience as a guide, we suspected that as the project progressed, the group would most likely dwindle in both membership and active participation. Meetings would be held less and less often, and some group members might lose interest entirely. This prospect was disheartening, especially since we knew it could take up to 8 months to complete a single protocol and get approval from the various governance committees.
To avoid what we feared might be a wasted effort, we looked for an alternative that would permit group members to meet frequently without giving up their time off, rearranging work hours, or neglecting patient care duties. To arrive at an effective solution, we had to alter our concept of meeting as a discrete event where participants sit down together in the same room and speak one at a time on a single issue.

“Meet you in cyberspace!”
We explored several alternatives to in-person meetings—including simply e-mailing the discussion and using a web log (blog). But these methods proved to be cumbersome and the discussion flow seemed chopped and disorganized.
We decided that the most plausible option was a “virtual,” or online, forum using either the Internet or an intranet (an internal, private computer network). To set up our forum, we’d simply need to create a password-protected virtual conference room on the World Wide Web and invite an open-enrollment workgroup.
To make this solution a reality, we researched a host of software applications and found many that offered everything we needed. The ideal application would protect proprietary information but still allow easy access to an open, interactive forum. Ultimately, we settled on Internet Relay Chat—a live chat system allowing real-time conversations among two or more people.
Once we found the specific application with the features we wanted, we started our online meetings right away. It took less than 2 weeks to assemble our invited team and start the discussion process. Most members of the group were able to use every feature of the discussion forum with little or no instruction.
Because we didn’t have to worry about scheduling conflicts (they don’t exist in the virtual environment), we were able to assemble a larger, more inclusive group than we would have otherwise—31 members instead of the usual six. All 31 members actively participated in the virtual meetings, but did so at their own pace and according to their own schedules. Our meeting forum was open 24 hours a day, 7 days a week, so members could participate at any time, from any location. Each of us controlled when, where, and how often we participated. When patient care needs were less intense, some of us accessed the forum from work. Others participated mostly from home, away from the distractions of the hospital environment.
Virtual meetings made the group’s dialogue ongoing and continuous, which led to a kind of nonstop policy development. Our constant communication cycle sustained the momentum of our discussion and kept members’ enthusiasm for the project in high gear.

Stringing together many threads
Unlike the traditional in-person meeting, where only one issue can be discussed at a time, our online forum enabled us to put many issues on the table at once.
We simply generated multiple discussion topics, or “threads.” Members could read and respond to several discussion threads after careful thought. As a result, we resolved multiple issues much more quickly and efficiently than we would have with traditional meetings. Members found the discussion threads user-friendly. They also liked the convenience of using e-mail to exchange relevant documents.
The project facilitator regularly generated new protocol versions from the forum and e-mailed them to group members. After receiving the new version, each member reviewed it and suggested changes, as appropriate, by posting comments in the online forum. These comments were then incorporated into a new protocol version.

Outstanding outcomes
Our virtual meetings were a great success—cheaper, more inclusive, and significantly more productive than in-person meetings. We reviewed about 18 separate versions of the protocols in just 35 days, with no in-person meetings and no additional salary costs related to time spent in protocol development. By our conservative estimate, virtual meetings saved us approximately $13,000 in direct costs.
As an added benefit, we were able to receive input from multiple disciplines. Nurses, neurologists, neurosurgeons, and pharmacists participated in the online discussion. As a result, everyone’s concerns were addressed early, leading to smoother implementation of our protocols.
After seeing our success, other staff members in our medical center have been infected with the virtual meeting “bug.” Several governance committees have adopted this format, eliminating face-to-face meetings completely. Others now use virtual meetings in a modified format to accent face-to-face meetings. Although they still meet in-person, they’ve incorporated virtual environments as a way to disseminate information and discuss topics between scheduled meetings. Virtual formats also are being used to clarify issues and continue discussions left unfinished due to meeting time constraints.


Challenges and pitfalls
We found that changing longstanding beliefs and traditions can be challenging. At first, we had difficulty persuading certain group members that virtual meetings could work. Eventually, though, we won them over because we’d identified influential leaders at the outset and included them in early efforts to establish virtual meetings. These leaders generated excitement among others, which encouraged reluctant staff members to participate.
Also, several group members needed significant coaching, support, and assurance until they felt comfortable using the electronic medium. After a while, many found they preferred this communication mode to face-to-face meetings. They reported that virtual meetings made them feel like a productive part of the group. Several said they felt more inclined to “speak up” in the online forum because they could take the time to formulate more complete and intelligent responses in a nonthreatening environment. And they enjoyed not having to wait their turn to speak!

Other key advice
If you’re considering switching to virtual meetings in your unit or facility, here’s some advice to consider:
• Choose a dedicated, energetic facilitator. The facilitator mediates the discussion and clarifies the group’s collective responses to formulate a unified solution.
• Recruit group members who are passionate about the issues and eager to participate in virtual meetings.
• Keep in mind that technical skills may vary greatly among group members. Some may be inexperienced using the electronic medium to communicate their thoughts and ideas. Offer them support, education, and reassurance.
Pushing for change can be an uphill battle—especially when challenging deeply rooted institutional traditions and deeply held personal beliefs. By being persuasive, passionate, and persistent in selling your new concept, you can “virtually” assure your success.

Selected references
Dinnocenzo D. How to Lead from a Distance: Building Bridges in the Virtual Workplace. : Walk the Talk Publishing; 2006.

Green A, Jordan C. Common denominators: shared governance and workplace advocacy—strategies for nurses to gain control over their practice. Online J Issues Nurs. 2004;9(1):10.

King K, Olson D. Welcome to the future: Transform your meeting format to engage virtually every staff member. Poster Presentation. American Association of Critical-Care Nurses: National Teaching Institute, Anaheim, Calif. May 19-26, 2006.

Scharfe-Pretino T, Von Bacho S. Sharpening your saw: nursing intranet web site: a critical communication tool. J Nurs Care Qual. 2006;21(2):104-109.

Kenneth J. King, RN, BSN, and DaiWai M. Olson, RN, BSN, are staff nurses in the Neurocritical Care Unit at , Mr. Olson is also a PhD candidate at the University of North Carolina-Chapel Hill School of Nursing.

The authors have received no financial support or influence from the manufacturer of any software corporations or titles mentioned in this article. Software titles mentioned are examples only; no recommendation was expressed or implied.

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