Your clinical group lacks a strategic plan. You are asked by members of your group to allow them to have input into your plans for its future. It occurs to you that one approach to develop, gain feedback, and communicate a shared agenda for change would be to bring people together at a retreat or away day. But what would be the agenda? Who should you invite? And how will the retreat run?
Before discussing retreats, a brief review of basic concepts (as I understand them) is in order. Vision and mission statements are important to guide organizations in decision-making, including setting priorities. While some decry this activity as an administration exercise, if performed appropriately, it can be used as a preamble to developing explicit strategic directions (that, in turn, can serve as the agenda for change you hope to accomplish as the leader). More importantly, a well formulated vision and mission can help inspire individuals to change and serve as key principles to guide effective decision-making. What follows is only meant to introduce the concepts, given the huge volume of material on this topic. You might find it useful to visit my Recommended Reading page for some ideas of books to consult for further information.
The process used to develop the vision and mission must be based on meaningful, candid and respectful conversations. To be useful, the vision and mission must be cogent, realistic, and explicit. While instructions on the process can be found in innumerable other sources, this section provides general comments about how the process could be achieved for a clinical group such as a department or division.
The vision is where the group wants to go. A vision statement should be inspirational and aspirational, but realistic. For example, not every group can hope to be the “best in the world”, but setting specific (and measurable) targets give a team something to aim for. Mission describes how the vision will be achieved. For academic groups, the mission should encompass at minimum education, research, and clinical care. The mission should be tangible and sufficiently encompassing that it will lead to the group towards the successful realization of the vision. Values are how the work will be conducted. Values must be true to the culture of the group. For example, many groups have values such as collaboration, but if the group is plagued by disrespectful behaviour such value statements, rather than enhancing collaboration, lead to cynicism.
The process for developing a group’s mission and vision is important and should include input from the entire team. From a practical point of view, the mission and vision are often set at an institutional level. However, there is no reason to be constrained by this fact, as long as the group’s statements are complementary to those of the wider organisation. At a minimum, clinical groups need to discuss what the institutional vision and mission means to them. Arising from the vision and mission are strategic directions. Strategic directions are created to realize the vision and mission. Strategic directions must be measureable with specific aims. While the vision and mission change infrequently, strategic directions are often more transient and have shorter time frames of usually years.
An opportune time to begin the journey of change is during an away-day or retreat. Setting the agenda for change requires broad input for several reasons. First, multiple inputs lead to a better agenda for change by uncovering potential resistance to change and possible pitfalls in effecting change. Second, involving the entire group often leads to more engagement for when change commences. Finally, the process of soliciting feedback communicates the plan for change, and builds awareness of impending change. If correctly conducted, retreats are an excellent approach to gain input into the agenda for change, but more importantly, to build engagement within the group for that change.
So, how do you conduct a retreat that is a worthwhile use of people’s time and not a cynical exercise? Retreats require planning over many months. Early in the process, it is useful to create a committee to establish plans and goals for the retreat. This committee, formed from relevant key disciplines, should ideally start planning at least 6 months prior to the event. One decision that needs to be made is who should lead the retreat. A professional facilitator may be better at controlling an unruly crowd and may be better at managing the day. A facilitator also frees up the leadership to listen and/or participate in the proceedings. A facilitator, however, has several disadvantages. A facilitator may add an unwanted formality to the retreat. A facilitator is usually unknown to the group and thus, unless very skilled, may actually inhibit conversation. Finally, individuals external to healthcare lack a certain credibility that may lead to disdain for the entire process.
The retreat committee also needs to consider how the agenda for the retreat will be developed and its content. One approach is to administer a pre-retreat survey to solicit topics/suggestions and also to determine the relative importance of key topics for discussion (such as safety, quality, innovation, etc.). E-mail surveys work well for this purpose, as long as everyone has access to, and everyone accesses, their e-mail. While ultimately the retreat organising committee will decide on the agenda, the input of the group should influence those decisions.
The retreat should start and end on time, with specific time allocated according to the agenda topics. Retreats should generally be one-day and consistent with work shifts of attendees, i.e. match the hours of the retreat to nursing shifts. While the agenda may warrant more than a single day, the second day often lacks energy and productivity of a single day. Workdays are much better than weekends to encourage attendance and emphasize importance. All but essential clinical work should cease for the day.
Deciding on who should attend the retreat is critical. In general, the retreat attendees should be from multiple disciplines and represent all groups involved in the agenda for change. Ideally, the total attendance should be less than 100. Provide breakfast, snacks and lunch (and skimp at your peril!).
The retreat should start with a presentation by the leadership on the current state, with data if available, and if possible, recount recent positive events. The leader should describe the goals for the day and the rules of engagement, including inviting comments and keeping on time. Soliciting comments from individuals by name early in proceedings is key to starting conversation and participation.
The majority of the retreat day should be spent talking and discussing, rather than filled with presentations. Expect the outcome of the day to be a list of issues or topics for a change; don’t expect solutions to come from the discussions. At best, you may capture a list of possible solutions to problems identified throughout the day.
The first formal agenda item should be a brief review of the vision and mission. Avoid extensive word-smithing and, if needed, take such discussion off-line. Developing a vision and mission in a large group may take considerable time; whereas adapting or discussing a pre-existing vision and mission should be relatively brief. Values may require even more time. Specifically, are the values truly consistent with group culture? If not, an important outcome of the retreat maybe a plan for strategies to ensure the values are achieved and enhanced within the group.
Following the discussion of mission, vision and values, the remainder will be spent developing the agenda for change. If the issues facing each discipline are unique, then the first half of the day can be discipline-specific. If discipline-specific issues are sensitive, then you will need to provide different breakout rooms for each discipline.
Another decision is how to conduct the retreat when working with a large multidisciplinary group. Engaging individuals can be challenging. Breakout sessions with small groups of 8-10 participants are one good way to enhance individual participation. The disadvantage of breakout sessions is that moving to new areas adds much time to the proceedings and complicates the retreat; who goes where, do participants move or stay put, etc? If chosen as a means to encourage discussion, breakouts should be no shorter than 45 and no longer than 90 minutes. In breakouts, one person should be assigned to lead the discussion and another to record ideas. After breakouts, the entire group reassembles. Presenting breakout deliberations to the reassembled large group is ideal, but sufficient time must be left, not just for presentation, but to allow for the large group to discuss presentations. The day should end with the entire group together and a summary of the next steps. Where feasible, a social event should follow the end of the retreat.
A document must be created that summarizes the retreat proceedings. All deliberations and suggestions should be recorded and used to create the retreat summary report. The retreat document should summarize the purpose of the retreat, a brief summary of the deliberations, and action items. The retreat report should be circulated within several weeks of the retreat requesting comments/views and corrections both from attendees and non-attendees. After the retreat report is finalized, action items should be assigned to individuals, groups, Task Forces, or committee (I will be writing more on the subject of Task Forces in an upcoming post).
In summary, vision, mission and values are a useful mechanism to engage staff and to develop strategic directions a part of an agenda for change. Retreats require much planning, but can be a useful exercise to accomplish much in one day.