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Want fresh ideas for improving your practice? Take your staff away from it all for a while.

Fam Pract Manag. 1998;5(1):56-62

In many busy practices, the first reaction to the thought of holding a staff retreat might be, “Who has time for that touchy-feely stuff?” But in the highly competitive, rapidly changing world of health care delivery, retreats can be critically important in helping you maintain a focus on quality and efficiency in your practice.

Why to retreat and what to do

The type of retreat to consider depends largely on your goals and on the resources you can commit to developing an environment that fosters meaningful interaction. Generally speaking, retreats can serve three purposes:

Strategic and operational planning. Some staffs pause annually or even twice a year to review policies and procedures, evaluate systems and processes, and rethink resource allocation. The focus is on continually increasing your quality of care and your practice's efficiency.

Just about anything that goes on in your office is fair game for discussion and improvement — everything from patient relations and “customer service” to office management, record keeping and personnel issues. The point is to get people's views about your strengths and weaknesses on the table so you can plan how to do a better job. Clearly, the discussions must be frank and free-flowing, and even sensitive issues must be brought into the open.

Among the planning activities you might consider is an analysis of your practice's strengths, weaknesses, opportunities and threats. You divide your staff into four teams, one for each area. The teams brainstorm and prioritize ideas in their categories. After discussing the findings, the entire staff develops strategies for maximizing the strengths and opportunities as well as for overcoming the weaknesses and threats.

Team building. Another reason to hold a retreat is to strengthen your team — integrating new staff members, reenergizing your current employees or both. Team-building retreats focus on your practice's culture and how you expect people to interact. If your culture is very positive, you can use a retreat to immerse new staff in it and reinforce existing employees' commitment to it. If your culture is ill-defined or problematic, a retreat lets you focus on how you want your staff to interact.

Completing personality profiles, such as the Myers-Briggs Type Indicator, can reveal the team's varied interpersonal styles and provide a nonjudgmental way to talk about how specific characteristics lead to different ways of thinking and working. Team-building exercises that draw on the diverse strengths of all team members show how different personalities can work together effectively (see “Collaboration prevents crack-up”). Other exercises, such as playing team sports during the retreat, also can help increase respect, rapport and understanding.

If thoughtfully structured, teambuilding retreats can clarify roles and expectations, ease tensions and identify the unique contributions of each staff member. They should provide a mix of reflection and renewal in a comfortable, creative atmosphere.

Collaboration prevents crack-up

Everyone has different skills and styles, but people still have to find ways to work together, come to consensus and build productive relationships.

Here's a staff-retreat exercise that challenges individuals to solve a problem as a group. It requires the strengths of both practical and creative personalities. The team must weigh options and make choices that affect the outcome of the project in a relatively short time frame.

  • The challenge: Protect a raw egg so it won't break when it's dropped six feet to the floor.

  • The rules: Use only the materials provided, keep one-third of the egg showing, complete your project in 20 minutes or less, listen to everyone's ideas and have fun!

  • The materials for each team: one raw egg; one six-inch, round, plastic foam plate; two chopsticks; two jumbo paper clips; two large rubber bands; two 18-inch pieces of string; two toilet paper tubes; one sheet of gummed file folder labels; and one 12-inch plastic bag.

  • The test: After each team has created its project, appoint one representative to come forward, hold the egg six feet off the ground and drop it onto a carpeted area (covered with a large trash bag).

  • One hint: Parachute models abound, but other ideas work, too. Here's the point: Most problems have a variety of workable solutions. Building on each others' strengths makes the whole team stronger. Listening to varying perspectives and ideas expands the realm of possibilities. Collaboration and cooperation make projects better — and more enjoyable.

Blue-sky brainstorming. Even the best managed and most collegial staff can't afford to coast on its success in a world where patients can “shop” for care based on its affordability, convenience and quality — and the attitude of the people providing it. Given this environment, staffs need to take time away from routine assignments to think “outside the box” about issues such as market share, service delivery and the implications of new technologies. Practices need to be constantly striving to improve, asking “What if we … ?” and “What should we be considering?”

You can facilitate this in a retreat with exercises such as asking the staff to imagine that the practice will be profiled in a journal. Have the staff outline the points they hope the article would make about the practice (such as the quality of the medical staff, the office's efficiency and the staff's focus on customer service). Then discuss how this ideal compares with reality, and brainstorm how you might move closer to the ideal.

This type of activity stretches minds and imaginations, keeps staffs from growing complacent and validates those who embrace change.

To make it work, don't make it work

Part of what makes or breaks a retreat is its site and format. These variables have a lot to do with how much you can accomplish and the level of candor and creative input you will receive.

Of course, your retreat has to fit within your resources, and most family practices don't have lots of extra money for special projects. So your first inclination might be to cancel your appointments, lock the doors, program the coffee maker and retreat within your own “friendly” confines. But a retreat in your office, especially during working hours, can feel like just another day on the job — one with an interminable staff meeting. The setting may be uninspiring and may not encourage people to break out of established organizational hierarchies and modes of thinking. Of course, every rule has its exceptions; depending on the staff and the agenda, some in-office retreats can work well. (See “How one practice handled its retreat.”)

Generally, better options range from a casual afternoon barbecue and meeting at someone's home to more formal, daylong sessions at local conference centers, historic properties or hotels. These settings are particularly conducive to team building, and even more so if you can include shared activities, such as tours, performances or meals, in addition to your meetings. Being away from the office, people will probably be more relaxed and more willing to question, wonder and suppose. And by structuring participants' seating and (to some extent) their interaction, you will enable people to work together in different ways and form new relationships.

If you have the resources, choose the ultimate in retreats: a weekend of meetings, socializing and sports at a resort. Such a setting is ideal for thanking your staff, building teams through extended interaction and brainstorming new ideas and opportunities — all away from the crush of work, family and civic responsibilities.

How one practice handled its retreat

John L. Hudson, MD

In 1996, I sold my practice to our local hospital. This change and the general shift toward managed care put tremendous strain on the office and affected staff morale. We needed to bring meaning back into our practice in the face of these outside pressures. So we agreed to develop a mission statement and a set of core values that could guide us through these changing times.

To accomplish this, we decided to hold retreats involving all 18 staff members and physicians. To minimize time away from family, we didn't choose a weekend but met twice during the week, closing the office at 3 p.m. and working until 9 p.m. We served dinner and paid the staff to attend.

The idea was met with a certain degree of skepticism. But once the first retreat began, you could feel the interest and energy grow.

We began by determining our core values. Each staff member suggested values for the group's consideration, and we listed all of them on flip-chart pages around the room. We then used nominal group process to trim the 120 suggestions to a final list of 15 — 10 related to patients and five related to ourselves. With these values in mind, we crafted a mission statement, again using nominal group process to evaluate several drafts.

Both physicians and support staff considered the two retreats extremely successful. The level of involvement was high, and everyone, from our clerks to our senior doctor, felt he or she had an equal opportunity to contribute to the process.

As a result of our work, the staff have begun working together more closely. They have bought into the power of having a mission statement and a set of core values because all staff members helped develop these documents.

We all agree that what we accomplished at the retreats was vital to the success and well-being of the practice — and vital to maintaining our morale. We just couldn't have accomplished this during our usual lunchtime staff meetings.

Dr. Hudson is medical director of Centura Medical Group, PC, a 100-provider primary care group in the Denver area, and a graduate of the Academy's Fundamentals of Management course. His project for that course dealt with the retreats he describes here.

Critical elements for success

But even an ideal setting doesn't guarantee a productive retreat. For that, you and your staff need to do some serious planning and organizing:

  • Make assignments for before and after the retreat. To vest staff members in the retreat's outcomes, ask each person to prepare materials or exercises for at least one agenda item. Delegate responsibility for directing discussions and moving the group to a decision or action. Include in their assignments appropriate follow-up after the retreat.

  • Develop a clear and thoughtful agenda. The retreat's agenda should outline the objectives for each meeting and the items to be covered. Assigning times to agenda items helps keep meetings on schedule, but don't try to tackle too much in any given session. Setting priorities for your agenda and sticking to them will help you use your retreat time well, but be flexible enough to explore innovative ideas or unrecognized issues if they arise.

  • Consider the details. Anyone who has read evaluations from a retreat knows what concerns participants most: the room temperature, the seating and the quality of the food. Creature comforts do matter!

    If people will be meeting for several hours at a time, make sure the room is arranged so that no one has to strain to see or hear the leader, the audiovisuals or the other participants. For full-day meetings, change the room's setup after lunch or at least change the seating assignments. A fresh perspective means better attention.

    Plan for midmorning and midafternoon breaks to refuel the mind and body. Sugary treats give people energy bursts for lively interaction; complex carbohydrates sustain the group for longer discussions. Most groups also want healthy choices, including juices, flavored waters, fresh fruit and yogurt. If you're serving lunch, consider holding the dessert for the afternoon break — it saves calories and dollars.

  • Establish the ground rules. Once the retreat begins, check your beepers, cell phones and anything else that buzzes at the door. Then you can get to work by setting the retreat's ground rules. Stress the importance of openness, cooperation and accommodation. Discuss the need for confidentiality and candor, and decide how disagreements will be resolved. Remind participants that it's acceptable, even necessary, to challenge, question and criticize people's ideas — but not them personally. Review how the sessions will be conducted and who will facilitate them. Decide how decisions will be made — consensus, majority rule or “what the leader says goes.” Explain how brainstorming works and what level of participation you expect in group exercises. Finally, involve the participants in setting criteria for measuring the retreat's success.

The work goes on

As you conclude your retreat, thank everyone for participating. Summarize your discussions, and review the decisions you've made. Most important, don't let your progress come to a screeching halt. Make assignments for implementing the group's decisions, and reinforce the message that reflecting on the quality of your operations is a process, not a special event. It's everyone's job, every day.

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Copyright © 1998 by the American Academy of Family Physicians.

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