Management gurus since the 1970s have taught leaders to “manage by walking around (MBWA)”; getting out of the office and into the workplace to see for themselves what was going on in their organization. It is a very old idea. Generals such as Napoleon Bonaparte and business tycoons such as Henry Ford were legendary for getting first-hand information about their organization and its environment, but MBWA has been around since before Moses walked among the people of Israel during the Exodus (c. 1400 BC).
Most MBWA is informal, with the boss walking from department to department or store to store, meeting people, talking, and most importantly listening to them. There are times, however, when leaders need to interact with their organizations and with other organizations more formally. My leadership team in the Joint Task Force – National Capital Medicine (later National Capital Region Medical Directorate (NCRMD), part of the Defense Health Agency), routinely met with leaders and workers at military hospitals and clinics throughout our market. We also visited Federal Facilities such as the Veteran’s Administration, and major regional partners including the hospitals and clinics of the Johns Hopkins, Medstar and INOVA systems. Sometimes formal trips to universities and other non-medical facilities were required, and often my team and I addressed groups of stakeholders in a town hall or public forum.
Visits are vital. They help people get acquainted and discuss important matters. Typically my team received a brief from the clinic including their leadership, their services, their successes and their struggles. I always liked to hear good news stories from our subordinate facilities and learn about their best staff so we could reward them publically. My team usually briefed them on key things that they needed to know from higher headquarters. Towards the end of early visits, we had a tour. Over the years, I can think of dozens of successful initiatives that have begun while collaborating during a visit.
Town halls are also important. Whether the audience is a group of hospital employees needing motivation or a crowd of military retirees seeking medical care, leaders must listen to their concerns and be perceived as listening. Town halls provide a useful venue to get organizational messages out and to get stakeholder messages in.
Visits and town halls, however, require a lot of work. Because both are ceremonial events, and because of the traditional mistrust between levels of an organization, visits and town halls need to be carefully planned and executed. Leaders and administrative support staff can get nervous. When my Executive Assistant called a hospital or clinic to arrange a visit, the first question that she often heard was “why?” Sometimes the “why” is interrogative and other times it is accusatory.
This article will discuss how to make formal visits to other organizations and town hall meetings more productive for everyone involved.
Formal Visits to Other Organizations
- What do you want to accomplish during the visit?
From 2003 to 2004, when was the Deputy Task Force Surgeon for the Task Force First Armored Division (TF 1AD), my boss, LTC John McGrath, was legendary for his no-nonsense drive. He told a story of being at a meeting in Baghdad in which the organizers seemed to have no purpose for the meeting. John stopped the banter and said “if no one else has an agenda for this meeting, I do.” He got his task accomplished.
Most people don’t want to waste time, and some consider visits from other organizations (or even higher headquarters in their organization) to be a waste of time; an interruption from their real work. Others see visits from their senior leaders as validation that what they do matters, and these visits help them feel more a part of the community. Most understand that the people from higher headquarters can provide resources and guidance for their mission, and professional mentoring. In addition to these general goals, leadership team must always have specific goals for each visit.
|General Visit Goals||Specific Visit Goals|
|A. Meet leaders and staff|
|B. Meet other stakeholders who may be present (patients, community members, investors)|
|C. Tour facilities|
|D. Award outstanding performers|
|E. Learn about successes and struggles of the organization|
|F. Discuss what is happening in your organization|
|G. Discuss ways to collaborate on common problems|
|H. Forge a way ahead, including assigning action officers and suspense dates to issues and arranging a follow up meeting.|
- How do you want to accomplish it?
It is hard for formal visits to be productive without an agenda, including approximate durations for each item. Taking minutes is also mandatory, since items discussed, conclusions reached, due outs (work to be done) and action officers (those responsible to get it done), and suspense dates (due dates) must be tracked. All parties to the visit must shape the agenda, since doing so makes the visit collaborative instead of coercive. Appendix A contains a sample agenda and list of slides for a visit to a subordinate facility. The list will need to be adjusted depending upon circumstances. For example, if the leaders know each other well, there is no need for slides identifying the leaders.
- Who do you want to meet?
My team worked with the facility we would be visiting to pick the right attendees. For example, for a visit to an outpatient clinic we would bring along our experts in primary care, appointing, referrals, and whatever specialties that clinic offered. For our visit to the nursing research unit at the National Institutes of Health (NIH), we included senior nursing researchers and physician researchers from Walter Reed and educators and clinicians from the Uniformed Services University for the Health Sciences. Sharing bios is a good idea. During a visit to the DC VA I discovered that our host and I went to the same graduate school, and during a visit to the NIH sharing bios enabled us to introduce people with common research interests.
The principal should not go alone. He/she needs someone to handle the unexpected, to watch the reactions of everyone involved, to take notes, and to write whatever trip report is required. The leader of the team cannot catch the facial expressions and body language of everyone else in the room but such clues are a key to successful communication. In larger or more contentious meetings, the principal may need more companions.
Having too many people is also ill advised. To prevent overwhelming our hosts we keep our team to no more than 4-5 people. Visits add to the workload of everyone involved, especially the facility hosting the event. People preparing for or conducting a visit can’t be doing something else. The more people your team has, the more people they will feel the need to include.
- A preparation list for visits – introductory paragraph, agenda, host slides, visitor slides, FAQs, date/time/location
Like everything else in life, visits require preparation. Before coming together, all parties should have done the following:
- Understood and agreed on the purpose, site, during, and attendee roster for the visit.
- Prepared (or edited) relevant briefs (introductory, information, decision, etc.)
- Ensured that all pertinent stakeholders are offered representation, including the press.
- Cleared the visit with appropriate authorities
Press coverage deserves a special note. President Richard Nixon told his staff that for every story, they needed to plan (or at least anticipate) the photo, the caption, the title, and the story line. In the modern world, they also need to anticipate the text, the Tweet and other social media posts (Facebook, Snapchat, Instagram, etc.). Unlike in Nixon’s day, there is no time between when something is said and when it is broadcast to the world. Reporters get information out the minute that they hear or see it. Leaders must be prepared.
For more information, please review Making Meetings Matter
Town Hall and Panel-type Events
Business meetings feature representatives discussing issues, and town halls are another variation on that theme. Town halls often involve senior leaders standing before groups of people and answering questions, sometimes aggressive and accusatory ones.
- What do you want to accomplish with the town hall meeting?
Groups sponsor town hall meetings to listen to and to talk to their constituents. Town hall meetings are useful for explaining complicated issues and getting messages out. They demonstrate to the stakeholders that their leaders value them and actively seek feedback. The theme of the meeting needs to match the spoken and the felt needs of the stakeholders.
- How do you want to accomplish it?
Community events such as town hall meetings need an agenda to guide discussion and minutes to record discussion. Leaders should work with their public affairs teams to craft short, pithy talking points so their message will be heard and remembered. Communication isn’t only verbal. Wearing the right uniform or business attire, having good posture and listening intently are important. Displays or posters can send worthwhile messages, and the venue itself speaks volumes.
- Recommendations during town hall meetings
Leaders should arrive early and talk personally to attendees. Gain as much good will as you can; most people find it harder to publically skewer someone they know personally than someone they do not. The filmmaker Alfred Hitchcock used big name stars in his thrillers because he knew that viewers would be more familiar with them. As a result, they would identify more closely with the characters and feel more impact when they watched the movies.
I delivered the keynote address at a 9-11 Tenth Anniversary Commemoration for Carson City, Nevada. Governor Brian Sandoval was there, as were key city leaders from police and fire. There were over 500 attendees. My speech went very well, for people in the first 20 rows of the outdoor venue. No one further back than that heard it because the sound system was faulty. Don’t let this happen. Have your support team arrive early to ensure that the venue, the audiovisual support, and other key parts of the meeting are working. This is true even if you are not the host – poor performance hurts all participants.
Leaders and their teams at Town Hall meetings need to be aware of recent news and other key events that affect listeners. They should use this knowledge to tailor the speech, the answers to questions, and further discussion. They must never argue – even if the questioner is rude and wrong. As a person of authority, arguing only makes you look bad.
People asking questions at Town Hall meetings will sometimes mumble or be otherwise unintelligible to those around. Leaders must listen completely to the concern or question, and then repeat it aloud. This ensures that you understand the question and that others in the audience have heard it.
After reflecting the question back, decide if you wish to answer it. Some questions are rude, inappropriate or self-incriminating and should not be answered directly. The person who frames the question frames the discussion, and leaders must not let themselves be forced into answering an unfair question. Jesus did not answer many of the accusatory questions hurled at him by the Pharisees and Sadducees. He was always in control of what He said and did. All leaders should follow His example.
If you decide to reply directly, do so briefly and honestly. Then add whichever of your talking points is most relevant. Remember, you have a message that you are trying to get out as well, and now is the time to do it. If you decide not to reply directly, you can ignore it, tell the questioner that you will get back to them, or tell them that you will not answer and why. Try not to accuse the questioner. Have a compatriot mingle in the crowd and get the name, question, phone number and email address of those who asked a question. Once you have answers, close the loop with the people who them.
Many facilities have more than one higher headquarters. Military medicine is divided into geographic markets, including the National Capital Region, the Tidewater Region, the Puget Sound Region, the San Antonio Region, the Colorado Springs Region, and the Hawaii Region. The Walter Reed National Military Medical Center, the Fort Belvoir Community Hospital, the Joint Pathology Center, and some other facilities in the National Capital Region military medical market fall directly under the National Capital Region Medical Directorate (NCRMD). Other clinics, however, have split responsibilities. For example, the Navy clinics at Quantico and Annapolis answer to the NCRMD for market issues and Navy Medicine-East for administrative issues. The same is true for the Army clinics at Fort Meade and Fort Myer and the Air Force clinic at Joint Base Andrews. Sometimes local clinics want teams visiting from one headquarters to first get permission from the other. Though it may not be technically necessary, if it keeps peace in the market and protects the local command, do it.
Commanders visit their subordinate facilities, but so do staff teams. A key part of staff work is to visit the leaders and staffs of other facilities. As the Chief Medical Officer, I did not visit as a commander but as a senior staff director of the JTF Cap Med – NCRMD. My team had blanket permission to visit whatever facilities we deemed necessary to accomplish organizational goals. Lower level leaders should have the same freedom. To avoid encroaching on the prerogatives of senior leadership, junior leaders coordinate their visits and ensure that they do not repeat messages. For example, top level leaders discuss strategic issues on her visits, while lower level managers focus on operational and tactical issues.
If communication and trust between people and commands is poor it may be hard to get permission. Rather than appealing to higher authorities leaders should try to convince the recalcitrant that the visit is in everyone’s best interest. When my JTF Cap Med team wanted to visit the Quantico clinic, the clinic leadership was excited to host us but their higher headquarters at Navy Medicine – National Capital Area (NCA), said “no”. I met with the NavMed NCA team, told them why this was important and how they would benefit, and offered to let one of their leaders join our visiting team. They agreed and the Quantico visit was a great success. Keeping minutes of visits allows us to document successes and justify further visits.
Permissions and coordination are also indispensable at Town Hall meeting and other community events. Everyone involved must know and agree on the goals of the meeting and must have an idea who will talk and what they will say.
Visits and town hall meetings are vital functions for both junior and senior leaders, but seldom are we taught how to do them. This article is intended to help leaders at all levels and their staff members better use formal visits and town halls to meet organizational goals. By taking important processes and standardizing them, we decrease confusion and get more done.
Appendix A – Formal Visit to a Subordinate Command – Sample Agenda and Briefing Slides
|1305-1345||Local facility Brief and Discussion|
|Title slide – facility, briefer and date|
|Slide 1 – Overview of brief|
|Slide 2 – Leadership team||Facility director, chief officers (medical, nursing, operations, financial), other key players whether they are present or not|
|Slide 3 – Floor plan or map of facilities||Provides a snapshot of the size of the building and scope of services|
|Slide 4 – Population overview||Who do we want to serve? In military medical facilities, this is the beneficiary population.|
|Slide 5 – Population served||Who do we serve? In military medical facilities, this is the enrolled population for primary care.|
|Slide 6 – Services offered to primary customers/patients||Primary care, behavioral health, specialty care, ancillary services, public health, surgical, etc.|
|Slide 7 – Services offered to others||Education, research, etc.|
|Slide 8 – Quality metrics – primary care||Access to care, continuity of care, emergency department utilization, secure messaging, HEDIS|
|Slide 9 – Quality metrics – specialty care||Access to care, ORYX, Partnership for Patients, operating room utilization|
|Slide 10 – Facility SWOT Analysis||Strengths, weaknesses, opportunities, threats|
|Slide 11 – Competitive environment||Primary competitors and market share for each|
|Slide 12 – Competitive advantages and disadvantages||Ours and theirs|
|Slide 13 – Marketing and communication||Ours and theirs|
|Slide 14 – Financial Inflows||Defense health program, other health insurance, other Federal reimbursement (Medicare, VA)|
|Slide 15 – Financial Outflows||Civilian personnel, pharmacy, contracts, other major cost centers|
|Slide 16 – Future plans and timelines||Services, costs|
|Slide 17 – Recent victories||Three things to be proud of, including the people who made them happen|
|Slide 18 – Recent struggles||Three things to overcome, including the people who are key to overcoming|
|Slide 19 – Needs from higher HQ||Three things that they need from us|
|Slides 20 – Summary|
|1350-1410||Higher Headquarters Brief and Discussion|
|Slide 1 – Overview of brief|
|Slide 2 – Leadership team|
|Slide 3 – Military medical regional overview||What is happening at the other hospitals and clinics in the region?|
|Slide 4 – Business plan metrics||How well is the region accomplishing its goals|
|Slide 5 – Business plan metrics|
|Slide 6 – Public sector developments||How are the political and governmental environments changing?|
|Slide 7 – Private sector developments||How are the competitive and economic environments changing?|
|Slide 8 – Other developments||Other changes that the subordinate facility should know about|
|Slide 9 – Our response||What higher headquarters is doing about these changes|
|Slide 10 – Summary|
|1420-1500||Facility Tour||When possible, meet and recognize the people who made the “Recent Victories” happen. Award commander’s coins if available.|
|1500||HQ team departs|