A senior civilian official in the military health system was at a surgical conference with a young Navy colleague. They chatted, and in the course of their conversation the Navy surgeon mentioned some exciting things that he was doing in his clinic to improve access, operating room utilization and quality of care. The civilian official asked the younger man to prepare a talk to present to a group of senior leaders. Eventually word of this arrangement spread throughout the levels of command and my team was tasked with making sure that the brief accomplished its purpose.
The Navy surgeon was smart, industrious, and enthusiastic about his team’s accomplishments. Their record was impressive, providing more patient care with better outcomes, higher satisfaction and fewer resources than before. Operating room utilization improved, and the surgical fellowship, threatened by poor case mix and volume, was on firmer ground.
Their brief was less impressive, containing slides without themes, results without numbers, and a slide sequence that meandered without destination. It said some things which would better have been omitted and omitted things that needed to be shouted from the mountain tops. This article will address the need to communicate more effectively through slide presentations.
The two primary kinds of briefs in the military are the information brief and the decision brief. The former seeks to convey important information to the audience, while the latter seeks a favorable decision from a decision maker. Although not every information brief needs to use slides, the practice is common.
The Slide Show
At a formal dinner Winston Churchill was served dessert, studied it carefully, and then exclaimed to the waiter “Take it away, it has no theme!” Too many presentations suffer from the same malady; the communicator is not entirely clear what he is trying to communicate. After the title slide, the first slide in any presentation must describe the purpose. The purpose must answer two questions:
1. Why I am giving the presentation.
2. Why you will want to listen. This is the “hook” of the presentation; the speaker wants his audience hungry for the meal he is about to serve.
One purpose statement I saw recently, “To provide background information on the surgical services at XXX medical center in the YYY health care network and how our initiative may be expected to improve them” may elicit a puzzled yawn. The audience was from other medical facilities in the region and they were more interested in their own hospitals than in XXX. These health care executives only cared about how the experience at XXX could help them improve their facility. A better purpose statement might have been “To describe surgical services at XXX medical center and discuss how our experience could benefit others.” This purpose statement is less wordy and emphasizes not what the speaker did but what the listeners can do. It suggests interaction and discussion rather than a one-way lecture. This is the time to tell a short and powerful story to illustrate the purpose and why the audience should care about it. Members of the audience decide whether or not they will listen in the first 30 seconds, so the beginning must be good.
The purpose must be limited in scope to what can reasonably be accomplished in the time allotted. No 10 minute brief can convey a detailed analysis of the Rise and Fall of the Roman Empire. Even if the speaker could do it, the audience couldn’t absorb it. The purpose must be laser focused and limited to the time available.
After the “purpose” slides, the next slides should tell a story; what was the problem, what was the solution, and what were the results? Leaders rarely want to study hundreds or even dozens of slides and usually want to see fewer than 10. Since a standard brief is 10 minutes with 5 additional for questions and since each slide takes about one minute to cover, each question should be answered in one or two slides.
1. What was the problem? In the example above, what was operating room utilization? What were the graduate medical education implications? The slide should feature two or three key metrics and a clear graphic to communicate the problem.
2. What was the solution? What did the team actually do to fix the problem? This needs to be specific as well. Was the solution a process reengineering, a sharing agreement, a new training program, an equipment purchase, a personnel hire, or something else? Perhaps it was a combination of these things. The solution needs to be clear at a glance to someone who has never seen the slide before. For example, one of the problems in the example noted above was unnecessary referrals from primary care. By training the primary care partners, the surgical team was able to see more patients requiring surgical intervention.
3. What were the results? How much did operating room utilization increase? How did the case number and mix improve? How did that impact the accreditation of the fellowship? Use the same metrics that were used in describing the problem.
The last section of the information brief, called perhaps the Application, should focus on how this impacts the audience. It bears repeating that the audience will listen if they expect to eventually get something back. The speaker needs to know the audience, what they expect to get back, and how to give it to them. The most effective speakers spend time before, during and after their briefs getting to know their listeners. Why did these people come? What do they want? How do they want it?
The last slide of the information brief is the conclusion slide. It includes only those bullets that the speaker wants the audience to remember. This is the place to summarize the talk and ask questions. Back up slides are placed after the conclusion and not meant to be shown unless someone in the audience asks a specific question that pertains to the slide. They should be held to the same standard as any other slide.
Another way to structure a brief is the Hook-Book-Look-Took mnemonic:
Hook – Something to get and hold the attention of the audience
Book – The content of what you want to say.
Look – What does the content mean?
Took – How does the content and its meaning apply to the audience?
It’s no stretch to figure out that the Hook is in the purpose, the Book and Look are in the content slides (problem, solution and results) and the Took is the application slide.
Just as the entire slide show has a theme and a direction, each slide must have the same. Real estate in the mind of a decision maker is precious, and real estate on the slide is vital to gain real estate in the mind. The briefer must make sure that each slide, and each element on the slide, contributes to achieving the goal.
1. The theme of the slide should be understandable at a glance.
2. Nothing should be distracting.
3. Use bullets rather than sentences because extraneous words make the whole thing less likely to be read.
4. Make the bullets as short and information-packed as possible.
5. Use high contrast colors or black and white and keep the font large enough to be read easily in the venue. Walk to the back of the room yourself and look.
6. In general, a slide should contain no more than five to seven bullets, with each bullet containing eight to ten words. The final bullet should be a transition to the next slide.
7. Each slide must contain new information or a fresh approach to understanding old information. Many presentations die because slide after slide includes things that the audience already knows. A recent slide deck that I reviewed had nine slides, one of which cited a national-level survey which confirmed that patients have a choice when selecting health care. The data was too general to be useful, and the slide is gone…the speaker can “voice track” it; say it instead of having it on a slide.
1. Ensure that each participant has a paper copy of the brief to read before the meeting (a “read ahead”). Also ensure that each one has one during the meeting.
Churchill opened one of his speeches to Parliament by saying “I am going to give a long speech today as I have not had time to prepare a short one.” He was right. It is harder to condense thoughts into a short delivery, but that is what speakers need to do. Briefers need to use no more words than are absolutely necessary to communicate their message.
Many people complain that nothing ever seems to get done in government, in the corporate world, and elsewhere. One reason is that staff members do a poor analysis and give poor counsel to their leaders. Other times staff members do a good analysis but fail to communicate it effectively. After discussing the brief with the Navy surgeon, we came up with a much better product. He gave the brief to the senior leaders and the feedback we received was that he “hit it out of the park.” However, his success was not primarily because of better slides; he made most but not all of the changes that we recommended. Rather his success was because of him. This young surgeon was skilled, dedicated, and excited about his story. He believed in his work and that enthusiasm made everyone else believe in it too. More than anything, humans are relational creatures. The right message is important, and hopefully this essay will help us all improve it, but so is having the right messenger. It is best to have both.