Meetings, bloody meetings
pharmafile | March 16, 2012 | Feature | Business Services, Manufacturing and Production, Medical Communications, Research and Development, Sales and Marketing | Les Rose, Meetings, clinical trials
I read recently that less than 2% of NHS Trust board meeting agenda items require decisions. What happens during the rest of the meeting time?
Sorry, that remains a mystery. The story begs the question of what meetings are actually for, and of course the problem isn’t confined to healthcare or pharmaceutical companies. It pervades modern business life.
I don’t really know whether it’s a bigger problem in drug development, but it certainly is a drain on resources, and meetings are of highly questionable value. So let’s look at the contribution they make to the R&D bottom line.
Years ago I ran a project management training course for a top five pharmaceutical company. At the end of the course, as usual I asked the trainees to commit to two actions they would take to improve project delivery.
The deputy head of department committed to planning more time between meetings so that he would not be late for the next one. Interestingly, this company had a whole wing of the building dedicated to meeting rooms, which were booked up months ahead.
Then there was the chap who flew to the other side of the world (in business class) to attend a meeting, to which he didn’t contribute a single word of discussion. He then flew back, presumably to report on the meeting, when that could have been done electronically.
Why do we need meetings?
Well, enough of anecdotes for the present. What are meetings for? Getting back to basics, drug development is a project-based activity. The purpose of a project is to deliver – what? At the top level, we want to deliver value to the company, patients, and payers.
That final deliverable then gets broken down at the planning stage to a multitude of intermediate deliverables, all linked together logically and taking various amounts of time, cost and effort to produce. There you have it – project management in two sentences. So I ask myself, what deliverable ever emerges from a meeting? What value can we measure
The answer is that, almost always there is no deliverable from a meeting. During the meeting we actually do not do any work, we only discuss what we are going to do when we get back to work.
Many of you will have seen the wonderful John Cleese film ‘Meetings Bloody Meetings’, in which he says that he has to take work home, as at the office he is always in meetings. That was nearly 40 years ago, and I sometimes wonder how much we have learned from it.
This means war…
That’s why I have found myself waging a war against unnecessary meetings. For example, on taking over a global Phase III programme, I phased out all regularly scheduled meetings. There was no detectable negative effect on project progress.
Meetings are still held, when they are needed – usually when there are critical problems to solve, or we are approaching a key decision point. You might say that there are always problems to solve, but most of the time, and with the right planning, the project manager can do this, using brief discussion with particular team members. There is rarely a need to involve the whole project team.
The tyranny of the teleconference
But that is what happens. Everyone on the study sits at their computer, logged into a teleconference, and mostly paying little attention while they do other things. Now I should explain that a good deal of my argument stems from what I see in clinical research projects that have been contracted out.
That is my role a lot of the time, to direct and manage contract research organisations on behalf of sponsors. In almost all contracts, there is provision for regular teleconferences, usually weekly (sometimes more frequently). The full CRO project team is booked into the teleconference, and their time billed to the client using the standard hourly rates.
I think you can see why regular teleconferences are so popular with CROs. Why should the sponsor have to pay people to recite at great length tedious statistics on study activities, when the same information is available in written form to read at any time?
What meetings are not for
So if progress information is available already, why do we need meetings in order to find out what is going on? The answer is that people deliberately withhold information, in order to deliver it at a meeting. This gives them a sense of power, and justifies their attendance.
In other words, the meeting is the end in itself, and ploys are cooked up to justify it. I usually tell my project teams that nobody gets into trouble for telling me bad news the moment they know about it, but they do get a very hard time for keeping it to themselves in the hope it will go away (it very rarely does).
Worse still, I do not expect people to knock a meeting sideways by suddenly revealing new information that destroys any decisions we might have thrashed out so far.
What meetings are for
If you are with me so far, you have probably spotted that the effectiveness of the chairperson largely determines success or failure. But when a study is contracted out, it is often not clear who occupies the chair. Is it the CRO project manager or the sponsor? The answer is that it doesn’t matter much as long as the person has the right chairmanship skills.
Underpinning those skills must be a vision of what meetings are really for. Believe it or not, I am not against them in general, I am just against their misuse. We can see that they are not for communication, which means that all necessary information must be on the table before the meeting starts.
OK, sometimes there is very late-breaking news, which the chair can capture before the session starts, by asking people as they arrive if they have anything new to report. They will be mortified that they can’t exercise power by delivering their bombshell at the most damaging point, but this is about team success not personal grandeur.
If a good project plan is in place and up to date, it automatically generates an agenda for the meeting. It answers questions such as:
• What deliverables are forecast to be late?
• What deliverables have quality problems?
• Are we on budget?
• Will we have the right people available to deliver on time?
• Which sub-projects are underperforming? Examples are biometrics, or geographical regions.
The output from the meeting is a revised plan that addresses the problems that have been predicted. Note that it is not a report condemning those responsible for what went wrong. You can’t change history.
Common abuses
You have all seen them. The minutes that report who said what, but not what they agreed to do. The agenda that’s the same every week. The minutes that arrive the day before the next meeting. Most of the time spent on arguing about what the study progress really is.
No clear chairperson, or a weak chairperson railroaded by a bully. But these things have become so embedded in company culture that they are often considered to be normal.
When to meet, and why
So far I have not said much about the need for face to face meetings. Undoubtedly, there is a need to meet people physically, and I don’t think it’s really possible to form a strong team without it. It is easier to assess how people will work together if the body language is visible.
So there is an excellent case for people to get together at project start. Typically there will be a kick-off meeting for the core team, and a series of regional meetings for study investigators. Both can be very effective if run well.
If there is a weakness, it is that the investigator meetings are not project-orientated. In my experience, there is too little emphasis on the time plan, and too much tacit acceptance that studies always run late.
Physical meetings are also needed at key stages, or when problems arise and motivation needs to be boosted. I have planned and conducted creative problem solving meetings mid-study, with regional groups of investigators, with a degree of success. At study end, getting round the table to do the blinded data review can be more efficient than trying to email databases around the company.
So let’s kill the routine meeting, which has become an end in itself and increasingly resembles a weekly act of religious worship. Every meeting must be for a purpose, and that purpose may vary.
It may be scheduled in the project plan for a key stage, or for a decision point. It may be unscheduled, but needed to solve a problem before it happens, because a variance has been predicted by the updated project plan.
We can do this by treating meetings as cost centres not profit centres – they have no intrinsic value, they just enable delivery by generating decisions.
Les Rose is a freelance clinical scientist, specialising in project management consulting. www.pharmavision-consulting.co.uk
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