AAOS Now

Published 2/1/2009
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Robert H. Blotter, MD

Planning a practice retreat

Retreats can be helpful—if planned properly

A period of tremendous change is frequently the impetus to plan a practice retreat. It certainly was in the case of my practice, Orthopaedic Surgery Associates of Marquette (Mich.), PC.

During the past few years, we had built a new office, replaced our chief operational officer of more than 30 years, hired two new partners, and attempted several joint ventures with hospitals. But the practice had no cohesive plan and lacked the teamwork to often achieve success. We felt stuck and unable to get the traction to progress further.

We had heard that a retreat, carried out properly, could set a group on the path for future success. But we also were fearful that a poorly planned retreat would waste time, energy, and money.

Retreats are about sparking change. Unlike meetings, which focus on current issues and immediate problems, a retreat takes a longer view and deals with long-term problems. (See “Is a retreat right for your practice?” below.) In our case, we needed to do some formal strategic planning and wanted to unify our group around a multiyear plan. Once we were sure of our reason for holding the retreat, we began planning. The following six steps will help you plan a successful retreat for your practice.

Find a facilitator
Once we decided to have a retreat, we needed to hire a facilitator. Ideally, the best way to find a facilitator is by referral. We talked to a successful group that held an annual retreat and contacted a facilitator who had given a presentation at a conference sponsored by the
American Association of Orthopaedic Executives. The advantage of using these sources is that the facilitators will have some experience working with orthopaedic surgeons. We interviewed both facilitators and selected the one we thought was right for us.

You may also be able to locate a facilitator through management consulting firms. Don’t expect a facilitator to be cheap; their services generally run from $5,000 to $10,000. The facilitator will man­age the structure of the retreat, but not the content. Once the actual retreat begins, a trained facilitator will help keep people focused, serv­ing as a traffic cop and creating an environment for honest two-way communication. A quality facilitator is an expert in group dynamics who knows when to pursue an issue and when to back off.

Be sure to bring your facilitator into the retreat planning as soon as possible. The facilitator needs to meet and get to know all the participants before the retreat. Our facilitator spent 3 days evaluating our practice and interviewing the partners and senior management.

Get everyone there
Ensuring that everyone attends the retreat is often the hardest task—and most crucial to success of the retreat. A retreat not fully attended is doomed to failure. Scheduling the retreat will often reveal the nonbelievers in the group. Because a retreat requires time away from the practice, family, friends, and hobbies, and because the outcomes are not readily apparent, getting the lukewarm to commit to the date can be challenging.

Don’t give up. Many orthopaedists are uncomfortable with the thought of a retreat because it often takes us out of our comfort zones. The problems addressed in a retreat may not lend themselves to finite scientific solutions but may require compromise and listening to others. Retreats can also unmask smoldering conflicts that are hindering your group’s advancement.

Set an agenda
A retreat agenda is essential. A retreat is limited in time so the agenda will need to be limited in scope. The more focused the agenda, the more likely that the retreat will be productive. Don’t try to do too much.

The participants should meet and determine what they want to accomplish and what are goals of the retreat. These expectations and goals should be shared with the facilitator, who can be helpful in drafting a realistic and achievable agenda.

Make sure to build in time for play and contemplation. Former President Jimmy Carter recalls that the major breakthrough in establishing the Camp David Accords came during recesses between the formal meetings.

Find a location
To think outside the box, you sometimes have to get outside the box. Select a venue that will communicate a change from the office or hospital. Remember, however, that an expensive or distant location will make full participation more challenging.

Minimize disruptions and distractions. Consider collecting cell phones and pagers during the retreat and arranging for outside coverage to care for patients while you are at the retreat. We did not do this, and the pages and phone calls were occasional distractions.

The facilitator may have suggestions about the actual set-up at the retreat. Some facilitators think that a U-shaped table arrangement, with participants sitting around the outside, conveys a formal atmosphere that limits the free flow of communication. At our retreat, however, the U-shape didn’t seem to inhibit our discussion.

Follow through is essential
If you walk away from your retreat with broad, expansive goals and never discuss them again, you will have wasted time and money. Make sure to leave with a list of follow-up initiatives, each of which is supported by measurable milestones. Set aside time to review these on a regular basis. This will ensure that all your time, effort, and money does not go to waste.

We came away from our retreat with three main focal areas. In each area, we established several action items. Each month, we plan to review these at our board meetings. During the coming year, we plan to make these goals a reality.

In the final analysis…
A retreat can provide an orthopaedic practice with the time needed to work on a collective vision. An outsider (the facilitator) can help analyze the present position of the practice in comparison to national benchmarks. This is what happened in our case, and it helped convert some of our nonbelievers.

With a united front, we could then turn our attention to a limited number of projects for the near future. We didn’t solve all our problems. Some of the tensions that had been developing weren’t resolved, but they were exposed and we hope to deal with them more openly. Our retreat wasn’t a single success or failure, but was the positive beginning our group needed.

Robert H. Blotter, MD, is a member of the AAOS Practice Management Committee. He can be reached at rblotman@hotmail.com

Is a retreat right for your practice?
Retreats are about sparking change—not just exchanging information. If your practice is considering one, ask why? If the answer is to improve morale or to reward partners for their hard work, save your money and have a party or picnic instead.

If you are more interested in presenting, promoting, or maintaining an agenda, the proper forum should be a meeting or office “town hall.”

If you have an annual retreat, pause and think twice before you plan this year’s event. Maybe you should consider skipping the retreat.

The following are good reasons to hold a retreat:

  • Build team unity and improve group trust
  • Find new ways to succeed
  • Help people to refresh, renew, and replenish
  • Help clear the air
  • Help develop collective vision with buy in by all
  • Analyze services the group should or should not provide
  • Correct course when things are going wrong
  • Transform your group’s culture
  • Make a tough decision