by Edward Baker, MD, MPH; and Susan Murphy MBA, PhD

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This article originally appeared in the Journal of Public Health Management and Practice and is shared here with permission from the authors and publisher. Read the article in JPHMP.

Life has changed in so many ways since the COVID pandemic began. As public health has become front page news, the saga of the public health workforce has also emerged. In the midst of overt threats toward public health leaders and cascading loss of trust in the public health system, frontline public health workers have continued to tirelessly serve the public under circumstances that were unimaginable 12 months ago (1).

Among the multitude of challenges faced by public health workers, working virtually without the benefits of direct face-to-face interaction has become the norm. This mode of getting the work done has posed special challenges which deserve attention. Further, as the pandemic stretches into its second year, “COVID fatigue” among public health professionals has threatened the capacity and resiliency of the local, state, and federal public health workforce. Frontline workers in all fields face similar challenges, as they navigate unrelenting work demands while struggling to preserve energy and maintain balance in the face of uncertainty.

In this column, we will reaffirm core principles of leadership and management, consider the COVID context, and then offer a set of guiding principles and best practices related to conducting virtual meetings and managing virtual teams during the pandemic.

Context: “COVID Fatigue”

In late June 2020, 40% of American adults reported struggling with mental health or substance abuse issues stemming from the pandemic (2). These struggles impact the public health workforce directly and indirectly. “COVID fatigue” among the public workforce seems to arise from a range of causes and underlying forces.

Obviously, as workers experience long hours week after week, fatigue sets in. Working remotely from a home office makes days and nights run together as do weekdays and weekends. Work seems always to be present because those unfinished projects remain in the line-of-sight. Many people work through their lunch hours and omit breaks throughout the day. Many team members are homeschooling kids while trying to keep up with their increasing workload. In some ways, many experience a “time soup” such that they are less aware of the concrete dimensions of time and begin to think in terms of “COVID years.” Some simply forget to do things that they have committed to doing.

These forces impact working women and minority workers disproportionately. For example, mothers working full-time spend 50% more time each day caring for children than fathers working full-time remotely (3); women also are disproportionately represented in lower wage jobs as are workers from minority groups, and both groups lack adequate childcare support.

In addition to the physical isolation associated with remote work, public health workers have lived through a period of extreme uncertainty regarding approaches to contain the virus and have not been provided with sufficient authoritative guidance on “what should work.” Further, the unprecedented involvement of political forces has undermined prudent public health practice to an alarming degree and even threatened the health and safety of public health leaders and their families (1). As a consequence, some public health leaders and staff have made the very difficult decision to leave their positions in alarming numbers, while others continue to “soldier on” despite these pressures.

As a result of these and other factors, public health workers have found it very difficult to establish priorities, to determine how to respond to outside influences, and how to maintain focus on a day-to-day basis. A range of symptoms related to “burn out” have surfaced including loneliness, depression, feelings of isolation, sleep disorders, and fatigue.

As the pandemic enters the first quarter of 2021, leaders will continue to be faced with the ongoing challenges of leading the workforce to maintain situational awareness, make wise decisions in the face of uncertainty, communicate with colleagues and the public, and manage energy (4). Furthermore, these same leaders will be challenged to learn from recent experiences, while continuing to confront day-to-day challenges and crises (5). 

Strategies for Continuing to Get the Job Done

Despite these and so many other factors, public health work is getting done! To address these challenges, public health professionals have adapted in creative ways. Leading during these times has required extra focus and attention to the mental and physical health of colleagues, team members, and clients.

Improved listening skills are crucial (6). Listening is NOT “waiting for your turn to talk.” It means being silent and hearing not only the words but observing the tone, body language, and facial expressions. A clever way to embody the art of listening is to visualize the word “SILENT” that includes all the letters of “LISTEN.” Effective leaders may check in with team members and let them know they are available for them. They may seek to understand struggles without overstepping boundaries. In team sessions, leaders may ask participants what keeps them up at night or how the team can support them better. Avoiding multitasking during a virtual meeting as a sign of respect for coworkers should be stressed. This is a time to celebrate accomplishments and successes in order to maintain self-confidence during this uncertain time in unchartered waters. Instead of talking only about what can no longer be done and other things that are changing, emphasize what is remaining the same and what has been improved upon.

Setting priorities in the face of overwhelming and conflicting demands will be a constant challenge. Leaders must help staff distinguish between the “must dos”, the “good to dos” and the “nice to dos.” Often public health workers are too generous with their time and agree to do things which could be delegated or simply postponed. Distinguishing “must dos” from “good to dos” may help address some of the overload faced by the workforce. Leaders can fine tune their ability to set priorities by stressing that a “delay is not a denial” and that saying “no” may be the best option.

Conducting successful virtual meetings 

A. Guiding Principles

At any time, high performing teams must focus both on the tasks to be performed and on the relationships among the team members (7). By running effective meetings, the culture of the entire team can be strengthened. Leading is still “doing the right thing” and management is still “doing things right” (8). Therefore, leaders must, in considering whether to hold a virtual meeting, be clear on the purpose of the meeting (9). In other words, ask “is this the right thing to do?” “Is this meeting the best use of our time?” Leaders should encourage staff to seek ways to solve problems without a meeting (eg, a phone call or a short email message) thereby saving time and improving productivity by avoiding “wasted time” in a meeting.
Then, if a meeting is clearly “the right thing” and the purpose is very clear, how should the meeting be conducted in the “right way”? No meeting should occur unless these questions are answered in advance. Don’t meet just to meet! Meetings can be expensive. To calculate the cost of holding a meeting, multiply the length of time by the sum of the hourly salary rate of the attendees. Ineffective meetings can also have a hidden cost called “meeting recovery syndrome” – the time it takes to calm down after an upsetting, ineffective meeting. This cost could last one day to a week or longer.

Leaders should encourage staff to engage in “Time Protective Behavior.” Often meetings are added to one’s calendar by another person. As a result, one may wake up and find that their day has been captured by others who have scheduled them into too many meetings. To guard against this happening, staff can conduct “calendar surveillance” one or two days ahead and block out time for meals, exercise, and just having space to get the “real work” done. Also, leaders should guard against last minute meetings when there is no real urgency to do so.

Typically, virtual meetings take more preparatory work than regular meetings (7). Preparation for a virtual meeting will take longer since the leader will, once the meeting occurs, be functioning as a “conductor of the symphony.” In addition to preparing and sharing materials, the leader should carefully “rehearse” to the greatest extent possible. We realize that, due to the extreme burden of COVID response, this may not always be possible. Nevertheless, just a short “rehearsal period,” even for 10-15 minutes, may yield benefits. During that time the leader should revisit the purpose and flow of the meeting. In advance, answer the question: “If the meeting is successful, what will happen?”

To prepare, be clear on the purpose (not just the topic) of the meeting (9), decide on the format of meeting, and test your assumptions before the meeting with a trusted partner. Is the purpose of the meeting a) to present information, b) decide how to solve a problem, c) share communication among a project team, or d) is it an impromptu meeting like a huddle?

If decisions need to be made, do not hold the meeting until all needed decision makers are available or a decision maker may choose a surrogate who has the power to make the decision. Otherwise, time will be wasted, participants feel disrespected, and solving the problem is delayed. In order to prevent “groupthink,” consider having everyone give their ideas and have the participants with the most power and influence give their opinions last. Otherwise, the group members may not provide their honest opinions and creative ideas. Consider dividing the participants into sub-groups and creating breakout rooms on Zoom or Microsoft Teams to discuss possible solutions. Then, have everyone re-join the main meeting and have a group spokesperson present results of small groups. When making decisions, do not grab onto the first good idea that is presented. Many groups make this mistake rather than continue to explore additional more in-depth solutions. When brainstorming ideas, ensure that no ideas are judged and dismissed early in the process. That far-out idea may be the perfect springboard to an outstanding one.

In a meeting with males and females, communication styles may affect rapport and decision making (7). For example, when there is an interruption in a meeting, often it is a man interrupting a woman. Women often do “turn-taking” when speaking while men interrupt each other as a matter of course. In meetings, when a woman is speaking and anyone interrupts her, she often thinks her turn is over and gives up the floor. So, in meetings, watch for this and ensure that the woman can finish her thought. Also, be aware that men often speak in a declamatory tone when bringing up issues while women may introduce ideas as questions.

Ramblers, dominators, and side conversationalists can weaken the effectiveness of a
meeting. What can the leader do? For the rambler, find a natural break or pause and intervene. The leader can also confirm understanding of the point and, if appropriate, direct a question to another participant or entire group to refocus on the meeting objectives. For the dominating participant, credit the speaker’s knowledge and contribution. Then state the need for opinions from other participants and ask the group for views and reactions. For side conversationalists, pause, look at the conversers, and ask them to share their ideas with the group. One benefit of virtual meetings is that it is more difficult to have a side conversation!

B. Best Practices: 10 Tips for Better Virtual Meetings

Reaching a common understanding of best practices and monitoring adherence to these practices may enhance organizational effectiveness (7) and also reduce the contribution of “bad meetings” to COVID fatigue among public health workers.

1. Invitees: Invite only those who really need to attend (typically no more than 10 persons). Avoid observers. If others need to know what happened, take good minutes and share with them. If observers show up, tactfully “uninvite” them; doing so sends the right message. When meetings have 10+ participants, only five or six people speak, and others do not participate very much. Further, leaders could encourage invitees to tactfully “uninvite” themselves before the meeting takes place once they see the agenda and conclude that their attendance is not an optimal use of their time.

2. Time management: Take only the time you REALLY need. Consider avoiding 60-minute meetings and try for 40-45-minute meetings instead. This gives participants with back-to-back meetings a chance for a short break before their next meeting that may start promptly on the next hour. Always start on time and end early if possible. Sometimes you only need 15 minutes; if so, have a 15-minute meeting and see what happens! Encourage participants to check into Zoom meetings a few minutes in advance. By signing in early, technical issues can be addressed ahead of time. If someone will be presenting, make sure to conduct a tech run prior to the meeting, especially for high-level meetings or if the person presenting is not familiar with presenting virtually.

3. Minutes: Assign someone to take minutes and distribute draft minutes for comment within 24 hours. Then revise, finalize, and distribute minutes within 48 hours after receiving comments. Sometimes you can have the note taker create and display notes during the meeting and invite comment in real time on the minutes; as a result, you can shorten the timeframe and enhance agreement on what was decided.

4. Roles and responsibilities: Assign someone to be the gatekeeper to help keep things focused. If the meeting discussion goes on a tangent, nudge the participants to return to the agenda item. If a new important topic has emerged, put that item in the “Parking Lot.” Ensure all participants know their role in the meeting. Consider rotating the meeting leader role as a way to mentor others about leading effective meetings. Once people learn to lead a meeting, they are often better participants.

5. Visuals and webcam use: Use visuals to manage attention NOT to provide a lot of information. If attendees need information, provide it in advance. In many meetings, attendees should have their webcams turned on. At other times, it may be preferable to give attendees the option to turn off their webcam, particularly to accommodate to their situation (eg, personal appearance concerns or distracting background activities).

6. Pre-meeting information sharing: Distribute slide set, the agenda, a purpose statement, and any information needed about 48 hours before meeting; don’t do so at the last minute or too far in advance. The best attendees are the ones who are prepared. When you are leading the meeting, prepare 3-4 days in advance and avoid last minute changes unless something major has happened. In some cases, you may wish to create a message board for the meeting such that you pose a central question to the group online and solicit answers to be posted asynchronously.

7. Meeting etiquette: Start each meeting with a clear statement of purpose BEFORE reviewing the agenda. Make clear what you hope to achieve. Also establish meeting ground rules. For example, set clear guidelines on having cameras on or off, how to indicate a desire to speak (“blue” virtual hands or physical hands?), and how to engage using the chat function. Hear from everyone, not just those who speak first and loudest.

8. Manage the flow: Set the tone at the outset if you are leading the meeting and spend a very few minutes having each person “check in” using a very few words that capture their mood state and succinctly what they hope the meeting will achieve. Once people have said something in the meeting, they are more likely to speak up again. Create an open environment to enhance discussion of ideas while surfacing and addressing differences of opinion and perspective. Consider how much time to spend on each agenda item and stick with the time allotted by you in advance. Therefore, you may need to interrupt the talkative participant tactfully and pace the meeting. If you do so, you will be appreciated! Pacing and tone are very important in virtual meetings.

9. Technology use: Use technology to invite engagement during the meeting (eg, use of chat function or other techniques). Of course, this requires multitasking if you are leading the meeting. Therefore, you may wish to invite a meeting partner to monitor the chat board and intervene in the meeting as desired. This helps to manage attention and bring side conversations into the meeting space. This practice, if properly managed, can enhance engagement and keep people “in the meeting” and reduce impact of distractions. You can also use polling tools and other technologic aids as you see fit, but be careful that you don’t get too carried away with the latest “shiny object.”

10. Summing up: Close the meeting with a clear statement of next steps and allow for time for meeting participants to succinctly comment on the extent to which the meeting achieved what they hoped for. Make it clear what the meeting has accomplished and what decisions were made. Ask “who else needs to know?” what happened in our meeting. Acknowledge the value of the contributions of team members in some tangible and explicit ways. Some form of recognition should be seen as a core responsibility of team leaders and managers. Don’t just assume that team members can simply “pat themselves on the back.” A little note of appreciation goes a LONG way. 

Summary and Benefits

Managing virtual teams requires special care and attention in the best of times (10). During the COVID pandemic, public health workers face the additional challenges of constant and shifting work-related demands along with the ambient uncertainty associated with the pandemic. Through it all, public health workers have adapted to working in virtual teams and to conducting virtual meetings using technologies which have now become commonplace.

By becoming more successful in leading virtual meetings, leaders can improve the conduct of these meetings and help to build trust in the team. By adopting better meeting practices, leaders demonstrate respect for others’ time and energy. Good virtual meetings can enhance group cohesion in the face of COVID-induced isolation and foster input from diverse team members who can contribute a range of insights and perspectives. Further, better meetings can enhance a sense of purpose and direction in a time of confusion and uncertainty. Better virtual meetings can help staff set priorities and distinguish between the “must dos,” the “good to dos,” and the “nice to dos” of work life.

Ideally, better virtual meetings, along with effective leadership and management practices, can help to establish boundaries such that the “always-on” phenomenon of the public health response to the COVID pandemic can, in some ways, be mitigated. Perhaps having better virtual meetings can contribute to mitigating the effect of COVID fatigue among the public health workforce and enhance capacity to fight the COVID-19 pandemic now and into the future.

References

1. Halverson PK, Yeager VA, Menachemi N, Fraser MR and Freeman LT. Public Health Officials and COVID-19: Leadership, Politics and the Pandemic. J Public Health Manag Practice. 2021. Vol 27. Supp 1. S11-S13.
2. Czeisler ME, Lane RI, Petrosky et a. Mental Health, Substance Use and Suicidal Ideation During the COVID-19 Pandemic- United States, June 24-30, 2020. Morb Mortal Wky Rep 2020; 69: 1049-1057.
3. Bateman N, Ross M. Why has COVID-19 been especially harmful for working women. Brookings Institution. Oct 2020. Accessed on Dec. 14, 2020 at:
https://www.brookings.edu/essay/why-has-covid-19-been-especially-harmful-for-working-women/.
4. Baker EL, Irwin R, Matthews G. Thoughts on Adaptive Leadership in a Challenging Time. J Public Health Manag Practice. 2020. 26: 378-379.
5. Keen PK, Gilkey R, Baker EL. Crisis Leadership- From the Haiti Earthquake to the COVID pandemic. J Public Health Manag Practice. 2020. 26: 503-505.
6. Baker EL, Dunne-Moses A, Calarco AJ, Gilkey R. Listening to Understand: A Core Leadership Skill. J Public Health Manag Practice. 2019. 25: 508-510.
7. Murphy SA. Maximizing Performance Management- Leading your Team to Success.2nd Edition. Medical Group Management Association. Englewood Co. 2016.
8. Baker EL. Leadership and Management – Guiding Principles, Best Practics nd Core Attributes. J Public Health Manag Practice. 2014. 20 (3). 356-357.
9. Porter J, Baker EL. Meetings, meetings and More Meetings. J Public Health Manag Practice. 2006. 12(1): 103-106.
10. Malhotra A, Majchrzak A, Rosen B. Leading Virtual Teams. Academy of Management Perspectives. 2007. Feb. 21 (1): 60-70.

ACKNOWLEDGMENT

This article is based in part on a recent presentation to senior leaders at the Cambridge (MA) Public Health Department to whom we dedicate this article. Their tireless service to the community in which one of us (EB) lives is a constant source of inspiration! By extension, we acknowledge the central role of local and state public health workers across the country who continue to serve their communities daily.

The authors also wish to acknowledge Ryan Baker, Helena Hengelbrok, Bob Irwin, and Gene Matthews, whose thoughtful comments and encouragement have greatly strengthened this article.