Effective facilitation

Fancy being an effective facilitator? Jennifer King explains what it is, outlines the benefits, and lists some dos and don'ts

Facilitation is not the same as chairing a meeting, training, teaching, counselling, or coaching, although there are many generic skills in common with these activities. It has a repertoire of skills in its own right, but the skill levels vary as widely as the scope of the role. With the rate of change and the struggle to maintain morale, some managers are turning increasingly to outside facilitators to help and guide them, others try to do it internally. Facilitation is demanding and requires considerable skill, but it can be immensely rewarding on all sides. In this article I examine the purpose and benefits of facilitation, the role of the facilitator, the pitfalls, and some tips for being an effective facilitator.

What is the purpose of facilitation?

"Facilitate" means to make possible, aid, and give scope. The scope of facilitation, as it is currently used in the health service, is broad-ranging from passive observation to active intervention and guidance. There are some detailed descriptions of facilitation in primary care that list the various ways in which facilitators have helped practices with quality improvement or specific initiatives such as health promotion^1-3. King and Flew describe the role of a facilitator in helping a practice with strategic planning after a period of change⁴. In the health service there has been an increasing focus on providing guidance to groups thatmay be tackling challenging issues and problems such as the following.

• Planning or developing strategy (such as educational strategy in deaneries and health authorities)
• Addressing team difficulties or conflict
• Refocusing after a period of change
• Identifying team roles and understanding team dynamics
• Building multidisciplinary teams
• Recruiting a new (senior) team member
• Introducing a new system or process (such as appraisal and performance management).

Steps necessary for successful facilitation

Prepare for the meeting

Make sure you read any briefing or backgroundmaterial and are sufficiently familiar with the subject. It helps if you are not an expert in the subject as it prevents you from becoming too involved in the discussion, but you need to understand the key issues.

Telephone interviews or meetings with the key people involved are particularly useful in identifying issues that individuals may not want to raise in a group. These advance conversations are especially important when facilitating a team that will focus on group process.

Agree on a contract with the group

Establish purpose – Ask the chairperson or meeting convenor to introduce the meeting, clarify its purpose, and then introduce you, to establish your credibility with the group.

Clarify your role – Remind the group that your role is to manage the process not to influence the content or conclusions or to provide solutions. Seek the group's permission to interrupt or cut off the discussion when you feel it is necessary ("You'll forgive me if I seem to be pushing you along at certain points – this is because I know you want to keep to time").

Manage expectations – Invite everyone to introduce themselves and (if appropriate) to state briefly what they hope to gain from the meeting. Record these expectations, agree those which fall within the scope of the meeting, and drop those which do not.

Agree housekeeping – Agree when the meeting will finish and when there will be breaks. Ask people to switch off mobile phones and pagers and suggest that they make any urgent calls during the breaks.

Establish ground rules

When appropriate, seek agreement that the discussions will be confidential or at least ask people to signal when something they say should be treated as "off the record." It helps to ask the group to suggest other ground rules – such as that everyone should be listened to and no one should dominate.Keep these ground rules clearly visible on a flip chart.

Create a positive atmosphere

Greet people and talk to them as much as you can before the meeting starts. This helps to build a relationship and some trust. Be especially appreciative of a person's first contribution to the discussion (however long or hesitant). It can take courage for people to speak up, and some need to be reassured that they can speak openly. Cutting people off too early can be very inhibiting.

Value every contribution and ensure that people are listening to one another and not just vying for the chance to make their own point. Comments like "I'd like to be sure we don't lose that point – can I just get some reactions?" can help to keep the discussion focused. Actively discourage put-downs within the group. Everyone's viewpoint should be respected. If a person seems quiet or lacks confidence ("I'm not sure I'm putting this very well") provide encouragement by reinforcing what he or she has said ("That's a helpful point – can you expand on it?"). If some members are not contributing invite them to do so but don't put pressure on them (some people find it very difficult to speak in a large group). If they are reluctant find an opportunity to talk with them during a break.

Provide a combination of support ("That's a very important point you have made") with challenge ("I'm hearing some very mixedmessages here" or "You seem to be getting bogged down in detail – I wonder if this is helpful?"). Above all, look, listen, and reflect.

Keep track of time

It can take courage and confidence to cut off a discussion when people are in full swing – especially if they are forceful and senior characters. Remember that ultimately they won't thank you for letting the discussion run off the rails or for keeping them late on a Friday afternoon. If they are strongly resistant to changing topic, remind them that this means there will be less time for others ("We can spend longer on this, but it means we won't have time for the other topics – what do you want to do?").

Be aware of the group's energy level

Attention spans vary in meetings, but most people lose focus after an hour. Breaks are important for physical comfort, but also they can have a remarkable effect when emotions start running high. Revisiting a thorny issue after taking some time out often defuses the emotion and allows the discussion to become much more productive.

Use your intuition

If you have a dilemma share it with the group. If you feel stuck, tense, or confused it is almost certainly because the group feels this too and cannot progress until the problem is dealt with.

Summarise themes as you go along

A flip chart is an invaluable tool for summarising themes and checking things back with the group. It also provides a record for the meeting convenor to take away. Use a second flip chart to record important issues that require more time than the meeting allows. This helps to keep the discussion focused. It is important to revisit remaining issues before the end of themeeting.

Warning signs and how to handle them

A participants says, "Would you mind if I just draw something on the flip chart?" – This is often a (not so subtle) takeover bid. The one who holds the pen holds the power. Provided this is kept brief it can be a useful way for participants to illustrate their point, but as soon as they have finished their diagram say, "Thank you – can I ask the rest of the group to respond?"

The chairperson dominates the process, preventing others from expressing their views – Prevention is better than cure, especially as you don't want to risk embarrassing the chairperson. Agree firmly in advance that if you notice the chairperson taking over you will make a prearranged signal (holding up a red pen is a useful ploy).

Participants begin side conversations – These are distracting and potentially disruptive, and they indicate that some members have become disengaged from the rest of the group. Asking "Is there something you'd like to share with the rest of the group?" is usually effective. It can help to take some time out ("It's clear that some members are bothered by something – shall we take a break while I discuss it with them as I feel it is getting in the way of our progress?").

Participants yawning and showing signs of agitation – These all indicate that people are becoming tired, losing interest, or feeling that they are not being heard. Rather than ploughing on, it is best to acknowledge these responses directly. There are several options:

"I can see some eyes closing – I think it's time for a break"

"Dr Feelgood has been trying to say something for the past few minutes – can we please hear from him?"

"This is obviously a difficult issue – I suggest we come back to it after a short break"

"It feels like we have got stuck on this issue – I wonder why that might be?"

"Some of you are starting to get frustrated – can you help us to understand why?"

Long silences – This can indicate that the discussion has run its natural course, in which case move on. It can also be a sign of tension. If so, acknowledge it: "You've gone very silent – can you say what you think the problem is?" People may have lost the plot somewhere and may need to be refocused. It's useful to summarise at this point: "We seem to have lost some direction – let's just summarise where we have got to and then agree how we should move things forward."

Getting bogged down in detail – Again, this is a sure sign that people have lost focus. As soon as you see this happening cut in and remind people (or ask them) what the key issue is.

Two participants entering a prolonged debate – This can feel like a boxing match with the rest of the members merely spectators. Here you will have to become a referee and call time quickly: "Is this an issue that concerns everyone?" If it is, then open it out for general debate and prevent the original protagonists from hogging the floor again. If it is not of general interest, close it down and move on.

Aggression directed towards the facilitator – Above all, remain calm and don't become defensive or take it personally. Acknowledge the anger and inquire what is behind it. One effective strategy is simply to throw the question back to the group "What do others think about this – does everyone feel this strongly?"

Games facilitators play

Facilitators can play games with groups (hopefully unintentionally), especially when they feel defensive, pressured, or tired. These include

• Failing to agree on a contract with the group at the outset
• Over controlling the group process (for example, forcing the pace and not allowing enough time to people to contribute)
• Being too passive (such as allowing dominant group members to take over)
• Making assumptions (such as, "Let's skip this bit – I'm sure you all know the background")
• Dominating with your own ideas or expertise (slipping into lecture or tutorial mode)
• Solving the group's problems ("What you really should do is . . .")
• Dismissing or belittling people's concerns ("Let's not waste time on this – it seems trivial to me")
• Colluding ("You're right, it does look pretty bleak")
• Using your own words to summarise their views

References

1. Duffy M, Griffin E. Facilitating groups in primary care. Radcliffe Medical Press, 2000
2. Griffin E, Duffy M. Facilitating organisational change in primary care. Radcliffe Medical Press, 2000
3. Havelock P. Using a facilitator. In: Pendleton D, Hasler J, eds. Professional development in general practice. Oxford: Oxford University Press, 1977. (Oxford General Practice Series 37.)
4. King J, Flew R. Shaping the future with strategic planning workshops. In: Pendleton D, Hasler J, eds. Professional development in general practice. Oxford: Oxford University Press, 1977. (Oxford General Practice Series 37.)
5. Heron J. The facilitator's handbook. London: Kogan Page, 1989.
6. Hart L. The faultless facilitator. London: Kogan Page, 1992.