key: cord-0964875-qbakzfnt
authors: Ellis, Ricky; Goodacre, Tim; Mortensen, Neil; Oeppen, Rachel S; Brennan, Peter A
title: The application of Human Factors at Hybrid meetings: facilitating productivity and inclusivity
date: 2022-01-03
journal: Br J Oral Maxillofac Surg
DOI: 10.1016/j.bjoms.2021.12.055
sha: 3efe2af6e91ef57ed84cf6adaa103d4adaa2cc07
doc_id: 964875
cord_uid: qbakzfnt

The COVID-19 pandemic has resulted in the widespread use of virtual meetings and conferences. As the healthcare sector attempts to return to normality, face-to-face meetings have started to resume. However, ongoing travel restrictions, risk of viral transmission, the omicron variant and self-isolation requirements have necessitated the use of novel hybrid meeting formats. These enable participants to attend either in-person or virtually using various online platforms such as Microsoft Teams and Zoom. Well organised and facilitated hybrid meetings can combine the advantages of in-person meetings with virtual participation, although the dynamics of communication between attendees is considerably different. This article discusses the benefits and pitfalls of the hybrid format, the human factors that impact productivity and inclusivity, and how to address these in future meetings.

The COVID-19 pandemic has caused significant disruption to normal working practices in healthcare. To reduce the risk of viral transmission, many meetings and conferences were changed to a virtual format, utilising video teleconferencing software that is now widely available, affordable and accessible. (1, 2) Commonly used online platforms include Microsoft Teams and Zoom, although there are many others. The online delivery of meetings has been met with a mixed response. Many have celebrated the change, which has facilitated important multidisciplinary and collaborative work within the UK and internationally during the pandemic. This includes the international collaborative efforts to understand and manage COVID-19, as well as the dissemination of knowledge regarding changes to practice in response to the pandemic.(3) However, the emergence of virtual meetings has left many missing the social interaction of face-to-face meetings and the networking and collaborative opportunities that often arise from meeting colleagues in person. (2) The mixing that is almost inevitably a part of meetings in person is felt by many to offer creative opportunities which are rarely replicated in the online virtual format. The long-term impact of lost interpersonal relationships across many aspects of social interaction has yet to be ascertained.

As the medical community attempts to resume normal services in the wake of the first waves of the COVID-19 pandemic and more recently, the omicron variant, there has been a rise in the number of hybrid meetings and conferences.(4) This format enables face-to-face socialisation whilst also including members using videoconferencing platforms who cannot attend in person, which may be due to ongoing travel restrictions, self-isolation, clinical responsibilities or personal choice. This format of meetings and conferences is also more robust, reducing the risk of cancellation if travel restrictions are changed due to new waves of COVID-19 infections or in response to the emergence of new variants. Many colleagues will have now attended hybrid meetings and appreciated the difficulties in making these meetings successful, productive and inclusive for all attendees ( Figure 1 ). This review will discuss the benefits and pitfalls of using a hybrid format for meetings and will discuss how having an appreciation of human factors (HF) can improve their productivity and inclusivity.

There is little doubt that virtual meetings are cheaper than holding face-to-face meetings. Attending virtually means no travel costs or additional accommodation requirements. These cost savings are likely to continue with the use of hybrid meeting formats due to fewer attendees incurring travel expenses and the use of smaller venues. Avoiding travel is likely to reduce the carbon footprint of the meeting significantly, thereby improving sustainability efforts. Lastly, attending virtually may also reduce the time needed to participate in the meeting by avoiding the need to travel long distances for some participants and the need to cancel more clinical commitments. This 'economy of time' has been highly valued following the move to virtual meeting attendance.

A key strength of virtual meetings during the COVID-19 pandemic is the ability to include experts and guests from further afield without incurring significant costs in time, money or travel. This has led to the multi-national collaborative work that has been instrumental in developing our understanding and management approaches to COVID-19, as well as meetings between national leaders regarding international policy. The benefits of including experts in the field that may otherwise have been unable to attend a face-to-face meeting cannot be understated. Science and medicine have made rapid developments during the COVID-19 pandemic and this collaborative work must continue to maintain the momentum moving forwards.

Facilitating virtual attendance increases the robustness of the meeting, making it more resilient to sudden changes in travel restrictions and self-isolation requirements due to COVID-19. Building a level of robustness into meeting plans is now vital to avoid the cancellation of events, which will have required considerable investment in time and funds to organise.

Virtual participation at hybrid meetings also increases the flexibility of attendance, enabling those who may have otherwise been unable to attend to join the meeting, in part or whole. This is particularly useful given the rapidly changing workload surgeons and other healthcare professionals are experiencing while clinical services recover from the initial waves of the COVID-19 pandemic. In the current climate, clinicians also often need to cover the responsibilities of colleagues at short notice due to sickness themselves or having to self-isolate because of COVID-19.

However, many clinicians and healthcare workers will have missed the social and creative aspects of face-to-face meetings during the COVID-19 pandemic. Wellconducted face-to-face meetings can be social, productive and inclusive.(5) The use of hybrid meetings harnesses the best of both forms of attendance and enables inperson attendance for those keen to return to socially interactive means of doing business and developing relationships. Seeing and meeting friends and colleagues in person after many months of lockdown and reduced social contact will be the favoured option for many attendees. (4) In summary, hybrid meetings can combine the advantages of meeting in person with those of attending from a distance. If well organised, these meetings can be efficient, productive and inclusive.

Hosting or chairing a meeting divided into two groups of attendees (those attending in person and those attending virtually) may present many new challenges compared with established methods of hosting either face-to-face or virtual meetings.

It can be difficult for virtual attendees to follow the meeting discussion if multiple participants speak simultaneously, or if there is background noise or chatter.(6) It may also be difficult for virtual attendees to identify the speaker when the room is covered by a single distant camera and when microphones might not have been placed ideally around the meeting room to pick up the contributions of each inperson attendee. It is also easy for virtual attendees to remain unnoticed when raising a 'screen-hand' to speak or requesting the floor to discuss a topic unless a designated person constantly monitors the online video conferencing platform. Each of these factors can lead virtual attendees to feel isolated, ignored, side-lined or even unheard. This can result in dissatisfaction, reduced participation with disengagement, and reduced productivity. (11, 12) There are some potential pitfalls when running hybrid meetings, but this meeting format also has many potential benefits over traditional face-to-face meetings (summarised in Table 1 ). Considering the human factors (HF) involved in the hybrid meeting environment may help to enable the productivity and inclusivity of a meeting by improving the effectiveness of interpersonal communication (Figure 2 ).

The key to an effective and productive meeting is organisation and prior planning. All attendees should receive a copy of the meeting agenda and any resources related to this well in advance of the meeting date. Having access to the agenda enables attendees to raise points for discussion in advance or plan points for discussion to be raised during the meeting. It also helps to give structure to the discussion, maintain concentration and therefore reduces the risk of error and loss of situational awareness.(13) Attendees should be made aware of the meeting format and that virtual participation is possible if required or preferred.

The meeting room cameras and microphones should be set up well in advance of the start of the meeting, allowing time for troubleshooting. As previously mentioned, consideration must be given to the quality of the microphone and camera as well as their positioning in the room to facilitate the involvement of virtual attendees. (14) The meeting or committee Chair should set out the rules of discussion and participation clearly to begin with, including the need for virtual attendees to turn their microphones off when not speaking to reduce background noise. It is vital that background noise in the meeting room is also reduced and that only one person speaks at any one time to enable virtual attendees to follow the discussion.

The rules of participation should include instructions for attendees on how to raise a point or contribute to the discussion. Attendees should then be invited to speak by the Chair. This identifies the speaker, reduces the risk of multiple attendees speaking at the same time and enables equal participation by virtual participants. (1) The Chair must impose a gentle but firm adherence to the 'rules of engagement' for hybrid meetings to perhaps a greater extent than is commonly experienced in either format used alone.

The meeting agenda should include regular breaks to help maintain concentration.

More frequent breaks are often required for virtual attendees to reduce screen time, and it has been recommended that a 10-minute break every 90 minutes is a suitable minimum, with a longer break every three hours.(1) Fatigue, hunger and dehydration reduce concentration and increase the risk of error, highlighting the need for frequent meeting breaks to maintain effectiveness and productivity. (15) (16) (17) The introduction of all meeting participants is vital to creating an environment where everyone feels welcome and included. It is also imperative to lower the hierarchy within this environment enabling all attendees to participate in the discussions. (18) This is particularly important in meetings where an authority or seniority gradient exists between attendees. The consequence of a hierarchy existing in such meetings may include 'group-think' in which members concur rather than disagree with the point raised to avoid causing disharmony or negative consequences.(1) This reduces the power of multidisciplinary and collaborative working, inhibiting progress and effectiveness.

An in-person attendee should be nominated to moderate the virtual platform by watching for attendees raising their hands or raising points of discussion in the chat box or message function. Without someone actively monitoring this position, it can be easy for in-person attendees to continue talkin,g unaware of virtual participants trying to contribute to the discussion. This role should ideally not be an additional responsibility of the Chair of the meeting, who is already tasked with moderating the entire meeting, indicating the next speaker, aligning the discussion with the agenda and actioning the points raised.

Equal opportunities to contribute to the discussion are an essential prerequisite for in-person and virtual attendees. This may require the meeting Chair regularly to seek contributions from virtual participants to develop an inclusive environment.

As with all meeting types, outgoing and confident participants may dominate the conversation. Therefore, this must be regulated by the meeting Chair to maintain an environment in which all participants have an opportunity to contribute. It is considerably more difficult to speak up or interject when participating virtually, which needs to be considered by the Chair if in-person attendees are dominating the conversation. As well as seeking input from virtual attendees regularly throughout the meeting, standard good meeting practice remains to ask all meeting participants for additional comments before moving on to the next item on the agenda.

Noise levels can rise during discussion and debate in meetings, sometimes subtly and without immediate awareness within the room. Whilst this may be tolerated to a degree during face-to-face meetings, increased noise levels and multiple people speaking simultaneously make following the discussion difficult for virtual participants and result in their exclusion. Meeting participants must be reminded of the rules of participation by the Chair if this occurs. More animated meetings may require a system for de-escalation, such as the Chair interrupting proceedings to nominate one participant to speak at a time, allowing all members the opportunity to contribute equally. Hybrid meetings increase the cognitive burden on the Chair and moderator, who may need to clarify points of discussion to ensure that all participants have heard and understood what has been said. Thankfully with good quality equipment and bandwidth, this is not required often.

Hybrid meetings that are well organised and moderated are powerful tools that combine the advantages of face-to-face meetings with virtual participation. Given their flexibility, reduced cost, and the ability to include participants from further afield, hybrid meetings are likely to play a significant role in healthcare and other industries moving forwards. Understanding the impact of human factors in this unique environment is vital to enabling productivity and inclusivity. Table 1 . The potential benefits and pitfalls of hybrid meetings.

More challenging for Chair and moderator

Easy to exclude virtual attendees

Loss of non-verbal communication

More robust to changes of circumstance May take longer

Increased risk of distractions 

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Jul 2;366:l4461. • Early access to meeting agenda • Suitable camera and microphone placement • Chair to set out rules of participation • Speakers

Organisation • Minimise background noise • Virtual attendees to turn microphones off unless speaking • Moderator to monitor videoconferencing platform and highlight virtual attendees wishing to contribute to the discussion

Environment • Virtual attendees to be given equal opportunity to participate • Chair to ask virtual attendees for regular contributions

Not required