B-5 rehabilitation planning meetings
Last updated: April 13, 2025
Rehabilitation planning meetings are central to rehabilitation, but some specialists say, “I did not train to be a specialist just to attend meetings.” Why are they essential? Rehabilitation is, above all else, a team activity, and the team, not any individual, collects, collates, and uses the information to arrive at a formulation and develop a plan. Every person contributes knowledge and, crucially, different ideas and perspectives so the team arrives at the best possible understanding. Then, when planning what to do, each person also contributes ideas and questions the assumptions of others. Each professional is a vital team member and can contribute information and ideas. A rehabilitation expert from any profession needs knowledge and skills about contributing and running a meeting effectively. Meetings are resource-intense; a good, well-run session is productive and can justify the resources, but bad meetings undoubtedly waste resources. Training in meetings, especially rehabilitation planning meetings, could hugely improve effectiveness. Some aspects of this competency are covered elsewhere on this site.
Table of Contents
The competency
The trainee actively engages in meetings with various professionals and organisations gathered to plan a patient’s rehabilitation. Participation consistently involves contributing to the meeting and occasionally taking the lead.
Introduction: why meet?
Multidisciplinary teams are much better able to solve complex problems, whether fighting a battle, building a hospital, or organising a national conference. Rehabilitation problems are usually complex, defined by the many interacting factors and the non-linear relationships between the variables involved.
A group of people with different areas of knowledge and skill is superior because each person will contribute information and ideas that others will not have. However, the main superiority of a team arises from the discussions and debates between team members as they question and clarify statements made by other people. Respectful, challenging conversations often advance understanding and generate new ideas, leading to a better formulation and plan.
Therefore, rehabilitation planning meetings can lead to efficient and effective management of a patient’s problems but require team members to know what is expected and have the skill to participate. It also requires an attitude that welcomes challenge as an opportunity to reconsider ideas and assumptions, not as an attack on one’s competence or integrity.
Types of rehabilitation planning meetings.
This competency is relevant to all clinical meetings by the team, sometimes with other people, whether about a named patient or a defined group of patients. Rehabilitation teams have many different types of patient meetings and use many names, such as goal-planning meetings, review meetings, case conferences, discharge meetings, best interests meetings, family meetings, outpatient reviews, sit-down ward rounds, and so on.
The archetypical meeting is the rehabilitation goal-setting (or goal-planning) meeting usually held on inpatients with the patient and family members present with the team. However, there are many variations on this, and all are rehabilitation meetings:
- Best-interest meetings about unconscious patients when the patient is not present
- A forum to discuss challenges posed by family members; they will not be present, but the patient might be
- A meeting to plan a behavioural approach to a patient’s socially inappropriate behaviours when the patient will not be present; the family might be
- A meeting with other teams or agencies to discuss options on future placement when the patient and family may not be present
- A meeting to review all active inpatients or outpatients when only the team is present
All these meetings are planning the patient’s rehabilitation.
Skills needed by participants.
The more each participant in a meeting is aware of the mechanics of meetings and how a participant should contribute, the more efficient and effective the conference will be. Most people in healthcare attend several sessions a week to discuss a patient or a group of patients, yet formal teaching about meetings is uncommon. I will discuss the knowledge and skills needed.
This page is structured around the roles of a chairman as articulated in 1969 in the Harvard Business Review by George Prince, who wrote about “How to be a better meeting chairman.” with additional ideas from another business site, CEO worldwide. Many roles are concerned with running an efficient meeting, and this is more likely if people attending already know how a meeting should be run. Further, in rehabilitation teams, it is appropriate for most members to be the chair occasionally.
Constructive conversation.
The key to effective meetings is excellent communication skills. This requires all those present to:
- Listen to the person speaking, be interested, and do not interrupt them
- Be constructive and develop ideas from others rather than ask for justification
- Avoid direct early critical comments in response to any new idea
- Encourage anyone who is not participating to speak
At the same time, everyone must avoid repetition or saying more than necessary, and no further comments are needed when something has been agreed upon.
Maintain focus.
Every meeting must have an agreed-upon purpose, which should be communicated to all participants well before the meeting and confirmed at the start. This is rarely undertaken, leading to less productive meetings.
All participants should contribute only to that goal. Anyone raising matters seemingly unrelated to the topic should be asked politely to stop unless they can show their contribution is relevant. Participants should refrain from adding information or ideas that are interesting but irrelevant to the meeting. Interesting thoughts can be raised, provided they are only mentioned to ensure they are then considered after the meeting.
Cover the whole context.
Sometimes, the team meets to discuss a specific issue, such as responding to an external event like a partner’s death. In that situation, discussion of other unrelated matters should be avoided.
Thus, the purpose must be integrated into the context to ensure the scope is defined and covered. Most gatherings are to plan all aspects of rehabilitation, and in complex cases, a common failure is focusing on manageable or resolvable matters to avoid confronting significant, more considerable difficulties. Everyone must remind themselves and others of the critical issues requiring discussion and consider how their contribution relates to the essential points.
In rehabilitation planning, complex issues often relate to the long-term, what will happen after the episode in question, and they concern accommodation, social activities, and social relationships. Two other issues commonly avoided are whether treatments should be stopped and when to tell someone their expectations will not be met.
In most rehabilitation planning meetings, someone should always ask about:
- The long term, such as accommodation and social activities
- Whether therapies remain appropriate
- Discharge expectations, such as when and where to.
Concluding, summarising.
The time and effort given to an issue should be proportionate to its influence. The temptation is to try to perfect a minor problem while not addressing “the elephant in the room.” Certainty is rare, and further information can always be identified so that discussions can be endless and ultimately inconclusive. A vital skill in rehabilitation is knowing when debate should stop because the situation is sufficiently determined compared to the other issues.
One technique is summarising the discussion to demonstrate that it is adequately resolved. During the meeting, one should expect several or many summaries, one for each issue. Making the conclusion explicit reduces the risk of continued misunderstanding. At the same time, an essential attribute of all participants is accepting that it is time to stop a discussion and resisting the desire to add one more small point.
All participants should be able to summarise and conclude discussions while accepting the summary and conclusions of others, only disagreeing if there is a significant, justifiable reason.
Knowledge: structuring meetings.
All meetings must have a structure, usually manifested in the agenda. Given their similar purpose, most rehabilitation planning meetings will have a similar structure.
In 1999, I proposed a detailed agenda for stroke rehabilitation goal-planning meetings. The details are only relevant to a small proportion of sessions, but the general structure is appropriate and will be used here. Rehabilitation planning meetings are too frequent to allow patient-specific agendas to be prepared and circulated; moreover, discussions will likely have a predictable structure within any service.
All rehabilitation meetings should have a similar general structure, although they will differ in the time devoted to each component. Moreover, additional parts may be added, or, rarely, portions may be left out. I will suggest a generic structure here. Most case conferences will have a similar design, close enough to enable anyone to prepare for rehabilitation meetings.
Introductions.
This is essential. It is polite, allows new people to explain who they are and why they are attending, and reminds family members and the patient who each person is. People should give their information clearly, in sufficient but not excessive detail.
Purpose
The purpose of a meeting should be given to everyone invited and should be restated at the meeting. If it is not given, it is appropriate for anyone attending to ask for the purpose to be explained. Everyone attending should remain focused on the reason for the meeting, which can be referred to as the goals of the meeting.
Patient’s perspective.
Any meeting about an individual patient should include their perspective. The details will depend on the reason for the meeting. The information may be provided by the patient, their family, or the team, but it is essential to always remind everyone that the patient’s interests are central. If the patient is absent, the reason should be recorded, along with a discussion of how their views will be considered and how any conclusions will be fed back.
Active discussion of the meeting’s goals.
This is the meat of a meeting. Each attendee needs to prepare regarding its purpose. Usually, this involves providing new and documented information and explaining how it may impact understanding of the situation or what interventions could be considered. Consider each separately if there is more than one goal for the meeting.
Summary
The chair should summarise topics discussed during the meeting, and the session must end with someone summarising what has been concluded, what has been decided, what actions are to be undertaken, by whom, and when.
Participant role.
Just as most rehabilitation patient meetings will have a similar structure, the role of participants will be similar across almost all services. All team members attending a rehabilitation meeting should know the vital features of their position, and preferably, all should also know and understand how to assume the role of chair.
Be well prepared
Everyone attending is required to prepare for the meeting. This depends on the organiser of the conference informing you about the following:
- the time and location, leaving you sufficient time to prepare
- the reason for the meeting.
- You should be made aware of anything specific required of you.
Behaviours in the meeting.
Although the chair may lead on some parts of the meeting, success depends upon all participants considering all aspects of the meeting. Thus, you should:
- be attentive and continually engaged, not only when you are asked to speak
- avoid repetition, even if someone from a different profession has covered matters you would expect to cover. You should confirm that you agree with the information given.
- Seek clarification, sometimes on behalf of other members who look puzzled. This is especially important when someone uses jargon or abbreviations, even if you know what they mean.
- Support the chair in stopping others who are off the topic, repeating things, or disrupting the meeting in other ways.
- Give your information succinctly and with an appropriate structure.
- Be open to new suggestions about what you may do or how your information could be interpreted.
Information for formulation.
A planning meeting should give little time for formulation if one exists, but every forum should consider the existing formulation and whether it needs improving. Each participant must review the current formulation if available and, if not, consider their formulation. You should bring any information relevant to the formulation to the meeting, and if the information alters the understanding of the patient’s situation, it should be given.
This information is not restricted to direct clinical details. It might include essential information about the family, accommodation, recent events, work, and other matters.
Information on prognosis and potential treatments
Many people attending will have expertise in an area where they may be able to give a more certain prognosis. Further, they will have interventions that they know most about. Therefore, you should come prepared to talk about prognosis where you have that information and to explain the options for intervention, those that might help and any that other people might consider helpful but are unlikely to help.
It would be best if you were prepared to suggest what you think would be most helpful, why, and how it might relate to other proposed interventions.
Information on patient priorities.
Even if the patient or family are present, you must give any information about the patient’s wishes, priorities, and expectations that might affect the choice of goals and interventions. You should ensure that everyone considers the “bigger picture”, the patient in their broader life now and in the future.
Learning
The easiest way to learn is to spend five or ten minutes after any meeting reflecting on what went well, what needed improvement, what you learned about conferences and how to participate in them (and what not to do!).
This can be extended to discussing the meeting with some or all the participants within an hour or so, with an agreed-upon short time to prevent over-analysis. The agenda should be simple: what went well, what could have been better, and what we learned.
Individual participants may use a case conference assessment tool, often abbreviated to cCAT, to gain feedback on their performance. It was developed for doctors in training but can be used by any profession. It was also designed for an archetypal meeting with the patient and family present, but it can be adapted. Due to its shortcomings, some UK rehabilitation medicine trainees considered developing a new tool, the Meeting Assessment Tool. Unfortunately, the tool was not fully developed and evaluated.
Nonetheless, it could be helpful for all professions and applies to most meetings. It asked the assessor to comment and give constructive feedback on the trainee’s performance in the following domains, omitting any that are not applicable:
- Setting the scene, introductions, and agenda
- Multidisciplinary teamwork and facilitation of team members
- Clarity of explanations to the patient and family (
- Problem-solving skills
- Dealing with uncertainty, conflict, or ethical issues
- Ability to sum up agreed actions and production of minutes
A second tool can be used to study the planning meeting itself; it is a 20-item questionnaire covering four aspects of a session. One of them asks the respondent to rate their contribution, which would also provide headings for a more detailed reflection on a meeting. Siva Nair and I have used it to study planning meetings in the UK. If anyone wishes to obtain more information about the conferences held in their service, a 36-item questionnaire for staff about meetings is available.
Understanding the expertise of other team members is also crucial, because it improves communication. Consequently, to be competent, one must learn about the roles of all other team members.
Conclusion
Rehabilitation planning meetings have been observed and evaluated, though not very extensively. I am still looking for much written about structuring and running them, what participants need to know, and the skills required. Most of the ideas here come from experience and studies of meetings in business. However, there are tools for assessing and giving feedback on the performance of individuals and also for evaluating and providing feedback on single sessions. If one adds feedback from reflection, alone or with others, on what went well, what could have been better, and what was learned, most people will soon be much better at participating in and chairing rehabilitation meetings. Rehabilitation planning is a team activity, so every team member should explicitly learn how they best engage in it. The whole team should aim to have all the knowledge and skills described here and continually improve by reflecting on their performance.
