I have intentionally looked for gratitude during this time of overwhelming illness, isolation, divisiveness and virtual connections. It is a practice that I work on daily. It may surprise you, but it wasn’t difficult for me to be grateful for virtual meetings.

I have been influencing others to use methods of holding conversations that encourage diverse perspectives, invite all voices and leverage the wisdom in the room since 2011. I have, on occasion, attempted to do this within an organization that didn’t always appreciate the methods or understand the purpose. Some were satisfied when a decision was made, despite hearing from a minority in the room. What they didn’t understand, or chose to ignore, was that the usefulness of the meeting was inversely proportional to the number of conversations that occur after the meeting and that those often were not in agreement with the outcome of the conversation in the meeting.

When people walk away from a meeting feeling unheard and believe they should be making the decision that has just been made by others, they don’t do everything they can to support the decision. When meetings are dominated by a few people it may not be anyone’s fault. Some people, usually men, do not need as much space between speakers before they feel comfortable speaking up (Deborah Tannen, 1990). As a result, those of us who do need space between speakers “can’t get a word in edgewise.” I have resorted to raising my hand—which, by the way, gets disapproving looks.

Virtual meetings make all this worse. The deafening silence is assumed to be agreement when in fact it is related to the awkwardness of technology. Everyone is worried about speaking over someone else and they are muted and they are using a different platform than the one they are used to and they can’t find the “raise hand.” This is why I am grateful! The virtual space is a great excuse for the application of a light structure that supports voices being heard.

Here are some methods that make virtual meetings more effective and more inclusive.


Using a check-in increases participation in the meeting. When everyone is invited to be heard at the beginning of a meeting, they are more likely to contribute to the conversation. You can use a check-in to bring some humanity into the room, focus the conversation, brainstorm ideas, bring awareness to the purpose, build the team or just have fun. The most effective checkin is to ask a question that invites people to contribute in a sequential manner. For example: the host asks whoever will go first to succinctly answer the question, “What do you hope we accomplish in the next hour?” Once someone volunteers to go first, the host lets someone else on their participant list know that they will be next. Something like, “Mark, thank you for offering to go first, Nicole you will be next.” Then when Mark is finished, “Thank you Mark, Nicole you are next then Sarah will be after you.” You may need to set up guidelines if they haven’t operated in this way, explaining that “we will be taking turns speaking and not responding to each person’s contribution.” A little order is necessary. If you have more than about 10 people in the meeting you may want to put them into breakouts and have them share with one or two other people rather than taking the time for everyone to speak to the whole group. Another way to cut down on time is to limit their answer to three words. You may need to inform them that, “I don’t know how to say this in three words” is 10 words. The beauty of the virtual space is that it begs for this kind of light structure and people get the chance to see how well it works.

The virtual space is a great excuse for the application of a light structure that supports voices being heard.


I have seen great and disastrous use of breakouts. Guidelines for effective breakouts include:

Purpose. Give people a reason for being in conversation and an assignment for a report out. The skillful use of questions makes a huge difference in the productivity of the breakout. Participants in a breakout should be given an assignment to report back to the full group. As a workgroup, their task for the time in breakout may be to figure out next steps and they may be asked to report out what they need from the other work groups in order to move forward. When back in the full group, they don’t need to talk about all of their discussion, just the points that are salient for other groups. Suggest that they designate someone to do the reporting as soon as they have checked-in.

Timing. Recently, I was put in a breakout for 5 minutes with three strangers and given five questions to discuss. We barely completed introductions, and only three of the four people addressed one of the questions. It takes time to get a feel for how long to give people in breakouts. Allowing for introductions of strangers or updates on work may be necessary. If there is a question to discuss, consider how many people are in the breakout and how long it will take for all the voices to be heard at least twice. Generally, for three or four people in a breakout, you will need at least 15 minutes to have any kind of reasonable discussion. The host can pop into breakouts and get a sense of how they are doing if the time is flexible, but it definitely is easier to sense the room when live. When there is ample time, 20-30 minutes is preferred for discussion of one or two related questions.

Number of people. It is broadly accepted that three or four people is the maximum for equitable discussion to take place. This also relates to the structure you impose within breakouts. One option is to continue the precedent set by the check-in and invite people to take turns. Most importantly, make them aware they need to share the air!

Information harvest. Often the sponsors or leaders organizing a meeting have an interest in knowing what happens in the breakout conversations. You can invite breakout groups to add to a shared document. You may want to know who is in the breakout, what options they discussed, what concerns they had, who else they think needs to be involved in a decision and next steps, for example. This shared document is one way the hosts can observe the progress of the groups.

Agreements. Agreements should express the guidelines for any breakout conversations. Listening to understand assures that voices are not only heard, but understood. Speaking with intention implies that people are cognizant of the vocal space they are occupying and sharing the air. A confidentiality agreement may be appropriate in some settings. If there is an operative decision to be made, determine who is making the decision, the role of the people in the room (are they decision-makers or stakeholders?) and what process will be used to make the decision. Will it be a process that is autocratic, consultative, democratic or consent-based?

Facilitation. The hosts should announce the time to return to the main room before going into breakouts and can broadcast a message warning the groups to be prepared to return with their report out. I recommend having a technical producer manage technical issues, such as people coming in late, falling out of groups, having difficulty with their connection or calling in by phone and the issues that causes with getting into breakouts on some platforms. The role of the hosts is design of the process and managing the content, making sure the conversations are meaningful and fruitful.

Choice of breakouts. Sometimes it’s best to allow people to choose their breakout group from different discussion topics. They may even create those topics and invite others to join them. If the technology doesn’t allow individuals to choose breakouts, the technical producer will need to be able to place them into the breakouts they prefer. One of the skills of leadership is curating topics that need meaningful conversations. People invited to meetings want to walk away feeling like they were part of a conversation that made a difference, not given information they easily could have read.

I hope that by using these guidelines in your virtual spaces now, your teams will see the utility and ask for them if they get back to in-person meetings. May your decisions be informed by diverse perspectives—and all the wiser! Originally published in Minnesota Medicine magazine Jan/Feb 2022


  • Dawn Ellison, MD

    Professional Coach, Emergency Physician, Corporate Advisor

    Influencing Healthcare, LLC

    Dr. Ellison is an ABEM certified Emergency Medicine physician who has found her encore career in engagement and well-being. Communication, compassion, community and connection are core to her approach. She has collaborated to create accessible resources for well-being during the COVID-19 pandemic. As the president of Influencing Healthcare, LLC she has leveraged her leadership and clinical experience to create collaborative healthcare cultures through coaching, workshops and retreats. She is a global steward of Art of Hosting and uses these skills to create inclusive spaces for robust conversations. Most recently she has been conducting retreats aimed for post-traumatic growth. Dr. Ellison has been sharing Stress management and resilience training (SMART) techniques with her coaching clients since 2013 and teaching the SMART program since 2018. She is a certified SMART trainer and certified professional coach.