Have you spent many frustrating hours dealing with the logistical hassles of long-distance teleconferencing? Rural physicians are often called upon, to participate in teleconference sessions over patient care, educational and administrative issues. These hassles are much worse when struggling to make teleconferencing work over interstate and international lines, often in the middle of the night. A group of experienced professionals have assembled some tips for others in the same predicament. As members of the WONCA Working Party on Rural Practice, and its technical sidekick, WRITE1, we have often struggled to make efficient use of our time and resources. It seems typical of such online meetings that, despite all the technological advances at our disposal, the most commonly asked question is 'Can you hear me?'
Our suggestions, comments and tips are in the following areas:
- Time zones
- Telephone tips
- Meeting management
- Sending files
- Taking it further
The next most frequently asked question at these meetings is 'What time is it with you?' It is not too hard to set up a teleconference between two parties and get the timing right, most watches have a dual time zone feature these days. But many secretaries get quite frustrated when things progress beyond this, especially if it means crossing the International Date Line. Add to this the switching with Daylight Savings Time, which is even more confusing across hemispheres, so there can be a two hour seasonal change instead of just one.
The most important tip that we have found is to specify the start time as Greenwich Mean Time (GMT). There's a reason the military use this standard (which they call Zulu): it is constant and everybody can usually work out where they are in relation to it. Make sure any British participants understand that this is not their local time in summer - it may be obvious but it's surprising how often this is forgotten.
On the Internet, there are several examples of world clocks that can help with this. Some of them feature fancy daylit globes and all sorts of graphical enhancements. The most useful and straightforward site that we have found is the Fixed Time Meeting Planner: www.timeanddate.com/worldclock/fixedform.html. Simply enter the time and date of the proposed meeting, along with the specified time zone, and it will return the equivalent time and date for a wide variety of places around the globe. This is very useful for trying to figure out what time is going to be least inconvenient for all those who are invited to attend.
Think about what kind of telephone you will use. Avoid mobile phones if at all possible - the battery or signal will inevitably die, usually at the most critical juncture. If you plan to take notes during the meeting, a hands-free arrangement is very helpful but do test it out before you conference. Regular telephones that offer a speakerphone option are very variable in sound quality - there is often far too much echo and pickup of surrounding noise. While you may not be aware of this, your colleagues will suffer horribly.
Good echo cancellation circuitry can be found on some phones, without having to go to expensive specialised conferencing units but do try before you buy. The alternative is to use a headset, this is preferable in a noisy environment. This does not just mean a busy hospital or work environment, it's amazing how often the kids and dog will choose teleconference time for 'singing practice'. But, again, try the headset, both for comfort and for pickup: some are very sensitive to breathing and background noise. A good headset can also be used for voice recognition with your computer - if you plan to do this lots, spend lots. Accuracy of recognition is affected more by microphone quality than anything else.
Computers also offer another option that can greatly reduce the costs of long distance teleconferencing. Voice-over-IP (VoIP) is a way of persuading your high-speed Internet connection to carry sound instead of data packets. For years, this was solely the purview of geeks and nerds, and while very cheap, the sound quality was laughable. But now there are some very good services available, with excellent sound quality. Pricing varies from one country and area to another so the best thing to do is to Google on the word 'VoIP' to see what is available locally.
You don't even need to own a computer to take advantage of VoIP cost-savings. Many of these international cut-rate dialing cards make use of the same premise and can connect you very cheaply. Do make sure that you have a local dial-in number to connect to their circuits or else you won't save much. Rates vary a lot and many exotic destinations are not covered. It is irritating to have to dial up to 40 digits (local service number, account number, password, then number desired!) but many services now offer Caller-ID registration. This means that you only need to dial a few extra digits, which is much more convenient.
Give some thought to which teleconference service you choose. Costs and service vary, with phone company services usually offering the highest rates. Do you really need to use a 1-800 service? While initially attractive, they are often exorbitant. It may be better just to reimburse your participants for their direct dial costs (especially if they can use a cut-rate card). Also establish how much they charge for recording the call and whether you need that.
Does the service automatically announce the arrival and departure of participants? This can be very useful, especially when some participants are having trouble keeping an open connection - the system lets you know whose line has been dropped. But they can also be a nuisance, with constant interruptions if there are several late-comers to the meeting. The automatic notifier does not wait politely for a lull in the conversation to say 'Sorry, I'm late'.
As with any other meeting, attention to the boring and mundane issues of agendas, information items etc is important, but it is much more so for international teleconferencing. There are always people who turn up at live meetings, not having received copies of anything. While this is easy to fix in the same room, it can be much harder to quickly distribute a bunch of paperwork electronically at the last minute. Many participants will not be able to access their email in the middle of a phone call. Try to avoid playing the game of 'Did everybody get that (document)?' for the first five minutes of the conference.
It is well beyond the scope of this article to deal extensively with running a good meeting. But a few pointers are particularly relevant to teleconferencing:
- Put the most important agenda items first, don't be tempted to clear the decks.
- Assign timings to agenda items and stick to them.
- Mark agenda items as information or action.
- Start on time.
- Don't revisit items for late-comers - they won't be late next time!
- Record minutes or at least notes with Action Items.
These sound trite and obvious but remember that an international teleconference sometimes has the cumulative cost of more than $20 per minute!
At the start of the meeting, it is helpful to remind participants to minimize background noise and distractions. It's so embarrassing to hear that toilet flush repeated, and the culprit never hears it. Similarly, avoid side conversations without mute - it's amazing, and awkward, to find out just how sensitive these microphones can be. Mute your computer as well - we're all tired of hearing those annoying Ta-Dah opening bars, as somebody fires up Windows to take notes... or surreptitiously do their email.
In small groups, people usually know each other's voices; but for large or less familiar groups, ask participants to identify themselves each time they start speaking. It sounds odd but is important nonetheless. Try not to let any one voice dominate the proceedings. This can be very difficult if the speaker has a half-duplex connection because you cannot interrupt their flow. (Half-duplex is a telephony term that refers to having only a single communication channel open at one time, in the style of old radios, where the user cannot speak and hear at the same time, similar to old style radio walkie-talkies)
Try to avoid teleconferencing for particularly difficult or heated issues. We all tend to be a bit more civilised when in direct company. Non-verbal communication is more important than we think, up to 55% of meaning can be conveyed this way2.
Some quick notes about sending out information before and after your teleconference. First of all, establish a common file format for notes. Most people have Microsoft Word or a word-processor that can handle Word files. But also pay some attention to the version of Word: participants from developing nations may be running relatively elderly programs. For plain and simple text, it does not matter. But if you intend to use features like Track Changes or embedded Comments for joint editing of a document, remember that these work differently across Word versions and not at all with other word-processors.
Avoid letterheads with fancy corporate logos - they can easily balloon the file size by tenfold. People with slow speed connections do not appreciate downloading 2 megabyte attachments, just to find out the meeting time.
Sometimes it is worthwhile posting the information directly onto a web site that all participants can access at their leisure, or more likely, from the office where they have a faster connection. This can work well for PowerPoint presentations - you can even set these up to play directly through a web browser, in the event that not all participants have PowerPoint.
Taking it further
Increasingly, it is feasible to host a combined audio and data teleconference, even video, but it is important to ask yourself how much value and effectiveness such bells and whistles add. It can be very helpful, for example, to use shared web surfing to guide a group in synchronous steps through a particularly complex process. Everybody's browser is hooked to the leader who then plays Pied Piper. All are literally kept on the same page. Many conferencing tools include this capability, including Microsoft NetMeeting and MSN Messenger. Robin Good has written an excellent overview of this for those who wish to explore this further3. However, this style of presentation is often overly forceful. It is easy to overwhelm your participants with information overflow, especially if they are not highly computer literate. This combined method, also known as audiographic conferencing, is more effective when used for educational purposes4,5.
To make this work to any extent, you really need to have separate phone and data lines, a luxury that many rural and remote doctors, whose need is greater than their city counterparts, can only dream of. Trying to squeeze too many things down one pipe usually means that none of it works well.
What does video add to the mix? Considerable debate (and money) is spent on this issue. There has been much promise but the technology, while improving, still frequently falls short. Do-it-yourself type video setups are now quite easy to install and not very expensive. They can be fun for chatting with the kids from a remote conference venue but are still rather flaky for real work. For those who want to experiment, MSN Messenger is free, flexible and fairly easy to setup.
Using these steps can add a great deal of clarity to your teleconference process and make your group much more effective. Some of these measures can also reduce your costs considerably. Above all, keep it simple and KISS your frustrations goodbye.
1. Wonca Rural Information Technology Exchange (WRITE). Sub-group of the Wonca Working Party on Rural Practice. (Online) 2004. Available: http://www.globalfamilydoctor.com/aboutWonca/working_groups/rural_training/write.htm (accessed 10 February 2005).
2. Mehrabian A. Silent messages: Implicit communication of emotions and attitudes. Belmont, CA: Wadsworth, 1990.
3. Good R. Towards a new generation of web conferencing tools: co-browsing and web touring. (Online) 2004. Available: http://www.kolabora.com/news/2004/11/29/towards_a_new_generation_of.htm (accessed 11 February 2005).
4. Kuramoto AM , Dean JL. Audiographic teleconferencing. A method of distance learning. Journal of Nursing Staff Development 1997; 13: 13-17.
5. Berk RA. The delivery of continuing education: teleconferencing, an alternative mode. Bulletin of Medical Library Association 1982; 70: 21-27.