Leadership In Action, Vol 26, Num1 Mar/apr 2006 Power Of ...
Power of Persuasion
Influence Tactics
for Health Care Leaders
Many of today’s leaders in health care organizations have a background
in medicine or some other scientific field. Largely because they have
been educated in a rigorously data-oriented approach and trained in
strongly hierarchical settings, they tend to use a narrow range of
influence strategies, limiting their management effectiveness. Using a
full range of influence tactics, and doing so strategically, can help such
leaders increase their personal and organizational effectiveness.
Leadership positions in a broad their rigorously data-oriented educa-
range of health care organizations—
tion and the strongly hierarchical set-
including those in the pharmaceutical,
tings of their postgraduate training.
biotechnology, and health insurance
To increase their leadership devel-
industries as well as hospitals and
opment and organizational effective-
other provider systems—are filled by
ness, scientist and physician leaders
scientists and physicians. These lead-
need to use a full range of influence
ers must, as is the case with their
tactics, and to do so strategically. In
nonscientific peers, be able to achieve
addition, the tactics must be tailored
business results by motivating direct
to the organization’s culture, to for-
reports and influencing multiple
mal and informal power structures,
stakeholders over whom they have no
and to the nature of the goal to be
formal authority.
accomplished.
As a group these scientist and
Influence may be thought of as the
physician leaders tend to be highly
ability to persuade another individual
intelligent and results oriented.
or group to carry out an action or to
However, many tend to overuse a
carry it out in a particular manner. We
small number of influence strategies,
have identified six major influence
limiting their management effective-
tactics. The first is logical persuasion,
ness. This overuse is due in part to
a reliance on facts and rationality to
b y B a r b a r a J . A . E i s e r, A r n o l d R . E i s e r, a n d M i c h a e l A . P a r m e r
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L I A • V O L U M E 2 6 , N U M B E R 1 • M A R C H /A P R I L 2 0 0 6
make a case. The second, personal
tist and physician leaders tend to use
challenges, the nature and context of
persuasion, involves several
logical persuasion most heavily, along
influence tactics, effectiveness factors
approaches, including friendliness and
with reciprocation as a secondary
and measures, a strategic decision-
the use of inspiration, praise, and
device.
making process for determining when
appeals to personal values. The third
Given the increasing pressures on
to employ one influence tactic or a
is consultation, a participative process
health care organizations of all types,
combination of tactics, and situations
in which suggestions and opinions are
leaders need to maximize their per-
exemplifying successful use of tactics
solicited and incorporated into a pro-
sonal and organizational effective-
by medical and scientific leaders.
posal or idea. Fourth is reciprocation,
ness. A number of factors, including
or exchange. The fifth is forcefulness,
ever-increasing regulatory oversight
FACTS AND LOGIC
which involves an overbearing com-
and bureaucratic requirements,
munication style, the use of fear, or
A hallmark of the education and
heavy persistence. The sixth and final
training of physicians and research
tactic is the use of alliances, aligning
scientists is an emphasis on solving
the support of individuals or groups to
problems by using facts and logical
convince another of the merits of a
thought processes. Whether in mathe-
Managers who fail to
case. Given their backgrounds, scien-
matical or purely scientific courses,
precision is valued, along with find-
develop a full range of
ing the “right answer.” Individual
A B O U T T H E A U T H O R S
excellence in the accumulation of
influence tactics may
knowledge is rewarded throughout
Barbara J. A. Eiser is a CCL
fall short of potential in
college and graduate and medical
adjunct executive coach and
schools. Competition is fierce for
president of Leading Impact,
their own and their
limited postgraduate places in presti-
a management consulting
gious academic institutions and for
firm focusing on executive
group’s performance.
sought-after employment opportuni-
and team coaching and
ties, which often require highly spe-
change leadership. She holds
cialized knowledge. Throughout this
an M.A. degree from
developmental period the organiza-
Columbia University and a master of city planning
tional systems and cultures within
degree from Harvard University.
greater pricing pressures from insur-
which students of medicine and sci-
ance companies and governmental
ence function are rigidly structured.
Arnold R. Eiser is vice pres-
programs, and heightened patient
As a result a majority of successful
ident of medical education
autonomy and consumerism, have
graduates in the sciences begin their
for Mercy Health System and
brought about increased competitive-
formal careers operating on the basis
a professor of medicine at
ness and a heavy focus on cost effec-
of the importance of individualism,
Drexel University College of
tiveness in the provision of medical
hierarchy, and proving correctness by
Medicine. He holds an M.D.
services and health care products. As
using facts in an exact manner.
a result many hospitals and pharma-
Scientists in the pharmaceutical
degree from Northwestern
ceutical companies have reorganized
and biotech industries often enter
University.
or merged, further complicating their
their career tracks as junior
Michael A. Parmer is a con-
leadership needs.
researchers, working on a single proj-
With these pressures, health care
ect or a small group of projects in a
sulting associate with the
leaders must become more strategic,
particular subject area. These scien-
Center for Case Management,
which entails being able to success-
tists eventually broaden and deepen
an international health care
fully influence a broad range of
their knowledge and begin to work
company that consults to
stakeholders. These interested parties
on more multifaceted projects—such
organizations on patient
may be individuals or groups, and
as developing the potency of a candi-
care management issues. He
they have different and at times com-
date molecule or completing clinical
holds an M.D. degree from
peting agendas and goals. To become
trials—often as members of cross-
the University of Medicine
more strategic, scientist and physi-
functional teams. As part of this work
and Dentistry of New Jersey.
cian leaders need to focus on five
the scientists may begin to develop
areas: early leadership development
some leadership skills, including the
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L I A • V O L U M E 2 6 , N U M B E R 1 • M A R C H /A P R I L 2 0 0 6
use of influence tactics. However, as
The major modes for this learning are
tion of their operating rooms
stated earlier, the most common tac-
action-oriented leadership courses
(ORs)—illustrates the use of these
tic is logical persuasion. Given the
and executive coaching. Although
five factors. The OR schedule is com-
need to share limited resources under
physicians and scientists may have an
plex, and any disorder in that sched-
challenging deadlines, scientists also
advantage because of their ability to
ule disrupts patient flow throughout
tend to use reciprocation, though to a
use logical persuasion, they need to
the hospital. Allotted time is the com-
lesser degree.
avoid overusing it. Particularly in
mon currency, and surgeons prefer to
In a parallel vein, physicians’
today’s health care environment, a
operate early in the morning. Disease
formative experiences include four
physician or scientist executive must
and injury have no timetable, how-
years of medical school and three to
be agile and able to apply a variety of
ever. Well-organized ORs build in
eight years of postgraduate medical
tactics to meet the multiplicity of
time and space flexibility to accom-
education. Throughout this period
changes on many fronts.
there is a heavy emphasis on acquir-
ing vast quantities of highly technical
FIVE FACTORS
scientific knowledge. During the sec-
ond half of medical school most of
How does one determine which influ-
Influence may be exer-
the training occurs in a clinical set-
ence tactics to use in a given situa-
ting, which is highly hierarchical.
tion? Although there are no set rules
cised in four directions
Upon completion of their training
ensuring the success of any particular
most physicians enter clinical prac-
tactic, several considerations can aid
in power structures:
tice or academia. Some join the phar-
the decision-making process.
maceutical industry, either early in
Awareness of the communication
upward, laterally, down-
their careers or after years in aca-
process is necessary, including the
demic or clinical practice.
fact that each person operates on an
ward, and outward.
Both scientists and physicians are
individual set of perceptions and
often promoted to formal manage-
underlying assumptions that affect his
ment roles as a result of excellent
or her interpretation of messages and
technical expertise. However, making
events. These perceptions are
the transition from contributing work
strongly affected by the context of
modate potential changes, but even
as an individual to accomplishing
the work environment, such as the
these attempts at resource allocation
work through others’ efforts can be
particular organizational culture with
can be insufficient on any given day.
difficult. These managers may not
its accepted behavioral norms, values,
Three hospital leaders, the chief of
realize the need for new skill sets that
and web of interpersonal relation-
surgery, the chief of anesthesia, and
focus on motivating and evaluating
ships—thus the maxim that percep-
the nurse who is director of periopera-
the performance of subordinates and
tion is reality. Grasping the impor-
tive services, jointly determine the
on working in complex relationships
tance of this invisible yet powerful
OR schedule. They are pressured by
with peers, superiors, and other
aspect of organizational systems may
three powerful groups: individual sur-
stakeholders. In addition, given their
be one of the most difficult tasks that
geons, OR nurses, and the hospital
developmental history emphasizing
data-oriented scientist and physician
administration. Surgeons submit cases
facts and logic, many do not
leaders must accomplish. Learning to
to the schedule and usually seek con-
acknowledge the value of the other
work effectively with it results in one
secutive blocks of time early in the
influence tactics, dismissing them as
of the most powerful competencies a
day. Because surgeons in private prac-
“soft skills.” These organizational
leader can possess.
tice often operate at more than one
challenges become increasingly com-
Five major factors determine the
hospital, they can take their cases
plicated as managers move up the
effectiveness of influence tactics in a
elsewhere if their scheduling prefer-
leadership ladder. If they fail to
given situation: the purpose for which
ences are not met. Skilled OR nurses
develop a full range of influence tac-
the influence is being used, the influ-
are often in short supply. Their scant
tics and the ability to use them judi-
encer’s communication skills, the tar-
numbers, irreplaceable expertise, and
ciously, these managers can fall short
get’s receptiveness, the nature of the
team loyalty give these nurses signifi-
of potential in their own and their
tactic, and the relative power of the
cant clout with their director and the
group’s performance.
influencer and of the target.
physicians. The administration seeks
Fortunately, the strategic and tacti-
A common challenge for hospi-
to maximize financial returns by
cal use of influence can be learned.
tals—ensuring the effective utiliza-
using OR time efficiently and by
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L I A • V O L U M E 2 6 , N U M B E R 1 • M A R C H /A P R I L 2 0 0 6
attracting the types of cases that yield
peers in a range of situations, includ-
purposes. This is important to a
substantial hospital fees.
ing cross-functional teams, as illus-
leader’s strategic objective of build-
When disruptions and challenges
trated by the OR scheduling example.
ing a personal reputation for effec-
occur, the three leaders use a range of
With the greater generational and cul-
tively accomplishing goals through
influence tactics, such as moral suasion
tural diversity in today’s workforce,
others.
(in regard to the purposes of competing
successful managers understand that
The second strategic objective is
requests), personal appeals to what are
the old command-and-control meth-
to build a web of interrelationships
often strong egos, sensitivity to hierar-
ods are less effective than using a
that will aid in accomplishing current
chies between doctors and nurses, and
broad range of influence tactics with
and long-term objectives. Leaders
other combinations of tactics depend-
subordinates. Successfully influenc-
begin the forging of this network by
ing on the needs of the individuals
ing OR nurses to be flexible and
determining the appropriate stake-
involved. Skillful influencing results in
helpful when scheduling changes
holders, potential allies, mentors,
an optimal schedule—successfully
occur now goes beyond the director
supporters, and competitors. Learning
of perioperative services simply
their goals, priorities, commitments,
telling them where and when to per-
and other motivations is important to
form their work. Being able to influ-
satisfying their needs and gaining
ence stakeholders outside one’s
their goodwill.
A three-step process is
organization has also become a
A three-step process is helpful
strategic advantage for leaders, who
when deciding on the appropriate
helpful when deciding
can then better monitor environmen-
influence tactics to use in a particular
tal trends and help build their own
situation:
on the appropriate influ-
and the organization’s reputation.
• Determine which individuals
ence tactics to use in a
MEASURING OUTCOMES
and groups are needed for support,
and consider why they might back a
particular situation.
How does one measure the effective-
request.
ness of using particular influence tac-
• Assess sources of potential
tics? A common method is to assess
resistance, whether overt or covert,
the outcome, of which there are three
along with the reasons why they
potential types. The first type, com-
would resist.
moving nurses to appropriate ORs and
mitment, is accomplished by persuad-
• Equipped with the knowledge
having surgeons and anesthesiologists
ing another party, through internaliza-
gained from the first two steps, con-
arrive promptly and complete their
tion of a positive attitude, to perform
sider which tactics have worked with
cases in a reasonable time.
a desired action. This is usually
each target in the past.
accomplished by using tactics such as
personal persuasion or consultation.
Part of the choice of appropriate
FOUR DIRECTIONS
The second type, compliance, is task
influence tactics will depend on the
Influence may be exercised in four
performance with the appearance of
particular context, the nature of the
directions in power structures:
conformity. Although there are
tactics, and the potential benefits and
upward, laterally, downward, and out-
instances where such compliance is
costs that stakeholders perceive for
ward. Upward influence includes both
sufficient, the underlying lack of
themselves. Thus, determining the
direct managers and others of higher
agreement can actually cause the
strategy includes assessing and com-
status in the organization, who may
third type, resistance.
municating each party’s benefits and
be in a matrix relationship or could
costs in the short term and the
become potential mentors. Physician
BEST PRACTICES
impacts of the strategy on long-term
and scientist executives who recog-
relationships.
nize the importance of moving
What are some of the best practices
beyond a purely fact-based perspec-
for developing a strategic perspective
A COMPLEX TASK
tive in order to accomplish organiza-
and method for deciding which tac-
tional goals may more easily request
tics to use in any given situation?
Scientist and physician leaders need
and accept political and interpersonal
First and foremost, good leadership
to apply a full range of influence tac-
advice from those superiors.
practice requires that influence
tics in appropriate contexts to
An increasingly important aspect
attempts be used in an ethical manner
accomplish critical organizational
of leadership involves influencing
and only for legitimate organizational
objectives. The multiplicity of stake-
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L I A • V O L U M E 2 6 , N U M B E R 1 • M A R C H /A P R I L 2 0 0 6
Two Influence Tactic Success Stories
What does successful application of
Rather than simply adopting an
they and their colleagues can pro-
influence tactics by scientist and
existing process, the team reviews
vide each other with the resources
physician leaders in the health care
and revises the pathway according
to complete projects successfully
field look like? Here are two examples:
to its own organizational needs. The
under tight deadlines. To an extent,
Hospital clinical pathways.
team may also gain additional
some may also employ aspects of
Physician executives such as hospi-
insight and support from all affected
personal persuasion.
tal chief medical officers are often
groups by circulating the draft path-
For example, a senior research
challenged to align disparate med-
way for a review and comment peri-
scientist in a pharmaceutical com-
ical staffs to accomplish collabora-
od, after which the pathway is con-
pany was asked to lead a cross-
tive goals. For example, reducing
sidered finalized.
functional team to discover the
variation in clinical practice to
During this time, an opinion
cause of contamination in several
enhance therapeutic effectiveness
leader typically emerges as the
batches of a product. The problem
and efficiency while also respecting
pathway’s champion. This alliance
needed to be solved quickly,
patient choices and differences has
partner may or may not have been
because the U.S. Food and Drug
led to the use of structured care
on the original committee; he or she
Administration had removed the
methodologies. (These methodolo-
typically rises to the role on the
product from the market and would
gies are also known as clinical path-
basis of personal persuasion, techni-
not permit it to be sold until the
ways, order sets, CareMaps, medical
cal expertise, and consultative skills.
company could prove it had resolved
algorithms, or practice guidelines.)
In one such instance, a specialist
the contamination issue. The senior
To effectively initiate these method-
physician who served as the cham-
scientist had to assemble a team
ologies, a leader needs to have
pion successfully presented the
that included several research spe-
established widespread credibility
finalized pathway to the hospital’s
cialists along with representatives
and developed resource networks
medical executive committee. His
from manufacturing, quality control,
and a host of allies, and he or she
influence and cooperation prepared
and regulatory departments at sites
must advise and consult with others
the way for the many pathways from
scattered throughout the United
on a regular basis.
different departments that followed
States. Along with her considerable
On a practical level, devising a
over the next few years. In each
technical expertise, the scientist
pathway requires analysis of current
case there were unique challenges,
leader had developed over her
care patterns and the application of
but the successful use of logical
decade of employment at the com-
evidence from the medical litera-
persuasion, alliances, personal per-
pany a widespread reputation for
ture. From a political perspective,
suasion, and consultation prevailed.
collegiality, fairness, being a team
implementation of a hospital’s clini-
Pharmaceutical research and
player, and giving appropriate credit
cal pathway policy first requires
development. Clinical research
to others. She made significant use
approval by the relevant clinical
today often requires collaboration
of her professional reputation, con-
departments and the medical staff
between various laboratories and
sultation, and alliances to build her
executive committee. A variety of
business divisions and strategic
team. She was also persistent in her
other stakeholders—commonly in
alliances with other companies or
follow-through with others, using
finance, legal, and nursing func-
university research departments.
pressure only in rare instances when
tions—also need to be actively
One early leadership position that
a deadline loomed. As a result, her
engaged to support the initiative. To
scientists commonly take on is as a
group was able to discover the
overcome resistance, the physician
project manager for research stud-
cause of the problem, create a cost-
leader must develop an influence
ies in their specialty areas, including
effective solution, and prepare the
strategy that typically incorporates
supervising others on their teams.
quality control and regulatory data
logical persuasion, personal persua-
As the scientist leaders gain more
documents in an extremely short
sion, alliances, forcefulness, recipro-
experience and manage more com-
time. The FDA then moved quickly
cation, and consultation tactics.
plex projects, they often begin to
to permit the product to be sold
Crucial to the process is local
use, in addition to logical persua-
again, thus restoring the revenue
customization of the pathway.
sion, reciprocation with peers, so
stream to the company.
holders and the diverse professional
complex and textured. These leaders
executive education and coaching,
cultures in the medical and pharma-
are beginning to understand the need
among other means, to become more
ceutical industries make the applica-
to move beyond an overdependence
strategic and successful in these com-
tion of influence tactics particularly
on logical persuasion and are using
plex settings.
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L I A • V O L U M E 2 6 , N U M B E R 1 • M A R C H /A P R I L 2 0 0 6
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