Power of persuasion: Influence tactics for health care leaders

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Power of PersuasionInfluence 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.

by Barbara J. A . E i ser, Arno ld R. E i ser, and M ichae l A . Parmer

L I A • VO LU M E 26 , N U M B E R 1 • M A RC H /A P R I L 20 0 6

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eadership positions in a broadrange of health care organizations—including those in the pharmaceutical,biotechnology, and health insuranceindustries as well as hospitals andother provider systems—are filled byscientists and physicians. These lead-ers must, as is the case with theirnonscientific peers, be able to achievebusiness results by motivating directreports and influencing multiplestakeholders over whom they have noformal authority.

As a group these scientist andphysician leaders tend to be highlyintelligent and results oriented.However, many tend to overuse asmall number of influence strategies,limiting their management effective-ness. This overuse is due in part to

their rigorously data-oriented educa-tion and the strongly hierarchical set-tings of their postgraduate training.

To increase their leadership devel-opment and organizational effective-ness, scientist and physician leadersneed to use a full range of influencetactics, and to do so strategically. Inaddition, the tactics must be tailoredto the organization’s culture, to for-mal and informal power structures,and to the nature of the goal to beaccomplished.

Influence may be thought of as theability to persuade another individualor group to carry out an action or tocarry it out in a particular manner. Wehave identified six major influencetactics. The first is logical persuasion,a reliance on facts and rationality to

Barbara J. A. Eiser is a CCL

adjunct executive coach and

president of Leading Impact,

a management consulting

firm focusing on executive

and team coaching and

change leadership. She holds

an M.A. degree from

Columbia University and a master of city planning

degree from Harvard University.

Arnold R. Eiser is vice pres-

ident of medical education

for Mercy Health System and

a professor of medicine at

Drexel University College of

Medicine. He holds an M.D.

degree from Northwestern

University.

Michael A. Parmer is a con-

sulting associate with the

Center for Case Management,

an international health care

company that consults to

organizations on patient

care management issues. He

holds an M.D. degree from

the University of Medicine

and Dentistry of New Jersey.

make a case. The second, personalpersuasion, involves severalapproaches, including friendliness andthe use of inspiration, praise, andappeals to personal values. The thirdis consultation, a participative processin which suggestions and opinions aresolicited and incorporated into a pro-posal or idea. Fourth is reciprocation,or exchange. The fifth is forcefulness,which involves an overbearing com-munication style, the use of fear, orheavy persistence. The sixth and finaltactic is the use of alliances, aligningthe support of individuals or groups toconvince another of the merits of acase. Given their backgrounds, scien-

tist and physician leaders tend to uselogical persuasion most heavily, alongwith reciprocation as a secondarydevice.

Given the increasing pressures onhealth care organizations of all types,leaders need to maximize their per-sonal and organizational effective-ness. A number of factors, includingever-increasing regulatory oversightand bureaucratic requirements,

greater pricing pressures from insur-ance companies and governmentalprograms, and heightened patientautonomy and consumerism, havebrought about increased competitive-ness and a heavy focus on cost effec-tiveness in the provision of medicalservices and health care products. Asa result many hospitals and pharma-ceutical companies have reorganizedor merged, further complicating theirleadership needs.

With these pressures, health careleaders must become more strategic,which entails being able to success-fully influence a broad range ofstakeholders. These interested partiesmay be individuals or groups, andthey have different and at times com-peting agendas and goals. To becomemore strategic, scientist and physi-cian leaders need to focus on fiveareas: early leadership development


challenges, the nature and context ofinfluence tactics, effectiveness factorsand measures, a strategic decision-making process for determining whento employ one influence tactic or acombination of tactics, and situationsexemplifying successful use of tacticsby medical and scientific leaders.

FACTS AND LOGICA hallmark of the education andtraining of physicians and researchscientists is an emphasis on solvingproblems by using facts and logicalthought processes. Whether in mathe-matical or purely scientific courses,precision is valued, along with find-ing the “right answer.” Individualexcellence in the accumulation ofknowledge is rewarded throughoutcollege and graduate and medicalschools. Competition is fierce forlimited postgraduate places in presti-gious academic institutions and forsought-after employment opportuni-ties, which often require highly spe-cialized knowledge. Throughout thisdevelopmental period the organiza-tional systems and cultures withinwhich students of medicine and sci-ence function are rigidly structured.As a result a majority of successfulgraduates in the sciences begin theirformal careers operating on the basisof the importance of individualism,hierarchy, and proving correctness byusing facts in an exact manner.

Scientists in the pharmaceuticaland biotech industries often entertheir career tracks as juniorresearchers, working on a single proj-ect or a small group of projects in aparticular subject area. These scien-tists eventually broaden and deepentheir knowledge and begin to workon more multifaceted projects—suchas developing the potency of a candi-date molecule or completing clinicaltrials—often as members of cross-functional teams. As part of this workthe scientists may begin to developsome leadership skills, including the

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A B O U T T H E A U T H O R S

Managers who fail to

develop a full range of

influence tactics may

fall short of potential in

their own and their

group’s performance.

use of influence tactics. However, asstated earlier, the most common tac-tic is logical persuasion. Given theneed to share limited resources underchallenging deadlines, scientists alsotend to use reciprocation, though to alesser degree.

In a parallel vein, physicians’formative experiences include fouryears of medical school and three toeight years of postgraduate medicaleducation. Throughout this periodthere is a heavy emphasis on acquir-ing vast quantities of highly technicalscientific knowledge. During the sec-ond half of medical school most ofthe training occurs in a clinical set-ting, which is highly hierarchical.Upon completion of their trainingmost physicians enter clinical prac-tice or academia. Some join the phar-maceutical industry, either early intheir careers or after years in aca-demic or clinical practice.

Both scientists and physicians areoften promoted to formal manage-ment roles as a result of excellenttechnical expertise. However, makingthe transition from contributing workas an individual to accomplishingwork through others’ efforts can bedifficult. These managers may notrealize the need for new skill sets thatfocus on motivating and evaluatingthe performance of subordinates andon working in complex relationshipswith peers, superiors, and otherstakeholders. In addition, given theirdevelopmental history emphasizingfacts and logic, many do notacknowledge the value of the otherinfluence tactics, dismissing them as“soft skills.” These organizationalchallenges become increasingly com-plicated as managers move up theleadership ladder. If they fail todevelop a full range of influence tac-tics and the ability to use them judi-ciously, these managers can fall shortof potential in their own and theirgroup’s performance.

Fortunately, the strategic and tacti-cal use of influence can be learned.

The major modes for this learning areaction-oriented leadership coursesand executive coaching. Althoughphysicians and scientists may have anadvantage because of their ability touse logical persuasion, they need toavoid overusing it. Particularly intoday’s health care environment, aphysician or scientist executive mustbe agile and able to apply a variety oftactics to meet the multiplicity ofchanges on many fronts.

FIVE FACTORSHow does one determine which influ-ence tactics to use in a given situa-tion? Although there are no set rulesensuring the success of any particulartactic, several considerations can aidthe decision-making process.Awareness of the communicationprocess is necessary, including thefact that each person operates on anindividual set of perceptions andunderlying assumptions that affect hisor her interpretation of messages andevents. These perceptions arestrongly affected by the context ofthe work environment, such as theparticular organizational culture withits accepted behavioral norms, values,and web of interpersonal relation-ships—thus the maxim that percep-tion is reality. Grasping the impor-tance of this invisible yet powerfulaspect of organizational systems maybe one of the most difficult tasks thatdata-oriented scientist and physicianleaders must accomplish. Learning towork effectively with it results in oneof the most powerful competencies aleader can possess.

Five major factors determine theeffectiveness of influence tactics in agiven situation: the purpose for whichthe influence is being used, the influ-encer’s communication skills, the tar-get’s receptiveness, the nature of thetactic, and the relative power of theinfluencer and of the target.

A common challenge for hospi-tals—ensuring the effective utiliza-

tion of their operating rooms(ORs)—illustrates the use of thesefive factors. The OR schedule is com-plex, and any disorder in that sched-ule disrupts patient flow throughoutthe hospital. Allotted time is the com-mon currency, and surgeons prefer tooperate early in the morning. Diseaseand injury have no timetable, how-ever. Well-organized ORs build intime and space flexibility to accom-

modate potential changes, but eventhese attempts at resource allocationcan be insufficient on any given day.

Three hospital leaders, the chief ofsurgery, the chief of anesthesia, andthe nurse who is director of periopera-tive services, jointly determine theOR schedule. They are pressured bythree powerful groups: individual sur-geons, OR nurses, and the hospitaladministration. Surgeons submit casesto the schedule and usually seek con-secutive blocks of time early in theday. Because surgeons in private prac-tice often operate at more than onehospital, they can take their caseselsewhere if their scheduling prefer-ences are not met. Skilled OR nursesare often in short supply. Their scantnumbers, irreplaceable expertise, andteam loyalty give these nurses signifi-cant clout with their director and thephysicians. The administration seeksto maximize financial returns byusing OR time efficiently and by


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Influence may be exer-

cised in four directions

in power structures:

upward, laterally, down-

ward, and outward.

peers in a range of situations, includ-ing cross-functional teams, as illus-trated by the OR scheduling example.With the greater generational and cul-tural diversity in today’s workforce,successful managers understand thatthe old command-and-control meth-ods are less effective than using abroad range of influence tactics withsubordinates. Successfully influenc-ing OR nurses to be flexible andhelpful when scheduling changesoccur now goes beyond the directorof perioperative services simplytelling them where and when to per-form their work. Being able to influ-ence stakeholders outside one’sorganization has also become astrategic advantage for leaders, whocan then better monitor environmen-tal trends and help build their ownand the organization’s reputation.

MEASURING OUTCOMESHow does one measure the effective-ness of using particular influence tac-tics? A common method is to assessthe outcome, of which there are threepotential types. The first type, com-mitment, is accomplished by persuad-ing another party, through internaliza-tion of a positive attitude, to performa desired action. This is usuallyaccomplished by using tactics such aspersonal persuasion or consultation.The second type, compliance, is taskperformance with the appearance ofconformity. Although there areinstances where such compliance issufficient, the underlying lack ofagreement can actually cause thethird type, resistance.

BEST PRACTICESWhat are some of the best practicesfor developing a strategic perspectiveand method for deciding which tac-tics to use in any given situation?First and foremost, good leadershippractice requires that influenceattempts be used in an ethical mannerand only for legitimate organizational


purposes. This is important to aleader’s strategic objective of build-ing a personal reputation for effec-tively accomplishing goals throughothers.

The second strategic objective isto build a web of interrelationshipsthat will aid in accomplishing currentand long-term objectives. Leadersbegin the forging of this network bydetermining the appropriate stake-holders, potential allies, mentors,supporters, and competitors. Learningtheir goals, priorities, commitments,and other motivations is important tosatisfying their needs and gainingtheir goodwill.

A three-step process is helpfulwhen deciding on the appropriateinfluence tactics to use in a particularsituation:

• Determine which individualsand groups are needed for support,and consider why they might back arequest.

• Assess sources of potentialresistance, whether overt or covert,along with the reasons why theywould resist.

• Equipped with the knowledgegained from the first two steps, con-sider which tactics have worked witheach target in the past.

Part of the choice of appropriateinfluence tactics will depend on theparticular context, the nature of thetactics, and the potential benefits andcosts that stakeholders perceive forthemselves. Thus, determining thestrategy includes assessing and com-municating each party’s benefits andcosts in the short term and theimpacts of the strategy on long-termrelationships.

A COMPLEX TASKScientist and physician leaders needto apply a full range of influence tac-tics in appropriate contexts toaccomplish critical organizationalobjectives. The multiplicity of stake-

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attracting the types of cases that yieldsubstantial hospital fees.

When disruptions and challengesoccur, the three leaders use a range ofinfluence tactics, such as moral suasion(in regard to the purposes of competingrequests), personal appeals to what areoften strong egos, sensitivity to hierar-chies between doctors and nurses, andother combinations of tactics depend-ing on the needs of the individualsinvolved. Skillful influencing results inan optimal schedule—successfully

moving nurses to appropriate ORs andhaving surgeons and anesthesiologistsarrive promptly and complete theircases in a reasonable time.

FOUR DIRECTIONSInfluence may be exercised in fourdirections in power structures:upward, laterally, downward, and out-ward. Upward influence includes bothdirect managers and others of higherstatus in the organization, who maybe in a matrix relationship or couldbecome potential mentors. Physicianand scientist executives who recog-nize the importance of movingbeyond a purely fact-based perspec-tive in order to accomplish organiza-tional goals may more easily requestand accept political and interpersonaladvice from those superiors.

An increasingly important aspectof leadership involves influencing

A three-step process is

helpful when deciding

on the appropriate influ-

ence tactics to use in a

particular situation.

holders and the diverse professionalcultures in the medical and pharma-ceutical industries make the applica-tion of influence tactics particularly

complex and textured. These leadersare beginning to understand the needto move beyond an overdependenceon logical persuasion and are using

executive education and coaching,among other means, to become morestrategic and successful in these com-plex settings.


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Two Influence Tactic Success StoriesWhat does successful application ofinfluence tactics by scientist andphysician leaders in the health carefield look like? Here are two examples:

Hospital clinical pathways.Physician executives such as hospi-tal chief medical officers are oftenchallenged to align disparate med-ical staffs to accomplish collabora-tive goals. For example, reducingvariation in clinical practice toenhance therapeutic effectivenessand efficiency while also respectingpatient choices and differences hasled to the use of structured caremethodologies. (These methodolo-gies are also known as clinical path-ways, order sets, CareMaps, medicalalgorithms, or practice guidelines.)To effectively initiate these method-ologies, a leader needs to haveestablished widespread credibilityand developed resource networksand a host of allies, and he or shemust advise and consult with otherson a regular basis.

On a practical level, devising apathway requires analysis of currentcare patterns and the application ofevidence from the medical litera-ture. From a political perspective,implementation of a hospital’s clini-cal pathway policy first requiresapproval by the relevant clinicaldepartments and the medical staffexecutive committee. A variety ofother stakeholders—commonly infinance, legal, and nursing func-tions—also need to be activelyengaged to support the initiative. Toovercome resistance, the physicianleader must develop an influencestrategy that typically incorporateslogical persuasion, personal persua-sion, alliances, forcefulness, recipro-cation, and consultation tactics.

Crucial to the process is localcustomization of the pathway.

Rather than simply adopting anexisting process, the team reviewsand revises the pathway accordingto its own organizational needs. Theteam may also gain additionalinsight and support from all affectedgroups by circulating the draft path-way for a review and comment peri-od, after which the pathway is con-sidered finalized.

During this time, an opinionleader typically emerges as thepathway’s champion. This alliancepartner may or may not have beenon the original committee; he or shetypically rises to the role on thebasis of personal persuasion, techni-cal expertise, and consultative skills.In one such instance, a specialistphysician who served as the cham-pion successfully presented thefinalized pathway to the hospital’smedical executive committee. Hisinfluence and cooperation preparedthe way for the many pathways fromdifferent departments that followedover the next few years. In eachcase there were unique challenges,but the successful use of logicalpersuasion, alliances, personal per-suasion, and consultation prevailed.

Pharmaceutical research anddevelopment. Clinical researchtoday often requires collaborationbetween various laboratories andbusiness divisions and strategicalliances with other companies oruniversity research departments.One early leadership position thatscientists commonly take on is as aproject manager for research stud-ies in their specialty areas, includingsupervising others on their teams.As the scientist leaders gain moreexperience and manage more com-plex projects, they often begin touse, in addition to logical persua-sion, reciprocation with peers, so

they and their colleagues can pro-vide each other with the resourcesto complete projects successfullyunder tight deadlines. To an extent,some may also employ aspects ofpersonal persuasion.

For example, a senior researchscientist in a pharmaceutical com-pany was asked to lead a cross-functional team to discover thecause of contamination in severalbatches of a product. The problemneeded to be solved quickly,because the U.S. Food and DrugAdministration had removed theproduct from the market and wouldnot permit it to be sold until thecompany could prove it had resolvedthe contamination issue. The seniorscientist had to assemble a teamthat included several research spe-cialists along with representativesfrom manufacturing, quality control,and regulatory departments at sitesscattered throughout the UnitedStates. Along with her considerabletechnical expertise, the scientistleader had developed over herdecade of employment at the com-pany a widespread reputation forcollegiality, fairness, being a teamplayer, and giving appropriate creditto others. She made significant useof her professional reputation, con-sultation, and alliances to build herteam. She was also persistent in herfollow-through with others, usingpressure only in rare instances whena deadline loomed. As a result, hergroup was able to discover thecause of the problem, create a cost-effective solution, and prepare thequality control and regulatory datadocuments in an extremely shorttime. The FDA then moved quicklyto permit the product to be soldagain, thus restoring the revenuestream to the company.

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Power of persuasion: Influence tactics for health care leaders