Physician executives share insights on ways to influence people - Gaining Influence

Physician Executive, July-August, 2002 by Ronald P. Hudak, Paul P. Brooke, Jr., Kenn Finstuen, James Trounson

AMERICAN HEALTH CARE continues to grapple with revolutionary changes transforming the organization, delivery and financing of health services.

Massive industry restructuring is changing the nature and roles of health professionals, dislocating the structure of health care organizations and altering the demands placed on their leaders. (1,2)

In this environment of increasing patient, provider, payer and public disenchantment, it is increasingly clear that physicians and physician executives must find effective ways to reassert authority and influence in their organizations.

A recent survey of Fellows of the American College of Physician Executives uncovered 286 possible ways for physician executives to increase influence in their organizations. These were then organized into nine discrete domains of influence.

I. Personal leadership

The most prevalent domain for increasing influence was personal leadership, which included 30 percent of all the ways to influence organizations. When it comes to personal leadership, 15 percent of the survey respondents said the most effective way to influence others is through strong communication skills.

The second most important way is through mentorship/role modeling, noted by 10 percent of the participants. A smaller number of respondents identified several other influence items including:

* Authority/power

* General leadership skills

* Listening skills

* Interpersonal skills

* Conflict management

* Negotiation skills

* Physician leadership

Interestingly, the survey turned up a number of items that are not considered by many Fellows as important keys to influence. These included:

* Open-mindedness

* Accessibility

* Perceptions

* Career management

* Reputation

* Diplomacy

* Self-assessment/awareness

* Empathy

* Time management

* Experience/involvement

* Translation of clinical to non-clinical

* Flexibility

* Wisdom

2. Organizational leadership and ethics

With 24 percent of all influence items, the second domain of influence--organizational leadership and ethics--was nearly as prevalent as the top-ranked domain.

Within this domain, the most frequently cited way to influence the organization was by staff interaction. This response was provided by almost 15 percent of the Fellows. However, it was closely followed at 12 percent by being aware and knowledgeable of organizational goals/objectives.

And once again, Fellows give little importance to some items that are generally considered to be significant aspects of leadership including:

* Values

* Staff knowledge

* Process/procedure of change

* People

* Making the boss look good

* Integrity

* Innovative solutions

* Evaluations

* Accountability/responsibility

3. Quality improvement

Compared to the large number of individual items that were suggested by respondents as ways that leadership can influence the organizations, physician executives identified only 41 that were oriented toward quality.

This third-ranked domain consisted of 14 percent of all the influence items. Here, the top item of influence was professional competency, cited by 12 percent of the Fellows. It was closely followed by two other ways to increase influence: best practice management and professional credibility.

Surprisingly, some of the mainstream issues in health care today barely received a mention by the Fellows when it came to influences linked to quality improvement. These include:

* Utilization management

* Outcome determination

* Legal, regulatory, and accreditation requirements

* Efficiency

* Credentials

* Cost effectiveness

* Safety

4. Financial management

The fourth-ranked domain, financial management, comprised only 10 percent of all influence items.

This was one of the most shocking results of this study because it is generally thought that physicians think they will gain influence if they can beat the business managers at their own game. But the fact that this domain is ranked lower than personal leadership suggests that knowledge of financial skills may not be as critical as some may believe.

In addition, unlike the other domains, the influence items were almost evenly divided between two items: financial skills and money management--and the money management influence mentioned most often was budgeting, cited by 20 percent of the respondents.

In comparison, only four individual Fellows cited items that are commonly accepted ways to increase influence such as cost reduction, hospital finance, physician revenue and contracting. Again, this is interesting since these subject areas may dominate a health care organization's performance and remuneration criteria.

5. Community leadership

Community leadership was considered nearly equal in importance to financial management. It was identified by 10 percent of the Fellows. Within this domain, over a quarter of the Fellows considered political involvement as the dominant way to influence the organization.

Very close at 21 percent were community/public health and current news development. Given the news-oriented culture of this country, it may be considered unusual that only one Fellow listed the media as a way to influence the organization.