Informal Leadership Support: An Often Overlooked Competitive Advantage.

Dr. Wilcox was exhausted. The challenges before him as Medical Director at the Precious Care Clinic continued to mount. Recent unacceptable clinical and financial outcomes demanded many changes, ranging from expanded practice guidelines to a new physician compensation plan. Yet few of his colleges seemed to agree about what to do next.

In spite of his best efforts, changes were often blocked and delayed. Opportunities for consensus were few and fleeting, as many of his partners seemed to make decisions based on selfcentered perspectives that gave little consideration to the long-term well being of the clinic. Personally dealing with the demands and preferences of his physicians one at a time or in small groups consumed more hours than he had available. Budgetary constrains, however, precluded adding people to his leadership team. As be confronted the expanding set of issues, Dr. Wilcox wondered what to do next to build support for the changes he knew were needed.

TRENDS IN THE HEALTH care environment--consumerism, net think, and complementary medicine, for example--produce ongoing pressure for change. Competitors, confronted with these pervasive conditions, often apply similar versions of common health care wisdom to address these challenges. This similarity in strategies is not surprising, given that health care leaders have been trained in many of the same programs, listened to the same consultants, read the same journals, gone to the same association meetings, and frequently spent their professional lives in the same industry.

While moving with the herd offers short-term reassurance, it provides little to no long-term competitive advantage. [1] Alternatively, looking for successful strategies proven in industries outside of health care and adapting them to your organization's needs provides a greater possibility of long-term advantage. [1] The use of informal influence leaders represents one such strategy.

Gaining support from informal influence leaders

Company executives employed by a well-known government contractor, in response to competitive pressures, decided to change both their job classification and pay policy systems. As rumors of the changes leaked out, employee reaction was quick, and it was negative. In the midst of this resistance, one vice president began meeting with groups of his influence leaders--individuals who exert strong influence within informal networks--for extensive conversations on the subject. The executive shared his views regarding business problems, proposed solutions, reviewed the inevitable tradeoffs, and listened to feedback. These dialogues created change all around the table.

The executive modified plans as he factored in the reactions of influence leaders and influence leaders changed some of their opinions after seeing the positive intent of this senior executive. Based on the outcomes of this process, other senior executives began conducting similar meetings with influence leaders in their areas. As a result, the company developed a better plan. It also emerged with 100 or so highly credible "in-the-trenches" informal influence leaders who helped explain the reasons and issues associated with this change more persuasively than the senior staff could ever hope to in a company of more than 10,000 people.

Informal influence leaders offer an often-overlooked source of competitive advantage--they have already earned credibility and respect from others, who regularly look to them for guidance. When sharing their views, they significantly influence the acceptance or rejection of new initiatives.

Informal influence leaders exist in every organization. In Organizational Transitions, Beckhard and Harris suggest using these "natural" leaders who have the confidence and trust of large numbers of their peers to guide change initiatives. [2] If informal leaders are persuaded to join in and support change efforts, they add their voice and influence to every conversation regarding the change initiative. The most important impact of influence leaders is often not in the headlines--it's in the cafeteria lines. Influence leaders reach into every conversation, every meeting, and every decision made in an organization. We know they exert influence. The important question is whether they will exert their leadership in support or in opposition to changes you propose. The first possibility leads to progress, the second to chaotic diffusion of you and your resources.

Who are informal leaders and how can I work with them?

A small number of influential individuals are frequently critical to igniting major transitions. [3] Diffusion of innovation research demonstrates that focusing efforts on the 5 to 10 percent of the population whose opinions are most valued will hasten the pace of change and increase the likelihood of success. [4] Opinion leaders hold the key to opening the door to success with change resistant others, who in turn can influence others in an ever widening circle of success. This pattern of expanding acceptance can be used in your health care organization to improve the likelihood of physician or administrator acceptance of your change initiatives.

How do you identify informal influence leaders? Others turn to them for advice, their opinions carry weight, and they sway views on tough issues. They are known. While you are probably already clear on who they are, resist the temptation to pick them yourself. Instead ask your physicians and/or employees to identify the two to three people they regard as most trustworthy. This will result in a list of names that occur regularly.

By asking for input from everyone, the resultant list will preserve the credibility of the people you will attempt to engage and will include the most vocal resistors of change--your "troublemakers." It will be tempting to cross their names off the list and their presence will result in some challenging conversations. However, your people know who the list of influence leaders needs to include and if they are excluded you will have undermined the credibility of the entire approach.

Having identified key influence leaders, steps must be taken to enlist their support. It is important that your influence leaders are invited, not appointed, and that they be free of the tinge that would come from being rewarded for exchanging or altering their opinions. Hints of them becoming part of the formal organization will undermine their capacity to shape opinions.

One useful tactic is to invite these key people to an influence leader summit. This very act of inviting communicates to them that they matter to you and that you will invest in them. At the summit you can share information not commonly known, clarify information that has made its way inaccurately through the rumor mill, and answer tough questions. Having openly included them, you are in a position to invite these influence leaders to serve as your trusted advisors and to share the burden of change with you as new partners in your inner circle.

Of course, not everyone invited to join the change effort will do so. Some will look at the proposed changes cynically, through old eyes, and believe that they cannot occur. Some will see their self-interest threatened and opt out. Some will want to see "which way the wind is blowing" and reserve taking action until they are clear that it is safe to do so. Others, however, will join in, even if tentatively at first, to see what it means to be a force for change.

The difference between success and failure in building partnerships with informal leaders is often the sincerity of the leader's offer to become involved. In many organizations, particularly those that have a history of failed top-down change efforts, this becomes a difficult conversation. It is the courage to ask for help that often captures the interests and efforts of critical informal leaders.

Those who don't join you will continue to have the same voice and influence they have always had. To the extent that your strategy is effective, however, their voice is no longer the lone voice and their change-resistant message is no longer the only message. Others, who are also highly credible and who may be effectively promoting views similar to your own, will have expanded your organization's informal conversations. Thus, to the extent that the group of influence leaders you are partnering with joins in, informal conversations become more balanced (pros in addition to cons) and employees have a real opportunity to make new choices regarding their own support for change initiatives.

How would this work in health care?

Evidence suggests that change is more likely to occur successfully when leaders create a case for action and a meaningful vision, enroll senior leaders in support of that vision, and encourage them to inspire and support others to follow. [5] But leaders also need a strategy that goes around the hierarchy directly to those whose informal influence will drive success or failure "in the trenches," where change battles need to be won.

Informal leaders will always shape opinions, decisions, and actions, and, as a result, will have a strong impact on the fate of the change efforts that you lead. The question remains--"Will you lead with their support... or against it?" While far from common practice, some health care leaders are beginning to take the systematic steps needed to partner with their informal networks.

The clinic CEO was known for consistently seeking, listening to, and incorporating the views of others. While she worked effectively through the formal hierarchy, she also regularly sought the views of both physician and employee influence leaders. These influence leaders were part of a group that met to provide input, shape ideas, and take accurate information forth to those who looked to them for the inside scoop. Their role in helping to sell others on new directions was clearly recognized.

For example, when it came time to consider affiliating the clinic with another health care organization, influence leaders made site visits and came hack to share their feelings with a hroad cross section of the organization. Many who listened to them would have heen more skeptical if the information they presented had come from the lips of the CEO.

The systematic use of informal influence leaders is not unknown in health care. However, because it is not yet common practice, the opportunity to use this approach to create a distinctive competitive advantage still exists for many health care leaders.

Are you doing what is required? What more could you do?

Have you taken advantage of the opportunity provided by working closely with your influence leaders? Have you taken the steps required to identify them, openly communicate challenges, solicit feedback, and ask them for their support? Figure 1 provides a short set of questions that lets you evaluate your influence leader activities. We suggest collecting candid, untraceable feedback from different perspectives (physicians, managers, and a cross section of additional employees).

Commitment to working with your influence leaders

Like our ancestors, we still defend our territory. In one study of Atlanta drivers, researchers found that when someone pulls up to wait for a parking spot, the other driver takes longer to leave the space than when no one is waiting, and if the driver honks it takes even longer. [6] Organizational leaders often defend their traditional ways of doing things, looking for new answers where they have found them before--within traditional health care settings. As environmental pressures mount, the advantage of using the same strategies and tactics employed by competitors continues to shrink. An alternative is adapting and applying answers successfully employed elsewhere to health care organizations. Working with informal influence leaders to share your change management efforts represents one such example.

Building ever closer alliances with trusted partners is increasingly critical to enduring health care success. [7] Developing informal influence leader support is an important step in gaining the trust and collaboration needed if change initiatives are to be successfully implemented. Communications are naturally more influential when they come from people who are known and trusted. The use of informal influence leaders, however, is not a substitute for traditional change leadership strategies and tactics. It is, instead, an opportunity to partner with powerful others to gain an additional advantage for your organization.

Lawrence H. Peters, PhD, is President of Leadership Solutions, a change leadership consulting firm, and Professor of Management with the Neeley School of Business at Texas Christian University.

Edward J. O'Connor, PhD, is a Principal with the Implementation Institute, a Professor of Management at the University of Colorado at Denver and a faculty member of the American College of Physician Executives and the Kaiser Consulting Network.

References

(1.) O'Connor, E. J. & Bujak, J. S. Looking for Answers in New Places: Applying Lessons from Winning Organizations. The Physician Executive, September/October 2000, 56-63.

(2.) Beckhard, R. & Harris, R. Organizational Transitions, Reading, MA: Addison-Wesley Publishing company, 1987.

(3.) Gladwell, M. The Turning Point. Boston, MA: Little, Brown and company, 2000.

(4.) Rogers, E. Diffusion of Innovations. New York, NY: Free Press, 1983.

(5.) O'Connor, E. J. & Fiol, C. M. creating a Roadmap for Leading change: In J. Lowery (Ed.), Culture Shift: A Leader's Guide to Managing Change In Healthcare. Chicago: American Hospital Publishing, Inc., 1997.

(6.) Ruback, B. Denver Post, May 13, 1997, P1A.

(7.) O'Connor, E. & Annison, M. Leading Your Partners: Building Trust through Promises and Performance. Article accepted for publication in The Physician Executive.

KEY CONCEPTS

* Informal Influence Leaders

* How Opinion Leaders Influence Others

* Influencing Others

* Increasing Acceptance of Change Initiatives

* Building Alliances with Influence Leaders

As environmental pressures mount, the advantage of using the same strategies and tactics employed by competitors continues to shrink. An alternative is adapting and applying answers successfully employed in other industries to health care organizations. Working with informal influence leaders to share your change management efforts represents one such example. Informal influence leaders offer an often-over-looked source of competitive advantage--they have already earned credibility and respect from others, who regularly look to them for guidance. When sharing their views, they significantly influence the acceptance or rejection of new initiatives. Influence leaders reach into every conversation, every meeting, and every decision mode in an organization. The important question is whether they will exert their leadership in support or in opposition to changes you propose. By identifying influence leaders and inviting them to join a group to discuss change initiatives, physician executives can create a positive force for change.