Lack of control: the physician executive's fear.

Jim Howard, MD, recently accepted the position of CEO of a small pharmaceutical company. Inspired by a book he recently read on management techniques, Howard decided to reinforce his two strongest vice presidents with a "job well done" compliment.

The VP of human resources was clearly pleased and responded with an expressive and appreciative, "Thank you!" The VP of information technology responded with a grimace, a perfunctory nod and an indication of his desire to get on to more pressing matters. So much for books on management, Howard thought.

What went wrong?

Many professions, but especially medicine, emphasize the need for control, the need to appear to be an authority figure with all the answers. Medicine especially is vulnerable to this thrust because it so often involves interactions with people who are suffering or frightened, who want solutions and who will pay to get them. To such a patient, diagnostics are a nuisance; a cure is the goal.

To the physician who assumes the role of an executive, however, these doctor-patient interactions can be detrimental in other environments. They force the physician into behaviors that are incompatible with effectively managing or even functioning in a well-run organization. Why?

Because superb organizations are not run by authority figures who are expected to have all the answers; they are run by a number of people who all have good ideas, who are needed in many ways, and who can hurt the organization.

The mistake made by Howard was that he did not first evaluate the people involved. Had he done so, he would have realized that each had to be treated differently, rather than according to some superficial advice from a management book.

In contrast to the practice of medicine, the physician executive must constantly focus on diagnosis and accept the fact that there will never be a cure, that an organization is a constantly evolving entity immersed in a constantly changing environment. "There are no hitching posts in the universe."

As a result, a physician executive must always be diagnosing, evaluating the people and assets in the organization, the environment outside the organization and how the two would most efficiently interact. And if the physician executive does a good job in evaluating and eliciting the ideas of others, the correct decisions and actions to be taken will almost always be quite apparent.

There are five interviewing behaviors that physician executives should make an integral part of their response, five behaviors that are used so frequently that they should almost define the personality of the physician executive.

(For those physician executives who fear giving up control--who would rather tell people the answer than ask them for their suggestions--a word of caution: Whoever asks the questions, controls the interaction.)

1. Executives must be overtly non-judgmental in their responses.

The difference between good management interactions and normal conversation is that the competent executive does not selectively reinforce or punish the behavior of the other person, i.e., the executive is non-judgmental.

Suppose you ask someone what traits he likes to see in other people. If you respond to his answer non-judgmentally, his subsequent behavior is likely to be more spontaneous, more reflective of his true attitudes.

However, if you respond by saying, "I'm surprised you think those traits are important; I think they're kind of superficial," you are judging the person; that is, you are trying to influence him and, unfortunately, you might succeed. As a result, you are not likely to elicit his true attitudes.

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The basic goal of most people is to avoid displeasing someone else. Any indication from the executive that suggests what she/he finds reinforcing or aversive, consequently, will color the entire interaction.

If, for example, the executive pairs the phrase, "We had a good, aggressive management team at my old company," with an enthusiastic tone of voice, she has increased enormously the probability that the subordinate will try to pair himself with aggressive traits in his own behavior, whether he is truly aggressive or not. This can be quite misleading to the executive.

For this reason, an effective management interaction requires executives to subjugate their personalities to that of the other person. No one, least of all physician executives, can afford to express attitudes and opinions when they're trying to understand, rather than influence, another person.

2. Ask general, ambiguous, value judgment questions.

The goal of a management interaction is to elicit the other person's true attitudes and feelings. This is best accomplished by asking general, ambiguous questions, such as "Could you tell me a little about that situation?" or "How would you suggest we deal with that?"

The employee's assessments might not only give you some good ideas, they can also tell you, for example, whether or not the person is decisive, hypercritical or detail-oriented, or whether they dislike a particular customer (and will probably be ineffective with that customer). Their assessments can tell you which situations and types of behavior in others they find reinforcing and/or threatening.

General, ambiguous, value judgment questions serve five purposes. First, they make most employees feel comfortable responding because there are obviously no right or wrong answers.

Second, general, ambiguous questions elicit different behavior patterns from different people. They allow the person the freedom to project whom he really is into his response, rather than confining him to a narrow range of behavior as determined by the executive. It is this projection of himself under ambiguous conditions that reflects his strongest (most frequent) concerns and tendencies.

Third, general, ambiguous questions tell the executive what the person wants to focus on, what they feel is most important.

Fourth, the responses to these types of questions tell the executive what the person feels comfortable talking about; thus, they are areas that can be safely probed.

Fifth, general, ambiguous questions lead subordinates to feel they are not being controlled because they have the freedom to respond in any way they wish.

3. Use short, quick phrases for probes.

It is true, however, that broad general, value judgment questions will often elicit perfunctory responses from most people. That's usually because no one cared about their responses in the past, as evidenced by the fact that, after their response, their questioner immediately focused on something else. For example:

Father: How was school today, son?

Son: Good.

Father (yelling to wife): What time are we supposed to be at the Smith's tonight?

You need to show people you are interested in them and what they say.

How? By probing!

Suppose you ask, "How do you like working here?" and your subordinate responds, "I think it's a pretty good company to work for." Most managers now turn to a different topic, feeling the question has been answered. It has not been answered.

A much better reaction on the executive's part is a quick, soft, interested, "How so?" or "In the sense of?" or "Because?" These are probes. They are crucial to a good managerial interaction and to eliciting meaningful behavior.

Consider the following two types of interviewing between a husband and wife:

Husband: What kind of guy am I as a husband? (good general question)

Wife: Well, you're all right.

Husband (angrily): Just what the hell is that supposed to mean? (The husband becomes judgmental and punishes his wife.)

A more effective approach for those brave enough to face the truth:

Husband: What kind of guy am I as a husband?

Wife: Well, you're all right.

Husband (soft, but with interested inflection): How so?

Now the husband may indeed find out his wife's true attitudes.

The importance of these short, probing phrases cannot be overemphasized. Such phrases are used to elicit what is frequently the richest material for evaluating people, events and the environment.

Following almost any response with a quick probe, "How so?" will generally elicit a more revealing and informative elaboration. It tells you where the person, when given the freedom, will focus her attention, what she cares about, what she likes and feels comfortable talking about.

Moreover, by using short phrases, the executive shows that he is truly interested in the person and not merely in eliciting attention and/or admiration with long-winded, repetitious lectures about actions that should be taken, but that no one in the organization is willing or wants to implement.

Consider the following two examples:

Subordinate: I really don't think the direction we're taking is the right one.

Executive: Because?

Subordinate: I just really don't think the direction is right.

Executive: In what sense do you feel it's wrong? You know, there are many facets to the old approach that were really bad and which I corrected. Our R & D department, for example.

This physician exec is trying to influence, not understand; he will say a good deal, have little impact and learn less.

Executive: How's our product doing in the marketplace?

Subordinate: Well, we're having a few problems.

Executive: Well, we know of some problems, but I'm sure we're fixing them. Say, are you free for lunch next Thursday?

This executive is more interested in avoiding conflict than in being effective.

Executive: How's our product doing in the marketplace?

Subordinate: Well, we're having a few problems.

Executive: How so?

This executive is intent on listening and evaluating the problems and the people rather than merely expressing his fears by extolling his accomplishments or ignoring the issue altogether. As a result, he will have fewer frustrations and fears later. He'll also be able to efficiently focus on issues relevant to this customer and to make much more effective decisions and recommendations.

4. Do not attempt to anticipate your next question; let the other person determine the flow of the interview.

An executive's questions should hinge on the other person's responses. If the executive is trying to think of his next question, he cannot possibly be listening to the individual. (This is one reason people who are controlling and intent on impressing others make poor executives; their focus is on how they appear to others rather than how others can best help the organization and how their product or service can help the customer.)

Attempting to anticipate the next question will also make any conversation stilted and disjointed. People frequently go off on tangents, after which a question or probe that would have been appropriate two sentences ago should no longer be asked.

Executive: Who did you report to then?

Subordinate: To the vice president of manufacturing. (Executive is about to ask what kind of person she/he was, but the subordinate continues.) Of course, I was only in that position four weeks when they transferred me overseas.

Basing your questions on the other person's last response is also important because it allows the individual to feel they are in control and, more importantly, that someone is really interested in what they are saying.

Let's return to a previous example:

Father: How was school today son?

Son: Good

Father: How so?

Son (somewhat shocked): What? Who are you?

Whoever asks the questions controls the interaction. This is why interviewing is so important in all areas of life. While we want others to feel they are controlling the interaction (so we base our questions on their responses), it is those who ask the questions who are truly in control.

If you are in an all day meeting with six department heads and you speak less than 5 percent of the time, but that 5 percent is spent asking questions, you will probably control much of the meeting.

Try this experiment: Ask anyone anything about any topic. Whatever their answer, base your next question on some part of their last response.

You (at a party): How long have you lived in New York?

They: Actually, I just moved here from Chicago six months ago.

Good You: Well, how do you like New York so far? (then a probe), or How was living in Chicago? (then a probe), or How would you compare New York and Chicago? (then a probe).

Bad You: I was in Chicago on a business trip recently. Actually, I travel quite a bit because people seem to need my guidance a lot. Have you ever heard of me ... say, where are you going?

5. Maintain an interested, conversational tone of voice with appropriate inflection.

No variable is more important in eliciting spontaneous behavior from another person than the executive's tone of voice.

Unfortunately, no variable is more difficult to master.

Many managers attempt to impress employees with their dominating confidence, reflected most openly in their tone of voice, which is likely to be flat, forceful and authoritative (much like John Wayne).

The best managerial tone, however, is soft, gentle, concerned and interested. Its softness connotes respect for the other person and their opinions. The executive's gentle inflection connotes a nonjudgmental but sincere interest in what the employee is saying. This is likely to be quite reinforcing to the employee and will increase the probability of his responding openly and honestly during the interaction.

A commanding or uninterested tone can be a severe negative, increasing the anxiety level of the employee. Such a tone decreases the likelihood that the person will respond spontaneously and openly and increases the likelihood the employee will respond in a short, factual, concise manner; this may well have little to do with how they truly feel, who they really are and how they actually see the situation.

Managing people is a difficult process. It requires an executive who is interested in others and their views, rather than one who cares only about trying to get others interested in them, in their views and in implementing their decisions.

Managing people requires an executive who is as intent on understanding the other person as on influencing the attitudes and behaviors of the other person. To carry out this difficult process effectively requires an astute manager, one who reinforces confidence in others rather than one who is intent upon proving to others how competent and confident they are.

By David W. Thompson, PhD

David W. Thompson, PhD, is a management psychologist based in Chicago, Ill. He can be reached at 312-642-0652. This article is adapted from his new book, The Manager: Understanding and Influencing People MTR Corp., 2004 (www.mtrcorp.net).