Physician Executives' persuasive styles of communication in downward influence situations.

In the January-February 1991 issue of Physician Executive, the author reported on the persuasive strategies used to influence both attractive and unattractive subordinates. The focus in the earlier study was on what was communicated. In this investigation, attention is devoted to the way physician executives communicate. The results strongly suggest that physician executives' communicator style preferences are affected by whether or not they like or dislike the subordinates they are attempting to persuade.

It is frequently argued in the medical management literature that physician executives can have a meaningful impact on the health care system in the United States. Advocates of this perspective contend that physician executives are among the most qualified to fill the gap between medicine and management,[1-3] manage a health care system that is out of control[4,5] and address the cost-quality dilemma tormenting the medical industry.[2,3,6] All implicit assumption of this point of view is that physician executives possess the necessary ability to influence others in order to make an important difference in managing health care organizations.

An investigation by Betson suggests that physicians themselves believe they are capable of exercising influence in their capacity as managers.[7] Betson found that 73 percent of the participants in her study reported having the ability to influence others in their organizations, while 25 percent indicated that they had at least some capability in persuading organizational members.

Despite what physician executives think about their own potential to persuade and what others assume about the ability of physician executives to influence, our current understanding of how physician executives actually perform when engaged in the process of persuasion is rather limited. Knowing more about how physician executives influence others in health care organizations is important, because the ability of physician executives to persuade others will determine much of their success in managing the health care enterprise. It is simply not enough for physician executives to know about the practice of medicine and the principles of management. They must be able to enact that knowledge on a day-to-day basis through the influence process and persuade all types of individuals at different levels of the organization to assist them in carrying out their goals. In short, increasing our understanding of how physician executives persuade may shed some light on how they are attempting to make a managerial difference in health care organizations.

An area in which physician executives can have an important impact is in the way they manage their subordinates. According to Rubin, managing subordinates is one of the most singular responsibilities of physician executives.[8] He argues that a difference can be made with subordinates by assisting them in becoming productive members of the organization. Rubin proposes further that physician executives can achieve this sort of outcome with their subordinates only if they are willing and able to engage in the exercise of influence.

One useful way to study how physician executives go about influencing their subordinates would be to examine their communication behaviors. An assumption of the present investigation is that in order to understand fully how interpersonal influence works in organizations, one must conceive of it as being fundamentally a communicative activity. As Walter succinctly argues: "To study influence, one must first study communication, for influence without communication is as wildly implausible as action at a distance. Influence is always accompanied by some form of communication, blunt or subtle, overt or tacit."[9]

The purpose of this study is to examine physician executives' communicator style preferences when attempting to influence subordinates who communicate with them in attractive (i.e., attentive, friendly, and relaxed) and unattractive (i.e., not attentive, not friendly, and not relaxed) styles. This represents a shift in focus from a previous study the author conducted exploring how physician executives go about persuading subordinates they perceive as attractive (likable) and unattractive (dislikable).[10] The emphasis in the earlier study was on the use of persuasive strategies, or what was communicated. In the present investigation, attention is on the way physician executives communicate, that is, their communicator style.

Following Norton, communicator style is "the way one verbally, nonverbally, and paraverbally interacts to signal how literal meaning should be taken, interpreted, filtered, or understood."[11] Norton theorizes that the way individuals communicate gives form to what they communicate. Style serves as a message about message content and, thus, works as a metamessage. Because it provides information on how the literal content of messages is to be taken or understood, the style element of messages functions to define the relationship between interactants. For example, a superior who typically makes requests of a particular subordinate in a dominating manner suggests that the superior and subordinate share a one-down relationship, with the superior desiring to demonstrate control over the subordinate. In contrast, a superior who usually makes requests of a subordinate in a open, friendly, and relaxed fashion suggests that they may share more of a symmetrical relationship, in that the superior is not as interested in displaying control over the subordinate.

The style element of messages is central to interpersonal influence, because "our workaday world so graphically reveals that it is often not what you say but how you say it that makes the difference."[11] This certainly would apply to both persuaders and persuadees. The way they talk to one another plays a potentially important role in how they define their relationships with one another and what may ultimately occur in an influence attempt. According to Norton, an individual's style of communication is persuasive in that it affects others' perceptions of the individual and influences the amount and kinds of rewards and punishments an individual receives from others.[11]

Study Method

Study participants were 200 physician executives located throughout the United States. All were members of the American College of Physician Executives. Eight-nine percent were men and 11 percent were women. Forty-nine percent were less than 50 years of age, while 51 percent were 50 years of age or older. Respondents worked in a variety of health care environments (hospitals, academe, managed care, group practice, government, etc.). Most participants were relatively experienced managers, with 76 percent having up to 10 years of experience and the remaining 24 percent having more that 10 years of managerial experience.

The way physician executives communicate in influence situations was measured by using Norton's short form of the Communicator Style Measure (CSM-S).[11] The CSM-S is a self-report, pencil-and-paper questionnaire consisting of 11 variables: friendly, dominant, relaxed, animated, open, precise, dramatic, attentive, contentious, impression leaving, and communicator image. For purposes of this study, the CSM-S was modified in two ways. First, impression leaving and communicator image were not used because they represent stylistic outcomes instead of actual communication behaviors. Second, the remaining nine measure were adapted to fit the context of the influence situation that was given to the participants (see figure 1, page 29).

Questionnaires containing a description of a target-of-influence who communicated in either an attractive or unattractive style (see figure 2, below) were randomly distributed. Fifty percent of the sample received a questionnaire featuring a description of an attractive target, while the other 50 percent received a questionnaire featuring a description of an unattractive target. Respondents were instructed to think of a subordinate with whom they actually worked and who communicated with them in a way that reflected the particular description that they were given. They were told that they were trying to persuade the subordinate to do something they wanted. They were requested to answer in terms of what they would actually do and not in terms of how they would like to see themselves act when seeking to persuade the person.

Because participants were asked to respond to only one type of target, a between-subjects design was employed. A multivariate analysis (MANOVA) procedure was used to test the nine hypotheses.[12]

Discussion and Conclusion

Nine hypotheses were offered in the study (see figure 3, page 30). All of the hypotheses were confirmed. In testing for differences, it was found that the communicator styles of friendly, relaxed, open, dramatic and attentive were significantly more likely to be chosen when attempting to persuade attractive subordinates than unattractive subordinates. At the same time, the styles of dominant, animated, precise, and contentious were significantly more likely to be selected to influence unattractive subordinates than attractive ones. The results from the tests for differences suggest that physician executives communicate differently when influencing subordinates they like compared to ones they dislike.

A ranking of the means of the various communicator style variables supports this conclusion and provides further insight into physician executives' communicator style preferences when influencing subordinates they perceive as likable and dislikable. When persuading subordinates they like, the participants in the current investigation prefer to be attentive, relaxed, friendly, and precise in the way they communicate. They show less of an interest in being open and dramatic but are even less interested in being animated, dominant, and contentious (see figure 4, page 31). When persuading subordinates they do not like, study participants prefer the communicator styles of attentive, precise, relaxed, friendly, and dominant. Animated, dramatic, contentious, and open were their least favored styles of communication to influence unattractive subordinates (see figure 5, page 31).

The rankings suggest that physician executives prefer to communicate in similar ways with subordinates they like or dislike. They seem to favor the communicator styles of attentive, friendly, precise, and relaxed to persuade either type of target. At the same time, the styles of animated, contentious, dramatic, and open appear to be physician executives' least preferred ways of communicating with attractive and unattractive subordinates. Despite these similarities, it is important to remember that the entire constellation of findings discussed above strongly suggest that the extent to which physician executives prefer a particular way of communicating in downward influence situations is affected by whether or not they like or dislike the subordinates they are attempting to persuade.

As pointed out earlier, Rubin believes that the most basic and critical managerial responsibility of physician executives is to engage in the exercise of influence so as to make a meaningful difference in the organizational lives of their subordinates.[9] On the whole, the results seem to indicate that physician executives are making such a difference by attempting in downward influence situations to communicate in ways that are confirming and motivating. Even when they find a subordinate to be dislikable, physician executives do not appear to become overly forceful in the way they communicate to persuade the subordinate. While the findings show that a dominant style is more likely to be selected in persuading an unattractive subordinate, its use is moderated by physician executives' being more inclined to be attentive, precise, relaxed, and friendly; these styles were also the preferred ways of communicating with subordinates who were perceived as likable.

The view adopted in this study is that much of the managerial success of physician executives is directly tied to their ability to influence. If physicians who have swapped suit coats for lab coats are going to make a meaningful contribution in managing health care organizations, they must be able to communicate (influence) their subordinates and other organizational members in ways that will help bridge the gap between management and medicine. According to Kralewski, physician executives must serve a pivotal leadership role in improving the internal management of evolving health care organizations, while formulating public policies guiding the development of the health care system.[13] In my view, physician executives can better meet this challenge if they become sensitized to the principle that influencing and communicating are inextricably linked processes. The way physicians executives communicate when attempting to persuade others with whom they work can make an important difference in whether they emerge merely as organizational caretakers or as effective change agents.

References

1. Burns, J. "The Credibility of the Physician Executive." In Curry, W. (ed.), New Leadership in Health Care Management: The Physician Executive. Tampa, Fla.: American College of Physician Executives, 1988, pp. 74-7.

2. Kaiser, L. "Key Management Skills for the Physician Executive," In Curry, W. (ed.), New Leadership in Health Care Management: The Physician Executive, Tampa, Fla. :American College of Physician Executives, 1988, pp. 78-101.

3. Slater, C. "Challenges of the Physician Manager's Role." In Schenke, R. (ed.), The Physician in Management. Tampa, Fla.: American College of Physician Executives, 1980, pp. 71-7.

4. Guthrie, M. "Why Physicians Move into Management." In Curry, W. (ed.), New Leadership in Health Care Management: The Physician Executive. Tampa, Fla.: American College of Physician Executives, 1988, pp. 45-9.

5. Ottensmeyer, D., and Key, M. "The Unique Contribution of the Physician Executive to Health Care Management." In Curry, W. (ed.), New Leadership in Health Care Management: The Physician Executive. Tampa, Fla. :American College of Physician Executives, 1988, pp. 50-64.

6. Schneller, E., and others. "The Future of Medicine." In Curry, W. (ed.), New Leadership in Health Care Management: The Physician Executive. Tampa, Fla.: American College of Physician Executives, 1988, pp. 24-44.

7. Betson, C. Managing the Medical Enterprise: A Study of Physician Managers. Ann Arbor, Mich.: UMI Research Press, 1986.

8. Rubin, I. "The Managerial Role." In Schenke, R. (ed.), The Physician in Management. Tampa, Fla.: American College of Physician Executives, 1980, pp. 45-56.

9. Waltar, B. "Internal Control Relations in Administrative Hierarchies." Administrative Science Quarterly 2(2): 179206, Sept. 1966.

10. Garko, M. "Persuasion Strategies for Physician Executives: Part II--Influencing Subordinates ." Physician Executive 17(1):31-5, Jan.-Feb. 1991.

11. Norton, R. Communicator Style: Theory, Applications, and Measures. Beverly Hills, Calif.: Sage Publications, 1983.

12. Steven, J. Applied Multivariate Statistics for the Social Sciences. Hillsdale, N.J.: Lawrence Erlbaum, 1986.

13. Kralewski, J. "The Physician Manager and the Evolving Health System." In Schenke, R. (ed.), The Physician in Management. Tampa, Fla.: American College of Physician Executives, 1980, pp. 1-18.

Michael G. Garko, PhD, is Assistant Professor, Department of Communication, University of South Florida, Tampa, Fla.