Physician executives share insights on ways to influence people -- part II. (Gaining Influence).

JUST LIKE OTHER professional organizations such as engineering, architectural or accounting firms, health care organizations want to better manage their knowledge and expertise. To do this, health care organizations are relying on physician executives focused on understanding, interpreting, controlling and improving the clinical processes. (1,2)

Evidence also suggests that increased physician involvement in governance and financial matters leads to improved organizational performance, with reduced resource utilization, lower costs and increased operating margins. (3,4)

To achieve such improvements, physician executives must be able to exert influence in clinical, operational and strategic initiatives.

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. However, it's probably not necessary for physician executives to pursue education, training or mentoring to learn all 286 influences. Rather, physician executives should consider strengthening those influences that their peers consider most important.

To be able to influence a broad range of organizational issues, physician executives may want to concentrate on acquiring the skills of the most important influence within each domain listed in Table 1. These techniques are generally not difficult to learn.

Top 10 ways to increase influence

Physician executives may wish to concentrate on techniques that optimize their ability to influence their organizations. The survey found that management skills dominate that list.

Interestingly, both personal and organizational skills are identified in this list, suggesting that physician executives need to effectively communicate both inside and outside their organizations.

Given the professional and scientific orientation of physician executives, it's surprising that no clinical skills are identified. This suggests that physician executives may need to extend beyond their traditional comfort zones of clinical expertise to increase their influence.

Similarly, none of the top-rated influences relates to quantitative or technical skills. None of the technical skill sets--such as financial management, business education, information technology and systems thinking--made the top 10.

However, not all the top skills relate to communications. The fifth most important influence relates to integrity at both the personal and corporate level.

These findings suggest that the most important skills needed by physicians to enhance their influence within their organizations are achievable without substantial investments of time or other resources. For example, small group sessions or formal seminars are appropriate means to obtain these skills.

Bottom 10

The lowest rated influences reflect a potpourri of techniques spanning the activities of physician executives. In clear contrast to the top 10, none of these influences relates to communication skills. These low-rated techniques reflect more operational skills.

Two influential routes

After a personal self-assessment, physician executives may consider taking one of two routes to improve their organizational influence.

The first route is to acquire skills relating to the top influence technique in each of the nine domains. For example, within financial management, the top skill is to learn how to prepare, interpret and analyze financial statements. This route requires physician executives to learn both qualitative and quantitative skills.

The second route is to focus on the most highly rated techniques regardless of domain. In this approach, physician executives focus on learning management skills.

For example, in addition to interpersonal and negotiating skills, these skills include listening, speaking and presentation techniques. However, the danger with this approach is that physician executives may ignore other areas within the organization that may be of value, such as information technology.

Although it may not be possible to learn all the necessary skills, this study suggests that there are techniques that may have a dramatic impact in the short term. Physician executives should assess their abilities in light of their organizations and learn the techniques that will substantially increase their influence.

TABLE 1

THE MOST IMPORTANT WAY WITHIN EACH DOMAIN TO INCREASE INFLUENCE

Domain of                  Most Important Way to
Influence                  Increase Influence       Mean  Deviation

Personal Leadership        Active listening skills  5.95       0.95

Organizational Leadership  Effective public         5.93       1.12
and Ethics                 speaking/presentation

Quality Improvement        Focus on reducing        5.75       1.15
                           medical errors

Financial Management       Financial statement      5.66       1.23
                           preparation,
                           interpretation
                           and analysis

Community Leadership       Communication and        5.48       1.20
                           presentation of trends
                           and techniques

Human Resource             Interpersonal and        6.11       0.94
Management                 negotiating skills

Introduction to            Mini-course on business  5.22       1.37
Business Education         plan development

Information                Basics for medical       5.37       1.39
Technology                 informatics

Systems Thinking           Course on "root cause"   5.29       1.36
                           analysis

(1 = unimportant, 7 = extremely important)

Although not normally acquired through on the job training, some
influence skills can be learned in short courses or training programs.
They include:

1. Active listening skills

2. Effective public speaking/presentation

3. Communication and presentation trends and techniques

4. Interpersonal and negotiating skills

Physician executives will require more extensive education to:

5. Reduce medical errors

6. Prepare, interpret and analyze financial statements

7. Develop a business plan

8. Understand medical informatics

9. Conduct a "root cause" analysis
TOP 10 WAYS TO INCREASE INFLUENCE (HIGHEST IS LISTED FIRST)

Influence                                     Mean   Standard
                                                    Deviation

 (1) Interpersonal and negotiating skills     6.11       0.94

 (2) Active listening skills                  5.95       0.95

 (3) Negotiation techniques                   5.94       0.87

 (4) Effective public speaking/presentation   5.93       1.12

 (5) Developing personal/corporate integrity  5.90       1.29

 (6) Conducting effective meetings            5.87       1.02

 (7) Conflict resolution theory and models    5.83

 (8) Developing a second approach:                       0.88
     Out of the box thinking                  5.79       1.18

 (9) Building coalitions and networks         5.77       0.99

(10) Managing change                          5.75       1.03

(1 = unimportant, 7 = extremely important)

The study found the top four most influential skills all relate to
communication.

* Interpersonal and negotiating skills

* Active listening skills

* Negotiation techniques

* Effective public speaking/presentation
THE BOTTOM 10 WAYS TO INCREASE INFLUENCE (LOWEST IS LISTED LAST)

Influence                                Mean   Standard
                                               Deviation

(1) Mechanics of successful grant        3.99       1.44
    funding

(2) Great plans and planners in history  3.92       1.47

(3) JCAHO quarterly updates              3.90       1.50

(4) Identifying donors and closing       3.89       1.48
    donation commitments

(5) Robert's Rules of Order refresher    3.85       1.61
    course

(6) Editing meaningful newsletter        3.63       1.23

(7) Course in institutional investments  3.62       1.33

(8) Tax laws, deferred giving, and       3.43       1.39
    philanthropy

(9) How to host a local clinical         3.43       1.36
    conference

(10) Golf lessons                        2.80       1.94

(1 = unimportant, 7 = extremely important)

It is important to realize, however, that almost all of these bottom
techniques were still rated at least average in importance with at least
a mean score of 3.5. Only the last three techniques were rated below
average:

* Tax laws, deferred giving, and philanthropy

* How to host local clinical conferences

* Golf lessons

References:

(1.) LeTourneau, B. and Curry, W. "Physicians As Executives: Boon or Boondoggle?" Frontiers of Heath Services Management. 13:3, 1997, pp. 3-25.

(2.) Schneller, E. "Accountability for Health Care." Health Care Management Review. 22:1, 1997, pp. 38-48.

(3.) Goes, J. and Zhan, C. "The Efficacy of Hospital-Physician Integration Strategies on Hospital Performance." Health Services Research. 30:4,1995. pp. 507-30.

(4.) Gray, B. "Trust and Trustworthy Care in the Managed Care Era." Health Affairs. 16:1, 1997, pp. 34-49.

RELATED ARTICLE: Details of the Study

The research design employs the Delphi technique. This technique, developed by RAND, has been demonstrated as appropriate in a variety of health care settings to establish priorities.

It is a very powerful technique that is adaptable to various respondents' professional backgrounds and time demands. The objective of this research is to obtain a consensus from physician executives on the most effective ways to increase influence in their own organizations.

All Fellows of the American College of Physician Executives (ACPE) were asked to respond to two iterations of a Delphi mail inquiry. There were two iterations of the Delphi technique, separated by content analysis by an expert panel. This article reports on the findings of the second round in which the Delphi members were asked to rate the formal or continuing education topics according to the importance that should be placed on them in dealing with those influences.

Ronald P. Hudak, JD, PhD, FACHE, is the associate dean and professor of health care management, School of Business Administration, Marymount University, Arlington, Va. He can be reached by phone at 730/284-5965 or by e-mail at [e-mail].

Paul P. Brooke, Jr., PhD, FACHE, is professor and dean of the School of Allied Health, Texas Tech University Health Sciences Center, Lubbock, Texas.

Kenn Finstuen, PhD, is professor of health care administration with the US. Army-Baylor University Graduate Program in Health Care Administration, U S. Army Medical Department Center and School, Fort Sam Houston, Texas.

James Trounson is the president of Medical Management, Inc., Boise, Idaho.