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

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.

6. Human resource management

The sixth-ranked domain was human resource management, but it was cited by only 7 percent of the Fellows as a way to influence organizations.

Though relatively small, it had the highest relative frequency for one influence item within the study. Specifically, team building was identified by 52 percent of the Fellows as the most prominent way to influence an organization.

7. Business education

8. Information technology

9. System thinking

The last three ranked domains may be considered influence outliers since, together, they accounted for only 4 percent of the ways to influence an organization.

Conclusion

As a group, the Fellows believe personal leadership is the most effective way to increase influence. Clearly, this category is very broad and, as suggested by the Fellows, consists of a wide variety of unique approaches to gaining influence.

For example, communication skills are important, but so is having a mentor or role model. In addition to general leadership skills, more specialized skills are also noteworthy. These skills, which might require formal education and continuing education, include conflict management, listening and negotiation.

However, in addition to the physician executive's personal leadership, organizational leadership and ethics are also ways to increase influence. These items, usually considered within the realm of organizational behavior, include staff interaction, organizational goals, planning and strategic thinking.

Finally, after enhancing personal and organizational leadership skills, physicians can also address quality improvement issues as ways to increase influence within the organization. These emphasize individual competency and best practices.

A clear hierarchy emerges of the ways that physician executives can increase their influence within their organizations. The challenge for physician executives is to assess themselves in light of these findings.

Then, it may be necessary to seek peer assistance, identify successful role models and participate in continuing or formal education to successfully increase their organizational influence.

Figure 1. Nine Domains to Increase Influence in an Organization

1 Personal Leadership

2 Organizational Leadership & Ethics

3 Quality Improvement

4 Financial Management

5 Community Leadership

6 Human Resource

7 Introduction to Business Education

8 Information Technology

9 System Thinking

[FIGURE 2 OMITTED]

ACPE Resources

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References

(1.) Davidson, P, Andersen, R, Hilberman, D, and Nakazono, T. "A Framework for Evaluating the Impact of Health Services Management Education." Journal of Health Administration Education. Winter 2000, 18:(1):, 63-107.

(2.) Leach, D and Stevens, D. "Substance, Form and Knowing the Difference." Frontiers of Health Services Management. Winter 2001 18:(2):, 9-14.

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 what are 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.

This article reports on the findings of the first round in which the Delphi members were asked to identify the five most effective ways that they feel physician executives can use to increase influence in their own organizations. During the second round, the Fellows were asked to review the feedback and to assign relative importance ratings for the domains. These results will be described in the September/October issue of The Physician Executive journal.

Ronald P. Hudak, JD, PhD, FACHE, is the associated 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.