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Persuasion strategies for physician executives: influencing subordinates.

Persuasion Strategies for Physician Executives: Part II Influencing Subordinates

A number of writers have pointed to the increase during the 1980s of physicians moving into the managerial ranks of health care organizations. [1-6] This rise in the number of physician executives (also termed in the literature as physician managers, physician administrators, and physician CEOs) reversed a decade of decline in physicians' occupying managerial positions. For example, in 1982 only 207 hospitals had physician-CEOs, compared with 813 in 1972. [7] However, Oberman reports that by 1985 that number rebounded to 241.

Another indication of the growing number of physician executives is reflected in the steady membership growth of professional organizations such as the American College of Physician Executives. During the past 10 years, membership in ACPE has risen from 428 to 4,887, with 100 new members on the average joining the organization each month. [8] Additionally, executive search firms report a substantial increase in the number of requests for physicians to fill management and administrative positions. [6] As more physicians have replaced their lab coats with suit coats, a sustained flurry of research activity has emerged focusing on:

* Why physicians are moving into

management. [9,10] * Why physicians are needed in health

care management. [11,12] * Why physicians make good

managers. [5,7,13] * The role and responsibilities of physician

executives. [1,14-16] * The necessity and obligation of physician

executives to develop managerial

skills. [3,17] * The importance of management-training

and the type of managerial

skills physician executives need to

be successful. [16,18,19]

All of these lines of research underscore the importance of physicians functioning as managers. Betson reflects the view of many when she argues that "physicians...are in a unique position to integrate practice and management to improve the health care system." [1]

The present investigation represents Part II of a research project examining the way physician executives use persuasion strategies. As in Part I, [20] it is contended that despite research on physician executives and the importance attributed to physicians being in management, we know little about how physicians actually manage. One way to correct this deficiency would be to examine how physician executives influence others in health care organizations. The perspective adopted in this study, as well as in the first one, is that managing and influencing are inextricably linked. Kipnis et al. remind us that "the essence of managerial work is the exercise of influence." [21]

Whereas Part I examined physician executives' strategic preferences in situations in which targets of influence were superiors with attractive or unattractive communicator styles, the current investigation explores whether there are any significant differences in the way physician executives go about influencing subordinates who communicate in an attractive style (i.e., attentive, friendly, and relaxed) compared to those who communicate in an unattractive style (i.e., not attentive, friendly, and relaxed).

Study Method

Study participants were 222 physician executives located throughout the United States. All were members of the American College of Physician Executives. Ninety-one percent were men and nine percent were women. Forty-eight percent were less than 50 years of age, while 52 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 75 percent having up to 10 years of experience and the remaining 25 percent having more than 10 years of managerial experience.

Physician executives' preferences for persuasion strategies were measured by asking them how likely they would be to select the strategies of assertiveness, bargaining, coalition, friendliness, higher-authority, reason, and sanctions (see figure 1, above) in influencing a subordinate who typically communicated with them in an attractive or an unattractive style. The questionnaire contained descriptions of two different targets. Respondents were instructed that the targets were subordinates with whom they worked and interacted on a daily basis. One was described as a subordinate who usually communicated with the respondent in an attractive communicator style, while the other was portrayed as communicating in an unattractive style (see figure 2, right). The physician executives were told that they were trying to persuade the subordinates to do something they wanted. They were asked to visualize the targets of influence as they read the characterizations and as they responded to the various items in the questionnaire. Respondents were also instructed to indicate what they would actually do and not what they would ideally like to see themselves do when seeking to gain compliance from the two targets.

Results

Seven hypotheses were offered in the study (see figure 3, p. 33). All of the hypotheses were confirmed. The results show that the physician executives were significantly more likely to use the strategies of reason and friendliness when influencing a subordinate who communicates in an attractive than in an unattractive style. They were also significantly more likely to use the strategies of assertiveness, bargaining, coalition, higher-authority, and sanctions when influencing a subordinate who communicates in an unattractive than in an attractive style.

Discussion

The present investigation extends the research of an earlier study examining physician executives' choices of persuasion strategies to gain compliance from superiors who communicate with them in attractive and unattractive styles. [20] The goals of the study reported in Part I and in this study were the same, except that the target of influence in the present investigation is a subordinate instead of a superior.

Two assumptions underpin the research in both studies. First, influencing and managing are intimately connected. That is, managing is influencing. Second, the way a persuadee communicates reflects how he or she conceives of the relationship shared with the persuader, thereby influencing the persuader's interpretation of that relationship, expectations about getting the persuadee to comply, and choices of persuasion strategies.

Physician executives in this investigation were significantly more likely to rely on the "softer" strategies of reason and friendliness to persuade a subordinate who communicates in an attractive than in an unattractive style. In terms of "harder" strategies, they were significantly more likely to select the strategies of assertiveness, bargaining, coalition, higher-authority, and sanctions with an unattractive than an attractive subordinate. The significant differences found in Part I and in this study convincingly demonstrate that target attractiveness is an important factor in physician executives' choices of persuasion strategies in upward and downward influence situations.

It is not only important to examine the significant differences between the way physician executives use influence strategies with attractive and unattractive subordinates and superiors, but also worthwhile to examine the rankings of the strategies associated with the two targets (see figure 4, p. 34). Just as they did in Part I when they were asked to indicate their strategic choices in influencing attractive and unattractive superiors, physician executives in this study showed a preference to employ the "softer" strategies of reason and friendliness to gain compliance from attractive and unattractive subordinates. Both strategies ranked first and second with both types of targets in Part I and in this investigation.

Coalition was another popular strategy in persuading subordinates and superiors. In this study, it ranked third in both target conditions and in Part I, it ranked second and third with unattractive and attractive superiors, respectively.

Although coalition was a favored strategy in both studies, the likelihood of physician executives using coalition tactics with unattractive superiors and subordinates is not the same. A test for differences shows that physician executives are significantly more likely to invoke coalition tactics with an unattractive superior compared to an unattractive subordinate. Hence, it appears that physician executives are not as inclined to involve other organizational members in influencing a subordinate they do not like compared to a superior they do not like. Physician executives may simply believe that they generally have more power to get a dislikable subordinate to do what they want than a dislikable superior and, therefore, do not have to rely as much on forming coalitions to get subordinates they do not like to comply.

Physician executives also exhibit a difference in their use of assertiveness with unattractive subordinates and superiors. A test for differences shows that physician executives are significantly more likely to select assertiveness to gain compliance from an unattractive subordinate than an unattractive superior. It could be that physician executives are more predisposed to invoke assertive tactics with subordinates they dislike than with superiors they dislike because the political consequences associated with using such tactics are considerably less with subordinates they do not like than with superiors they do not like.

Conclusion

It is important to study the way in which physician executives influence their subordinates. Rubin asserts that "the most basic and critical responsibility a leader has is to make a positive difference in the lives of his or her subordinates." [22] He suggests that physicians in management have a responsibility to help their subordinates perform their tasks "faster," "cheaper," and "smarter." According to Rubin, making such a positive difference requires physician executives to engage in the exercise of power and influence. He contends further that, in order for physician executives to make a difference with their subordinates, they must understand the full extent of their power and influence, be able to determine which influence style is necessary and appropriate for a particular situation, and ultimately adapt that style to the situation.

The findings from the current study suggest that physician executives recognize differences across influence situations and are able to adapt to those situations. The strategic differences found in influencing likable and dislikable subordinates provides support for this review. However, a more complete and accurate picture of whether physician executives are making a difference with their subordinates is needed. One way to determine if physician executives are being effective in downward influence situations would be to examine their subordinates' perceptions of how they exercise their power and influence on a day-to-day basis. With this approach, subordinates who are managed by physician executives can offer their views about the ways in which physician executives' influence efforts either do or do not make a difference in their organizational life.

In an upcoming issue of Physician Executive, the author will report on the first of two studies focusing on physician executives' communicator styles in influence situations.

REFERENCES

[ 1.] Betson, C. Managing the Medical Enterprise:

A Study of Physician Managers. Ann

Arbor, Mich.: UMI Research Press, 1986.

[ 2.] Burda, D. "Hiring of Physician Executives

on the Rise." Modern Healthcare 18(15):40,

April 8, 1988.

[ 3.] Burns, J. "The Credibility of the Physician

Executive." In Curry. W. (ed.), New

Leadership in Health Care Management:

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American College of Physician Executives.,

1988, pp. 74-77.

[ 4.] Nelson, S. "The Rising Incomes and

Numbers of MD Execs." Hospitals

61(18):63, Sept. 20, 1987.

[ 5.] Ottensmeyer, D., and Key, M. "The Unique

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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.] Wallen, E. "Rising Number of Doctors

Sought for Managerial Positions." Physicians

Financial News 5(6):3,8, March 30,

1987.

[ 7.] Oberman, L. "Do Physicians Make Good

Hospital CEOs? More Experts Say Yes."

AHA News 23(33):1,5, Aug. 24, 1987.

[ 8.] Schenke, R. Personal communication, 1990.

[ 9.] Guthrie, M. "Why Physicians Move into

Management." In Curry, W. (ed.), New

Leadership in Health Care Management:

The Physician Executive. Tampa: American

College of Physician Executives, 1988, pp.

45-49.

[10.] Wallace, C. "Physicians Leaving Their

Practices for Hospital Jobs." Modern

Healthcare 17(10):40-1,44,48,55-6, May 8,

1987.

[11.] Hughes, F. "The Challenges Facing

American Medicine: The Search for a New

Equilibrium and Its Implications for

Physician Executives." In Curry, W. (ed.),

New Leadership in Health Care Management:

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Fla.: American College of Physician

Executives, 1988, pp. 1-21.

[12.] 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. 22-44.

[13.] Doyne, M. "Physicians as Managers."

Healthcare Forum 30(5):11-13, Sept.-Oct.

1987.

[14.] Brady, T., and Carpenter, C. "Defining the

Management Role of the Department

Medical Director." Hospital and Health

Services Administration 31(5):69-85, Sept.-Oct.

1986.

[15.] Burns, J. "Company Physicians Can Play

a Role as Health Managers,

Communicators." Business and Health

4(7):60, May 1987.

[16.] 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.

[17.] Spratt, J. "The Physician's Obligation to

Development of Managerial Skills in

Health Care Facilities." Nebraska Medical

Journal 55(8):473-80, Aug. 1970.

[18.] Radecki, L. "The Making of Physician

Managers: A Training Approach." Management

Review 75(10):14-5, Oct. 1986. [19.] Martin, L., and others. "The Importance

of Management-Training for Academic

Physicians." Surgery 95(1):52-4, Jan. 1982.

[20.] Garko, M. "Persuasion Strategies for

Physician Executives: Part I - Influencing

Superiors." Physician Executive 16(6):9-13,

Nov.-Dec. 1990.

[21.] Kipnis, D., and others. "Patterns of

Managerial Influence: Shotgun Managers,

Tacticians, and Bystanders." Organizational

Dynamics 12(3):58-67, Winter 1984.

[22.] Rubin, I. "The Managerial Role." In

Schenke, R. (ed.), The Physician in

Management. Tampa, Fla.: American

Academy of Medical Directors, 1980, pp.

45-56.

PHOTO : Figure 1 - Summary Definitions of Persuasion Strategies

PHOTO : Figure 2 - Target Descriptions

PHOTO : Figure 3 - Study Hypotheses

PHOTO : Figure 4 - Ranking of Persuasion Strategies

THE AUTHOR

Michael G. Garko, PhD, is an Assistant Professor in the Department of Communication, University of South Florida, Tampa.
COPYRIGHT 1991 American College of Physician Executives
No portion of this article can be reproduced without the express written permission from the copyright holder.
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Title Annotation:physician communication styles study; part 2
Author:Garko, Michael G.
Publication:Physician Executive
Date:Jan 1, 1991
Words:2265
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