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Persuasion strategies for physician executives.

Despite the various studies on physician executives and the importance attributed to physicians being in management, there is little systematic research on how physicians actually manage. One useful way to determine the nature of that role would be to examine how physician executives actually influence (manage) others in health care organizations. The perspective taken in the study reported in this article is that managing and influencing are inextricably connected. Previous research convincingly supports this principle by showing that managers' choices of compliance-gaining strategies to accomplish personal or organizational goals represent a major dimension in the exercise of interpersonal influence in managerial settings(l-3)

Investigators have identified various factors affecting managers' choices of compliance-gaining strategies.(1,2,4) A substantial portion of this research examines how characteristics of the manager as an agent-of-influence condition strategy choices.(3) Factors directly relating to targets' potential influence on managers' compliance-gaining stratgy selections have not been examined as widely. While useful, much of the target-related research centers on how a target's organizational status (i.e., superior, co-worker, subordinate) affects tactical decision-making.-" Conspicuously missing are studies directly exploring how a target's communication behavior affects the way a manager goes about getting the target to do something.

It is not just the agent's strategic communication behaviors that constitute the compliance-gaining process. Bateson suggests that the agent and target function as elements in a circuit of compliancegaining interaction.1-10 Being members of that circuit, each simultaneously influences and is influenced by the other through communication. Thus, it is important to study not only agent characteristics but also target-related behaviors, because both "influencer" and "influencee" characteristics have an impact on a manager's choice of compliance-gaining strategy.(3)

This study investigates the influencee's impact by exploring the role of target communicator style in physician executives' persuasion strategy selections. More specifically, it examines physician executives' choices of compliance-gaining strategies in upward influence situations where the target-of-influence is a superior who communicates in an attractive or an unattractive style. The focus is on gaining compliance from superiors, because upward influence is generally considered to be an essential dimension of organizational behavior,(11) managers' ability to exercise upward influence is closely linked to their overall leadership effectiveness,(12) and managers engaged in upxyard influence are at a relative power disadvantage, giving their strategic decisions increased significance."

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 old, while 52 percent were 50 years or older. Subjects 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' experience and the remaining 25 percent having more than 10 years of managerial experience.

Physician executives' preferences for compliance-gaining strategies were measured by asking them how likely they would be to select the strategies of reason, bargaining, friendliness, assertiveness, coalition, and higher-authority (see figure 1, right) in influencing a superior who typically communicated with them in an attractive or in an unattractive style. (14) The questionnaire contained descriptions of two different targets. Respondents were instructed that the targets were superiors with whom they worked and interacted on a daily basis. One was described as a superior who usually communicated with the respondents in an attractive communicator style, while the other was portrayed as communicating in an unattractive style (see figure 2, below). The physician executives were told that they were trying to persuade the superiors to do something. They were asked to visualize the targets-of-influence as they read the characterizations and as they responded to the various items. 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.


Six hypotheses were offered in the study see figure 3, page 11). All of the hypotheses were confirmed. The results show that the physician executives in this investigation were more likely to use the strategies of reason and friendliness to gain compliance from a superior who typically communicates with them in an attractive style Om with one who typically communicates with them in an unattractive style. On the other hand, physician executives were more likely to rely on the strategies of assertiveness, bargaining, coalition, and higher authority to influence a superior who usually communicates with them in an unattractive style than in an attractive style.


This study sought to explore how physician executives actually manage in upward influence situations. It also attempted to shift the focus from how individual characteristics affect agents' choice of compliance-gaining strategies to how target communication behaviors influence agents' decisions about what strategies to use. More specifically, the present investigation examined the impact of superiors who communicate in attractive and unattractive styles on physician executives' strategic maneuvers to gain compliance. The guiding perspective of the study was that the way a target communicates reflects how he or she conceives of the relationship shared with the agent, thereby affecting the agent's perception of that relationship, expectations about getting the target to comply, and choices of compliance-gaining strategies.

The results of the present investigation strongly suggest that superiors who as targets-of-influence communicate in attractive and unattractive styles differentially affect physician executives' strategic preferences. For example, managers were significantly more likely to employ the strategy of reason with an attractive than with an unattractive superior. Additionally, they were significantly more likely to prefer assertiveness, bargaining, coalition, and higher-authority to influence an unattractive than an attractive superior. Thus, the results strengthen the perspective that target attractiveness has an impact on agents' choices of compliance-gaining strategies. The findings also broaden our understanding of the relationship between target attractiveness in strategy selection by showing the effect of target attractiveness in upward compliance-gaining situations, where the agent potentially possesses less power than the target.

Reason emerged as the preferred means to persuade superiors who communicate in either attractive or unattractive styles. It could be that managers believe that reasoning with their superiors is the most strategically effective thing to do when seeking compliance from them.

Bargaining was among the least popular strategies in the present investigation. Physician executives may be reluctant to bargain in upward influence situations because they may consider it inappropriate in superior/subordinate relationships for subordinates to initiate an exchange of benefits and favors. In other words, they may perceive themselves as not possessing enough power or status to take the first step to employ the strategy of bargaining. This is not to suggest that physician executives would never bargain with their superiors in order to get them do what they wanted. They may be inclined to bargain when the superior as a target-of-influence clearly initiates a bargaining transaction or at least provides some cue that bargaining is desired.

Managers may also be compelled to use bargaining tactics in situations where the superior is perceived as being a difficult target to influence. This is somewhat supported by the findings in this study. Physician executives were significantly more likely to bargain with a superior who was not communicatively attentive, friendly, and relaxed compared to one who was. Large mean values associated with the strategy of friendliness suggest that physician executives consider this strategy to be indispensable in gaining compliance from superiors. Physician executives may believe that there is a lot to gain or lose when seeking to get their superiors to do something they want. What may be at stake for them is not only the achievement of their immediate objectives, but also their relationship with the superior. Consequently, they may use friendly tactics to assist in preserving that relationship.

Among the stronger means of influence (assertiveness, coalition, higher-authority), coalition was the most likely strategy to be used for both attractive and unattractive communicator targets. It also ranked second and third in likelihood-of-use among all the strategies with unattractive and attractive superiors, respectively. Coalition is one of the more complex means of influence managers can use to gain compliance. In addition to persuading the designated target, it potentially requires influencing one or more other organizational members to participate in the compliance gaining attempt. Despite the intricacy of employing coalition tactics, physician executives seem to consider them essential in upward influence. Physician executives may seek the assistance of others because they may generally perceive their superiors to be formidable targets requiring more persuasive power than they possess as individuals.


The U.S. health care system is undergoing unprecedented change. It is frequently argued that these changes, coupled with rising costs, require the active participation of physicians in the management of the health care system. (11-17) However, one cannot presume that a good doctor makes a good manager or that the training to practice medicine fosters the necessary skills to manage health care organizations. The ability of physician executives to exercise influence successfully will determine to a large extent how effective they will be as managers. Without the ability to persuade, physician executives will find it difficult to serve as links between medical staffs and management, to contribute to organizational stability and change, to establish and maintain medical standards, or to make any meaningful contributions in addressing the cost crisis besetting the health care system. This study has attempted to take an important step in illuminating how physician executives influence. A number of other avenues can be pursued to advance our understanding of how physician executives engage in the influence process in health care organizations. In addition to the present study's focus on upward influence, future studies could examine the strategy preferences of physician executives when influencing their co-workers and subordinates. Knowing how physician executives gain compliance from targets with different organizational status would provide a more complete understanding of the way they are influencing. It might also provide direction in preparing physicians to enter the world of management.

A number of writers comment that most physicians lack managerial training and are not prepared to move from medicine to management(17-21) For example, Kurtz argues that as physicians make the transition from clinicians to managers, they continue to behave in a clinical modality. That is, they function independently and autonomously from other organizational members and see themselves as the ultimate authority, with little inclination to engage in participative and collaborative team management. "While clinical behaviors are critical for success in the practitioner role, they tend to create conflict, resistance, and tension in the managerial role."(19) Hence, the chances of getting others to comply under these conditions would not be good. Systematically studying the way physician executives gain compliance from their superiors, co-workers, and subordinates could assist in determining to what extent and under what conditions they may be managing as clinicians.

If physicians are adopting the norms and values of their clinical role to manage and lack preparation for management, they may influence in ways that are different from nonphysician executives. It would be worthwhile to study physician and nonphysician executives to determine directly if there are any differences in the way they persuade other organizational members. Because most physicians do not have extensive backgrounds or formal training in management, it might also prove useful to see if physician executives with different years of experience and training use influence strategies in dissimilar ways. Finally, an assumption of this study was that the way a target communicates affects an agent's choice of compliance-gaining strategies. Particular attention was given to targets who communicate in attractive and unattractive styles. However, targetsof-influence can communicate in a variety of other ways during a compliance-gaining attempt. They may communicate in contentious, dramatic, or dominant styles when interacting with an agent. Future research could explore the effect of different target communicator styles on physician executives' choices of compliance gaining strategies.

References 1. Kipnis, D. The Powerholders. Chicago, Ill.: University of Chicago Press, 1976. 2. Krone, K., and Ludlum, J. 1990. An Organizational Perspective on Interpersonal Influence.' In Dillard, J.(Ed.), The Production of interpersonal Influence Messages. Scottsdale, Ariz.: Gorsuch Scarisbrick, Publishers, 1990, pp. 123-42. 3. Seibold, D., and others. 1985.'Communication and Interpersonal influence.' in Knapp, M., and Miller, G. (Eds.), Handbook of Interpersonal Communication. Beverly Hills, Calif.: Sage, 1985, pp. 551-611. 4. Podsakoff, P. Determinants of a Supervisor's Use of Rewards and Punishments: A Literature Review and Suggestions for Future Research.' organizational Behavior and Human Performance 29(l):58-83, Feb. 1982. 5. Erez, M., and Rim, Y. The Relationship between Goals, Influence Tactics, and Personal and Organizational Variables.' Human Values 35(10):871-8, Oct. 1982. 6. Kipnis, D., and Schmidt, S. An Influence Perspective on Bargaining within Organizations.' In Bazerman, M., and Lewicki, R. (Eds.), Negotiating in Organizations, Beverly Hills, Calif.: Sage, 1983, pp. 303-31 9. 7. Kipnis, D., and others. Intraorganizational Influence Tactics: Explorations in Getting One's Way.' Journal of Applied Psychology 65(4):44052,Aug.1980. 8. Rim, Y., and Erez, M. A Note about Tactics Used to Influence Superiors, Co-workers, and Subordinates. Journal of Occupational Psychology 53(4):319-21, Dec. 1980. 9. Ruesch, J., and Bateson, G. Communication: The Social Matrix of Society. New York, N.Y.: Norton, 1951. 10. Bateson, G. Steps to an Ecology of Mind. New York: Ballantine, 1972. 11. Kipnis, D., and Schmidt, S.'Upward Influence Styles: Relationship with Performance Evaluations, Salary, and Stress.' Administrative Science Quarterly 33(4):528-42, Dec. 1988. 12. Mowday, R. 1979. Leader Characteristics, Self-Confidence, and Methods of Upward Influence in Organizational Decision Situations.' Academy of Management Journal 22(4):709-25, Dec. 1979. 13. Mowday, R. 1978. The Exercise of Upward influence in Organizations.' Administrative Science Quarterly 23(l):137-56, March 1978. 14. Kipnis, D., and Schmidt, S. 1982. Profiles of Organizational influence Strategies.San Diego, Calif.: University Associates, 1982. 15. Cohn, R. 1986. The Medical Director-The Untapped Potentil of the Position.' Hospital and Health Services Administration 31(6):51-61, Nov.-Dec. 1986. 16. Montgomery, K. 1986. Today's Physician Manager: A New Breed.' Physician Executive 12(5):14-17, Sept.-Oct. 1986. 17. 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. 18. Harffield, J. Physicians in Management.' in Curry, W., (Ed.), New Leadership in Health Care Management. The Physician Executive. Tampa, Fla.: American College of Physician Executives, 1988, pp. 109-120. 19. Kurtz, M. 1988. The Dual Role Dilemma.' in Curry, W. (Ed.), New Leadership in Health Care Management. The Physician Executive. Tampa, Fla.: American College of Physician Executives, 1988, pp. 65-73. 20. Yanda, R. Doctors as Managers of Health Teams: A Career Guide for Hospital-Based Physicians. New York, N.Y.: AMACOM, 1977.
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Title Annotation:Influencing Superiors, part 1
Author:Garko, Michael G.
Publication:Physician Executive
Date:Nov 1, 1990
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