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Physician executives' persuasive styles of communication in upward influence situations.

This article examines the communicator style choices of physician executives when attempting to persuade a superior whose own style of communication is attractive and unattractive. In the November December 1990 issue of Physician Executive, the author reported on persuasive strategies physician executives use to influence such targets of influence. Whereas the earlier study focused on what physician executives communicate to be persuasive, the present investigation treated the way physician executives communicate to persuade attractive and unattractive superiors. The results suggest that the way physician executives communicate in upward influence situations is affected by the way their superiors communicate with them.

There are a host of writers who argue directly and indirectly that, if physician executives are going to make any substantial contribution in managing health care organizations and in solving the various technical, financial, legal, political, and social problems besetting the U.S. health care industry, they need to function as leaders.(1-3) Intersecting with this argument is the frequently advanced position that physicians who have swapped their lab coats for suit coats are best suited to address these problems.(1-2)

The research associated with both of these perspectives has helped to legitimize the idea of physicians' being in management and to portray physician executives as leaders and not just caretakers of the health care industry. However, little effort has been made to examine how physician executives put their potential for leadership into practice, especially in influence situations.

It is assumed in the present study that leadership is inexorably linked to the process of influence. As Hackman and Johnson put it, "exercising influence is the essence of leadership."(4) Numerous other organizational scholars conceive of the relationship between leadership and influence in similar ways. For example, Hersey and Blanchard contend that "leadership is the process of influencing the activities of an individual or a group in efforts toward goal achievement in a given situation."(5) Koontz and O'Donnell propose that "leadership is influencing people to follow in the achievement of a common goal."(6) Finally, Bass asserts that "an effort to influence others is attempted leadership.(7)

Just as leadership is assumed to be intimately tied to the process of influence, so is it assumed to be inextricably connected to the process of communication. Communication serves as the means by which leaders influence the attitudes and behaviors of organizational members to bring about institutional change. In short, leadership as a form of influence, is an empty concept without communication. Communication is what vitalizes the exercise of leadership. As Pace asserts, "communication is...the only process by which a leader can exert influence."(8)

Hence, one way to gain some insight into how physician executives function as leaders in health care organizations is to examine the way they communicate when engaging in the process of upward influence. As leaders, physician executives must be communicatively persuasive with their superiors so that they can gain the necessary support and resources to achieve their personal and institutional goals. Thus, the purpose of this study is to examine physician executives' choices of communicator styles or the way they communicate when attempting to persuade superiors whose own styles of communication with them are either attractive (i.e, attentive, friendly, and relaxed) or unattractive (i.e., not attentive, not friendly, and not relaxed).

Focusing on individuals' communicator styles in persuasive situations is important because the way a person communicates functions as a message about what he or she communicates, that is, how the content of his or her messages is to be interpreted, filtered, or understood by the other person in a communication transaction.(9) In a real sense, the way people communicate with one another reveals how they define their relationships. For example, in the case where a superior is typically not attentive, not friendly, and not relaxed in his or her communication with a subordinate, it is reasonable to expect the subordinate to infer that his or her boss does not think very much of their relationship. In contrast, a superior who interacts with a subordinate in an attentive, friendly, and relaxed fashion would probably be perceived by the subordinate as having positive regard for their relationship.

Moreover, a superior with an unattractive style would probably be viewed as a more difficult target of influence than a superior with an attractive style. It is expected that physician executives will be more likely to choose "stronger" ways of communicating to persuade a superior who is perceived to communicate in an unattractive than in an attractive style and to be more likely to choose "softer" styles of communicating to persuade a superior who is perceived to communicate in an attractive rather than an unattractive style.

Study Method

Study participants were 200 physician executives located throughout the United States. All were members of the American College of Physician Executives. Eighty-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, academia, managed care, group practices, government, etc.). Seventy-six percent had 10 years or less of experience, and the remaining 24 percent had more than 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).(9) CSM-S is a selfreport, 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, impression leaving and communicator image were not used because they represent stylistic outcomes instead of actual communication behaviors. Figure 1,[TABULAR DATA OMITTED] page 18, contains descriptions of the communicator styles.

Questionnaires containing a description of a target of influence who communicated in either an attractive or an unattractive style were randomly distributed (figure 2, right). 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 superior with whom they worked and who communicated with them in a way that reflected the description that they were given. They were told that they were trying to persuade the superior to do something they wanted. Respondents were asked to visualize the superior while reading the characterization and while indicating how likely they would be to communicate in the different styles. They were also requested to answer in terms of what they would actually do, 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.


Nine hypotheses were offered in the study (figure 3, page 20)[TABULAR DATA OMITTED]. All of the hypotheses were confirmed. The results show significant differences in physician executives' communicator style preferences. On the one hand, they were significantly more likely to select the communicator styles of friendly, relaxed, open, dramatic, and attentive with an attractive superior than with an unattractive superior. On the other hand, physician executives were significantly more likely to prefer the communicator styles of dominant, animated, precise, and contentious with an unattractive superior than with an attractive superior.

Discussion and Conclusion

This investigation has attempted to explore physician executives' choices of communicator styles when seeking to influence superiors whose own styles of communication are perceived to be attractive and unattractive. Previously, the author examined physician executives' use of persuasive strategies with attractive and unattractive superiors.(10) Whereas the purpose of the earlier study was to gain some insight into what physician executives prefer to communicate, the current research sought to shed some light on the way physician executives prefer to communicate in upward influence situations.

In terms of the results, physician executives in this study were significantly more likely to select the communicator styles of animated, contentious, dominant, and precise to persuade a superior who is perceived to communicate in an unattractive than in an attractive style. On the other hand, study participants were significantly more likely to choose the communicator styles of attentive, dramatic, friendly, open, and relaxed to persuade a superior who is perceived to communicate in an attractive than in an unattractive style. Thus, the findings suggest that physician executives communicate differently in persuasive situations with superiors who interact with them in attractive and unattractive styles.

In addition to the differences outlined above, there are at least two important similarities in the way the physician executives in this study preferred to communicate persuasively with attractive and unattractive superiors. A ranking of the means reveals that attentive, friendly, and relaxed were the top three communicator style variables for both types of targets of influence and that the communicator style of contentious was the least popular. In a study focusing on physician executives' communicator style choices in downward influence situations, the author also found that attentive, friendly, and relaxed were the three most preferred styles and contentious was the least preferred way to persuade attractive and unattractive subordinates.(11)

Regardless of whether the target of influence is an attractive or an unattractive superior or subordinate, there are potential advantages in physician executives' being communicatively attentive, friendly, and relaxed and not contentious. By being attentive communicators, physician executives signal a willingness to provide responsive feedback to what their superiors and subordinates have to say during an influence attempt. A friendly style helps to confirm with superiors and subordinates that they are worthy of being acknowledged. Communicating in a relaxed style portrays a physician executive as calm and collected and not hampered by nervous mannerisms, creating the perception that he or she is confident and in control. Finally, by not communicating in a contentious style, physician executives avoid all of the negative effects and consequences of being argumentative with superiors and subordinates.

All of the advantages associated with physician executives' being attentive, friendly, and relaxed and not contentious contribute to their being effective leaders (persuaders) in health care organizations. As leaders, physicians in management must be able to enact their medical and managerial knowledge on a day-to-day basis and to be persuasive with individuals at different levels of the organization. In order to accomplish these goals, physicians in management need to establish "healthy" relationships with their superiors and subordinates. They can greatly enhance their chances of creating such relationships by communicating in persuasive situations in ways that promote mutuality and connection and downplay divisiveness and competition. Although physician executives in this study were more likely to use "stronger" communicator styles to influence unattractive than attractive superiors, they did not show a preference for using these styles. Thus, it would seem that physician executives are attempting to exercise their leadership in ways that could potentially make a positive difference in how health care organizations are managed.


1. Curry, W. (ed.) New Leadership in Health Care Management: The Physician Executive. Tampa, Fla.: American College of Physician Executives, 1988.

2. Schenke, R. (ed.). The Physician in Management. Tampa, Fla.: American Academy of Medical Directors, 1980.

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

4. Hackman, M., and Johnson, C. Leadership: A Communication Perspective. Prospect Heights, Ill.: Waveland Press, Inc., 1991, p. 92.

5. Hersey, P., and Blanchard, K. Management of Organizational Behavior: Utilizing Human Resources. Englewood Cliffs, N.J.: Prentice Hall, 1982, p. 83.

6. Koontz, H., and O'Donnell, C. Principles of Management, 2nd ed. New York, N.Y.: McGraw Hill, 1959, p. 435.

7. Bass, B. Leadership, Psychology, and Organizational Behavior. New York, N.Y.: Harper and Row, 1960, p. 90.

8. Pace, R. Organizational Communication: Foundations for Human Resource Development. Englewood Cliffs, N.J.: Prentice Hall, 1983, p. 71.

9. Norton, R. Communicator Style: Theory, Applications, and Measures. Beverly Hills, Calif.: Sage Publications, 1983, p. 228.

10. Garko, M. "Persuasion Strategies for Physician Executives: Part l--Influencing Superiors." Physician Executive 16(6):9-13, Nov.-Dec. 1990.

11. Garko, M. "Physician Executives' Persuasive Styles of Communication in Downward Influence Situations." Physician Executive 19(1):27-31, Jan.-Feb. 1993.
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Author:Garko, Michael G.
Publication:Physician Executive
Date:Mar 1, 1993
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