use of influence tactics. However, as
stated earlier, the most common tac-
tic is logical persuasion. Given the
need to share limited resources under
challenging deadlines, scientists also
tend to use reciprocation, though to a
lesser degree.
In a parallel vein, physicians’
formative experiences include four
years of medical school and three to
eight years of postgraduate medical
education. Throughout this period
there is a heavy emphasis on acquir-
ing vast quantities of highly technical
scientific knowledge. During the sec-
ond half of medical school most of
the training occurs in a clinical set-
ting, which is highly hierarchical.
Upon completion of their training
most physicians enter clinical prac-
tice or academia. Some join the phar-
maceutical industry, either early in
their careers or after years in aca-
demic or clinical practice.
Both scientists and physicians are
often promoted to formal manage-
ment roles as a result of excellent
technical expertise. However, making
the transition from contributing work
as an individual to accomplishing
work through others’ efforts can be
difficult. These managers may not
realize the need for new skill sets that
focus on motivating and evaluating
the performance of subordinates and
on working in complex relationships
with peers, superiors, and other
stakeholders. In addition, given their
developmental history emphasizing
facts and logic, many do not
acknowledge the value of the other
influence tactics, dismissing them as
“soft skills.” These organizational
challenges become increasingly com-
plicated as managers move up the
leadership ladder. If they fail to
develop a full range of influence tac-
tics and the ability to use them judi-
ciously, these managers can fall short
of potential in their own and their
group’s performance.
Fortunately, the strategic and tacti-
cal use of influence can be learned.
The major modes for this learning are
action-oriented leadership courses
and executive coaching. Although
physicians and scientists may have an
advantage because of their ability to
use logical persuasion, they need to
avoid overusing it. Particularly in
today’s health care environment, a
physician or scientist executive must
be agile and able to apply a variety of
tactics to meet the multiplicity of
changes on many fronts.
How does one determine which influ-
ence tactics to use in a given situa-
tion? Although there are no set rules
ensuring the success of any particular
tactic, several considerations can aid
the decision-making process.
Awareness of the communication
process is necessary, including the
fact that each person operates on an
individual set of perceptions and
underlying assumptions that affect his
or her interpretation of messages and
events. These perceptions are
strongly affected by the context of
the work environment, such as the
particular organizational culture with
its accepted behavioral norms, values,
and web of interpersonal relation-
ships—thus the maxim that percep-
tion is reality. Grasping the impor-
tance of this invisible yet powerful
aspect of organizational systems may
be one of the most difficult tasks that
data-oriented scientist and physician
leaders must accomplish. Learning to
work effectively with it results in one
of the most powerful competencies a
leader can possess.
Five major factors determine the
effectiveness of influence tactics in a
given situation: the purpose for which
the influence is being used, the influ-
encer’s communication skills, the tar-
get’s receptiveness, the nature of the
tactic, and the relative power of the
influencer and of the target.
A common challenge for hospi-
tals—ensuring the effective utiliza-
tion of their operating rooms
(ORs)—illustrates the use of these
five factors. The OR schedule is com-
plex, and any disorder in that sched-
ule disrupts patient flow throughout
the hospital. Allotted time is the com-
mon currency, and surgeons prefer to
operate early in the morning. Disease
and injury have no timetable, how-
ever. Well-organized ORs build in
time and space flexibility to accom-
modate potential changes, but even
these attempts at resource allocation
can be insufficient on any given day.
Three hospital leaders, the chief of
surgery, the chief of anesthesia, and
the nurse who is director of periopera-
tive services, jointly determine the
OR schedule. They are pressured by
three powerful groups: individual sur-
geons, OR nurses, and the hospital
administration. Surgeons submit cases
to the schedule and usually seek con-
secutive blocks of time early in the
day. Because surgeons in private prac-
tice often operate at more than one
hospital, they can take their cases
elsewhere if their scheduling prefer-
ences are not met. Skilled OR nurses
are often in short supply. Their scant
numbers, irreplaceable expertise, and
team loyalty give these nurses signifi-
cant clout with their director and the
physicians. The administration seeks
to maximize financial returns by
using OR time efficiently and by
Influence may be exer-
cised in four directions
in power structures:
upward, laterally, down-
ward, and outward.

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