Clinicians in management: a qualitative study of managers’ use of influence strategies in hospitals

Abstract

BackgroundCombining a professional and managerial role can be challenging for doctors and nurses. We aimed to explore influence strategies used by doctors and nurses who are managers in hospitals with a model of unitary and profession neutral management at all levels.MethodsWe did a study based on data from interviews and observations of 30 managers with a clinical background in Norwegian hospitals.ResultsManagers with a nursing background argued that medical doctors could more easily gain support for their views. Nurses reported deliberately not disclosing their professional background, and could use a doctor as their agent to achieve a strategic advantage. Doctors believed that they had to use their power as experts to influence peers. Doctors attempted to be medical role models, while nurses spoke of being a role model in more general terms. Managers who were not able to influence the system directly found informal workarounds. We did not identify horizontal strategies in the observations and accounts given by the managers in our study.ConclusionsManagers’ professional background may be both a resource and constraint, and also determine the influence strategies they use. Professional roles and influence strategies should be a theme in leadership development programs for health professionals.

Role-meanings as a critical factor in understanding doctor managers' identity work and different role identities

“…Moreover, given that centrality of clinical identity seems important to obtain legitimate authority to manage (Croft et al, 2015;Spehar et al, 2014) and has also been considered as the basis for a medical educator role (Bartle and Thistlewaite, 2014), another question to be explored is the extent to which clinical identity is compatible with managerial identity or educational identity.…”

The Western Australian Clinical Senate as a Model for State-Wide Clinical Engagement

“…In the article by Sephar et al, the authors state that resistance to change in healthcare organisations can be linked to power battles within the structure of the organisation [16]. Day to day decision-making is influenced more by staff on the front-line rather than by those with more formal power, who are higher up the organisational chain.…”

“…Sephar et al undertook a study into the influence strategies used by nursing and medical staff in Norwegian hospitals using "profession neutral" management [16]. The authors reviewed various literatures that applied sociological theory to organisational change and also to clinical engagement, stating that policy makers hoping for system wide change need to have an understanding of professional power bases and influence strategies existing in healthcare organisations which can result in resistance to change.…”

“…One common classification distinguishes between the power an individual holds in relation to their status or position and embodies notions of reward, legitimate or coercive power (position power) versus power associated with referent or perceived attractiveness and/or expert power (personal power) [16,17].…”

“…Sephar et al analysed decision making and power structures in health and concluded that within many hospitals "power lies in expertise and that managers with a clinical background are more likely to draw on expert power than on formal position power" [16].…”