- Influence
Deliberate conduct (either positive or negative) that causes measurable results or effects, which may or may not have been intended, in respect to character, aims, processes and outcomes
Strategic influence supports healthcare leaders in influencing others as part of achieving specific and wider goals, objectives and plans for healthcare delivery. Influence is imparted to have impact on others in order to share ideas, concepts, opinions and actions.
- Strategic influence
Influence tactics and techniques used to impact the thinking, reasoning, decisions and outcomes of others with key points, arguments and perspectives to achieve desired results
Using influence
Healthcare organisations and systems are large, complex and connected in different ways. The roles and effectiveness of leaders and managers in the health sector are critical to growth, development, efficiency, effectiveness, quality and safety. The collaborative and connected nature of healthcare, both within health organisations and externally, means that health mangers need to rationally and authentically influence specifically and widely to achieve objectives.
Effective use of influence can affect the behaviours of staff and others in the health system so as to achieve goals and objectives. It aids leaders and managers to engage with and make effective contributions to decision-making processes, as well as allowing them to harness and use their power to maximise engagement and involvement in strategic management processes. Finally, effective influence use helps leaders to be effective in health-related management, as it enables them to understand and manage the resources and constraints of clinical backgrounds experienced by healthcare managers (Spehar, Frich & Kjekshus, 2014).
The ability to work influence, strategy and leadership-enabling activities together forms a critical pathway towards strategic direction and achievement of outcomes. In healthcare, leaders seek to move teams, departments, units and organisations towards outcomes and seeks to change them in relation to the environments in which they work. Key strategic activities for managing organisations include identifying problems and goals, decision-making, planning, positioning, learning and reviewing. These activities are framed and managed through effective strategic leadership and management. Vital in these environments is the translation of ideas, directions and activities through internal and external strategic influence.
Targets
The agent of influence is the individual or group of people attempting to exert influence. In considering the strategic use of influence, the targets of the agent need particular consideration. The targets of influence are the people or groups that the agent is trying to influence. Targets can be people who are experiencing a problem, are engaged in the work of the organisation, are at risk or are in a position to make decisions and act. They can also be people and groups who are contributors to specific issues either through their actions or through their lack of actions.
It is important to remember that a manager’s or leader’s influence is not limited to their own direct areas of responsibility. Depending on the impact and outcomes that they are trying to effect, they may need to influence downwards, affecting those who work for them (subordinates) and over whom they have direct control and responsibility; upwards, seeking to affect those in higher positions of authority, power and responsibility; and laterally, to their peers – those with similar roles and responsibilities, powers and resources. Healthcare managers and leaders may also need to exert influence externally, in other organisations, in the community and with decision-makers in the healthcare system.
Negotiation
Positional authority or power is insufficient to sustain change in complex organisations with large numbers of internal and external stakeholders. Manning and Robertson (2003) report on two areas of influence tactics: strategist-opportunist and collaborator-battler. Strategist and opportunist tactics include those that use reasoning and partnership to effect change, with opportunistic leaders and managers capitalising on favour and exchange for influence. Collaboration tactics use partnering, and battler tactics use coercive and assertive tactics. Framing one’s strategic influence style within one of these areas can be useful, because the impact of one’s negotiations is supported by the types of influence strategies used. Consideration of the types of influencing tactics to be used when entering a negotiation can maximise outcomes.
Frameworks for influencing strategically
Tactics
Research and development of influence tactics, approaches and objectives were carried out between 1990 and 2000 by Gary Yukl from the University of Albany, New York. Yukl’s formative work provides a sound understanding and expression of key knowledge about leaders’ and managers’ abilities to influence. The work has been criticised, as the results are difficult to replicate across industry sectors. Other authors have also extended Yukl’s list of influencing tactics. However, the influencing tactics reported in the original research offer a useful way of considering how managers might develop their use of influence (Yukl & Chavez, 2002; Yukl & Falbe, 1990). This includes how they might influence others, identify tactics being used on them and frame complex responses when two or more approaches are necessary to achieve a strong influential effect.
Complex problems, situations and operations require a range of responses. In healthcare organisations, it is most likely that influence and influence strategy are not linear in nature or confined to a single approach, as different situations may require different approaches and strategies to bring about the desired outcomes. Over time, recognition of attributes and changes in personnel, or a change in the direction of goals and outcomes, may also require changes in influencing tactics. The following framework of 11 influencing tactics provides a guide for mapping individual approaches to influential leadership and management as well as tactics to support projects and operations (Yukl & Chavez, 2002; Yukl & Falbe, 1990).
Pressure
Pressure tactics support proposals or requests for help. Alignment is achieved through demands, intimidation, frequent requests or regular returning to the issue. Influence can be direct (such as sending emails or other communication requesting support and outlining consequences) or indirect (such as putting a project or service out to public procurement tendering to force competition).
Upward appeals
This approach is designed to leverage seniority in attaining compliance: senior management or a higher authority is invoked in order to persuade involvement or agreement from targets. To create such influence, the agent may only have to imply that senior managers would prefer the options being proposed.
Exchange
Exchange tactics involve offering rewards for compliance to a proposal. They can also involve connecting the current proposal to a past favour to be reciprocated.
Coalition
These tactics involve seeking the support or involvement of targets to work on an issue in partnership so as to persuade more targets to give support to the proposal.
Ingratiation
The agent causes the target to think favourably of them or creates an atmosphere of goodwill and connectivity as a prelude to asking for support for a proposal. The agent may activate a relationship or remind the target of a previous relationship or assistance as a mechanism for building connections in order to place the new proposal within that positive relationship.
Rational persuasion
With this approach, the agent provides a factual or evidence-based argument to highlight as the main focus the viability of the proposal to garner support.
Inspirational appeals
The agent appeals to values or ideals to increase the target’s confidence in a proposal through the use of emotion, enthusiasm or excitement.
Consultation
The agent gains the target’s involvement in the decision-making and planning for a project and thereby creates a situation of target engagement, through which they can work to ensure the target’s further involvement.
Legitimation
This approach secures trust in a proposal by connecting it to policies, procedures, rules or other dependable sources inside and outside the organisation.
Apprisement
The agent explains the proposal in a way that shows how it will benefit the target: personal gain and value are highlighted as the results of the target’s acceptance of the proposal.
Collaboration
Assistance is offered to the target in return for their acceptance of the proposal, and value alignments between the agent and the target are proposed in return for the distribution of influence to other targets.
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