MA DipEd DipTM
4 Health Ltd
Wendy is managing director of 4 Health Ltd, a training and development consultancy firm based in the West Midlands. She is an organisational development specialist and architect of learning organisations, and has authored several books and publications on healthcare development
The creation of GP consortia as ‘the only game in town’ will establish these new commissioning organisations as key players in the design, procurement and performance management of healthcare services in England. It leaves consortia in real positions of power with great authority and accountability. Regardless of what Andrew Lansley’s listening exercise will produce in terms of amendments to the Health and Social Care Bill, consortia are here to stay for the foreseeable future.
GPs will have a leading role in the commissioning of the majority of secondary care services, but is that the same as the clinical leadership they are used to? It seems there will be some significant differences. When asked to define ‘leadership’, many GPs suggest frequent phrases such as visioning new ways of delivering healthcare, modelling new services, and making difficult decisions about limited resources and treatments with limited clinical evidence.
Leadership has been described as the “process of social influence in which one person can enlist the aid and support of others in the accomplishment of a common task”.(1) For GP consortia, the ‘social influence’ can be defined as the cultural, economic or political influence that one consortium exerts over another or over the consortium’s key partners and suppliers.
Similarly, effective leaders have a sphere of influence covering the people around them (inside and outside their organisations). Leaders operate at all levels in an organisation and are generally identified as critical to their organisations’ ability to deliver its objectives. I believe this places practice managers in a position of strategic importance, as their business expertise will be crucial to a practice’s role in the consortia. So what tools and techniques do they have at their disposal?
Figure 1 shows a breakdown of the types of people ‘influencers’ need to understand if they are trying to persuade them.
‘Followers’ make decisions based on how other trusted people (including themselves) have made similar decisions in the past. They tend to stick to what they know and will modify proven solutions rather than take a completely new direction.
Generally, they don’t seek the limelight and believe that “putting your head over the parapet means you may get shot at”. They prefer a more cautious approach but will readily accept responsibility for the decisions they do make. They tend to be engaging and are good at seeing problems and solutions through the eyes of others.
When negotiating with followers, any influencer needs to:
- Demonstrate past applications and successes of their solution by linking the old to the new. Supply proof, proof and more proof.
- Emphasis the safety of their approach and keep it simple, with concise and relevant information.
- Seek common, respected people as champions for their approach.
‘Controllers’ are those that must feel in control of every step of the decision-making process and need to feel a high degree of ownership of the original idea. They use fear and uncertainty to make others stop and think, which helps them avoid complacency. They welcome any opportunity to take charge and restore order, especially during a crisis. Controllers trust their own judgment implicitly and will steadfastly resist organisational or political pressure to sway them. They leave little to chance and will want the details and minutiae of any situation. They will want any solution to produce a faster or cheaper result while maintaining/improving the overall quality.
Any influencer needs to:
- Present the solution as their idea (or heavily shaped by them).
- Demonstrate the solution negates their fears and anxieties related to the problem.
- Ensure they have all of the details laid out in the proposal or supporting documentation.
- Build alliances with people who understand how the controllers’ systems, rules and regulations work in order to build resilience into the solution.
‘Charismatics’ are passionate about new and innovative ideas and solutions, in fact the bolder the better. They will check out the validity of the solution and will ensure others have thought through the consequences of the action too. They take responsibility for their decisions and will accept appropriate blame for their mistakes.
Charismatics are risk-takers and love thinking and doing ‘outside the box’. They tend to make decisions quickly but will not act rashly or without enough information. They have a good grasp of the things that affect an organisation’s bottom line and want to be seen to be competitive in comparison with others.
Influencers need to:
- Give the headlines first, highlighting important information before describing the problem in detail.
- Acknowledge and address risks up front to demonstrate that the right level of thinking and analysis has taken place.
- Stay grounded by fighting the urge to get caught up in their enthusiasm, remaining focused on the outcomes.
- Refer to the innovative aspects of the solution, demonstrating the traditional problem it solves.
‘Thinkers’ need to cautiously and methodically work through the pros and cons of all options before making a final decision. They prefer hard data and research with a logic and defined methodology attached to it. Analysis is critical to them and they will need to explore the pros and cons of situations.
Thinkers will proceed cautiously and will not consider emotional arguments in the decision-making process, preferring the logical approach. They are flexible and open to new ways of doing things if it can be demonstrated that it is more effective or efficient.
Influencers need to:
- Present arguments/solutions in a logical and chronological order (they need to hear things from start to finish).
- Be exhaustive in the presentation of the information and include research data, survey results, case studies, cost-benefit analysis, etc, then give them ample time to digest the facts.
- Encourage the thinker to discuss your options with their colleagues (discussion helps them to define their perspective).
- Engage their help in filling in any small gaps you have in order to encourage ownership of the solution.
‘Sceptics’ are highly suspicious of every piece of information and will be reluctant to trust anything that doesn’t fit into their world view. They will often make decisions that go against conventional wisdom, preferring to design bespoke solutions. They are forthright in their opinions and will share them willingly, leaving you in no doubt how they feel. They are capable of taking bold and risky decisions because they are unafraid of being wrong.
Sceptics will do what it takes to get a job done, take difficult decisions, deliver bad news or step on toes. They have an ability to ignore distractions and can be single-minded with the task at hand. Many sceptics are not interested in what should be done and are more interested in what could be done.
Influencers need to:
- Establish their credibility and gain the confidence of the sceptic. This can be done by gaining the endorsement from someone in the sceptics’ inner circle, someone they trust.
- Be prepared to be challenged vigorously and be clear about your position/solution. You may have to find the middle ground but you will need to reason your thinking and don’t put the sceptic in a defensive position.
- Keep emotions and egos in check and don’t take anything the sceptic says or does personally. Remain confident and calm.
- If you need to go back to the source of the credibility when presenting data, don’t rely on secondary data with a sceptic, as they will spot the weakness and use it.
Influencing others does not mean people will automatically take action. The influence of people requires an amount of salesmanship, being politically savvy (with a small ‘p’) and a sophisticated understanding of attitudinal change.
To effectively influence any of the five types, you need to:
- Tailor any proposals or papers to the needs and concerns of the main decision maker.
- Understand the types of people you are seeking to influence and present the information in their style.
- Observe the actions of people – watch how they handle big decisions and problems. What do you observe that might help you decide on their style?
- If you are working with people for the first time and there is no opportunity to observe, use a process of elimination to identify their style.
When you are trying to influence others it will come back to their words versus their actions. Try not to make snap judgements about the people you may have to influence in the future; look at what their actions tell you.
An influencing situation is not about the one doing the influencing but the focus of the influence. There are no shortcuts; preparation is the key. The more you tailor your argument/case to the type and style of the other person the more positively it will be received. Ensure you pre-empt their concerns and have answers prepared.
In today’s NHS environment, tough business decisions need to be made and this has to be done from a position of expertise and knowledge. Practice and business managers alike are full of sound and brilliant ideas but they will not sell themselves – they need help.
By utilising simple influencing approaches you can stack the odds in your own favour about the role you will play in the new consortia. They will do better with your expertise than without it – so learning how to influence them to take you seriously is a crucial first step.
1. Chemers, M. An Integrative Theory of Leadership. New Jersey: Lawrence Erlbaum; 1997.
2. Miller B, Williams GA. The Five Paths To Persuasion: The Art of Selling Your Message. New York: Warner Business Books; 2005.
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