Essential Skills for Influencing in Healthcare

A Guide on How to Influence Others with Integrity and Success

Price Andrew, Andrew Scowcroft

• Publisher: CRC Press
• Year: 2021
• ISBN:
  9781000466966
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

There is no shortage of issues to be addressed in healthcare, and no shortage of good ideas. What is often lacking is an approach to influencing change that has genuine integrity and trust built in from the start. And integrity is not just a word or a vaguely held value. It has to be demonstrated practically through the way managers and clinicians engage with their colleagues. From the Preface This highly practical book provides clinicians and managers with the knowledge and tools that will enable them to successfully influence their staff and colleagues. Built on the conviction that the way to influence others is through respect and understanding - not threat or manipulation - it promotes an optimistic, confident approach to leadership where trust and respect is fostered.

CHAPTER 1

Learning to influence

Personally I’m always ready to learn, although I do not always like being taught.

(Winston Churchill)

This book could profoundly alter the way you influence people, or it could leave you unchanged. The difference will lie in the extent to which you are ready to learn. And by ‘learn’ we don’t mean acquire facts. The sort of learning we need to do to become effective in influencing encompasses values, attitudes and behaviour, not just information. So we will start with the issue of learning.

This chapter focuses on the things that can prevent you learning to become a more effective influencer and how you can overcome them. We’re not talking about external factors here, but internal ones such as our assumptions about people and the way things should be done which can either prevent or enable learning. These internal factors matter more than IQ when it comes to real learning, by which we mean learning that changes us. More than just cleverness is required to change the way we deal with people; humility is also needed. Unless we are prepared to change, why should those around us do so?

LEARNING DOESN’T HAPPEN AUTOMATICALLY

Much of what we have written in this book is already in the public domain. We do not lay claim to any trade secrets or fresh revelations. And quite apart from what can be found in books, each day of our lives brings new opportunities to learn and change. For us, the really interesting question is that with all this knowledge available so widely, and with daily experience as a rich potential source of learning, how come individuals, teams and organisations seem to find it so hard to learn to change what they do?

Imagine if learning automatically took place every time we were exposed to a learning opportunity, and we always accepted the lessons that experience offered. Our organisations would be very different. We would all become steadily wiser and more effective throughout our working lives and pass on this learning to younger colleagues who would be keen to listen. Our work would be progressively improving in all aspects as learning is passed on. We would never make the same mistake twice and innovative practice would be quickly adopted. The reality is often very different. Organisations and people within them often seem to find learning, and the changes that go with it, difficult. This is reflected in the fact that organisational learning has been a major theme in management literature since the 1990s and interest in the subject shows no sign of waning.

Changing how people work is notoriously difficult and, more often than not, it fails.¹ In a field as vital as healthcare, an expert group chaired by the Chief Medical Officer for England admitted: ‘The NHS has no reliable way of identifying serious lapses … analysing them systematically, learning from them and introducing change which sticks so as to prevent similar events from reoccurring’.² And, as we all know, doing something for a long time may or may not lead to improved performance. Twenty years’ experience may mean the steady accumulation of a wealth of wisdom or it may mean one year’s experience, repeated 19 times. We can only conclude that there is more to learning than simply being exposed to opportunities to learn. Other factors must be involved which can obstruct or enhance learning. This chapter invites you to recognise the things that stop you learning and overcome them.

THE CHALLENGE OF REAL LEARNING

Some learning is simple. You may learn that a certain combination of keys on your computer keyboard is a shortcut, saving you precious time with a regular task. You already knew how to use a computer and you are familiar with the idea of shortcuts, but you have now added another one to your repertoire. Or your professional studies might provide knowledge of an area that, hitherto, you knew little or nothing about. The gap is filled in and you now possess more information. You note or memorise the new data and incorporate it into your work, but it fits neatly along-side other things you already knew or builds on more basic professional knowledge you already possess.

But other learning may be more of a struggle. In his early management career, Andrew Price saw himself as an energetic, decisive but compassionate manager. He wasn’t sure exactly how he had formed this view but it fitted in with his vague ideas of what good management was and the sort of person he’d like to be. When he moved from operational management in hospitals to a leadership training department, he was exposed to self-assessment tools, personality tests and to people skilled in giving feedback. Over time, he was confronted with compelling evidence from several sources that, in fact, people saw him as slightly withdrawn, sometimes slow to reach a decision and reluctant to take centre stage. At first, he resisted the picture that was emerging. Was he the decisive, heart-on-his-sleeve powerhouse he had imagined or this more thoughtful, introverted type who often left decisions for as long as he could? But although he struggled with the feedback because it did not fit with the way he had seen himself, he had to admit that it did explain a lot. He began to realise why he had not enjoyed certain roles, particularly those which allowed little time for reflection and involved almost constant activity. The part he struggled with most was the realisation that although he genuinely felt compassionate and concerned for the people he managed, he did not often display it. All of this led to a succession of changes, from a conscious decision to be more openly encouraging and supportive, to a resetting of career goals. Learning had taken place, but it had been neither quick nor easy. At the heart of Andrew’s struggle was the tension between the feedback he was receiving from other people and the idea he had of himself.

A more dramatic example from popular culture is the 1996 film Jerry Maguire which starred Tom Cruise. The hero is a sports agent who, after suffering a nervous breakdown, realises his career and much of his industry are based on deceit and dishonesty. This realisation, this new learning, leads him to make significant changes in his behaviour and he decides to work with uncompromising integrity from then on. The film shows the cost of this learning as clients and friends are mystified or even alienated by his transformation. What he learns about himself leads to profound changes in how he conducts his relationships and how he does business.

TWO TYPES OF LEARNING

The difference between the first examples and the later ones is that for Andrew, and for the character in the film, the learning could not just be slotted in alongside what they already knew. Instead, it challenged what they had previously believed and how they had previously acted. This was disruptive learning: learning that displaced rather than augmented. The challenge for Andrew was to let go of how he saw himself and accept a more realistic, and ultimately more helpful, self-image. This required time and painful honesty. Learning a computer shortcut or filling in the gaps in your technical knowledge tend to present much less of a challenge.

These two types of learning correspond to some extent with Piaget’s idea of learning by assimilation and learning by accommodation.³ The former is where the learner can easily perceive, understand and act on the new information. The latter, however, requires ‘an internal structural change in your beliefs, ideas and attitudes’,⁴ something easier said than done. When we talk about learning to influence, the learning required is mainly learning by accommodation. When we run our Vital Signs management development programmes, we make the point that the only learning that matters is learning that results in changed behaviour. Giving people more theories or facts about management will not, in itself, change behaviour. And without a change in our behaviour – what we do, how we communicate and how we deal with people – there is no change in our managing or influencing.

METANOIA: CHANGING YOUR MIND

In English, we use the term ‘learning’ for both the acquisition of knowledge which may be trivial and for profound alterations in how we think and act. Peter Senge⁵ makes the point that a better word exists for profound learning but it has fallen out of use. Metanoia is a Greek word meaning a change of mind or a change in our thinking. In ancient religious tradition, it signifies a fundamental transformation or mind-shift. It conveys the idea that to make significant changes in how we behave, significant changes in our thinking are required.

This deeper, more disruptive learning is necessary if we are to become effective influencers. For this reason, we encourage you to expect some degree of struggle as you put your knowledge into practice. Indeed, it is in the areas where you encounter the greatest difficulty that the potential for learning may be greatest as your deeply held assumptions and values are challenged. But without this willingness to struggle, to work with the concepts in practice, it remains an academic exercise.

DEFENDING AGAINST LEARNING

It is this struggle that leads us to avoid learning. We are aware that this sounds heretical but, as individuals and organisations, we have many ingenious ways of avoiding any learning that challenges existing ways of thinking or acting. It is this that explains why it is not enough simply for there to be opportunities to learn. Such opportunities may be ignored, spurned or not even recognised. When we talk about these defences against learning on our programmes, a common response is for people to say ‘My boss should be on this course’. It is much easier to see where other people, particularly those whose seniority means they are more exposed to scrutiny, are going wrong. In fact, as we will see, a readiness to criticise others can in itself be a way of avoiding personal learning. But you will gain much more from this chapter if you use it to reflect on your own willingness to learn and change.

Defence 1: ‘It’s their fault!’

We’ve taken the name of this defence from a remark made by a client some years ago. One of us was working with a group of nurses, whose ward had received a large number of complaints, to help them think through what action they needed to take. After a morning of reflection and analysis resulting in a wall covered in flip-chart diagrams and drawings, the ward manager gave us her conclusion. ‘It’s a blame culture here,’ she said, ‘… and it’s their fault!’

This defence works by finding fault with someone else and thereby absolving ourselves of the need to learn. ‘It’s their fault,’ we point out, ‘so I don’t need to change’. Of course, our use of this defence, because we all employ it from time to time, is usually much more subtle.

It works like this. Perhaps you have been trying to influence your boss to support an initiative you are convinced will improve the work of your team. Your proposal is turned down and as you walk away disappointed from the meeting, there is a strong temptation to locate the reason for the setback with your boss. He is too cautious, you might think, he cannot see the real issues. You may accuse the boss, silently or in private with your friends, of plain stupidity. If this is not the first time this has happened, you console yourself in the next team meeting by saying how typical it is for him to act this way.

Blaming others is all too common. ‘It’s those idiots in finance/IT/headquarters’ is a common response when our influencing has not led to the desired result. Of course, our criticisms may contain some truth, but that is not the point. Locating the fault elsewhere distracts us from the lessons that we can learn. Focusing on the real or imagined failings of others saves us asking ourselves difficult questions about the way we went about influencing them.

Or imagine you have been involved in a project run jointly with another organisation or agency. The course of action that se...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Preface
• About the authors
• Acknowledgements
• Dedication
• Introduction
• 1 Learning to influence
• 2 Learning about yourself
• 3 Organisational culture
• 4 Influencing organisational change
• 5 Influencing in formal settings
• 6 Being a role model
• 7 Summary and next steps
• Index