DDHA 8113 Week 1 Authority Versus Influence Post Example

Week 1 Discussion: Authority, Influence and Leadership

The Appointment Letter Came in March; the Neurologists Arrived Later: Authority and Influence in a New Service Line Director's First Six Months

Hello, everyone. I direct the neurosciences service line at a composite three-hospital system I will call Calder Valley Health. I was appointed eighteen months ago after eight years running surgical operations, and my first six months taught me the difference this week asks about. The appointment letter gave me authority over budgets, schedules and the service line's capital requests. It did not give me the neurologists, neurosurgeons and neuro ICU nurses, none of whom report to me and all of whom could decline anything I proposed.

My first initiative shows the gap. I wanted the three hospitals' outpatient neurology clinics to use one scheduling template, so that new patients with seizures or suspected multiple sclerosis would be seen within two weeks at any site. I had the authority to change the template, and I did. Within a month, two of the three clinics had quietly rebuilt their old templates under new names. Nobody refused me. They simply did not do it, and I had no lever that could make them, because the physicians' schedules belong to a medical group I do not manage.

Pfeffer (1992) argues that power in organizations comes less from position than from control of resources others need and from the ability to frame what counts as a problem. I had position. The neurologists had the resources that mattered, their own time and their patients' trust, and they had already framed the template as an administrator's solution to a problem they did not think they had. Battilana and Casciaro (2013) found that change agents with strong ties to people who were ambivalent about a change were more successful in getting it adopted, while strong ties to outright opponents helped less. My mistake was to treat the template as a matter for my authority when it depended on relationships I had not yet built.

What changed things was slower. I spent the next three months attending each clinic's monthly meeting, asking what made new-patient access hard and saying little. One neurologist, ambivalent rather than opposed, offered to pilot a version of the template she had redesigned herself, and her colleagues followed when her new-patient wait fell. The template we use now is about 70 percent mine. The influence that made it stick was hers, which fits the view of Uhl-Bien et al. (2014) that leadership is produced jointly by those who lead and those who choose to follow.

My claim for discussion is that in a professional service line, authority mostly sets the agenda, while influence decides whether anything on it happens. I would like to hear from those of you who lead people who do report to you. Does the gap close, or does it just become harder to see?

Reply to Tomas

Tomas, you argue that the gap closes when people report to you, because nurses on your units follow schedule changes the week you make them. I wonder whether what you see is adoption or compliance. Pfeffer's point applies there too: your nurses control the quality of their own effort, and a change can be followed on paper while the discretionary effort that makes it work is withheld. Your falls rounding example is interesting here. You said the rounding happened every hour after you mandated it, but you also said the documentation became uniform within a week. In my experience, uniform documentation that appears within a week is a sign that people are complying with the form rather than owning the work. What would you see if the work was really adopted?

Reply to Grace

Grace, you suggest that my neurologist ally was really a sponsor, and that I should have recruited her first rather than discovering her. That is a fair criticism of my sequence. Battilana and Casciaro (2013) would agree that the order of relationships matters, since their finding was about whom the change agent was already close to. My disagreement is with the idea that I could have known she was ambivalent before I spent time in the clinics. The people who looked like supporters in my first month were the ones who agreed politely in meetings. The person who mattered was the one who argued with me about details, because arguing about details meant she was already thinking about how it might work.

References

Battilana, J., & Casciaro, T. (2013). Overcoming resistance to organizational change: Strong ties and affective cooptation. Management Science, 59(4), 819-836. https://doi.org/10.1287/mnsc.1120.1583

Pfeffer, J. (1992). Understanding power in organizations. California Management Review, 34(2), 29-50. https://doi.org/10.2307/41166692

Uhl-Bien, M., Riggio, R. E., Lowe, K. B., & Carsten, M. K. (2014). Followership theory: A review and research agenda. The Leadership Quarterly, 25(1), 83-104. https://doi.org/10.1016/j.leaqua.2013.11.007