Persuasion is The Language of Care Manager Success

by Webmaster. Portions of this post appeared in the Harvard Business Review May-June, 1998
Published on Nov 07, 2015

To be a successful persuader on behalf of the patient, the hospital care manager must test and revise ideas in concert with the physician’s concerns and needs.

If there ever was a time for hospital case managers to learn the fine art of persuasion, it is now.  Issues of appropriate resource utilization, transitional care for high risk patients, and regulatory oversight of Medicare spending per beneficiary, essentially come down to asking, what can we do to make our patients’ progression-of-care cost effective, safe, and appropriate to their needs and preferences.  The answer is to effectively persuade.

Persuasion is widely perceived as a skill reserved for those high pressure salespersons or it may be seen as just another form of manipulation – devious and to be avoided.  But exercised constructively and to its full potential, persuasion supersedes sales and is quite the opposite of deception.  Effective persuasion becomes a negotiating and learning process through which a persuader, the care manager, leads colleagues, the physician and the healthcare team, to a problem’s shared solution.  Persuasion involves moving people to a position they don’t currently hold, but not by begging or cajoling.  Instead, it involves careful preparation, the proper framing of arguments, presentation of vivid supporting evidence, and the effort to find the correct emotional match with your audience.

Since physicians control upwards of 80% of clinical costs and directly, and indirectly, impact quality and outcomes of care, care managers must appeal to them by helping them to see how they can get from here to there, by establishing some credibility and by giving them a reason and assistance to get 'there'.

Generally, when we’re trying to persuade others, we use a relatively straightforward process.  First we state our position.  “Doctor, the care you’re prescribing for this patient might be better delivered in an outpatient setting.”  Second, we outline the supporting arguments.  “The patient may be at risk for the cost of this care, depending upon his insurance benefits, and may suffer an avoidable adverse event if they unnecessarily remain in the hospital.”  Finally, you use assertive, personal enthusiasm to advocate for the patient and help the physician see the light.  

If you're not achieving success to advocate for your multiple stakeholders, but expecially the patient, there may be a better way to approach the problem but it takes preparations. Care managers must learn more about their audience’s opinions, concerns, and perspectives.  They have to invite the physicians to discuss their issues and even debate your position and offer honest feedback and suggest alternative solutions. The case manager must test and revise ideas in concert with the physician’s concerns and needs. Yes, successful persuasion demands compromise.  When physicians see that the care manager is eager to hear their views and willing to make changes in response to their needs and concerns, they generally respond very positively.  They trust the care manager more and listen more attentively. They see the care manager as flexible and are thus more willing to compromise themselves.  Because this is such a powerful human dynamic, effective care managers enter the persuasion process already prepared with judicious compromises.  

Many years ago in the Harvard Business Review, Jay Conger suggested that “there’s just as much strategy in how you present your position as in the position itself.” Here are four essential steps he discussed in the article.   

  1.  Establish credibility.  A care manager cannot advocate a new or contrarian position without having the physician wonder; Can I trust this individual’s perspectives and opinions?  Such a reaction is understandable.  In the hospital setting, credibility grows out of two sources:  expertise and relationships.  Care managers are considered to have high levels of expertise if they have a history of sound judgment or have proven themselves knowledgeable and well informed about their proposals.
  2. Frame a common ground.  Even if your credibility is high, your positon must still appeal strongly to the physician. Care managers must be adept at describing their positions in terms that illuminate their advantages.  Ask any parent and they’ll tell you that the fastest way to get a child to come along willingly on a trip to the grocery store is to point out that there are lollipops by the cash register.  That is not a deception.  It is just a persuasive way of framing the benefits to taking such a journey.  In the hospital, framing is obviously more complex, but the underlying principle is the same.  We often refer to framing as the WIIFM proposition…what’s in it for me?
  3. Provide evidence.  With credibility established and a common frame identified, persuasion becomes a matter of presenting evidence. Sure, having data to support your position but of greater importance is the language use to make your case.  Supplement data with examples, stories, metaphors, and analogies to make your position come alive.  The use of language paints a vivid word picture and in doing so, lends a compelling and tangible quality to the care manager’s point of view.
  4. Connect emotionally. In the world of healthcare, we like to think that our colleagues use reason to make their decision, yet if we scratch below the surface, we will always find emotions at play. Good persuaders are not afraid to show their own emotional commitment to the position they are advocating.  If the care manager is committed to advocating for the patient and is questioning the value of another diagnostic test for a terminal patient, then they have to show that their commitment is not just in their mind but in their heart and gut as well.  Equally important is that the care manager has a strong and accurate sense of the physicians’ emotional state and is able to adjust to tone and their arguments accordingly.  The important point is to match your emotional fervor to your audiences’ ability to receive the message.

As the patient’s and family’s primary advocate, the care manager's ability to persuade the physician and the healthcare team can be a force for enormous good.  It can pull the care team together; move ideas forward, galvanize change, and forge constructive solutions.  As marketplace contingencies continue to shift, the care manager’s commitment to persuasion is more necessary than ever.