Published: 06/12/2001, Volume III, No. 5784 Page 30
How often do people in lower-level positions in the NHS seek out those at the top and tell them what they really think about what is going on? After years of research, we have concluded - not often.
The reasons are twofold. First, most of us feel intimidated by our superiors. Even when we know more about something than they do, it can be hard to get the words out. But there is another reason. When we are faced with someone of higher status, we habitually exaggerate the extent to which we agree with their opinions as a means of acquiring influence over them - what is called 'ingratiation theory'.
1 One of the world's greatest philosophers summed it up well. Homer Simpson, giving Bart some career advice, counselled him always to look a manager in the eye and say, 'Great idea, boss. '
In the NHS, those at chief executive level and their senior management colleagues, knowingly or otherwise, run across this problem every day. People bring problems to their attention. But they pull their punches, hesitate, and express disagreement over small things, only to restate their agreement more emphatically with bigger things. The fact that the occasional, minor disagreement surfaces simply reinforces the manager's illusion that open and honest communication is the norm. But do not managers recognise what is going on and make allowances for it? The answer seems to be - no.
We have worked with many senior management teams in the NHS. Most of them immediately grasp the importance of ingratiation theory and even provide their own amusing illustrations of how it works. But the catch is that they mostly assume they themselves are exempt from it. The explanation for this is simple. Most of us assume we perform better on various fronts than we actually do. Thus, managers assume they are more approachable than other managers and that their subordinates feel freer to speak their mind than is actually the case.
2The continued belief by managers that what they think they know is accurate has been dubbed 'the boss's illusion'. It means that senior management teams often have an extremely lopsided view of the internal climate in their own organisations.
We have conducted numerous assessments of the communication climate in trusts - what are known as communication audits. Almost always, we find that the only people to be surprised by any problems are the senior management team.
We recently conducted a communication assessment in one European healthcare organisation and reported some modestly critical findings to the top management team. Its unsurprising response was:
To disparage the data and its validity: such denial ensures that organisations persist with courses of action everyone else recognises to be failing.
To subject critical feedback to incredibly rigorous scrutiny, whereas positive feedback was nodded through: several positive findings in our report were accepted as inevitable and accurate.
To re-interpret negative feedback as positive: many interviewees described the senior management team as 'control freaks'. One member of the team immediately responded: 'I see that as a compliment.
All it means is that we have high performance standards. 'The findings meant no such thing. All this prevented the senior managers from acquiring a clear grasp of their problems - and precluded an action plan to address them. The absence of critical feedback may become a vicious cycle, in which:
the group responds by denying a crisis;
Feedback pointing to the crisis is disparaged as coming from tainted sources outside the magic circle of key decision-makers;
those who might offer feedback grow discouraged;
the conviction of those at the top that things are much better than they are, and no outside help is needed, is reinforced. Shipwreck beckons.
So what can be done?
All managers should recognise that ingratiation occurs. Team briefings should cater for upward as well as downward communication.
Positive feedback should be subject to the same critical scrutiny as negative feedback.
Crucially, we need to seek out objective feedback on our organisation's performance.
Demands on the NHS are rising. Dealing with them needs the full engagement of staff at all levels.
Decision-making can no longer be the preserve of a select few at the top. Communication is a critical tool to move the NHS in this direction. Managers can do worse than honestly audit their performance to effect future improvements.
Dr Dennis Tourish is reader and Dr Paul Robson is senior lecturer in management studies at the department of management studies, Aberdeen University.
1Rosenfeld P, Giacalone R, Riordan C. Impression Management in Organisations. Routledge, 1995.
2Hargie O, Dickson D, Tourish D. Communication in Management. Gower, 1999.