title: Clinicians in management: a qualitative study of managers' use of influence strategies in hospitals.
abstract: BACKGROUND
  Combining a professional and managerial role can be challenging for doctors and nurses. We aimed to explore influence strategies used by doctors and nurses who are managers in hospitals with a model of unitary and profession neutral management at all levels.
  
  
  METHODS
  We did a study based on data from interviews and observations of 30 managers with a clinical background in Norwegian hospitals.
  
  
  RESULTS
  Managers with a nursing background argued that medical doctors could more easily gain support for their views. Nurses reported deliberately not disclosing their professional background, and could use a doctor as their agent to achieve a strategic advantage. Doctors believed that they had to use their power as experts to influence peers. Doctors attempted to be medical role models, while nurses spoke of being a role model in more general terms. Managers who were not able to influence the system directly found informal workarounds. We did not identify horizontal strategies in the observations and accounts given by the managers in our study.
  
  
  CONCLUSIONS
  Managers' professional background may be both a resource and constraint, and also determine the influence strategies they use. Professional roles and influence strategies should be a theme in leadership development programs for health professionals.
authors.affiliation: Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P,O, Box 1089, Oslo NO-0318, Norway. ivan.spehar@medisin.uio.no.
authors.forename: Ivan
authors.initials: I
authors.lastname: Spehar
authors.forename: Jan C
authors.initials: JC
authors.lastname: Frich
authors.forename: Lars Erik
authors.initials: LE
authors.lastname: Kjekshus
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006739:Hospital Administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D009718:Nurse Administrators; D008486:Physician Executives; D024382:Professional Role; D036301:Qualitative Research