Advisory Law Group

Published in Anesthesiology News
March 2011

The water was deep and dark as the scuba divers were about to jump from the boat’s stern (divers—not diver—because of the buddy system). They knew to never dive alone.

Yet, if you are like most anesthesia group leaders, you don’t think twice about attending—alone—a meeting or negotiation session with two or more hospital administrators. Wait; you, too, need a buddy.

A flashback to college: You are taking Psychology 101 and are required to “volunteer” as the subject for a psychology experiment. You step into a room with a group of four other students. The researcher tells you that a series of posters will be shown one at a time, each poster displaying a number of dark lines, and that each of you is to announce which two lines are the same length. You are sitting in the fifth position and will be asked for your response last.

At first, it’s obvious to you and your fellow participants which two lines match. But then, after a few minutes, the other students begin “matching” another set of lines, lines that you see as completely mismatched. What match do you announce?

Of course, the other four students are confederates of the researcher and, in this experiment of the type first conducted in 1951 by Prof. Solomon Asch at Swarthmore College, they were purposely answering incorrectly to see if others would, too. In the Asch experiment, about 33% of responses given by the subjects conformed to the erroneous pronouncements of the confederate group. And 75% of the participants agreed with the “mistaken” position of the confederates some of the time.

Many anesthesia group leaders view themselves as rugged individualists. You’ve worked hard to get where you are today and you’re pretty sure—no, convinced—that you have a strong personality. You would never fall sway to group pressure, especially manipulative group pressure.

Although that might be true in connection with situations in which you hold obvious power, such as when chairing meetings of your own group, the Asch experiment indicated that, as in scuba diving, there is a lack of safety when outnumbered by the circumstances, even if you know that the others are wrong.

After querying the subjects who sided with the confederates, Prof. Asch discovered several categories of explanations. Some said that they themselves were wrong and that the others were right, so they agreed. Others said they went along with the incorrect answer in order “not to spoil the results.” Some said that even though they knew that the others were wrong or acting like sheep, they could not stop themselves from agreeing, too. Finally, some said that they saw their disparate view as a sign of deficiency that they must hide.

Note that the Asch experiment did not single out weak subjects. Prof. Asch found that in a two-person “group” of one confederate and one real subject, the subject was not affected to any real degree by the confederate’s manipulation. With a ratio of two confederates to one subject, the subject agreed with the erroneous viewpoint close to 14% of the time. But add just one more confederate to the mix—three confederates to one subject—and the subjects’ conformity rate more than doubled to almost 32%.

Practical Lessons

Let’s go back to your meeting with hospital administration: If it’s to be one on one with the CEO, and assuming you have a strong personality, there is relatively little danger in being swayed against your will. Consider, however, that most senior hospital administrators are well versed in a range of persuasion techniques and have daily practice in deploying them; you probably do not.

Many hospital administrators know better than to meet alone; they love team meetings—their team, of course, with you present. Want to discuss acquiring new intubation equipment? “Fine,” says the CEO. “Meet with me at 4:00 and I’ll have the COO, the CFO and the OR director attend so that we can get their input.”

Prof. Asch discovered that having even one truthful partner—a buddy—accompany the subject depleted the majority of most of its power.

Before diving into the next meeting with any opposition party, bring along a buddy. In fact, make the buddy system your group’s regular meeting paradigm, but prepare ahead of time to make sure that your buddy is going to agree with you no matter what. The buddy must understand that the meeting is not an open discussion; his or her presence is to support, in lockstep fashion, your position.

Better yet, attempt to design encounters that stack the “Asch” odds in your favor. When invited by an administrator to a one-on-one meeting, bring along one or two colleagues to create positive group pressure.

Or, go all the way: Invite the administrator to your department meeting and push for agreement then and there.
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Mark F. Weiss is an attorney who specializes in the business and legal issues affecting anesthesia and other physician groups. He holds an appointment as clinical assistant professor of anesthesiology at USC’s Keck School of Medicine and practices with the Advisory Law Group, a firm with offices in Los Angeles and Santa Barbara, Calif. He can be reached by email at markweiss@advisorylawgroup.com and by phone at 800-488-8014.