“When you make peace with authority, you become authority”
— Jim Morrison

In many professions, making the jump from being one of the staff to being in charge can be a difficult transition. Arguably, there is nowhere that this transition is more challenging than in health care.

One way to success in this transition is accepting that authority is a two-way proposition—acknowledging and respecting the authority of others while gaining acknowledgement and respect of your own authority from those in higher positions.

It always goes both ways no matter where you are in that chain. The leadership transformation from successful clinician and peer to successful leader of, and among, peers is crucial.

Despite all of the positive attributes that made leaders successful in their former roles and drew the attention of others for their promotions to leadership, their effectiveness can be eroded if they don’t become comfortable with their authority and assert it when necessary. This means feeling comfortable setting boundaries and saying “no.” Being able to say no effectively is one of the most important elements in accepting and asserting authority. It doesn’t mean just putting an adversarial foot down and drawing a line on the linoleum, but saying no in positive ways that enhance relationships, improve internal customer satisfaction and benefit the organizations and people involved.

A Resource for Asserting Authority

A good source for this topic is The Power of a Positive No: How to Say No and Still Get to Yes, by William Ury, which I’ve just read. The book is filled with examples of how to say no in positive ways, along with a roadmap for doing so. Ury, director of the Global Negotiation Project at Harvard, has mediated around the world in everything from “coal strikes to boardroom battles to civil wars.” He is an expert at “getting to yes,” which was the title of another bestseller he co-wrote. In this latest book, he explores how saying no is often the best way to get to yes.

“With a negative No you distance yourself from the other,” Ury says. “With a positive No, you do the opposite. You move closer. You seek to stay connected with the other through respect.”

The first challenge is that leaders must be customer-centric. They need to serve the wants and needs of their superiors and colleagues from other departments, all with the ultimate goal of better serving the patient. The other part about that challenge is they need to take care not to be overly customer-centric, bowing to every whim and need of those internal customers to the point that they are over-promising and under-delivering.

New leaders in particular often feel trapped into saying yes to everything to satisfy their colleagues and build a strong customer-centric program. In the long run things may be dropped on them that complicate their jobs and lessen their effectiveness.

Not asserting authority to push back when necessary can result in leaders taking on tasks that stretch the available resources, which can burn out healthcare leaders and their staffs very quickly.

That’s why newly promoted supervising directors need to hone the art of respectfully standing up in a way that shows they are comfortable in their own authority, but without angering, offending, or losing the confidence of, those in positions above them or equal to them.

“All too often, we cannot bring ourselves to say no when we know we should,” Ury writes. “Or we do say no, but in a way that blocks agreement and destroys relationships. We submit to inappropriate demands, injustices, even abuse, or we engage in destructive fighting in which everyone loses.”

Ury says that “no” is equally important as “yes”, and calls it, “the precondition to saying yes effectively.” He says the book’s message is “learning how to assert and defend your interests.”

If new leaders want to be respected they will need to become comfortable with their authority and collaborate with members of other departments. Accepting and asserting authority well helps develop a positive image, which creates good personal marketing that is often overlooked as a priority by leaders. Healthcare leaders must learn how to say no effectively in order to assert and defend the interests of not only themselves but those they lead as well. Saying no effectively demonstrates their authority to those they lead and follow. The respect they gain from their subordinates comes from the feeling that their leader is “looking out for them.”

Asserting Your No

“The essential action in asserting your “No” is very simple,” the author writes. “You are setting a clear limit, drawing a clean line, creating a firm boundary.”

But you are doing it in a way that gets results without ruining relationships. Ury explains that a positive No begins with a Yes!, which is an affirmation of your core interests, proceeds to your No., and then ends with a Yes?, which is an invitation to a positive outcome.

To illustrate how this works, Ury uses the example of a man who confronts his father, who is also his boss, at a family dinner to let him know that this year he will not be working overtime and he will be spending the holidays with his family instead of working. His No gets him to Yes because he used this formula to respectfully stand his ground.

The man told his father his “Yes!” which was that his family needed him so he would be spending the holidays with them. Then he expressed his “No.” which was to tell his father that he would not be working on weekends or the holidays. For his “Yes?” he proposed to create an arrangement that would allow him to spend the time with the family while still getting the necessary work done in the office.

The technique has served me well in my leadership coaching practice. I didn’t realize until I read the book that I had been using this Yes! No. Yes? formula.

As an independent consultant you can easily become overwhelmed by taking on too much work. Nobody wants to turn down good business, but when you overload yourself you take the risk of short-changing your clients on quality.

When a good prospective job comes along with a client, and I need to say no because I would be too busy to do my best, I start not by saying no, but by expressing my “Yes!” in which I might say: “Yes, I would like to work with you, and I have a full workload right now. Can I call you again in three weeks so we can discuss a good time for both of us to start? I would like to work with you immediately and I can serve you better and focus more on you when I allow an appropriate amount of time for each of my clients.”

Then I deliver my “No.” which is “I can’t start working with you until the end of the month.” However, this is tempered by my “Yes?” which might be, “In the meantime, give me your information, spend a little time jotting down what some of your issues and needs are, send them to me, and by the time we talk we will have a good starting point.”

“Because no is the word we use to express our power, the normal tendency is to overdo our “nos,” so they come across as attacking—or to underdo our “nos,” so they come across as weak and hesitant,” Ury says. “The challenge is to get it just right. How can you be assertive without being aggressive?”

There is much more to delivering and following through on a positive no, including how to uncover and unlock these elements, how to deliver them, and the importance of having a backup plan. For the rest though, I recommend that leaders read this enlightening book.