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Emotional Intelligence Skills for Maintaining SocialNetworks in Healthcare OrganizationsBrenda Freshman a & Louis Rubino ba University of California School of Public Health, Health Services Department, Los Angelesb California State University Health Sciences Department NorthridgePublished online: 07 Aug 2010.

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The Importance of Social Networks inHealthcare Today

In today’s healthcare industry, the importance ofsocial networking cannot be stressed enough. Argu-ments have been made that social networks func-tion as social capital (Coleman 1988). Whether themanager or leader is forming relations internally orexternally, cooperative associations are key to thesuccess of the individual as well as the organization.

Henry Mintzberg’s (1973) seminal study onmanagerial work revealed that managers spendmuch of their time in a liaison role. The managersstressed the importance of disseminating and mon-itoring information among co-workers. In addi-tion, whereas managers viewed their behaviors asplanned, rational, and controlled, Mintzberg foundreactive oral communication and disconnectedinteractions to be more the order of the day. How-ever, these daily interactions are the conduitsthrough which social networks are formed; socialnetworks are either strengthened or weakened bythe quality of these communications.

Collaborative relationships are more likely thanantagonistic ones to produce better services, sharedcapital, increased economies of scale, and expandeddatabases. All of these are elements that are viewedas essential in a competitive environment (Coile1998). Furthermore, for a health center of any type

Abstract. For healthcare organizations to survive in theseincreasingly challenging times, leadership and managementmust face mounting interpersonal concerns. The authorspresent the boundaries of internal and external social net-works with respect to leadership and managerial functions:Social networks within the organization are stretched byreductions in available resources and structural ambiguity,whereas external social networks are stressed by interorgani-zational competitive pressures. The authors present thedevelopment of emotional intelligence skills in employees asa strategic training objective that can strengthen the internaland external social networks of healthcare organizations.The authors delineate the unique functions of leadershipand management with respect to the application of emo-tional intelligence skills and discuss training and futureresearch implications for emotional intelligence skill setsand social networks.

Key words: emotional intelligence, social networks, interper-sonal skills, management, leadership

e present concepts to inform andmotivate healthcare professionals todevelop emotional intelligence (EI)

skills to strengthen their social networks. In thisarticle, we provide an introduction to social net-works in healthcare as well as definitions of EI. Weunderscore the application of EI skills to enhanceand manage social networks of healthcarethroughout the article, and we describe differencesand similarities with respect to management ver-sus leadership functions. We also review implica-tions for training and leadership development.

Brenda Freshman is an adjunct assistant professor in the School of Public Health, Health Services Department, at the Universityof California, Los Angeles. Louis Rubino is an associate professor in the Health Sciences Department at California State

University, Northridge.

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Emotional Intelligence Skills forMaintaining Social Networks inHealthcare OrganizationsBRENDA FRESHMAN and LOUIS RUBINO

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HOSPITAL TOPICS: Research and Perspectives on Healthcare 3

to be successful, it must reach out to the commu-nity. Large external networks are at times consid-ered difficult to manage, but the goodwill, thepolitical will, and the resources they bring to theorganization make the benefits far outweigh thecosts (Weil, Bogue, and Morton 2001).

What comprises a social network? Specific bound-aries vary in the literature and research. Carroll andTeo (1996) looked at two types of social networkswhile investigating differences between managersand nonmanagers: (a) organizational member net-works and (b) core discussion networks. In theirstudy, organizational member networks includedonly formal ties to the organization and based mem-bership on job position and function. Core discus-sion networks consisted of the individuals withwhom a person discussed vital and sensitive matters.This research indicated that the social networks ofmanagers and nonmanagers do differ. In organiza-tional membership networks, managers showedbroader scope and were more likely to belong tosocial, professional, and service clubs. Furthermore,the core discussion groups of managers were largerand contained more intimate ties when comparedwith those of nonmanagers. Carroll and Teo con-cluded that managers’ work is essentially interactive.

Other social network assessments in researchinclude collecting data by means of listing organi-zation members and asking each employee to keeptrack of frequency of conversation and depth ofrelationship (Labianca, Brass, and Gray 1998).Money (1998) suggests that one use variables ofclique formation and centrality when looking atmultilateral negotiations in social networks.Clique formation can be used to measure strengthof ties between subgroup members within a largerorganizational context. Centrality looks at thestrategic place of an individual within a network.One can measure this in three different ways: (a)degree (the number of ties in the network betweenindividuals), (b) closeness (the sum of the fewestnumber of contacts between an individual andeach person), and (c) betweenness (the frequencywith which an individual acts as an intermediarybetween pairs of others in the network).

When one is developing a social network analy-sis for a specific organization, one must give con-sideration to multiple ingroup and outgroupmemberships as well as logistical practicalities ofdata collection and validity. Figure 1 depicts astakeholder model to provide clarity on the demar-cations of the internal and external social networks

Vendors

AccreditingAgencies

Public Agencies

Strategic Partners

FinancialStakeholders

CommunityGroups

Media

Patients

Management/FocusInternal Social Network

Professionals

Internal Stakeholders

External Stakeholders

Operations

Administration

FIGURE 1. Boundary delineations of internal and external networks with leadership and manage-ment focus (double arrows represent continual interactions between all elements of the model).

LeadershipFocus/External social

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in healthcare organizations. The internal socialnetwork is composed of all the people who are for-mally employed by the organization. This includesprofessional staff (e.g., nurses, doctors, and clini-cians), operational staff (e.g., housekeeping, build-ing maintenance, cooks, and food servers) andadministrative staff (e.g., managers, directors, andadministrators). The external social network iscomposed of all the members of the organizationwho have direct contact with people not employedby the organization as a central part of their joband those people with whom the employees areinteracting.

Note the distinction of internal and externalnetworks and the differences in leadership andmanagement focus. These specific differences arediscussed later in the article. The point to be madehere is that members who hold different functionswithin organizations will also hold different func-tions in the network, although not always relatedto formal position. For instance, employees withhigh charisma and low authority may be central tokey networks.

Application to HealthcareHealthcare executives need to form good rela-

tions within the organization to stay betterinformed and to bring a depth and richness totheir careers (Ross, Wenzel, and Mitlyng 2002).

Personal and interpersonal skills need develop-ing to allow the individual to comfortably createthese relationships. These skills are recognizednationally as the most important competenciesneeded by graduates of healthcare administrationprograms to be effective managers (Davidson et al.2000). Longest (1998) states that interpersonalcompetence for senior managers is the knowledgeand ability to articulate their visions and prefer-ences, to motivate people to communicate ideas,to handle negotiations, and to manage conflicts. EIcan provide the framework to create such compe-tencies and thus aid in the forming and strength-ening of internal and external social networks. Inturn, stimulating the growth of EI skills canstrengthen a healthcare organization’s internal andexternal social networks.

The Evolution of Emotional Intelligence:A Brief History

It is not hard to imagine that as long as humanbeings have been conscious, we have been trying tofigure out how to feel better and get along with

each other. Written history has documented wordsof wisdom on these topics through time. The dis-ciplines of philosophy (such as that espoused byAristotle, Sir Thomas More, and William James),religion, science, fiction, and nonfiction are exam-ples of humanity’s continued attempts to improveupon civilization. Thus, the basic societal drivetoward understanding the intelligence of our emo-tions can be traced back a long way.

With the birth of the field of psychology and thelater expansion of scientific methodologies,researchers could begin to focus more formally oninterpersonal skills. In 1937, psychological resear-chers Thorndike and Stein began to describe andevaluate “social intelligence.” In the 1940s, DavidWechsler (1940) wrote about “intellective” and“non-intellective” intelligence, referring to the tradi-tional IQ set of skills and the social emotional set ofskills, respectively. The nonintellective skills weredescribed by Wechsler as psychological skills havingto do with attitude, behavior, and change. Through-out the decades, issues such as trust, respect, andwarmth (Hemphill 1959), as well as self-actualiza-tion (Shostrum 1965), personal adjustment (Steckand Bass 1973), and self-assessment (Boyatzis 1982),to name only a few, have been investigated as personal and managerial competencies. In 1983,Gardner introduced the idea of “multiple intelli-gences” with “interpersonal” and “intrapersonal”components.

Salovey and Mayer (1990) later began specifi-cally discussing EI as four hierarchical abilities: (a)the accurate perceiving, appraising, and expressingof emotions; (b) the generating of feelings ondemand when they can facilitate an understandingof oneself or another person; (c) the understandingof emotions and the knowledge that can bederived from them; and (d) the regulating of emo-tion to promote emotional and intellectualgrowth. A more recent report issued by The Con-sortium for Research on Emotional Intelligence inOrganizations represented emotional intelligenceas “about two dozen social and emotional abilitiesthat previous research has shown to be linked tosuccessful performance in the workplace. Theseabilities are grouped into five core areas: self-awareness, self-regulations, self-motivation, socialawareness, and social skills” (Cherniss 1998). Forthe purposes of this article, the five EI skill cate-gories are delineated as (a) self-awareness, (b) self-regulation, (c) motivation, (d) empathy, and (e)social skills. Healthcare requires administrators

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with high EI. Many of the daily duties performedby the healthcare manager or leader can be classi-fied under the five EI skill categories (See Table 1).How the manager completes those tasks will beshaped by the person’s EI abilities.

Differences Between Management andLeadership Functions

The EI skills described here are beneficial forboth healthcare managers and leaders. There hasbeen much discussion on the differences betweenmanagers and leaders (Kerfoot 1998). It seemswidely accepted now that there are distinct differ-ences in the roles played by managers versus lead-ers in any business. Some managers lead; some donot. Some leaders manage; some do not. It is amatter of which behaviors are exhibited to fulfillthe job requirements at the time. Leadership andmanagement are two distinct yet complementarysystems of action. According to Kotter (1990),management is about coping with complexity.Leadership, by contrast, is about coping withchange.

Zimmerman (2001) makes some distinctionsbetween the two roles as well. Leaders are vision-aries (set future direction), collaborators (developcorporate culture by working with people insideand outside the organization), salespeople (moti-vate to obtain employee buy-in), and negotiators(make the tough decisions while balancing con-flicting priorities). Managers are more like cap-tains (ensure the team is operating efficiently),analysts (gather information to make educateddecisions), conductors (balance individual,departmental, and organizational goals), and con-trollers (monitor results, trends, and resources).Zaleznik (1977) writes of a “managerial mystique”that perpetuates the development of people whorely on and strive to maintain orderly and stablework patterns. People yearn for leaders who candemonstrate some risk-taking behavior and takecharge at critical moments. When all things areconsidered, though, both leadership and manage-ment require one to interact with people; thus theimportance of personal and interpersonal skills isapparent for each.

TABLE 1. Administrative Activities in Healthcare as Classified in the Five Emotional Intelligence (EI)Skill Categories

Examples of healthcareEI skills set Definition administration application

Self-awareness A deep understanding of one’s emotions and drives • Decisiveness• Issues about control• Personal assessment• Burnout/workaholism• Personal value/self-worth

Self-regulation Adaptability to changes and control over impulses • Ethical behavior• Temper/patience• Favoritism/nepotism• Multi-tasking/time management• Objectiveness

Motivation Ability to enjoy challenges and to be passionate toward • Being positivework • Counter downsizing/cutbacks

• Organizational culture concerns• Emphasizing cost controls• Employee/physician meetings

Empathy Social awareness skill: the ability to put oneself in • Bioethical issuesanother’s shoes • Patient centeredness

• Patient/family interventions• Employee problems• Employee Assistance Programs

Social Skills Supportive communication skills: abilities to influence • Negotiation techniquesand inspire • Being attentive

• Personal evaluation• Figurehead role• Governing board/committee relations

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Managers typically focus more on relationshipsin the internal network between employees. Lead-ership responsibilities tend to deal more with theexternal boundaries of the organization, and there-fore the social relationship networks formed out-side the organization become more critical to lead-ers. Thus, although managers often lead andleaders often manage, for the purposes of EI train-ing in the healthcare organization, we look at lead-ership and management as distinct functionalroles. It is likely that both these functions will bepracticed at some time by all employees.

When people are learning and applying any newskill, their motivation and success increase withrelevance. Hence, we have to take into considera-tion the employee’s organizational context (includ-ing but not limited to formal and informal rolesand relationships, organization climate, and indus-try norms). Therefore, although the skill setapplies to both leaders and managers, Table 2 dis-plays distinctive examples that can lend clarity andrelevance to the concepts.

Development and Training ImplicationsOn the basis of the premise that an effective train-

ing program must involve a match between employ-ee function and the skills to be learned, trainingdevelopers could benefit from an expanded visionby using employee-relevant examples. By usingstakeholder models that include a social networkcomponent, developers can better target training

needs and design better methods of delivery. Forexample, using a leadership frame to look at how EIskills are applied in external social networks andusing a management frame for examples of EI ininternal social networks will customize the learningexperience for organization employees. Table 3 illus-trates how each of the five EI categories can beapplied in managerial and leadership social net-works.

Figure 1 and Table 3 are presented as examplesof places to begin a social network audit. Mappingout an analysis of internal and external networkrelationships for each managerial and leadershiprole will be a sizable task, but one that could great-ly expand the understanding of the flows of socialenergy in your organization. Facilitators of EItraining programs will be able to use theirenhanced perspective in several ways.

First, when selecting case examples, developerscan make choices that fulfill the needs of theirspecific audiences. For instance, if the training isconducted in a hospital, one could train the vari-ous first-line supervisors as a cohort. By using realexamples of daily interdepartmental interferences,one can help meaningful problem solving to takeplace, thus providing the opportunity for a doublebenefit—teaching by practical example and solv-ing workplace challenges. As a case in point, anadmitting manager and the surgical supervisorcould both relate to a case example that is broughtup involving surgery start time.

TABLE 2. Examples of Emotional Intelligence (EI) and Its Application to Healthcare Managerial andLeadership Functions

Managerial applications Leadership applicationsEI skills set in healthcare in healthcare

Self-awareness—a deep Having confidence in making Having confidence when speakingunderstanding of one’s emotions decisions about operations in publicand drives

Self-regulation—adaptability to Considering ethics of pay raises Considering ethics of disguisingchanges and control over impulses for favorite employees payments for referrals

Motivation—ability to enjoy Driven by being a pragmatic Driven by having people look upchallenges and to be passionate manager to youtoward work

Empathy—social awareness skill, Getting involved in patient Setting a patient-centered visionthe ability to put oneself in bioethical issues for the organizationanother’s shoes

Social skills—supportive Good listening skills during Having an excellent rapport withcommunication skills, abilities to employee discipline meetings governing board membersinfluence and inspire

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Second, when reviewing specific skills such asself-reflection, the instructor can apply the skill atthe appropriate level of intervention in a suitablecontext. In this case, managers might be asked toreflect on a recent confrontation with an employeethat caused an increase of tension in the work envi-ronment. With the use of an internal social networkanalysis, the effects of this interaction can be viewedat multiple levels within the work group (i.e.,intrapersonal, interpersonal, group, department,etc.). Another example would be how differentmanagement levels react to a downsizing mandate.

When facilitating leadership, one might presentskill learning in terms of reflecting on the leaders’internal sources of vision and motivation through-out their external social network. Perhaps variousexternal stakeholders could be imagined and aleader would be asked to reflect on how eachstakeholder might accept a particular communitybenefit project. Regardless of the particular sce-nario, solutions at each level (intrapersonal, inter-personal, group, organization, and community)can be greatly assisted by a network analysis.

The third, perhaps most evident, benefit of con-ducting a social network analysis is the subsequentclarity one gains by analyzing a situation frommultiple perspectives. Similar to the continuousquality improvement programs that have blos-

somed in healthcare organizations over the past 20years, success will come to those programs thatinclude the input of all parties involved in theprocess being examined.

Managers’ ImplicationsToday, managers and leaders must develop a social

network to be successful. Reichheld (2003) reportsthat superior leaders create networks of mutuallybeneficial trust-inspiring partnerships. Maintainingand growing those networks can be crucial to anorganization’s and an individual’s success. StanleyBing lightheartedly wrote in a recent Fortune articlethat “the new CEO will understand that the basis ofall good business is making and keeping friends, andwill therefore be a pleasure to meet, greet, and go tothe bathroom next to” (Bing 2002).

Astute healthcare executives recognize the need tofocus on a skill set such as EI to build strong socialnetworks. Three ways to demonstrate this EI abilityare (a) through developing a strong internal net-work and using it to gather information from peo-ple in the know; (b) by developing internal relation-ships that are broad based and with one’s peers,senior leadership, board, and staff; and (c) by build-ing external friendships that are long lasting andbased on respect and shared success. Developingstrong social networks adds value to an organization

TABLE 3. Emotional Intelligence (EI) Skills and Managerial Applications in Internal Networks andLeadership Applications in External Networks

Managerial applications Leadership applicationsEI skills set internal network focus external network focus

Self-awareness—a deep Ability to recognize personal Confidence in decision making,understanding of one’s emotions emotional triggers in self and awareness of value differences andand drives others similarities between self, health

system, and other entities

Self-regulation—adaptability to Remaining calm and focused when Confidence and poise in changes and control over impulses confronted with anxiety and upsets negotiations with vendors

in direct reports

Motivation—ability to enjoy Acknowledging what brings you to Keeping in touch with an inspiringchallenges and to be passionate work each day, how you, your job, vision that is communicated to alltoward work and your employees function in the organization stakeholders

bigger picture

Empathy—social awareness skill, Building trust and understanding Understanding the larger effect topthe ability to put oneself in within a department or functional management decisions can have onanother’s shoes domain all social networks in involving the

organization

Social skills—supportive Employees who are satisfied with Building and strengthening keycommunication skills, abilities to feedback and understand and act to relationships with external powerinfluence and inspire complete organizational objectives resources

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and helps executives secure their position duringthese times of increasing competition and perfor-mance requirements (Broscio and Scherer 2003).

Emphasis is placed today on healthcare man-agers’ having more control over their own careers(Patterson 1998). With so many changes takingplace, many executives have been displaced. Hav-ing a well-developed social network could not onlyhelp people find their next position but also mightbe beneficial to a new organization and thereforeprovide an incentive to being hired. Building effec-tive EI skills allows managers and leaders to con-tinually maintain their social networks. Masterfulpractice will allow the administrator to greet newchallenges with a more relaxed presence and confi-dence (Sperry 2003).

Future Empirical and Strategic ImplicationsWe present this article as a starting point for fur-

ther discussion, research, and application on thedevelopment of EI skills and their influence onsocial networks. Topics of much needed empiricalstudy are ubiquitous with respect to EI skills gen-erally, and specifically concerning their use andeffectiveness in healthcare systems. Investigationsusing both quantitative and qualitative techniquesare encouraged to allow for a more comprehensiveview of the data. Studies such as those looking atthe effects of an EI training program on validatedmeasures such as organization culture, customerservice, and employee satisfaction would furtherthe knowledge base in the application of EI skillson the job in the healthcare environment.

We present the use of stakeholder models as abasis for social network audits as a tool for prepar-ing for EI training efforts. We encourage consul-tants and practitioners to modify and extend thetools provided here to best fit their situationalneeds. Employees at all levels could benefit by map-ping out the internal and external social networksassociated with their job functions. This type ofexercise would provide information on which indi-viduals could reflect with regard to the effects oftheir behaviors and moods on their social networks.

Summary Healthcare organizations would be wise to

incorporate an EI training program for their man-agers and leaders. Equally important is for thedevelopers of those programs to take into accountthe specific needs of the different members of theirtraining audience. The example we worked

through here was between managers and leaders,yet a social network analysis could be drawn forany functional member of an organizational unit.Beyond the scope of this article, yet critical tomention, is that the tailoring of any EI develop-ment program should directly involve employeeparticipation. Comprehensive and appropriateneeds assessment techniques should be used.

A few select healthcare facilities have incorpo-rated programs that emphasize the EI skills set(Grossman 2000), but these are not common-place. Nevertheless, healthcare entities are con-cerned with the skills being taught to the prospec-tive healthcare leaders and managers and arepushing for some type of competency assessmentfor all new graduates (Association of UniversityPrograms in Health Administration 2001). Thecompetencies stressed through EI should betaught not only to our current healthcare execu-tives but also to our future healthcare administra-tors. A recent review by graduate directors of suchprograms showed that there was a clear need tohave students develop improved human relationsskills (Anderson et al. 2000). Competency assess-ments are being discussed at the level of theNational Health Administration Education Asso-ciation (Hudak, Brooke, and Finstuen 2000;Wright et al. 2000), and therefore the timing isgood to bring EI training to both the classroomand the workplace.

Once the value of EI is understood and applied,the competencies developed are sure to benefitboth internal and external social networks. Thesenetworks will play a part in having a favorableeffect on such external dealings as accreditation,managed care contracting, and collaborationbetween one-time competitors. Internally, havingmanagers and leaders with good EI skills will boostteam productivity (Barth 2001) and increase orga-nizational effectiveness (Goleman 2000)—twoconditions that are desperately needed in health-care today. In any case, managers or leaders whoallow themselves to become more emotionallyintelligent, and thus enhance their social networks,will improve not only their own personal qualitiesbut also those of their organization.

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