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Understanding Influence: Ethical Sales Skills for Healthcare Professionals

Increased competition and shrinking reimbursement are two sides of a vice squeezing healthcare and senior care professionals pressured to fill beds their buildings. The temptation is greater than ever to say the one statement that will close the deal and influence the consumer to choose your facility. Where is the line between good sales skills and unethical behavior?

There is no simple answer to apply to the myriad of complex situations faced daily by healthcare professionals and others working with referral sources, prospective consumers and their families. Codes of Ethics provide general guidelines, which act as a reminder of the goals and purposes of elder care providers, but practical advice about handling common situations is lacking. As buyers as well as sellers of goods and services, we are all influenced, knowingly or unknowingly, by various psychological factors that affect our purchasing decisions. Understanding influence and how it can be used effectively and ethically can direct our decisions when interacting with clients.

According to Webster, influence is the “power of persons or things to affect others, seen only in its effects”. Indeed, healthcare professionals are in the business of exercising power over individuals and families to affect the decision to utilize a particular facility, product or service. There is nothing inherently sinister about exercising power to influence decisions provided that the influencing is done fairly and without deception. Influence can simply be a matter of putting your best foot forward, presenting your community and services to a consumer in a way that will influence that person to select your facility above the competition.

In his book, Influence: The Psychology of Persuasion, Robert Cialdini identifies seven rules of influence, all of which can be applied effectively and ethically. Understanding the principles of contrast; reciprocity; scarcity; authority; consensus; commitment/consistency; and friendship/liking can assist senior care professionals engage in intelligent sales skills. While the concepts discussed can apply in any sales setting, the examples presented focus on the relationship between the senior care professional presenting the senior living community and the prospective consumer and his or her family.

Contrast: Changing Perception Based on Immediate Prior Experience

First impressions can only be made once. The first impression can be used to influence the person’s overall perception of the community and set the stage for the buying decision. Whether your facility is an assisted living or skilled nursing community, begin by showing every prospective client the most expensive and most attractive room. After seeing the best first, other rooms will not compare well and, if the person can afford it, will want the best the community has to offer. If the person cannot afford the number one unit or room, then the other, less expensive rooms will appear to be a bargain by contrast yet the person will know that he or she is part of a “good neighborhood”.

Reciprocity: Obligating Behavior by Giving Back the Same Type of Behavior

By behaving towards a prospective consumer in a particular way, we can influence her to reflect our behavior and mirror it back to us. For example, remember that the overwhelming number of healthcare and senior care decision-makers is women. When showing a facility to a woman, begin the tour by giving the person a flower. The flower is a gift, a Thank You for taking the time to visit the facility. A gift generally creates a sense of obligation in the recipient. The person’s desire to give back to you may take the form of the person’s complete attention, favorable comments made later to third parties, or enrollment of the family member. Understand that you are creating a sense of obligation and use it wisely. If the person gives you her undivided attention, make sure what you are saying is worth listening to, otherwise you will have wasted an opportunity.

The flower itself endures while the memory of the visit is fresh in the person’s mind. It will also foster conversation from third parties and will give the person an opportunity to talk about your facility. “Where did you get that lovely flower?” “At a beautiful assisted living facility I went to visit with my daughter”. Reciprocity delivered.

Scarcity: Motivation by the Possibility of Losing a Benefit

People are more motivated by what they might lose than by what they might gain. For some sectors of the healthcare industry, scarcity exists and need hardly be pointed out to consumers. Facilities with high occupancy rates are a real issue for elderly males and those with Alzheimer’s and related dementias. What can be done for those facilities that are struggling with low occupancy rates?

While a facility may be almost empty, certain steps can be taken to make the building seem more full. Many senior living communities have small commercial spaces such as community rooms or halls that can be rented out to community groups for a variety of reasons such as personal fitness classes, seminars, or social functions. Having more people in and around the facility doing things that are fun gives the impression that census is better than it may be.

Take a look at the physical presentation of your facility. Is everyone parking in the lot behind the building because it is closer to the entrance leaving the front lot disserted? Have people park in front of the building to give the impression that parking is limited because the facility is full.

As long as the actual census is not misrepresented, there is nothing wrong with rearranging the window dressing to make the facility look fuller than it really is. If people think the facility only has a few spaces available, they will not want to be left out.

Authority: Encourage the Response to Comply with Authority Figures

Anyone who has ever seen a doctor understands the response that the figure in the white coat evokes – compliance with what the doctor says. Other authority figures create the same Pavlovian response. Experts usually do know more about a particular subject than laypersons do so we rely on their expertise in making our decisions. A wise exercise of influence is to emphasize the ways in which your facility and staff are authority figures.

The message to send to the community at large is that independent authority figures recognize your facility as outstanding. Promote and communicate affiliations with organizations and agencies such as AHCA, ASHA, ALFA, CARF and JCAHO by listing them on your letterhead, brochures, newsletters and other documentation. When a new affiliation is entered into or accreditation achieved, announce it in your newsletter and in a press release.

To communicate the professionalism of your staff, make sure that people display their degrees, diplomas, certificates and other credentials on their office walls or areas visible to residents or prospective consumers. As authority figures, healthcare professionals can influence consumers by encouraging reliance on their advice.

Consensus: Decisions Influenced by the Decisions of Others

Consumers base decisions on what other consumers are doing. If one restaurant is hot and trendy, then everyone wants to eat there. The same principle applies in healthcare. When tied together with the idea of scarcity, consumers can be influenced to select your facility over the competition simply because everyone else is making the same choice.

Even if census is a problem, the message can be conveyed to prospective consumers that your facility is the hot place to be. For example, plan facility tours during, immediately before and after well-attended events. People get caught up in the excitement of preparing for a party or the exhaustion of cleaning up after an event. The fun of a party is infectious. Prospective consumers will want to join in because everyone else is having fun.

If your facility has gotten strong results from customer and consumer satisfaction surveys promote that information in newsletters and letters to prospective consumers. People will assume, “If that person is happy then I will be too.”

Commitment/Consistency: Create Barriers to Change

No one likes to be viewed as flighty or contradictory. Once a statement or a decision is made, people will act in accordance with that behavior. This principle can be used very effectively with the concept of authority figures.

For example, Dr. Jones loves referring patients to your facility. With Dr. Jones’ permission, he is featured on the front page of your newsletter indicating that he frequently refers patients to your community because of the high quality of care people receive. This newsletter should be sent to doctors, hospitals, case managers and other referral sources communicating the importance of this relationship and the positive endorsement from Dr. Jones. Make sure Dr. Jones gets copies of the newsletter with his smiling face on the front page so that he can distribute it to his patients.

By linking your facility with Dr. Jones, your staff will work hard to keep Dr. Jones happy and Dr. Jones will continue to be a referral source for your facility. This marriage will be a barrier to both sides to change their commitment to a good relationship.

Friendship/Liking: Saying Yes to Ourselves

People are more favorably inclined to say “Yes” to someone who is similar in terms of age, sex, and social group. It is like saying, “Yes” to ourselves. Fostering ways to identify with the consumer can influence the decision to come to a facility where that person or family member will feel at home.

If possible, select the person to give the facility tour to match the characteristics of the person who is coming to look at the facility. Choose someone from your staff who is the same age, sex, and social group as your prospect. The consumer will feel more relaxed and more open to receive the information about your facility.

Everyone who gives facility tours should be trained in the basic interactive skills of listening and finding ways to identify with the prospect. Ask questions that may unearth similarities such as where the person is from, where they went to school, if they have children, what hobbies they enjoy. Careful listening will give you the connection you need to influence the person to see herself in you.

Influencing decision making in creative, caring ways can improve sales skills and promote the image of your facility. There is no room or need for unethical behavior in applying these principles when interacting with the community. Utilize your power wisely.

Additional Materials:

Code of Ethics:

American College of Healthcare Executives
Center for Health Care Ethics
Healthcare Information and Management Systems Society
American Marketing Association: Code of Ethics


American Journal of Ethics and Medicine
American Journal of Law and Medicine
Journal of the American Medical Association
Journal of Health Politics, Policy and Law
Kennedy Institute of Ethics Journal
New England Journal of Medicine

Influence: The Psychology of Persuasion, Robert B. Cialdini, Ph.D., William Morrow and Company, 1984, 1993.

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