Prior to beginning work on this discussion read Hill (2013) “Partnering with a Purpose: Psychologists as Advocates in Organizations,” Cohen, Lee, & McIlwraith (2012) “The Psychology of Advocacy

Partnering With a Purpose: Psychologists as Advocates in Organizations James K. Hill Waypoint Centre for Mental Health Care To ensure that psychological issues are on policymakers’ agenda, psychologists often focus pro- fessional advocacy efforts in the political and social realm. Psychologists working in organizations, however, also have a role in ensuring that professional issues rise into the consciousness of organizational decision makers. In an era of health care reform, the advent of program-based management, limited resources, and managed care, psychologists are under increasing pressure to show their worth inside organizations and often have limited ability to communicate with organi- zational leaders. Psychologists typically report to nonpsychologists who may have only a general understanding of what psychology offers and can often misunderstand requests from psychologists about patient care alternatives, time for research, ability to present at conferences, and so forth.

Advocacy is one avenue for increasing effective communication of psychologists’ perspectives and interests that can serve to educate leaders about the value of psychology and how to best use psychological expertise. A major benefit of organizational advocacy is learning advocacy skills in a known environment, which can then be transferred to broader social advocacy. The article discusses the development of advocacy skills in organizations and suggests possible advocacy activities that are consistent with the professional role. It is argued that clarity of the message and partnering with decision makers are important as psychologists advocate for the role of psychology in service delivery.

Keywords:organizational advocacy, professional psychology, collaboration, communication Psychologists do not do a good job at advocating (Fox, 2008), and they certainly do not advocate as well as other professions (DeLeon, Loftis, Ball, & Sullivan, 2006;Lating, Barnett, & Hororwitz, 2010). This argument is the theme in almost every article that discusses professional advocacy within the disci- pline. Myriad reasons are put forth that explain why psychol- ogists do not promote, or even defend, our discipline. Lack of time, lack of training in/understanding of advocacy, no guar- antee of success, or finding professional satisfaction in other elements of the role may all partially explain psychologists’ disinterest in advocacy. Another barrier that may thwart many psychologists is that social advocacy seems so monumental that it is easier to focus on more familiar tasks. Most professional associations have some form of advocacy committee, but psy- chologists may not have the time or organizational support to join such groups. Advocacy within the workplace offers aninitial step for psychologists who want to promote their disci- pline but are daunted by the unfamiliar territory of political advocacy (i.e., lobbying government, political contributions).

By working with partners and promoting a clear message, psychologists in organizations can present their issues to deci- sion makers.

Advocacy is a process of communicating benefits and ensur- ing that policymakers can access high-quality information.Fox (2008)definedadvocacyas “the use of political influence to advance the profession through such means as political giving, legislative lobbying, and other active participation in the po- litical decision-making process” (p. 633). Often the goals are to influence social policy funding and decision making that relate to issues core to the practice of psychology. Other efforts might be to highlight research findings applicable to public policy.

Finally, advocacy may simply involve collaborating with others to better meet common goals.

In the workplace, psychologists can refine advocacy skills in an environment that builds on already established positive relationships that are part of their professional role. This is especially true in organizations in which psychologists are not supported by a departmental model but are simply another professional on the team. There may also be an immediate and tangible benefit to advocacy efforts by an increased potential of seeing one’s actions effect change. Once psychologists hone their advocacy skills within a familiar workplace environment, these skills can generalize to political and social advocacy. This article highlights the importance of organizational advocacy in developing skills to promote the profession of psychology as essential to effective client care.

This article was published Online First July 15, 2013.

J AMES K. H ILL earned his PhD in psychology from the University of Saskatchewan. He currently works at Waypoint Centre for Mental Health Care and has previously worked in independent practice, hospital, com- munity, and government settings. His areas of interest include professional practice issues, improving clinical standards, psychologically healthy workplaces, and knowledge translation.

I GRATEFULLY ACKNOWLEDGE Milton Almeida and Lara Robinson for their helpful comments on versions of this article.

C ORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to James K. Hill, Bayview Dual Diagnosis Program (5th floor), Waypoint Centre for Mental Health Care, 500 Church Street, Penetanguishene, ON L9M 1G3 Canada. E-mail:[email protected] This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Professional Psychology: Research and Practice© 2013 American Psychological Association 2013, Vol. 44, No. 4, 187–1920735-7028/13/$12.00 DOI:10.1037/a0033120 187 Organizational Advocacy 1 For the present purpose,organizational advocacyis the process by which professional members influence organizational change so that the discipline’s clients, goals, programs, and interests can be met within the broader organization. This can be done within a structure that includes a psychology department, but even the sole psychologist on a team can engage in advocacy.Table 1summa- rizes some professional activities that offer potential for organiza- tional advocacy, including the target audience commonly associ- ated with the activity. Advocacy efforts can target both client services and the profession as a whole (Fox, 2008;Lating et al., 2010). Psychologists interested in organizational advocacy would typically target their employer or contracting agency; however, there may be opportunities to advocate in partner organizations.

For example, when receiving a consultation request or a referral, psychologists can take the opportunity to provide more details regarding the role or service options provided by the discipline.

Many familiar professional issues could be advocated at the orga- nizational level, such as clinical services, retention issues, evidence-based practice, or ethical issues.

In discussing advocacy,Safarjan (2002)noted that there are four prerequisites in advocating change: (a) identifying a clear problem, (b) assessing the goal, (c) developing a strategy, and (d) imple- menting a plan. Of note, this is often psychologists’ approach when providing clinical services. Psychologists have a goal of helping clients change, moving from assessment to intervention to reach agreed-on goals. In fact, everyday clinical skills relate to advocacy: writing (Radius, Galer-Unti, & Tappe, 2009), relation- ship building and maintenance (DeLeon et al., 2006;Lating et al., 2010), public speaking (Lating et al., 2010), and high-level ana- lytical skills to synthesize information. Clinical psychologists are also accustomed to providing clear, unbiased information and recommendations to decision makers regarding diverse clinical issues. When psychologists make recommendations, they aread-vocatingfor a specific plan; they use data to direct those recom- mendations. In social advocacy, psychologists report believing that they will have little effect, do not feel knowledgeable, or are simply unaware of key issues (Heinowitz et al., 2012). It is unlikely that these factors will be as pervasive at work. A positive intermediary step to building confidence would be to highlight how many skills psychologists use every day in the workplace related to advocacy.

In organizational advocacy, the target of change is ensuring that clients have access to prompt and effective psychological services within the organization. This may be easy in some organizations (e.g., hospitals with psychology departments), but can be a chal- lenge if the system itself does not have clear psychology leadership (e.g., program-based systems). Thus, the goal in organizational advocacy is the promotion of psychological services within the organization, not as peripheral services or consulting, but as a vibrant discipline essential to client well-being. This strategy fo- cuses on leveraging a psychologist’s activities with professional promotion and advocacy. To use this strategy, psychologists would highlight and celebrate their unique contribution to the team and organization. Of course, the success of this strategy depends on whether the organization facilitates such efforts or whether the barriers to change outweigh the psychologist’s ability and energy to advocate.

It is within organizations that psychologists can test their skills, use their expert role, set aside time to advocate, and see the fruits of their efforts. Psychologists often informally advocate in their organization and on their team. Organizational advocacy is part of the role, but can benefit from more structure and emphasis. Psy- chologists engaged in organizational advocacy must assertively educate leaders about psychology’s role and value in effective service delivery while maintaining professional integrity by using solid evidence grounded in theory and research. Advocacy and the Professional Training Model It is often noted that psychologists do not tend to include advocacy as part of their professional model (Radius et al., 2009; Thompson, Kerr, Dowling, & Wagner, 2011). Physicians and nurses trained in professional schools are better at advocating for their patients while promoting their role as being essential to providing quality services (DeLeon et al., 2006;Lating et al., 2010). These professions see the benefit of having their members at planning, policymaking, and leadership tables and support those interested in these leadership roles. Psychologists, on the other hand, seem content to focus on professional tasks related to a specific client or limited to issues related to their clients.Lating et al. (2010)point out that psychology is one of the few professions with a high-level academic training model as the norm (i.e., doctorate). Thus, training focuses less on developing a profes- sional identity and more on developing an academic portfolio; publications and research often outweigh professional practice issues within universities. This bias may also explain why aca- demic psychologists do not often discuss professional issues such as advocacy and the presence of psychology as a profession, and 1This article focuses on health care environments, but the arguments are equally applicable to other settings: schools, correctional facilities, busi- nesses/organizations, and human resource departments. Table 1 Summary of Organizational Advocacy Activities Activity Advocacy target Highlight unique contribution Team members Supervisor/manager Provide timely and effective consultations Referral agent Team members Supervisor/manager Provide research information for key decisions/discussionsTeam members Referral agent All managers Sit on committees Committee members Supervisor/manager Senior management Create standard business plans for making a case for new psychology positionsSupervisor/manager Other managers Human resources Senior management Coordinate a message with partners (other disciplines) All levels Fill in service gaps All levels Clearly say, “This is what psychology offers” rather than allowing people to assume the skills are unique to the individual psychologist All levels This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 188 HILL practitioners facing clinical demands often do not have time to write journal articles.

Lating et al. (2010)note the duality with respect to professional advocacy: Fostering an attitude of advocacy is instilling the notion that as psychologists we may need to be the active voice for those who cannot speak for themselves. At other times, we may need to be the active voice that advances and protects our profession. (p. 203) This duality is central to professional advocacy; psychologists advocate in those areas in which they believe their role will improve service quality. This concept needs to be more central to our professional training model and stated explicitly. Although advocacy seems central to our professional role, and provision of excellent services is a subtle form of advocacy, overt advocacy efforts are often minimized or ignored in our training and practice.

In essence, psychologists need to see advocacy as consistent with, and perhaps essential to, their professional role (Burney et al., 2009).

Finally, in understanding advocacy barriers, psychologists should be clear on their partners and their message. What unique contribution does psychology bring to the partnership? What ben- efits are there to the client, team, service, and organization of having a psychologist instead of another professional? Psycholo- gists need to have the answers to these questions as they advocate so that they know their role in the partnership. For example the scientist–practitioner approach, which is often unique to psychol- ogists, promotes critical evaluation and debate. Other professionals may not understand this cultural norm in psychology, which can result in misinterpretation. Those unused to this norm may per- sonalize debate or dismiss psychologists as overly critical or not team players. A simple discussion around the traditional psychol- ogist training model can clarify some misunderstandings. For example, the debating of ideas is a positive strategy that psychol- ogists use to get to the best solution; it is unrelated to interpersonal conflict. Once this professional value is clear, it may be easier to highlight the benefits of fostering spirited discussion and debate with psychologists’ partners in the organization. Thus, this ability to be impartial and critical becomes a key role within advocacy partnerships instead of a professional liability. Organizational Advocacy as Partnering A collaborative approach to advocacy can be beneficial, with advocates educating others in the organization about the value of psychological services. Under this perspective, the goal of advo- cacy ceases to be convincing others to the psychological perspec- tive but, rather, increasing potential partners’ understanding and support of psychology issues. By creating a partnership, psychol- ogists position themselves as key players in solutions that meet the collective goals of the partnership. Even when the final goal is not what one first envisioned, the fact that the psychological perspec- tive was part of the process is a positive outcome, and reasonable goal, of a successful advocacy partnership.

If psychologists believe they have something to offer, they need to offer it and take credit for its benefits, especially in the current social and economic climate. Psychologists in independent prac- tice often need to show the benefits of their role by providing timely, effective, and targeted consultative services; those in or-ganizations would be well served to adopt a similar approach. This might include prompt return of phone calls, efficiently completing written reports, providing summaries in user-friendly language, or including follow-up consultation meetings so that clients/teams/ referring agents can ask questions once they have received the report. These approaches are good business in independent prac- tice, and can be good business in organizations as psychologists use these methods to become more integrated with the team, decision makers, and organization. Under this perspective, judi- ciously using professional activities as opportunities to promote the discipline becomes the core avenue of advocating for psycho- logical services. These avenues might also include providing clin- ical, research, or ethical consultations, which show psychology’s value to the organization at large. Thus, other disciplines become partners and advocates, arguing for inclusion of psychology in key sectors while lessening the likelihood that psychologists’ advocacy efforts will be perceived as self-serving (Cohen, Lee, & McIl- wraith, 2012). In my experience, having those outside psychology making such arguments has met with the most success in advo- cating for service change and improvement of psychological ser- vices. Thus, partnering can be essential to advocacy, especially in sectors in which psychology has less voice.

In discussing the health sector,Safarjan (2002)notes, “Psychol- ogists have the knowledge, expertise, and experience necessary to change health care delivery system, yet in state hospitals, they are not positioned to easily promote change” (p. 949). This is true because psychologists often find themselves focused on service delivery, a role for which they trained and in which they feel comfortable. It is through partnering at the organizational level, however, that psychologists can position themselves to effect change and provide broader support for the discipline.Cohen et al.

(2012)identify getting more involved in health care administration as one way to become better positioned. For example, psycholo- gists sitting on committees within the organization automatically raise the profile of the discipline. Natural committees for psychol- ogists often involve research and ethics, but other committees on professional issues or specialty populations are also good options.

This helps to position psychologists as key stakeholders in orga- nizational improvement and allows them to identify new organi- zational priorities. The key in working on committees is not simply promoting a psychological perspective, but also supporting other views that help improve services; this is also advocacy. Another opportunity is to identify and, if possible, fill service gaps. This raises psychology’s status as an essential service partner while providing an opportunity to advocate for both clients and the discipline. If psychologists cannot fill the gap, one can advocate by diplomatically noting the limitation of current resources and show how changes in psychological services might help meet ever- changing needs.

Another way to position oneself through partnering is to become the content expert on key service issues (e.g., competency models, evidence-based practice, trauma-informed care). Whether through a committee process or not, psychologists can provide organiza- tional leaders with information that helps decision making. This education role, to which psychologists are accustomed, might be as simple as forwarding a research article or as complex as writing a briefing note or longer report. As psychologists build their repu- tation as an essential discipline in improving decision making, their influence improves. In organizations in which psychology has This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 189 ORGANIZATIONAL ADVOCACY a strong history, such efforts may be more welcomed and effective.

Often, when there is a limited history, good work can often be dismissed as being specific to that psychologist. Thus, it is essen- tial for psychologists to explicitly state that their work is consistent with the discipline and not simply a skill unique to the individual psychologist. Psychologists interested in organizational advocacy would be well served to assess their specific skill sets and status within the organization and be realistic in choosing advocacy activities that fit their strengths. Advocacy efforts should empha- size natural relationships and grassroots partnering when one feels one has less influence on the broader organization or when work- ing outside a departmental model.

Psychologists can view partnership as part of working for im- provement in service delivery. Focusing on areas of growth is essential to moving forward and initiating change. Many have noted that senior management is often ignorant about problem areas within their organization (Jurkiewicz, Knouse, & Giacalone, 2002;Tourish, 2005;Tourish & Robson, 2006), and the respectful sharing of information may be invaluable to leaders. Psycholo- gists’ skills in partnering and motivating are useful in highlighting difficult messages. This is the point of advocacy: If leaders already agreed, then there would be no need to advocate. Yet being too open in sharing negative information may have an equally negative impact on one’s position in the organization (Eisenberg & Witten, 1987); open communication and advocacy come with some risk.

The key elements of reducing risk when sharing criticism in the organization are to (a) use a professional approach, avoid person- alizing; (b) build on already established relationships; and (c) be transparent and accountable.

By maintaining a respectful, professional approach to providing constructive feedback, the target audience may be more willing to listen. Furthermore, building on positive relationships already de- veloped via the professional role can be important to targeting the message.Kassing (2001)labeled open dissent to organizational decision makers asarticulated dissent. People perceive articulated dissenters as being less argumentative and verbally aggressive than those who use more passive ways to dissent. Furthermore, observ- ers assessed articulated dissenters as having high-quality relation- ships with supervisors and believing that the organization would welcome input. Much depends on the organizational culture. Do leaders encourage open discussion, or do they ignore the construc- tive nature of the process and dismiss criticism? Correctly assess- ing the culture helps to identify key partners for relationship building. Psychologists should partner with leaders in the organi- zation who meet goals by encouraging autonomy, manageable workloads, work–life harmony, service accessibility, and valuing relationships (Robertson & Tinline, 2008).

On establishing a receptive audience within the organization, it is essential that there is a clear message to communicate. Inter- views with current staff, surveys, focus groups, and so forth can serve as data-gathering devices to highlight core issues faced by psychologists in the organization. Questions can focus on two related areas: (a)Internal:What can the discipline do to support its members; and (b)External:What organizational issues impact professional psychology practice? These questions could be added to a psychology meeting agenda or, depending on the situation, a more formalized interview process may be necessary to cover all issues. Using a formalized process to gather the information re- flects systematic data gathering. A formalized process communi-cates the goals and priorities of the initiative so that people can make an informed choice regarding participation. A formalized process also sends a signal to the rest of the organization that the results reflect the professional nature of the activity and should be taken seriously. The power of documentation also means that psychologists will need to be careful about how they conduct any data-gathering process and report the results; however, these skills are generally part of the psychologist’s repertoire. Organizational Advocacy as Communication Identifying partners and having a clear message are elements of building a cogent communication strategy.Safarjan (2002)de- scribes several principles for advocates, three of which are partic- ularly relevant to organizational advocacy and communication: (a) Improve quality of life, (b) do not make assumptions, and (c) speak their language. The goal in organizational advocacy is the im- provement of services and quality of life of clients, the discipline, and professional service partners. Psychologists need to educate administrators and management about their unique contribution and not assume leaders already know how psychology helps them meet organizational targets. Psychologists can also use leader language by understanding and linking corporate goals and pres- sures to their core interests. Advocacy at its best creates win–win solutions to complex problems. Thus, psychologists also need to recognize the organizational and social realities of what can be improved and ensure that their advocacy efforts fit within those realities, giving decision makers room to interpret messages so that everyone can have success (Eisenberg & Witten, 1987). For ex- ample, advocating for increased assessment services might allow several solutions (hiring a psychologist, hiring a psychometrist, increased part-time/contract use, use of overtime, improved tech- nology), whereas advocating for a new psychologist may end with no change. Being clear on the goal but vague on the solution allows effective communication to build collaborative partner- ships.

Informal avenues of communication can be successful depend- ing on the willingness of leaders to hear and act on concerns. Many psychologists, however, do not provide information in a way that is useful to leaders. At best, an informal conversation can serve to vent frustration, brainstorm ideas, or even plan in a targeted meeting. Savvy psychologists might follow up informal meetings with an e-mail to highlight issues, but these rarely rise to contain- ing the level of information managers need to understand and become partners in advocacy efforts. Communication must be- come two-way, with both management and psychologists working together to meet common goals. Motivating leaders to listen can be a big challenge in organizational advocacy, especially when psy- chologists are not decision makers. Not listening may not be disinterest, but simply a reflection of workload demands or not truly understanding what leaders can do to facilitate change.

An easy way to support and motivate managers, especially in large organizations, is to help managers meet their goals. For example, if managers are focused on best practices and meeting externally set targets, a briefing note on the research evidence related to key practices may be welcome. If management is dealing with a professional ethical issue, such as dual relationships, then psychologists might provide a description of how they grapple with that professional issue. Another useful strategy to highlight This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 190 HILL commonalities is targeted messaging (Fox, 2008). By targeting communication to specific groups, psychologists can have a greater influence. The central element of targeted messaging is to merge psychologists’ interests with the interest of the target audi- ence, similar to lobbying in the political realm (Galer-Unti, Tappe, & Lachenmayr, 2004). For example, if a manager is working on a 3-year plan, it can be useful to provide clear easily understood information about psychology’s activities and workload projec- tions. For example, I maintain a generic psychologist position business case that can be modified in partnership with managers to highlight why their specific service might want to add a psychol- ogist. Communicating solutions can be a much more effective form of advocacy than simply indicating deficits (Cohen et al., 2012).

By clearly identifying the discipline’s role in meeting objectives and emphasizing leadership, psychologists may counter manage- ment’s natural tendency to dismiss criticism (Tourish, 2005).Fox (2008)notes that accurate and current information is important in advocacy, but that targeted messages that speak to leaders’ con- cerns can be effective in gaining influence. Targeting efforts by directly linking psychologists’ issues to the corporate vision, mis- sion, and core values can increase the likelihood they will be heard. One might briefly review how the issue is consistent with stated corporate values and how it diverges. Corporate values are often aspirational, so identifying areas of growth can be helpful in understanding how to progress. One might also show how proper support and use of psychologists increase the chances of meeting stated goals. By engaging leadership partners in a collaborative discussion, psychologists become allies in meeting goals and any requests are not dismissed as more demands on limited resources.

Most leaders understand that they are responsible for leading the organization to live stated values.

Finally, communicating results can have an impact on the suc- cess of advocacy efforts. If the target audience ignores a detailed report, psychologists could provide a one-page briefing note. If a full business case is overwhelming, they can provide a one-page cost– benefit analysis. If leaders are uninterested in the issues important to psychology, they can ensure that reports go to col- leagues or potential partners in the organization. Deciding whether a written report should be detailed or simply a brief one-page highlight depends on two interrelated elements: (a) the message and (b) the audience. If the message is clear and concise, a brief report might be best. In these cases, the hope is that those reading the report will want to follow up, giving an opportunity to provide more detail in person. Providing clear information that helps busy audiences quickly understand key points also gives structure to any future discussions. This approach also helps to “plant a seed” so that even if there is no immediate follow-up meeting, the disci- pline’s issues are now known. Complex issues or messages may warrant a more detailed report, allowing discussion of the conflict- ing issues. Although psychologists might find the issues interest- ing, others may not; psychologists should motivate the audience by highlighting common ground. Interested audiences are more likely to read and absorb a detailed report if it helps reach goals. Part of having an effective message is having something to say; the remainder is how it is communicated.

Psychologists should target and coordinate the message and identify the paths of least resistance so that ideas can build mo- mentum. They should avoid making an end run around managersand ensure that sharing the information is constructive criticism not venting frustration. If a report is too critical, they should tone down those elements so that some goals are met and be realistic in what one can achieve. AsDeLeon et al. (2006)point out, “. . . half a loaf really is better than none” (p. 150). Advocacy is about coordinating a message to increase its chances of being heard and then working to improve the system for clients and psychologists.

If one’s voice is discounted at the outset, or the message is seen as offensive, one is unlikely to see the change one hopes to achieve. Conclusion Organizational advocacy offers a strategy for psychologists to develop political advocacy skills within a known environment:

their own workplace. By trading on their positive professional relationships, psychologists can look at honing their communica- tion and partnering skills to serve their clients, their discipline, and the organization as a whole. This can be especially important to psychologists who work outside a departmental model, who might struggle with raising professional service issues beyond their im- mediate team. One motivator to this targeted form of advocacy over political advocacy is that psychologists may enjoy immediate feedback as they see their efforts improve their daily work. A key part of communicating a targeted message is to base the message on solid data and partnering with the audience and key decision makers. Linking to corporate goals helps psychologists partner with leaders and promote the discipline while improving their workplaces and client service. If psychologists are to be seen as a core constituency in society, they must promote themselves as a core constituency within their organizations. References Burney, J. P., Celeste, B. L., Johnson, J. D., Klein, N. C., Nordal, K. C., & Portnoy, S. M. (2009). Mentoring professional psychologists: Programs for career development, advocacy, and diversity.Professional Psychol- ogy: Research and Practice, 40,292–298.doi:10.1037/a0015029 Cohen, K. R., Lee, C. M., & McIlwraith, R. (2012). The psychology of advocacy and the advocacy of psychology.Canadian Psychology, 53, 151–158.

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