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Public Relations Roles and Power in United States Hospitals

Permanent Link: http://ufdc.ufl.edu/UFE0042965/00001

Material Information

Title: Public Relations Roles and Power in United States Hospitals
Physical Description: 1 online resource (74 p.)
Language: english
Creator: BOSILKOVSKI,CHRISTINA M
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2011

Subjects

Subjects / Keywords: HOSPITALS -- POWER -- PUBLIC -- RELATIONS -- ROLES
Journalism and Communications -- Dissertations, Academic -- UF
Genre: Mass Communication thesis, M.A.M.C.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: The purpose of this study is to identify the roles and functions public relations practitioners serve in hospitals. Discovering what roles practitioners serve, what training practitioners have, as well as their perceptions of practice and their power in the hospital industry in the United States can help illuminate the current status of public relations in hospitals. The study was conducted through an online survey, administered to professionals working in hospital public relations departments. Determining what skills are most in demand today and what power practitioners believe they have can help better prepare public relations students for employment in hospitals, as well as show what functions of public relations practice need to be strengthened to prevent encroachment by other professions who could take those voids as opportunities.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by CHRISTINA M BOSILKOVSKI.
Thesis: Thesis (M.A.M.C.)--University of Florida, 2011.
Local: Adviser: Lee, Moon.
Electronic Access: RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2011-10-31

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2011
System ID: UFE0042965:00001

Permanent Link: http://ufdc.ufl.edu/UFE0042965/00001

Material Information

Title: Public Relations Roles and Power in United States Hospitals
Physical Description: 1 online resource (74 p.)
Language: english
Creator: BOSILKOVSKI,CHRISTINA M
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2011

Subjects

Subjects / Keywords: HOSPITALS -- POWER -- PUBLIC -- RELATIONS -- ROLES
Journalism and Communications -- Dissertations, Academic -- UF
Genre: Mass Communication thesis, M.A.M.C.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: The purpose of this study is to identify the roles and functions public relations practitioners serve in hospitals. Discovering what roles practitioners serve, what training practitioners have, as well as their perceptions of practice and their power in the hospital industry in the United States can help illuminate the current status of public relations in hospitals. The study was conducted through an online survey, administered to professionals working in hospital public relations departments. Determining what skills are most in demand today and what power practitioners believe they have can help better prepare public relations students for employment in hospitals, as well as show what functions of public relations practice need to be strengthened to prevent encroachment by other professions who could take those voids as opportunities.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by CHRISTINA M BOSILKOVSKI.
Thesis: Thesis (M.A.M.C.)--University of Florida, 2011.
Local: Adviser: Lee, Moon.
Electronic Access: RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2011-10-31

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2011
System ID: UFE0042965:00001


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1 PUBLIC RELATIONS ROLES AND POWER IN UNITED STATES HOSPITALS By CHRISTINA BOSILKOVSKI A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DE GREE OF MASTER OF ARTS IN MASS COMMUNICATION UNIVERSITY OF FLORIDA 2011

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2 201 1 Christina Bosilkovski

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3 To my parents and my academic m entors

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4 ACKNOWLEDG MENTS I would like to thank Dr. Moon Lee for keeping me tethered to the University of Florida for her immovable confidence in my abilities, resolve, and desire to learn and for her resolute optimism. Mom and Dad, you are the reason I came to highly value an educ ation, when so many others can only dream to have the opportunity. I would not have been able to make my goals a reality without your constant support, love, faith, and encouragement. Las tly, I would like to thank the public r elations graduate class of 201 0 for the time we were able to spend learning together, supporting each others endeavors, and making friends in the process.

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5 TABLE OF CONTENTS page ACKNOWLEDG MENTS .................................................................................................. 4 LIST OF TABLES ............................................................................................................ 7 ABSTRACT ..................................................................................................................... 8 CHAPTER 1 INTRODUCTION ...................................................................................................... 9 2 LITERATURE REVIEW .......................................................................................... 14 Reasons for the Increasing Importance of Public Relations in Hospitals ................ 15 Public Relations: A Brief History of RelationshipCentered Practice ....................... 20 History of Hospital Public Relations ........................................................................ 22 Public Relations Role Typologies ........................................................................... 25 Practitioner Perceptions of Power ........................................................................... 29 The Role of Education ............................................................................................ 31 Hypotheses and Research Questions .................................................................... 33 3 METHODOLOGY ................................................................................................... 36 Sample .................................................................................................................... 36 Instrument Building ................................................................................................. 39 Data Analysis .......................................................................................................... 44 Role Function Items ......................................................................................... 44 Power Items ..................................................................................................... 46 Activity Items: Mana gerial or Technical ............................................................ 47 4 RESULTS ............................................................................................................... 51 Profiles of Practitioners ........................................................................................... 51 Hospitals ................................................................................................................. 51 Practitioner Roles in Hospitals (RQ1) ..................................................................... 52 Daily Activities and Practice ............................................................................. 52 Roles ................................................................................................................ 53 Perceived Power in Hospitals (RQ2) ....................................................................... 54 Potential Predictors of Power (RQ3) ....................................................................... 55 Demographic Correlations ................................................................................ 55 Correlations with Roles ..................................................................................... 55 Educational Training (RQ4) .................................................................................... 56

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6 5 DISCUSSION ......................................................................................................... 59 Limitations ............................................................................................................... 61 Suggestions for Future Research ........................................................................... 64 LIST OF REFERENCES ............................................................................................... 66 BIOGRAPHICAL SKETCH ............................................................................................ 74

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7 LIST OF TABLES Table page 3 1 Role item loadings .............................................................................................. 48 3 2 Power item loadings ........................................................................................... 49 3 3 Managerial versus technical activity loadings ..................................................... 50 4 1 M ean scores of managerial versus technical items ............................................ 58

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8 Abstract of Thesis Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Arts in Mass Communication PUBLIC RELATIONS ROLES AND POWER IN UNITED STATES HOSPITALS By Christina Bosilkovski May 2011 Chair: Moon Lee Major: Mass Communication The purpose of this study is to identify the roles and functions public relations practitioners serve in hospitals. Discovering what roles practitioners serve, what training practitioners have, as well as their perceptions of practice and their power in the hospital industry in the United States can help illuminate the current status of public relat ions in hospitals The study was conducted through an online survey, administered to professionals working in hospital public relation s departments. Determining what skills are most in demand today and what power practitioners believe they have can help better prepare public relations students for employment in hospitals as well as show what functions of public relations practice need to be strengthened to prevent enc roachment by other professions who could take those voids as opportunities

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9 CHAPTER 1 INTRODUCTION There is an increasing demand for public relations services in the health industry (PR blotter, 2009). The P ublic R elations S ociety of A merica (PRSA) directory of firms lists 26 industry specializations within public relations, including health/medical (Counselors Academy, 2009). Public relatio ns has had its place within the health industry for more than 40 years (Thomas, 2006) and within hospital practice specifically since the 1960s (Gordon & Kelly, 1999). Practitioners are employed in diverse health organization settings, such as health maintenance organizations, hospitals, other healthcare agencies (such as nursing home corporations), pharmaceutical companies, medical clinics, health science centers and nonprofit health agencies (Newsom, Turk & Kruckeberg, 2000, p. 16). In the past the r ole of public relations in health industry work was that of information dissemination, but as a result of a shift toward a market driven health industry (Thomas, 2006), its role has expanded to include wider functions, such as building health campaigns alongside those intended to be the target receivers of the message to ensure effective implementation (Parrot, 2004) Research on types of message appeals, comm unication channels used, and the effect of cultural beliefs on campaign reception has increased the presence of the consumer in crafting organizational or campaign messages (Parrot, 2004). The type of outreach expected of public relations practitioners has an element of advocacy to it, combin[ing] social networking and mobilization, interpersonal communication and negotiation, as well as the use of media for generating public pressure (Servaes & Malikhao, 2009, p. 1).

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10 Each year, the United States (U.S.) invests billions of dollars in the health industry. In 2008, total U.S. health expenditures amounted to $2.3 trillion (Historical, 2010), and by 2018, spending is projected to reach $4.4 trillion (National Health 2010) With increasing investment being made into this economic sector, an increasing amount of support services will be needed to accommodate its growth. Health industry communication needs range across all care aspects, including effective policy formation, public health campaigns, individuals seeking health information, ehealth, patient health practitioner communication, and communication between health practitioners, both within an d across professional and subspecialty boundaries (Jones & Watson, 2009, p. 115). The salience of the health field itself draws more attention to the communication and relationship management services needed to support it: Health is central to our lives, a major topic of news, is politicised, underresourced, and a subject open to alternative perspectives, so it is unsurprising that this sector of the public relations industry is expanding (LEtang & Pieczka, 2006, p. 254). But while public relations has long had its pl ace in hospitals, there has been confusion about exactly what functions hospital public relations practitioners should serve (Gordon & Kelly, 1999) and are serving What this study investigates is how public relations specialists within hos pitals define their roles. Most role studies have used the four frames set out by Broom and Dozier: expert prescriber, communication facilitator, problem solving process facilitator, and communication technician (1986). This study, however, uses newer role groupings identified by Leichty and Springston (1996), although based on Broom and Doziers four roles, in hopes of capturing a greater degree of the intricacies in each role behavior;

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11 Leichty and Springstons alternative groupings are internals, generali sts, externals, managers and outliers. Examining hospital public relations practice through this framework will show whether public relations practitioners are employed in role s that theory predicts to be most likely to produce excellent practice; the inve stigation also will advance research regarding alternative role proposals It is important to investigate the applicability of these alternative roles to hospitals to determine if they are acceptable, more descriptive measures than those developed in 1986, and to continue pushing public relations research forward. Specifically, identifying public relations roles within hospitals has not been attempted since 1999 (Gordon & Kelly); new research is needed to reevaluate the roles public relations holds in hospitals in 2011. Students preparing for employment as public relations professionals in hospitals need to know what skills are considered most important to work in this setting, and what to prepare to meet the demands of potential employers ; likewise, university instructors need to know which skills are important to teach in the classroom to prepare students for practice in the field. In addition to roles questions, practitioners are also asked about how they perceive their power within the hospital (Cho, 2006; French & Raven, 1959) to determ ine how power and role interact and what types of power are more prevalent with in the roles enacted by hospital public relations practitioners Fre nch and Ravens (1959) typology of five power scoercive, reward, legitim ate, referent, and expert power are used for measurement Practitioners who enact different types of role behaviors may have different types of perceived power; some types of power may not appear at all in hospital public relations practice. Identifying which types of power

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12 practitioners perceive they have will help to reveal the position of the department in the larger organiz ational structure of the hospital and indicate how important hospital managers believe public relations to be to the success of the hospital. While power studies are not new to public relations academia (Cho, 2006; Porter & Sallot, 2003; Sallot, Porter & Acosta Alzuru, 2004) and roles research has long sought to identify the higher and lower level functions (i.e. management versus technical behaviors) of public relations practice (Broom & Dozier, 1986) there has yet to be a study connecting roles research with practitioner power perceptions specifically in hospitals. Gordon and Kellys study indirectly addresses the question of practitioners positions within the organizational hierarchy of a hospital by examining the connection between model/role performance and departmental potential for excellence in hospitals, as determined by their likelihood to engage in strategic planning. Cho (2006) applied French and Ravens power measures to health public relations practitioners, but this sample encompassed a vari ety of medical related contexts that can be very different fr om one another and only assessed practitioners perceptions of power in media relations University instructors can use information on power prevalence to understand the types of power they shoul d be preparing students to practice as professionals in the hospital public relations field. Thus, there is a need not only to perform a roles study in hospitals to update studies conducted more than ten years ago in 1999, but also significant value in determining how power coincides with these roles. Results are needed to identify what types of employment opportunities exist for public relations practitioners in hospitals, what is expected of practitioners in these positions, and to compare current findings to

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13 those from 1999, which determined that practitioners were functioning in mostly technical positions that fell short of excellent practice standards according to theory Lastly, consumers of hospital services need to know what principles and practices guide the professionals in charge of advocating for their interests within the organization; because health is central to every persons life, individuals should have knowledge of who can serve as a resource for improving the service they receive and maki ng sure their needs are being taken into consideration within organizational decisionmaking. This study was conducted through an online survey of public relations practitioners within hospitals. Professionals in the field are in the best position to illu minate the status of hospital public relations and to evaluate which skills employers deem important for practice. Findings can help practitioners prepare for employment in hospitals, as well as illuminate whether public relations practice in hospitals ali gns with what public relations theory recommends

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14 CHAPTER 2 LITERATURE REVIEW Public relations (PR) is based in a tradition of continual relationshipbuilding (Ferguson, 1984) to manage stakeholder values on multiple platforms. It contributes to the effectiveness of hospitals by identif[ying] the most strategic publics as part of strategic management p rocesses and conduct[ing] communication programs to develop and maintain effective long term relationships between management and those publics (Hon & Grunig, 1999, p. 9). In an effort to adapt to challenges posed by the evolution of communication practic es in the 21st C entury, health communicators will be required to take a more interdisciplinary approach to information approach (Thomas, 2006, p. 181); thus, calls are being made for models of communication that take account of the complexity of health communication that involves multiple systems, such as multiple organizations being involved in a patients care, different professions and specialties within a health care system, and family systems (Jones & Watson, 2009, p. 117). While healthrelated public relations is discussed as a rapidly expanding field (LEtang & Pieczka, 2006) with robust opportunities (Wilcox & Cameron, 2007, p. 256), there is a dearth of research concerning public relations interaction with the health industry (Wise, 2001). Moreover, few studies have been conducted on hospital public relations. H ealth public relations is an area of growing sophistication (Wilcox & Cameron, 2007, p. 257), and the health industry is among those that are currently hiring the most for public rela tions work (PR blotter, 2009). Findings support that PR practitioners working for health organizations believe that they are recognized by their professional peers as proficient media communicators as well as experts in the field (Cho & Cameron, 2007, p. 16), but this still leaves open questions about what greater

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15 roles PR practitioners serve in health organizations as well as whether practitioners are recognized for their work by people other than their professional peers. Thus, this study seeks to ex amine this question in the hospital public relations environment because assessing whether organizational practice mirrors what Excellence theory suggests as best practice in hospitals can contribute to enhance organizational performance (Gordon & Kelly, 1999). In the competitive market of health services, hospitals need to be as effective as possible. As the health sector hospitals as a large part of it has been rapidly expanding and is accordingly expected to be in increasing need of public relations ser vices, it is important that practitioners are prepared to meet this potential demand and fulfill the expectations of employers If the public relations field is not ready to offer the services hospitals may increasingly need, professionals in other fields may advance to the detriment of public relations. If encroachment phases public relations out of the communication process, the department that takes over may have principles based in solely organizational interests, rather than multiple stakeholder representation. Reasons for the Increasing Importance of Public Relations in Hospitals Hospitals, health agencies, pharmaceutical companies, and governments often find themselves embroiled in issues that pit them against factions opposed to their policies or proposals (Knight, 1999, par. 18), rendering relationship management a constant necessity. Certain factors have recently converged to require a more specialized approach to address these new industry wide concerns that have a direct, trickle down, or ripple impact on hospitals. First is a shift in the health paradigm: Healthcare has shifted in the 20th century from a focus on acute to chronic care and prevention, thus making health promotion in

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16 the medical encounter, and therefore, communication, more cr ucial to health and wellbeing than ever (Gray, 2008, p. 422). It is because of this shift that the context, messages, audiences and other aspects of health communication can be expected to change (Thomas, 2006, p. 181). A 2009 report released by the Ame rican Hospital Association (AHA) states, Hospital care is the largest component of the health care sector (p. 1). Thus, hospitals are no longer just a place to go for the fatally ill or already diseasedthey have become a mainstay in a healthy American s ociety. Because there is an emphasis on continual care in all health services (including hospitals), there is an increased need for public relations to build relationships to enable, facilitate, and enhance the health services people are receiving through better communication about them. Hospitals have been typified as cold, unwelcoming places, and practitioners work to dissociate these characteristics from how hospitals are perceived; more hospitals are engaging their patients in an effort to cultivate a dialogue that will enhance organizational performance and reputation (Thomas, 2007). Practitioners must work proactively to establish trusting, mutually beneficial relationships between hospitals and stakeholders so that organizational messages will be well received at all times rather than only trusted when there is a serious health threat for which hospital expertise is explicitly being sought; this type of forwardlooking communication can guide the chronic care and prevention approaches to health pro motion by ensuring health threats are communicated effectively when they are still in the potential stage, before they augment into an actual or full scale health hazard to the public

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17 Secondly, concerned publics have become increasingly vigilant, following recent years of corporate scandal and manipulation in the health industry. Hospitals are affected by the volatility of consumer trust in organizational motives; as consumers of hospital services, publics are keeping a closer eye on the way hospit als integrate stakeholder interests with those of the organization. As a result, the communication process has turned toward a more transparent method of relating to stakeholders as a way to reduce stakeholder concern, criticism, and fear (Rawlins, 2009). Online media centers are one example of how hospitals are trying to address demands for transparency and accessibility. Thirdly, there has been a shift in the way people seek and receive health information and services from hospitals. Patients are engaging their health decisions in a more proactive manner (Thomas, 2007), and c ommunication must mirror this trend to allow for a more participatory dialogue between hospitals and their publics (Servaes & Malikhalo, 2009). There has been an overall shift from a paternalistic model of medical practice towards a patient centred healthcare firmly based on mutuality, patient autonomy, professional neutrality and shared decision making (Sarangi, 2004, p. 1). This shift suggests that practitioners will have to more ac tively engage with hospital patients and their families on a level that respects their input into the hospital treatment process as much as that of a doctor. Hospitals have shifted to a market based focus, expanding the number of voices who have an interest in health communication issues, from advertisers to pharmaceutical companies to policy enforcement agencies ; as a result, h ospitals find themselves in the position of having to work to attract and retain patients in a

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18 competitive market environment. To accommodate this need to maintain a steady client base, practitioners in hospitals must engage in role behaviors that advocate for the hospital (Wise, 2001) and manage its reputation to ensure its stability as a patient based institution. While this may seem contrary to the integrity of the aforementioned goal of fostering participatory dialogue between hospital staff and patients, it is the challenge and responsibility of the practitioner in balancing these two goals. As such, public relations must span both technical and managerial roles within hospitals; at the very least, direct access to managers will help advance public relations by providing valuable feedback and boundary spanning (Wise, 2001, p. 477 ) to identify growing health trends. The publics engaged in this communication have also changed, as the American public has become more differentiated (Thomas, 2006), demanding more responsive, personalized approaches to communicating about health issues This need for tailored messaging, the new frontier for health communication (Wilcox & Cameron, 2007, p. 257) brings about challenges to practitioners in hospitals in how to reach their audiences in an appealing manner. The role of dialogue and practices like boundary spanning in the process of tailoring health messages are functions that make public relations an important part of reaching hospital audiences. Dialogue within public relations goes beyond unidirectional communication practices like the public information and press agentry models to fost er goodwill between an organization and its publics (Kent & Taylor, 2002). Practitioners navigate the complex interests of various stakeholder groups, from health care clients to doctors, medical reporters, investors, and patients (Wilcox & Cameron, 2007, p. 257). Women, the primary health consumers

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19 of the household, receive a significant amount of medical information from public relations sources (Wilcox & Cameron, 2007, p. 257). Because hospitals also focus on chronic and preventative care, the range of clients a hospital may serve necessitates extremely different communication measures; a patient who is at the hospital for diagnosis of a terminal illness needs specific messages and communication outreach measures that differ from those practitioners use for a patient recovering from minor surgery. Lastly, the way people choose to communicate has been altered dramatically by the prevailing impact of the Internet and digital technologies. In 2009, 61% of adults in the United States sought health information online (Fox & Jones, 2009). An estimated 28% of adults use the Internet to find information on hospitals and other medical facilities, largely to seek rankings or reviews of hospitals (Fox & Jones, 2009). The Pew Internet and American Life Project (Fox & Jones, 2009) reports that women, specifically younger, higher educated female internet users are more likely to look for information online about medical facili ties. In addition to their doctor and traditional sources of health information, patients are finding information and discussing issues in online forums and social media communities (Kane, et. al., 2009). Emergent media have rapidly become an integral part of modern communication in countless industries; likewise, hospitals are trying to understand how to harness the power of social media to advance industry goals (Kane, et. al., 2009). A conference held at the P ublic R elations S ociety of A merica (PRSA) Hea lth Academy in 2009 found that the overriding message that emergedis that even social media requires the particular skill that is at the core of our profession: building and nurturing mutually beneficial relationships (Payton, 2009,

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20 p. 18). Thus, the next section examines the impact the concept of relationship has had on public relations and the components that comprise the relationship unit. Public Relations: A Brief History of RelationshipCentered Practice In the p ast 25 years, public relations scholars have come to value the relationship as the center of public relations efforts; this relationshipfocused approach in regard to relationships between organizations, between organizations and one or more groupings in society, or more generally with society itself (Ferguson, 1984, p. 16) is a defining characteristic of what sets public relations apart from other communication practices. It is what allows public relations to command a presence in hospitals as a distinct, valuable, and necessary function. The introduction of the relationship as the central unit of study in public relations in the 1980s caused a shift in thinking about public relations from a practice centered on communication output measures to one based on relationship measures (Bruning, Castle, & Schrepfer, 2004; Ferguson, 1984; Hon & Grunig, 1999; Wu, 2005). Ferguson posited the relationship as the key to cultivating and maintaining lasting, mutually beneficial partnerships that achieve both the short range and long term goals of public relations. Moreover, the measure of a relationship can be adapted to both macro and micro levels in guiding public relations campaigns and management plans. As multidimensional abstractions (Ferguson, 1984, p. 16), interorganizational relationships, for instance, require a communication approach that allows flexibility for the constantly changing environment of these interactions; thus, no matter who the involved parties are, public relations is able to coordinate a situation that is satisfying to the parties involved because it is based on an examination of what is important in their particular relationship dynamics. Without this type of adaptability, it would be difficult to

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21 coordinate the varying levels of relationshipdevelopment a hospital engages i n with its many stakeholders. Following Fergusons proposal of relationshipcentric practice, focus turned toward developing a way to measure the components that comprise the makeup of relationships. Building on previous work, Bruning and Ledingham (1999) provided measures for the complex factors of organizationpublic relationships. Categorized as professional, personal, or community, organizationpublic relationships exist on many levels; hence, they require a measurement tool that is accordingly multi item and multi dimensional (Bruning & Ledingham, 1999, p. 165). This organizationpublic relationship scale includes measures of trust, openness, involvement, investment, and commitment as indicators of relationship quality. Hon and Grunig (1999) also developed relationship measures, focusing on the six factors of control mutuality, trust, satisfaction, commitment, exchange relationship, and communal relationship. Control mutuality refers to the balance of power relations existing in the relationship. T rust is the mutual faith displayed by the involved parties in the abilities and intentions of the other; trust can be further broken down into integrity, dependability, and competence. Satisfaction is related to the reinforcement of positive feelings when relationship expectations are fulfilled. Commitment refers to the desire to continue relationship efforts. Exchange relationship involves one member conferring benefits upon the other in faith that the favor will be eventually returned or because a favor has already been granted. Lastly, a communal relationship occurs when the well being of the other party is the main motivator for actions, regardless of benefit to the first party in the relationship.

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22 It has been discussed that there is perhaps no other f ield that could benefit more from the application of relationship management than public health (Park & Reber, 2008, p. 3), and hospitals are at the center of many community battles to foster better health, serving as the main information hub and health program provider that connects the local public on community health issues While the [r]elationship is a core concept for many disciplines, such as interpersonal communication, organizational communication, labor management studies, international relations and public relations (Wu, 2005, p. 25 26), it is particularly the specialty and central unit of measurement of public relations. Likewise, as relationship management, public relationsnecessitates integrating concepts from the disciplines of mass media, interpersonal communication, interorganizational behavior, social psychology, marketing, and management (Bruning & Ledingham, 1999, p. 159). Thus, the relationship should still be the unit of analysis as the primary measure of mutually beneficial relati onshipbuilding (Park & Reber, 2008) that contributes to the effective long term success (Hon & Grunig, 1999, p. 9) of hospitals interests. Public relations work encompasses the tasks of choosing credible sources, developing a message strategy, defining the appropriate sources of data, and determining the settings and/or channels for optimal communication delivery (Rimer & Kreuter, 2006, p. S195) as part of relationship building strategies, of which the goal is to create a substantial behavioral relat ionship, which may be enhanced by effective communication (Wan & Schell, 2007, p. 28). History of Hospital Public Relations In terms of public relations, practitioners, with the necessary training and support, could play vital roles in helping public health bodies achieve their organizational goals with respect to providing essential health services (Wise, 2001, p.

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23 477). And while health public relations practitioners feel valued most for their expert power in media relations expertise (Cho, 2006), their work extends much deeper than that. As their traditional roles as media and community liaisons offer opportunities for fram ing issues of interest, so do their less recognized roles as lobbyists, negotiators, and environmental scanners (Knight, 1999, par. 10). Hospitals use public relations in a variety of functions, including employee relations, media relations, government relations, community relations, andmarketing relations (Guth & Marsh, 2007, p. 37). Public relations in a hospital setting is outlined to have two main functions: to strengthen and maintain the publics perception of the institutions and to help mark et the hospitals proliferating array of services (Wilcox & Cameron, 2007, p. 566). While valid, the two main functions Wilcox and Cameron (2007) identify for public relations in hospitals simplify the complexity of the public relations practitioners res ponsibility to advocate for multiple stakeholders simultaneously. It also plays an integral role in managing internal governance (Van Kooy & Ettinger, 2002) at hospitals as well as in external policy negotiations with the U nited S tates (U S.) government (M oon, 2007) and other external stakeholders. In 1966, healthrelated public relations focused heavily on publicity (Weiner, 1966). A review of hospitals a little over a decade later demonstrated that public relations in hospitals was still heavily dominated by publicity geared activities (news releases, publications, media relations) as well as fundraising practice (Gelineau, 1979). A 1993 study of Canadian hospitals warned against the possibility of encroachment of public relations by other fields that there is potential for public relations to be restricted to the role of technical support in the areas of publicity and internal

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24 communications as fund raising moves from amateur to professional status and as hospital administrators investigate the r evenue generating potential of marketing (King & Scrimger, p. 40). This is as true now in the United States as it was in Canada in 1993. Gordon and Kellys (1999) review of public relations departments in hospitals found that oneway models were more comm only practiced than the twoway models so promoted by Excellence theory, and practitioners were more likely to be employed in a technician role rather than a managerial role. The public information model was found to be more prevalent as well. While Gordon and Kelly examined public relations role performance in hospitals in 1999, they categorized roles according to the manager technician dichotomy, simultaneously giving a clear picture of well defined roles and limiting practitioners to diametrically opposed categories that do not allow for variability. Practitioner roles in hospitals have yet to be assessed using newer role identifications that allow for the greater depth of hybrid roles, as well as in connection with the types of power practitioners percei ve they have. It is necessary to pursue research using newer methods that build on older, more accepted measures to ensure research is evolving in a progressive direction, as well as keep up with the evolution of practitioner responsibilities in modern [hospital] practice. Not only does the relational perspective illustrate the need for public relations practitioners to be conversant with strategic planning and other managerial processes, it also provides a framework for scholarly inquiry, a platform for developing educational curricula, and a rationale for practitioners charged with accounting for program initiatives (Ledingham, 2003, p. 182). Thus, the importance of education, to be discussed later in this review, is underscored. In their study of prac titioner role and

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25 power perceptions in connection with web usage, researchers Sallot, Porter, and Acosta Alzuru assert, Without the power to participate in strategic decisionmaking, practitioners are often relegated to technician type staff positions, me rely producing informational materials at the bidding of others (2004, p. 270). Thus, in coordination with assessing the role behaviors practitioners in hospitals display, this study delves into their perceived power to help depict the status of public re lations within the hospitals greater organizational structure: exactly how much power practitioners believe they have professionally in the hospital, and how they practice it Public Relations Role Typologies Studies on public relations roles (Berkowitz & Hristodoulakis, 1999; Sallot, Porter, & Acosta Alzuu, 2004; Wu & BaahBoakye, 2007; Wu & Taylor, 2003) and power perceptions (Sallot, Porter, & AcostaAlzuu, 2004; Wu & Taylor, 2003) within organizations have been widely discussed in public relations lit erature. Broom (1982) outlined four roles that practitioners tend to play in organizations: those of the expert prescriber, communication facilitator, problem solving process facilitator, and communication technician. A practitioner in the role of expert prescriber researches and defines the problem, develops the program and takes major responsibility for its implementation (Broom, 1982, p. 18). A communication technician is valued more for his or her communication, journalism, and media skills, while a c ommunication facilitator is a liaison, interpreter and mediator between the organization and its publics (Broom, 1982, p. 18). The process facilitator guides the planning, programming, and implementing of all program phases, as well as identifying and solving the accompanying problems

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26 While these roles are widely respected in public relations literature, criticism of these four roles has led researchers to seek alternative ways of characterizing public relations role behaviors. A criticism of Broom and Doziers manager technician dichotomy is that it assumes the mutual exclusivity of both (Leichty & Springston, 1996; Porter & Sallot, 2003) In fact, positive correlations between the manager and technician scales suggest the possible existence of hybrid roles that consist of activities from both (Leichty & Springston, 1996) Another criticism is that there is a lack of theoretical basis for the management scale; the management factor consists of eighteen items that might be labeled the everything other than technical activities factor (Leichty & Springston, 1996, p. 468). Leighty and Springston therefore developed and tested additional role activities to try to capture the intermediate levels of public relations activity. The eight role activity factor s identified were: advocacy, public relations catalyst, gatekeeping, public relations training, public relations counsel, technical activity, research and information acquisition. Advocacy dealt with representing the organization to external publics (Lei chty & Springston, 1996, p. 469). Public relations catalyst was measured by four items from Broom and Smith to assess the extent to which the practitioner serves as a PR project manager by keeping people informed, enthusiastic, and involved (Leichty & Springston, 1996, p. 469). Gatekeeping assesses decisions as to what information to pass along and whom to pass it to (Leichty & Springston, 1996, p. 470), while public relations training involves nonpublic relations employees. Public relations counsel reg ards the expert knowledge practitioners dispense as part of teamwork. The technical activity scale refers to writing and producing materials, while information acquisition information

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27 collection regards external publics. The research items look mostly at q uantitative research. Based on these activities, five groupings emerged from Leichty and Springstons study: internals, generalists, traditional managers, externals, and outliers. Internals are most similar to the role of problem solving facilitator because they spend much time coordinating efforts within the organization, showing both high levels of process leadership and technical activity. Generalists show crossover with some of the other role activities, as generalists perform various activities as par t of their daily responsibilities. One possible reason for the lack of specialization of the generalist is that practitioners who fall into this category may tend to work in departments of smaller size (Leichty & Springston, 1996). Similar to the internal i st the generalist provides support for internal public relations processes and shows high technical activity, but is also highly active with external publics (advocacy, information acquisition, research, etc.). Traditional managers, like Doziers notion of the communication manager, show low technical activity, but higher scores on public relations counsel, gatekeeping, information acquisition, advocacy, and public relations catalyst. They are expert prescribers with a collaborative orientation (Leichty & Springston, 1996, p. 475), and typically have the most experience and work in the largest public relations departments. Traditional managers and generalists perceive their roles to be more managerial than the other groupings do. Like internals, external s are strong in technical activity, but give higher attention to advocacy and information acquisition; externals can be likened to Broom and Smiths communication technician role. They interacted with publics

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28 frequently, but played passive roles within th eir organizations (Leichty & Springston, 1996, p. 473). Lastly, outliers, the weakest grouping, represent individuals who score significantly below average on seven of the eight activities measured; one possible explanation for their different markings is that these individuals may be part time practitioners (Leichty & Springston, 1996). Insistence that public relations participate in a management role within organizations has grown (Wehmeier, 2009). The assertion that public relations in the health indus try has emerged in recent years as a vital member of the management team (Broom, 2009, p. 449) suggests that there is room for public relations, but that it has yet to be extensively discussed in academic literature. Choice of role behavior for practition ers, however, often depends on the decisions of upper level managers: Which model the dominant coalition chooses depends on whether the dominant coalition feels threatened by that model and whether it fits with organizational culture, the schema for publi c relations in the organization, and whether the public relations department has the potential to carry out the preferred model (Grunig, 1992, p. 303). In cases where public relations is not given a management role in the communication process, practitioners are still responsible for presenting issues to the dominant coalition and fairly mediating all stakeholder interests (Knight, 1999). Surveying 191 heads of public relations departments in U.S. hospitals, Gordon and Kelly (1999) found, however, that hospitals that employ public relations as a management role can achieve greater organizational effectiveness. They defined organizational effectiveness by four performance measures: whether the hospital met its budget, achieved long term strategized objectiv es, reached short term objectives, and

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29 advanced its mission (p. 151152). Organizational effectiveness is crucial to hospitals in the wake of the shift to preventative care, advent of technologies, and new consumer expectations; inefficient hospitals that cannot meet consumer expectations or fail to adapt to the new technological norms will suffer and be surpassed in the industry. The studys main finding was that hospital public relations departments were most heavily engaged in technical work and practice d mostly unidirectional models, particularly the public information model. With emergent technological tools at practitioners disposure (Seltzer & Mitrook, 2007), it would be beneficial to evaluate whether hospital public relations practice still falls sh ort of two way symmetrical practice 12 years later. Moreover, recent attention to social media as business tools may have also altered practitioners perceptions of their power within the hospitals, as they become the hospitals gatekeepers with the expert ise in social media use. Practitioner Perceptions of Power Using the power typology developed by French and Raven in 1959, practitioner perceptions of power within hospitals can help give a reference point from where to analyze their identified role behaviors. French and Ravens power typologies, while developed i n the 1950s, are still widely used. The measures are well established in marketing (Busch, 1980; Narayandas & Rangan, 2004; Dwyer & Walker, 1981; Kasabov, 2007; Mayo, Richardson, & Simpson, 1998; McDaniel, Futrell, & Parasuraman, 1985), health (Bolam, Mcl ean, Pennington, & Gillies, 2006; Popovich & Warren, 2010), and business management (George & Sleeth, 2000; Kudisch, Poteet, Dobbins, Rush & Russell, 1995; Kutschker, 1985; Porrini, 2006; Wilcox, Howell, & Breivik, 2008) literature. French and Ravens power constructs have only been minimally explored in public relations (Spicer, 1997), and there have only been a few

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30 applications to healthrelated public relations (Cho & Cameron, 2007; Cho, 2006). This study seeks to use these cross disciplinary measures in the hope of expanding the scope of traditional public relations literature. French and Raven identified five types of power individuals wield within organizations: coercive, reward, legitimate, referent, and expert. Raven contends that a sixth power base is informational, but French maintains that the informational element is an i nfluence, not a power, as power does not have the same conceptual foundation as informationbased exchange (Raven, 2008, p. 12). Given that much of public relations work in hospitals involves that active exchanging of information, this sixth element was included, using measurement items developed in this study Coercive power is that which is based in punishment to be inflicted from failure to comply with expected behavior, while reward power is that which one individual can wield over another by means of incentive (French & Raven, 1959). Legitimate power refers to that which occurs when one individual is obligated to submit to the influence of another due to an accepted norm that the individual has a legitimate right to wield that influence over the other party. Referent power relies on identification between two parties, where one feels a favorable sense of likeness or membership to the other, thus ascribing to that association, while expert power cannot occur without the superior contribution of knowledg e by one party over another. Informational power derives from the persuasiveness of communications and arguments provided by the influencing agent (Koslowsky & Schwarzwald, 1993, p. 136). Leichty and Springstons hybrid roles would suggest power is const antly in flux and a subject for negotiation. Raven suggests that powerholders could benefit from

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31 using multiple types of power concordantly, but with the caveat that one basis of power may undermine another (2008, p. 14). A traditional manager, for example expected to show high levels of gatekeeping and advocacy, and PR catalyst thus would be expected to show informational and expert power as well as some levels of reward, legitimate or referent power, being in a typically respected position of authority It is possible that the manager wields coercive power as well. A traditional manager that lacks the higher types of power (e.g. legitimate) may not be an effective leader at all, or may indicate that public relations is not valued as a central function i n that hospitals department. Thus, it is important to identify which types of power practitioners perceive they hold. Public relations practitioners in hospitals may not demonstrate all five six types of power, but different role behaviors may produce dif ferent patterns of perceived power. Identifying which types of power are not perceived to play a part in hospital public relations can be just as important as identifying which types are prevalent. In addition to role behavior and power, educational backgr ound may also influence how public relations practitioners function and perceive their power in hospitals; while formal and informal training are an ongoing part of public relations job preparation, education very basically forms the foundation for optimal or ideal, public relations practice. The Role of Education In order for public relations to have an impact on organizational effectiveness, Kelly (1994) indicated that practitioners must first and foremost have an educational background in public relati ons Kelly advocated educational training as a way to curb the dangerous possibility of encroachment by other professions. Newsom (1977) lamented the lack of college and university course offerings for public relations, and while the educational curriculum has expanded over the last 30 years, it still suffers from

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32 limited offerings and lack of consistency. Gelineaus study of practitioners working in hospitals found that twothirds of practitioners surveyed had no formal educational training in public relat ions (1979). Quane noted in 1973 that few colleges offer graduate degrees in public relations at all, let alone courses that relate to hospital PR (p. 21). A study of hospital public relations department heads in 1999 found that twothirds of practitioners surveyed had at least some college training in public relations or communication (Gordon & Kelly). While this figure may seem to be an improvement, an argument can be made that an organization is only as strong as its weakest link; many factors can int ervene between a managers formal public relations knowledge and his employees ability to carry out that knowledge in a way that fulfils the greater purposes of public relations. Research by Leding ham supports the inclusion of public relations in management functions with practitioners trained in management processes and able to apply those skills to public relations problems and opp ortunities (2003, p.184). Yet Gordon and Kellys evaluation found only 9% of public relations depar tment heads in hospitals had a masters or doctoral degree, and 28% a bachelors degree (1999, p. 153). It is important, however, to test for the formal educational training and knowledge of hospital practitioners beyond those in the managerial role. A health or medical degree ma y make a difference in the status public relations practitioners wield in hospitals (Cho & Cameron, 2007). In a public relations textbook featuring 19 case studies, four of them are about medical/health issues (Parkinson, 2006). These case studies regular ly appear in crisis communication chapters (Broom, 2009; HansenHorn, 2008; Wilcox & Cameron, 2007). The view that healthrelated public relations belongs under the umbrella of crisis

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33 communication seems to indicate that communication in this realm is not as important unless something goes critically wrong to threaten the health of the public at large, However, public relations has greater applicability within health organizations than j ust resolving crisis situations; hospitals employ public relations pers onnel as part of their regular staff, although the roles practitioners in hospitals serve varies from one hospital to the next. Nonetheless, the repeated incidence of public relations in connection with health organizational case studies may be a starting point to gaining the greater recognition of healthfocused public relations as a specialty. Hypotheses and Research Questions Based on an examination of the functions public relations practitioners fulfill in hospitals, this study was designed to uncover t he roles employers in hospitals assign as public relations responsibilities, as well the perceived power of practitioners in their hospitals. In order to further understand the values important to current hospital public relations practice, this study sou ght to explore the ideas below. H1: Practitioners in hospitals have roles that focus on higher technical activity rather than strategic management processes. H2: Power types will interact differently with the different roles. H2 a. T he more they perceive they are playing the traditional manager role, the more likely practitioners are to perceive that they are display ing coercive power H2b. T he more they perceive they are playing the traditional manager role, the more likely practitioners are to perceive that they are display ing reward power. H2c. T he more they perceive they are playing the traditional manager role, the more likely practitioners are to perceive that they are display ing legitimate power.

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34 H2d. T he more they perceive they are playing the tr aditional manager role, the more likely practitioners are to perceive that they are display ing expert power. H2 e The more they perceive they are playing the external [ liaison ] role, the more likely practitioners are to perceive that they are display ing expert power H2f. The more they perceive they are playing the external [liaison] role, the less likely practitioners are to perceive that they are display ing coercive power H2g. The more they perceive they are playing the external [liaison] role, the less likely practitioners are to perceive that they are displaying reward power H2h. The more they perceive they are playing the external [liaison] role, the less likely practitioners are to perceive that they are display ing legitimate power H2 i The m ore they perceive they are playing the internal role, the more likely practitioners are to perceive that they are displaying coercive power H2j. The more they perceive they are playing the internal role, the more likely practitioners are to perceive that they are displaying rewar d power. H2k. The more they perceive they are playing the internal role, the more likely practitioners are to perceive that they are displaying legitimate power. H2l. The more they perceive they are playing the internal role, the more likely practitioners are to perceive that they are displaying expert power. H2 m The more they perceive they are playing the g eneralist role, the more likely practitioners are to perceive that they are display ing coercive power. H2n. The more they perceive they are playing the g eneralist role, the more likely practitioners are to perceive that they are displaying reward power. H2o. The more they perceive they are playing the g eneralist r ole, the more likely practitioners are to perceive that they are displaying legitimate power. H2p. The more they perceive they are playing the g eneralist role, the more likely practitioners are to perceive that they are displaying referent power.

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35 H2q. Th e more they perceive they are playing the g eneralist role, the more likely practitioners are to perceive that they are displaying expert power. RQ1: What roles do public relations practitioners serve in hospitals? RQ2: What types of power do practitioners perceive they have in hospitals? RQ3: What are the potential predictors of the different types of power? RQ3a Do years of experience in public relations correlate with the types of power practitioners wield? RQ3b. Is there a connection between the size of a hospitals public relations department and the types of power practiced by practitioners? RQ3c. Are different roles correlated with different types of power? RQ4: What training do hospital public relations practitioners have? RQ4a Does edu cational background have an effect on practitioner roles? RQ4b. Does educational background have an effect on practitioners perceived power?

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36 CHAPTER 3 METHODOLOGY Sample As a way to gauge what functions public relations personnel in hospitals serve and the types of power they per ceive they have, the researcher conduct ed an online survey of practitioners working at hospitals in the public relations (PR) department. The survey was launched October 19, 2010, and concluded January 6 2011. I n 1999, Gord on and Kelly enlisted the help of 30 state hospital associations to survey 191 heads of public relations departments in hospitals, from a sample size of 500; their response rate was 38.2%. Similarly the first round of survey invitations in this study was administered through state hospital associations and regional member associations from the Society for Healthcare Strategy and Market Development (SHSMD). A probe email was sent to these members the week before to determine willingness to participate; chapters that agreed to participate received the survey October 19, 2010 or in the weeks following as some were pending board approval. The second round of invitations sent the week of December 20 2010 consisted of a simple random sample taken from the American Hospital Directory (AHD), which lists just less than 4,000 hospitals in the U nited S tates It is one of the most complete dir ectories for U.S. hospitals As the website lists hospitals in alphabetic order grouped by state, a list was compiled featur ing all the hospitals listed, as such. The hospitals in the alphabetic listing were numbered, and a random number generator from Randomizer.org was used to choose 800 hospitals to comprise the sample. The following sample size formula was also used to calc ulate initial sample number selection:

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37 n= [Confidence level* (v) (1v)]/Confidence interval n= [1.96* (.5) (1 .5)]/.05 According to this formula, a population size of 3,958 (Total number of hospitals on AHD list) requires a sample size of 384 to yi eld results at the 95% confidence level. The formula does not account for whether all of the hospitals had a public relations department or whether practitioners in those departments responded to the survey. A sample size of 800 was chosen so that response levels might sufficiently supplement those provided by the initial round of surveys administered through state/regional associations. The websites of the 800 chosen hospitals were visited to attain email contact information for distribution of the survey to the main public relations practitioner contact(s) at the hospitals. The following key words were the most common indicators of publi c relations contacts: media affairs, public affairs, community relations, and marketing and public relations. In cases where direct contact information was unclear or not available on the website, the survey invitation was submitted through the websites g eneral contact form with a request to submit to the public relations department. Practitioners who received the survey invitation served as the point of contact with additional practitioners within the hospital. In addition, unresponsive state and regional associations were emailed a second time, resulting in nine state and eight regional groups total that agreed to distribute the survey; the survey invitation was posted to P ublic R elations S ociety of A merica (PRSA) Health Academy s LinkedIn and Facebook p ages on December 22, 2010 as well.

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38 Those hospitals that did not employ people specifically in public relations responded that they assigned public relations like duties to individuals in human resources or marketing or simply did not have public relations departments. Twenty h ospi tals confirmed that they did not employ public relations personnel and were excluded from the study. Hospitals that employ ed persons as public relations practitioners but did not have a separate public relations department were inc luded for analysis, as long as the persons indicated to be specifically devoted to public relations practice. A number of hospitals featured one department that combined t wo disciplines (i.e. Department of Marketing/Public Relations ); these were included f or analysis. Twelve hospitals were excluded because their hospital did not have a website, and 46 hospitals were excluded because their website did not feature any form of email contact or submission ; practitioners from three hospitals responded that while their hospital did have a public relations department, they declined to complete the survey A total of 207 surveys were analyzed. Background information on hospitals was provided by the American Hospital Directory (AHD), which includes number of staffed beds, number of total discharges, and gross p atient revenue. The AHD provided this information collected from the hospitals most recent Medicare Cost Report. This information was linked to practitioner responses based on identification by the practitioner of the hospital at which they work. The survey was designed with Qualtrics; survey invitations were distributed via U niversity of Florida webmail so that practitioners received an immediate sense of the academic nature of the research in the hope of encouraging a respectable response rate. Those practitioners interested in the main findings of the study provided their email

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39 address in the survey form and will be emailed a summary of the findings in April at the conclusion of research. Instrument Building The survey was created using Qualtrics, and results were analyzed using PASW Statistics Software The survey featured four sect ions. The first section assessed practitioner roles via daily task behavior. Adopted from Leichty and Springston (1996), the items used to measure role behavior represent eight postulated factors: advocacy, public relations catalyst, gatekeeping, public relations training, public relations counsel, technical activity, research and information acquisition. Four clear roles were expected to result from these items in accordance with Leichty and Springstons findings (1996) : those of internals, generalists, traditional managers, and externals. A fifth role, outliers, was expected to be a weak grouping. Respondents were asked to indica te the degree to which they felt the stated activity is a part of what they do. These role items were measured on a scale from 1 to 5, 1 being Never True and 5 signifying Very Often True. Five items were used to measure the advocacy factor. These item s were expected to load together in a factor analysis to capture advocacy behaviors. Provide information informally to outsiders that will induce them to act favorably to your organization. Provide information informally to groups outside your organizat i on to create a favorable image. Provide information on a formal basis to groups outside your organization intended to create a favorable image. Provide information informally to outsiders that will induce them to act favorably to your organization (this was an accidental duplicate meant to read formally, not informally)

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40 Represent the organization at events and meetings. The public relations catalyst factor was measured by four items. Take responsibility for success or failure. Ke ep management actively involved. Keep others in t he organization informed. Operate as a catalyst. Gatekeeping was measured by three items. Decide when to transmit information acquired from outside your organization to others within your organization. Decide what portions of information acquired from outside your organization to transmit to others within your organization. Decide to whom within your organization to send information obtained from outside sources. The PR training factor was a threeitem measure. Informally instruct others, not in PR, how to interact with people outside your organization. Formally instruct others, not in PR, how to interact with people outside of your organization. Work with managers to increase their skills. The PR c ounsel factor was measured by four items. Collaborate with nonpublic relations people to define and solve problems. Plan and recommend courses of action. Make communication policy decisions. Keep management informed of public reactions. The communication technician factor featured four items. Produce pamphlets and brochures Edit/r ewrite for grammar and spelling. Wri ting public relations materials. Do photography and graphics. The formal research factor had two measures.

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41 Conduct communication audits. Report public opinion survey results. Lastly, the information acquisition factor used two items. Formally acquire information from sources or groups external to your organization. Informally acquire information from sources or groups external to your organization. Leichty and Springstons (1996) cluster analysis suggested that the se eight factors should fall into the five patterns of role behavior described here. Internals typically score d high on technical activity, PR catalyst, and gatekeepi ng, but low on advocacy, training, information acquisition and research (p. 472). Generalists should show above average markings for all eight factors. Traditional managers demonstrate d low technical activity and research, and above average scores for PR c ounsel, gatekeeping, information acquisition, advocacy, and PR catalyst (473). The fourth role, the external typically showed high markings for technical activity, advocacy, and information acquisition, and low for gatekeeping, PR counsel, PR catalyst, research, and training. The last group, the outliers was a weak grouping that scored very low on most of the factors and thus may have differ ed characteristically from practitioners in the other roles. The second section contained two questions about practi tioner daily activities. A question on the types of public relations practiced was developed based on the main types of public relations identified to be practiced by hospitals One question on the specific activities practitioners engage in daily was developed using a combination of manager technician items from Kellys (1994) roles study and Gelineaus 1979 study on hospital public relations Activity items in this survey corr esponded with items used in

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42 Kellys (1994) and Gelineaus (1979) studies to maintain measurement in a form that was comparable to findings from these two researchers previous studies The third section assessed what types of power practitioners perceived they wield in the hospitals where they work. Items used to measure power were adapted from Hinkin and Schriesheim (1989) to measure the five types of power identified by French and Raven (1959) reward, coercive, legitimate, expert, and referent including items developed in this study to measure the contentious sixth informational influence/power. The power items were measured on a scale from 1 to 5, 1 being Strongly Agree and 5 signifying Strongly Disagree. Five items assess ed reward power I can increase pay levels at work. I can influence peo ple at work getting a pay raise. I can influence people at work getting a promotion. I can provide other s at work with special benefits. I can give people at work positive attention when they perform the way I want them to. Coercive power was also measured by five items. I can make work difficult for people at work. I can make thing s unpleasant for people at work. I can make being at work distasteful for people at work. I can give oth ers undesirable job assignments. I can give people at work negative attention when they perform in a way that is unsatisfactory to me. Legitimate power featured five statements.

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43 I can make people at work feel like they should satisfy their job requirements. I give people at work the feeling that they have responsibilities to fulfill. I can make people at work recognize that they have tasks to acco mplish. I can make people at work feel that they have commitments to meet. I can make people at work feel that they should c ontribute their equal part to team efforts. Expert power related t o the following five statements. I can give people at work good t echnical suggestions. I can share my considerable experience and/ or training with people at work. I can provide people at work with needed technical knowledge. I can provide people at wor k with sound jobrelated advice. People at work seek my advice consistently on one or more specific (work related) topics. Referent power used these five items. I can make people at work feel valued. I can make people at w ork feel like I approve of them. I can make people a t work feel personally accepted. I can make people at work feel important. I can influence others personal standards at work by virtue of my own. Lastly, informa tional power was measured by five items. I have knowledge of the inner technical workings of my hospital that make my job easier. I have knowledge of the inner personal workings of my hospital that make my job easier. I understand the reasoning behind why I perform the task s that I do in a certain manner. I understand the reasoning behind the managerial decisions that are made. I have knowledge of which resources to seek outside of my hospital to make my job easier.

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44 Hinkin and Schriesheims measures s how ed high to acceptable levels of internal consistency, acceptable levels of reliability and discriminant validity, and some support for convergent validity (Drea, Bruner, & Hensel, 1993). External consistency was at an acceptable level as well (Borchgrev ink & Susskind, 1996). Three singleitem instruments have been previously used to measure the five power bases, the latter two of which are slight modifications of the scale proposed by Bachman et. al. in 1966, but all three of the instruments have been shown to have poor content validity, a potential high level of measurement error, and questionable reliability due to their single item nature; for practicality reasons concerning survey time estimate as well as the abovelisted concerns these scales were n ot included in the survey The last section asked demographic information of participants, including educational background, years of experience, years spent working at the hospital, department si ze, etc. These questions were designed to identify the cha racteristics that typified modern hospital public relations departments and practitioners. They were also used to examine correlations with roles and perceived powers found in these hospitals. Data Analysis The data was subjected to factor analysis to determine which items aligned together regarding roles, powers, and activities Factors with a Cronbachs alpha below .70 were discarded. Factors loading less than three items were dismissed as well. Role Function Items Following the original researchers (Lei chty & Springston, 1996) principal components factoring with a Varimax rotation was used to assess role functions to preserve the comparability of the resulting roles with those found in the 1996 study The principal components method analyzes each measure under the assumption that the

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45 original measures do not have measurement error. C oefficients with an absolute value below 0.4 were suppressed. Initially, seven factors loaded, but only five were kept f or this assessment. The first factor that emerged comprised five items intended to measure PR Catalyst (3 items) and PR Counsel (2 items); thus, this factor is termed PR Catalyst/Counsel, combining the original researchers categories. The second factor loaded a total of four items for Research (1 i tem) and PR Training (3 items). The third factor produced included six items that spanned Communication Technician (2 items), PR Counsel (2 items), PR Catalyst (1 item), and In formation Acquisition (1 item). As characteristic of a person responsible for diverse activities, the third factor is termed Factotum in this study because it encompasses items that span across several of the Leichty and Springstons (1996) original categories. The fourth factor loaded thr ee Gatekeeping items. The fifth factor loaded four Advocacy items. The sixth (2 Communication Technician items 1 Research item) factor was dropped because it had a Cronbachs alpha of .64. The seventh (1 Information Acquisition item 1 Advocacy item ) fac t or was dropped beca use it had a Cronbachs alpha of .67 and featured only two items not enough to validate adequate measure ment of a theoretical construct Thus, factor analysis pr oduced five accepted categories; these factors were each transformed to scales by adding each respective factors items together, and dividing by the total number of factors five in this case The first (Cronbachs alpha = .78), with its PR Catalyst an d PR Counsel loadings, resembled the role that Leichty and S pringston (1996) term traditional managers. The second (Cronbachs alpha = .75), with its PR Training and Research alignments, did not follow any of Leichty and Springstons

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46 prescribed roles, and was termed [ I nternal ] Organizational A uditors in this st udy for their focus on assessment and instruction with in the organization. The third factor (Cronbachs alpha = .74) represented items from the widest range of activities, and therefore suited the role of Generalist. The fo urth factor (Gatekeeping) had acceptable Cronbachs alpha reliability of .73 and was most likened to the role Leichty and Springston call ed Internals T he fifth factor (Cronbachs alpha = .71), compo sed entirely of Advocacy items, also did not fit any of the prescribed roles exactly, but coincided with Leichty and Springstons idea of Externals; thus they were termed external liaisons in this study for their focus on external representation and interface with outside publics. Power Items Principal axis factoring with a Varimax rotation, suppressing coefficients with an absolute value below 0.4, showed that items loaded as expected for four of five types of power and Ravens debated sixth power Initially, items loaded into a sevenfactor solution. Coercive power clearly loaded all five items intended to measure the power, with a Cronbachs alpha of .87. Reward power loaded three items, all intended to measure reward power, at a Cronbachs alpha of .83. Referent power loaded four items, one of which was an item intended to m easure reward power (Cronbachs alpha = .77). Legitimate power loaded four items (Cronbachs alpha = .88). The expert and informational powers were divided in the nature of their loadings, spanning across three factor loadings. Factors 6 and 7 were dismiss ed because while they showed the most decisive loadings of expert versus informational power and Factor 7 had an acceptable Cronbachs alpha of .79, they were both comprised of too few items to be considered a sufficient measurement of a theoretical constr uct: Factor 6 featured one item, and

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47 Factor 7 contained two items. Thus, the final power found in this study combined both expert and informational items ( 2 expert, 2 informational), and as such, was considered the expert/informational power (Cronbachs al pha = .71). Given the lack of agreement between the original researchers French and Raven on the existence of a sixth power (informational), the loadings did not provide a clear answer either. The items were then transformed to scales to represent the five accepted factors into which they loaded. Activity Items: Managerial or Technical To test the first hypothesis, the survey items adapted from Kelly (1994) and Gelineau (1979) were subjected to Principal Axis factoring, suppressing items below.40, to determine if the items loaded in a pattern resembling distinct manager and technical scales. Factor 1 clearly loaded four management items (Cronbach s alpha = .73), while Factor 2 consists of four technician items (Cronbachs alpha = .72). Factor 3 was dr opped because it had a Cronbachs alpha of .66; Factor 4 was dropped because it loaded one item

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48 Table 3 1. Role item l oadings Items Factors F1 F2 F3 F4 F5 Keep management informed of public reactions 0.70 Take responsibility for success or failure 0.65 Keep management actively involved 0.55 Plan and recommend courses of action 0.72 Operate as a catalyst 0.57 Formally instruct others, not in PR, how to interact with people outside of the organization 0.82 Conduct communication audits 0.55 Informally instruct others, not in PR, how to interact with people outside your organization 0.79 Work with managers to increase their skills 0.68 Make communication policy decisions 0.53 Writing PR materials 0.72 Collaborate with nonPR people to define and solve problems 0.51 Keep others in the organization informed 0.51 Edit/rew rite for grammar and spelling 0.62 Formally acquire information from sources/groups external to your organization 0.42 Provide information on a formal basis to groups outside your organization intended to create a favorable image 0.70 Decide what portions of information acquired from outside the organization to transmit to others within the organization 0.85

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49 Table 31. Continued Items Factors F1 F2 F3 F4 F5 Decide when to transmit information acquired from outside your organization to others within your organization 0.53 Decide to whom within your organization to send information obtained from outside sources 0.52 Provide information informally to groups outside your organization to create a favorable image 0.81 Represent the organization at events and meetings 0.50 Provide information informally to outsiders that will induce them to act favorably to your organization 0.48 F1=Catalyst & Counsel (Traditional Manager) ; F2=Training ([Internal] Organizational Auditor) ; F3=Factot um (Generalist); F4=Gatekeeping (Internals); F5=Advocacy (External Liaisons) Table 3 2 Power i tem l oadings Items P1 P2 P3 P4 P5 I can make being at work difficult for people at work 0.88 I can make things unpleasant for people at work 0.90 I can give others undesirable job assignments 0.55 I can give people at work negative attention when they perform in a way that is unsatisfactory to me 0.57 I can make being at work distasteful for people at work 0.78 People at work seek my advice consistently on 1 or more specific (work related) topics 0.49 I understand the reasoning behind why I perform the tasks that I do in a certain manner 0.60 I can share my considerable experience and/or training with people at work 0.67

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50 Table 32. Continued. Items P1 P2 P3 P4 P5 I can influence people at work getting a promotion 0.57 I can increase pay levels at work 0.83 I can influence people at work getting a pay raise 0.90 I can make people at work feel important 0.56 I can give people at work positive attention when they perform the way I want them to 0.47 I can make people at work feel like I approve of them 0.68 I can make people at work feel personally accepted 0.66 I can make people at work feel like they should satisfy their job requirements 0.59 I give people at work the feeling that they have responsibilities to fulfill 0.60 I can make people at work feel that they have commitments to meet 0.66 I can make people at work recognize that they have tasks to accomplish 0.58 P1=Coercive; P2=Expert/Informational; P3=Reward; P4=Referent; P5=Legitimate Table 33. Managerial v ersu s technical activity l oadings Producing an employee publication 0 .5 7 Editing and/or Producing an annual report 0 .54 Photography/design of non employee publications 0 .76 Advertising/Marketing hospital services 0 .53 Managing people 0 .64 Conducting evaluative research 0 .57 Developing strategic planning/hospital policy decisions 0 .53 Recruiting personnel 0 .63 F1=Managerial, F2=Technical

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51 CHAPTER 4 RESULTS Profiles of Practitioners A majority of respondents are female (77.4%, n=154). While age ranged from 23 years old to 67 and above, the average age of respondents was 43.3 years (SD=11.6). Nearly all respondents were employed in a full time position (94.9%, n=186). Practitioners had wor ked on average eight years (SD=6.96) at their current hospital, having just over a decade (M=10.87, SD=10.21) of outside experience in public relations (PR) aside from their current position. Nearly a quarter (24%, n=46) of practitioners claimed zer o years of experience outside their current position. Almost half (49.7%, n=93) of respondents reported an income of $70,000 or more, while 26.8% (n=50) earn between $50,000 and $69,999. Hospitals Hospitals in a minimum of 37 states are represented in thi s study. Professionals work in hospitals that average 474 (SD=1, 941.22 ) s taffed beds, 12 414 (SD=10, 514.26) total annual discharges, and $1 329 588.17 (SD=4, 358 247.57 ) in gross patient revenue. A handful of hospitals that had staffed bed numbers of more t han 1,000 account for the large deviations. Most respondents work in a hospital that has a public relations department (85.4%, n=170), with an average of four people (SD=4.65) working in the department in a public relations capacity. However, 32.4% (n=60) of respondents reported themselves as the sole person in the public relations position. Practitioners represented hos pitals in every region of the United S tates The Southeast (32.5%, n=54) and UpperM idwest (20.5%, n=34) were most heavily present, while pr ofessionals in New England (3.6%, n=6) and West (6%, n=10) hospitals were least present.

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52 Practitioner Roles in Hospitals (RQ1) Daily Activities and Practice The most commonly reported types of public relations activities practitioners engage in are media relations (M=4.75, SD=.58) and comm unity relations (M=4.40, SD=.89 ). For example, most practitioners (81.3%, n=169) reported that they practice media relations on a daily basis. E mployee relations (M=3.68, 1.14 ), crisis management (M=3.62, SD=1.12), and pat ient relations (M=3.16, SD=1.18) fell into the middle range. Least common among the type of public relations activities practiced on a daily basis were internati onal relations (M=1.69, SD=1.26) and investor relations (M=1.54, SD=1.08). Seventy four percent (n=154) reported that they never practiced investor relations for instance. In terms of specific activities, w riting news releases/responding to media inquiries (M=4.84, SD=.55), advertising/marketing hos pital services (M=4.24, SD=1.30), and producing an employ ee publication (M=4.16, SD=1.20) were the top three activities reported by hospital public relations professionals From these top three, for example, 78.4% (n=163) of respondents said that they are nearly always involved with advertising/marketing hospital services. Most of the other activities listed were also rated largely on the positive end of the spectrum, as seen in the following examples. Seventy two percent of respondents (n=150) said that they are nearly always engaged with photography/design of non employee publications as well as with coordinating fundraising/special events/press conferences. A majority of respondents also nearly always engage in giving s peeches to community groups and representing the hospital at events (59.2%, n=123) and managing people (55.8%, n=116). However, less than half of respondents report the same high, positive level of involvement with developing

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53 strategic planning/hospital policy decisions (47.3%, n=98) and counseling hospital management/governing board (43.8%, n=91). The three activities least often performed are recrui ting personnel (M=1.91, SD=1.04), contacting public officials/legislators (M=2.70, SD=1.31), and conducting evaluative research (M=2.92, SD= 1.25). Table 41 at the end of the chapter shows that practitioners rated technical items higher on average than they did managerial items, lending support for Hypothesis 1that practitioners are practicing roles that demonstrate higher technical activity than managerial A paired samples T test reveal ed support for Hypothesis 1, the idea that practitioners practice roles that focus more on high technical activity (M= 3.99, SD= 1.02) than managerial activity (M= 2.92, SD= .91 ), t (205) = 13.64, p = .00 = .05. In addition, Factor 1 (PR Catalyst/PR Counsel), which represented the Traditional Manager role, was compared with Factor 6, which consisted of two Communication Technic ian items that loaded together : P roduce pamphlets/brochures and do photography/graphics Factor 6 loaded a Research item as well, but this item was dropped to achieve an acceptable Cronbachs alpha of .71 A paired samples T test also support ed the idea that practitioners practice roles that focus on higher technical acti vity (M= 4.14, SD= 1.12) more than managerial activity (M= 4.35 SD= .59 ), t (207) = 2.51, p = 01 = .05. Therefore, this study provides evidence in support of H1. Roles From the five factors identified, practitioners displayed highest involvement with the Advocacy (n=205, M=4.36, SD=.64), Catalyst/Counsel (n=207, M=4.35, SD=.59), and Factotum functions (n=203, M=4.34, SD=.52) ; thus, the top three roles practitioners represent are External Liaisons, Traditional Managers, and Generalists. They also

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54 identified positively with the Gatekeeping role function (n=207, M=4.05, SD=.77) ; hence the role of the Internal is present in hospital public relations as well Furthermore, professionals indicated that they are moderately involved in PR Training process es (n=206, M=3.24, SD=.86) and thus, engage in some level of the [I nternal ] Organizational A uditing role P erceived Power in Hospitals (RQ2) P ublic relations practitioners believe they have high levels of expert/informational power (n=201, M=4.33, SD=.51) and referent power (n=202, M=4.16, SD=.58). They also perceive they have some measure of legitimate power (n=200, M=3.81, SD=.79). However, they do not perceive themselves to have much reward power (n=203, M=2.5, SD=.96) or coercive power (n=196, M=2.40, SD=.90). Looking at the powers breakdown further, 84% (n=169) of practitioners reported that they have expert/informational power within their hospital, while .5% (n=1) reported they do not possess that power Similarly, 71.9% (n=145) perceive that they w ield referent power while only 3% (n=6) do not believe that they do. Just more than half of hospital public relations practitioners (54.5%, n=109) reported they have legitimate power ; however, since only 12% (n=24) believe they do not have legitimate power, there was a sizeable group of practitioners offering neutral responses on the subject. Lastly, reward power and coercive power are remarkably absent in hospital public relations practice: 10.8% (n=22) of practitio ners said they have reward power, while only 4.6% (n=9) believed that they have coercive power.

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55 Potential Predictors of Power (RQ3) Demographic Correlations Y ears of experience in public relations was not statistically correlated with the different types o f power practitioners believe they possess. Both years of professional experience aside from current position in hospital and years of experience as p ublic r elations professional at current hospital were tested, but showed no correlations with power perception s. Likewise, there was no significant correlation between the size of a hospitals public relations department, signified by total number of beds, and the types of power professionals believe themselves to practice. Correlations with Roles The PR Catalyst/Counsel Factor, representing Traditional Managers did not correlate as expected. Statistical correlations were found with referent r (199 ) = .33 p < .0 1; legitimate r (197) = .32, p < .01; and expert/informational powers r (198) = .40, p < .01. Hypotheses H2c and H2d are supported. There was a significant, if weak, correlation with reward power r (200) = .18, p < .05 indicating support for H2b. The expected strong correlation with coercive power was absent r (195) = .05, p = .52 indi cating H2a is not supported. Furthermore, the correlation with referent power was unexpected. The PR Training Factor, which represents the [Internal] Organizational Auditor role showed no strong correlations. Weak s tatistical correlations were found for r eward power r (199) = .17, p < .05 and legitimate power r (196) = .19, p < .0 5 Factotum, which indicates Generalists, showed some statistical correlation with the referent, r (195) = .28, p < .01; legitimate, r (193) = .27, p < .01; and expert/informat ional powers r (194) = .34, p < .01 ; therefore, there is support for H2o,

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56 H2p, and H2q respectively. The expected correlation with coercive power r (192) = .01, p = .87 was absent, as was the expected correlation with reward power r (198) = .06, p = .42 ; therefore, H2m and H2n are not supported. The Gatekeeping Factor, capturing Internals, shows statistical ly significant but weak correlations with referent, r (199) = .20, p < .0 1 ; legitimate r (197) = .33, p < .01; and expert/informational powers, r (198) = .25, p < .01. Thus, H2k and H2l are supported, although the correlations are not strong. T he originally anticipated presence of coercive power, r (195) = .04, p = .54, and reward power, r (202) = .13, p = .07, is absent in the final results. Hypotheses 2i and 2j are not able to be supported. Lastly, External Liaisons the Advocacy Factor were not correlated with any of the powers. Notably this role lacked the statistical correlation with expert/informational power r (198) = .10, p = .15 ; thu s, hypothesis 2e is not supported. Hypotheses 2f, 2g, and 2h are supported in the absence of correlations with coercive r (194) = .09, p = .21 ; reward r (200) = .07, p = .32; and legitimate powers r (198) = .12, p = .10 Educational Training (RQ4) Alm ost all respondents had some form of higher education: Nearly twothirds of respondents (62.8%, n=125) held a four year (B.A./B .S.) degree, 29.1% (n=58) a masters degree, and 2% (n=4) a d octor al degree. Most practitioners held a degree in a communicationrelated field, though not necessarily specifically public relations; in fact, only 16.2% (n=32) claimed to have a final degree in public relations. Journalism was the most prominent final degree category, but even that totaled only 18.7% (n=37) of surveyt akers. No significant correlations were found to indicate that level of educational training (i.e. two year, four year, m asters degree, etc.) was related to roles (RQ4a). Likewise,

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57 n o significant correlations were found between level of educational training and perceived power (RQ4b). A very weak statistical correlation was found with reward power r (192) = .16, p < .05.

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58 Table 41. Mean scores of managerial v ersu s technical i tems Items Mean Std Dev Managing people 3.58 1.38 Conducting evaluative research 2 91 1.25 Developing strategic planning/hospital policy decisions 3.27 1.20 Recruiting personnel 1.92 1.04 Producing an employee publication 4.16 1.20 Editing and/or producing an annual report 3.57 1.57 Photography/design of non employee publications 3.98 1 39 Advertising/marketing hospital services 4.24 1.30

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59 CHAPTER 5 DISCUSSION Hospital public relations p ractitioners work is mostly media and community centric a finding that is not surprising, given the heavy use of the media from any public service industry as an outlet for communication with the external community. As former A merican H ospital A ssociation chairman Richard Umbdenstock noted, Community support built the nations hospitals (2006, p. 4). Um bdenstock stressed that in this communication age in which publics demand transparency from institutions, its more important than ever that hospitalsstrengthen their ties with their communities (2006, p. 5). The community con nection, he argued, extends its significance beyond the immediate context to larger advocacy trials, meant to trickle upwards to polic y decisionmakers in government, the media, and opinion leaders. The absence of international scope to practitioners work and lack of contact wi th public officials/legislators indicates that hospital public relations professionals define their community in a directly local context. Aside from the focus on media and community, hospitals hire one to a handful of public relations professionals to encompass a variety of communications activities, rather than for specialized modes. The absorption of Leichty and Springstons (1996) Formal Research items into other factors following this studys fac tor analysis suggests that research has become a function that practitioners in many roles must engage in. Marketing activities are among those expected of professionals as many hospitals combined the marketing and public r elations departments Thus, professionals who are not adaptable to multi disciplinary work may find it difficult to meet the demands of hospitals that require more range from thei r communication employees.

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60 P ractitioners reported high involvement with developing strategic planning/hos pital policy decisions but their lack of coercive power perhaps shows that while there has been movement toward invol ving public relations in management activities they have not yet attained that leverage within the hospitals organizational structure ac cording to the traditional definition of a manager in most disciplines While Cho (2006) specifically studied media relations, his similar finding of the lack of coercive power health public relations practitioners perceive they have aligned with this stud ys findings. Chos suggestion that this lack of coercive power could indicate that health public relations practitioners seem to play a fair game (2006, p. 575) could be applicable to hospitals as well To clarify this idea, public relations professionals may disagree with, or be at odds with, the demands of some of the various publics of a hospital; however, if a practitioner is to fairly and ethically manage the relationships of an organizations stakeholders, accommodation and understanding may be the appropriate response in lieu of forcefulness The powers practitioners most strongly perceive themselves to possess are referent, legitimate, and expert/informational, while most estimated they have very little reward power within the hospital. These findings suggest that hospital public relations practitioners enjoy personal sway at their workplace, without having much tangible reward or compensation to offer others for that exchange of power Public relations educators can evaluate the public relations coursework currently offered at universities to determine if they are adequately preparing students to posses referent, legitimate, and expert/informational powers in practice Consumers of hospital services can take the lack of coercive power and the prev alence of referent, legitimate, and

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61 expert/informational powers in public relations to indicate how well practitioners may be able to serve as advocates for patient interests in the organization; the powers public relations practitioners displayed are base d in understanding rather than force. Equal numbers (9.6%, n=19) reported final degrees in marketing and business, and a small number (5.1%, n=10) held a degree in health a dministration ; while a n educational background in journalism or a communicationrel ated field is most prevalent the results show that a specific degree in public relations is not necessary to enter this line of work. The number of higher education degrees hospital public relations practitioners hold, however, has only slightly increased from those recorded in Gelineaus (1979) review over 30 years ago. Surprisingly, the size of public relations departments as indicated by the number of public relations professionals in the department, has increased only a little since the 1979 study. A possible reason for this lack of expansion may include hospital budget cuts and the current overall financial crisis se eping into all sectors of the United States economy as Gordon and Kelly noted the immediate effect of budget cuts on hospital public rel ations departments even in 1999. Another possible explanation is that public relations responsibilities are being delegated to other departments or that hospital management does not view public relations as a necessary function that hospitals need. Limita tions While a number of state hospital associations and regional hospital public relations organizations affiliated with the Society for Healthcare Strategy and Market Development agreed to distribute the survey to their members working in hospital communications, not all sta tes were responsive to the request for distribution; thus, some states are better represented than others. Furthermore, the second method of

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62 distribution, which included survey distribution to a sample of 800 chosen from the American Hospital Directory, may have yielded some responses outside the public relations field. Due to unavailability of contact emails for all public relations contacts online, in cases where no public relations contact was to be found, the survey invitation was addressed to t he Depar tment of Public Relations but submitted through the hospital s general Contact Us form with a request to forward. The initial method of contact email collection proposed (telephoning hospitals) was found to be ineffective when implemented on the mass s cale needed to provide the desired sample size; of the 443 hospitals telephoned in July August, contact emails were garnered for 149 hospitals, while 79 responded they did not have a public relations employee and the remaining number were unresponsive despite messages left on their machines. Thus, the telephone approach was abandoned for the email/contact us method. However, influence of entirely nonpublic relations personnel was limited by screening those responses out of the final response set. The data collection period of this study was extended first to accommodate those regional associations that required board approval for survey distribution. When these efforts yielded insufficient response, a threefold effort to boost the number of initial responses was made by sending out second requests to unresponsive associations, emailing the sample of 800, and posting on the Public Relations Society of America Health Academys social networking sites. Survey timing proved difficult in regard to vacation time: a number of auto response emails received indicated practitioners were out of office at various points of the holiday season. Thus, the survey concluded in the week following the New Year.

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63 A major limitation this study faced is the combination of titles many of the respondents hold: specifically those with titles such as marketing and p ublic relations coordinator or director of c ommunications. While marketing and public relations, for example, are based in distinct academic principles of their specif ic communication disciplines, the combination of these two disciplines into one job title or position made it difficult to entirely isolate the public relations influence; it can also be used as an indication that employers want employees who can bridge multidisciplinary practice. In Leichty and Springstons (1996) study, the eight role factors identified were subjected to c luster analysis to produce the five roles used as the basis of their study. However, a viable cluster analysis could not be replicated. Thus, as a substitute, the role factor loadings were examined to determine which of Leichty and Springstons roles they most resembled. The first factor fit the notion of Traditional Managers because it loaded both PR Counsel and PR Catal yst items, but l acked the aboveaverage levels of Gatekeeping, Information Acquisition, and Advocacy originally found. The second factor did not match any of Leichty and Springstons roles and became the new role of [Internal] Organizational Auditor. The third factor rese mbled the Generalist description in its loadings of Communication Technician, PR Catalyst, PR Counsel, and Information Acquisition items. The fourth factor, while likened to Leichty and Springstons Internal role, featured only Gatekeeping items and lacked the high technical activity and high PR Catalyst activities expected. The fifth factor, dubbed External Liaisons to resemble the Externals role, was composed entirely of Advocacy items and lacked the high levels of technical activity and Information Acq uisition expected.

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64 Another limitation concerned the ability to adequately test the first hypothesis. Only two of the Communication Technician items loaded together in the Principal Components analysis, and the clustering could not be completed to determine a Traditional Managers grouping according to Leichty and Springstons original method. Thus, for the purpose of answer ing H1, the discarded sixth factor that of Communication Technicianwas compared to Factor 1 i n a paired samples T test; however, the items used from Kelly (1994) and Gelineaus (1979) studies were al so subjected to paired samples T testing as a supplemental measure. Lastly, the survey item s are all self assessed measures. Especially in regard to ones perception of his or her level of power within an organization, this type of measurement leaves room for error for the professional who perceives himself to be more or less powerful than he is in actuality, or for the one who desires to be seen as more powerful and so reports his levels as higher to fit a more desirable profile. However, the argument is made that the practitioner is the best person to estimate his own power levels because he ex periences them firsthand and most intimately. If a practitioner feels powerful, it is likely because he is experiencing some measure of power. Suggestions for Future Research Further testing needs to be done to clarify and refine new role measures, such as those proposed by Leichty and Springston (1996). Not only do the items need to be tested by confirmatory factor analysis to determine if they accurately measure what they are intended to measure, but the role categories need conceptual clarification. The loadings of this study did not reflect st rong evidence for the need for eight factors to measure role behavior, for example. Furthermore, the outlier category that Leichty and

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65 Springston propose, in particular, lacks a strong conceptual basis and is the weakest role category. However, the impetus for new role studies that diverge from traditional accepted theory is both needed and well timed, as there has not been extensive research into alternative role proposals in decades; with the rapid evolution of n ew communication methods over the past decade alone, public relations roles must be reexamined to determine what new expectations exist for professionals in this field. Encroachment from other professions may be prevented if practitioners are prepared to m eet the demands of the new communication climates into which their hospitals have been thrust. From social psychology, m ore research on the possibl e existence of a sixth power should be conducted, as the loadings from this study showed split evidence for i ts existence. Examining power perceptions in different types of public relations (i.e. public affairs, investor relations, international relations) would be able to show the position of public relations within other types of organizations as well as test C hos (2006) idea that coercive power is almost antagonistic to the goal of public relations.

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66 LIST OF REFERENCES Ameri can Hospital Association. (2009). Beyond health care: The economic contribution of hospitals. Retrieved 12 December 2010, from the World Wide Web: http://www.aha.org/aha/researchandtrends/healthandhospital trends/2009.html Berkowitz, D., & Hristodoulakis, I. (1999). Practitioner roles, public relations education, and professional socialization: An exploratory study. Journal of Public Relations Research, 11 (1), 91 103. Bolam, B., Mclean, C., Pennington, A., & Gillies, P. (2006). Using new media to build social capital for health. Journal of Health Psychology, 11 (2), 297 308. Borchgrevink, C. P. & Susskind, A M (1996). The validity of the Hinkin and Schriesheim power scales and superior subordinate power relationships within hospitality. Journal of Hospitality & Tourism Research, 20 (1), 39 55. B ronn, P. & Bronn, C. (2000). A reflective sta keholder approach: Coorientation as a basis for communication and learning. Paper presented at the 7th International Public Relations Research Symposium. Broom, G M., (1982). A comparison of sex roles in public relations. Public Relations Review, 8 (3), 1722. Broom, G. M., (2009). Cutlip & Centers effective public relations. (10th ed.). New Jersey: Pearson. Broom, G. M. Casey, S., & Ritchey, J. (1997). Toward a concept and theory of organizationpublic relationships. Journal of Public Relations Resear ch, 9 (2) 8398. Bruning, S. D. Castle, J. D. & Schrepfer, E. (2004). Building relationships between organizations and publics: Examining the linkage between organizationpublic relationships, evaluations of satisfaction, and behavioral intent. Communic ation Studies, 55 (3), 435 446. Bruning, S D ., & Ledingham, J. A. (1999). Relationships between organizations and publics: Development of a multi dimensional organizationpublic scale. Public Relations Review, 25 (2) 157170. Busch, P. (1980). The sales managers bases of soci al power and influence upon the sales force. The Journal of Marketing, 44 (3), 91101. Centers for Disease Control and Prevention. 2009 H1N1 flu (swine flu). Retrieved 30 September 2009 from the World Wide Web: http://www.cdc.gov/H 1N1FLU/

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67 Cho, S. (2006). The power of public relations in media relations: A national survey of health PR practitioners. Journalism & Mass Communication Quarterly, 83 (3), 563 580. Cho, S., Cameron, G. (2007). Redefining the power of public relations in organizations: A national survey of health PR practitioners. Conference paper presented at the International Communication Association. Dolan, P. (2009). Should doctors use Twitter? American Medical Association. Retrieved 18 October 2010, from the World Wid e Web: http://www.ama assn.org/amednews/2009/06/29/bisa0629.htm Drea, J. T., Bruner, G. C. & Hensel, P. J. (1993). Comparing alternative measure of the French and Raven power bases. Journal of Personal Selling & Sales Management, 13 (4), 73 80. Drevdahl, D., Dorcy, K., & Grevstad, L. (2001).Integrating principles of community centered practice in a community health nursing practicum. Nurse Educator, 26 (5), 234239. Dutta, M. & Basu, A. (2008). Meanings of health: Interrogating structure and culture. Health Communication, 23 (6), 560 572. Dwyer, R., & Walker Jr., O. (1981). Bargaining in an asymmetrical power structure. The Journal of Marketing, 45 (1), 104 115. Ferguson, M. (1984). Building theory in public relations: Interorganizational relationships as a public relations paradigm. Paper presented at the Association for Education in Journalism and Mass Communication Annual Convention. Fox, S. & Jones, S. (2009). The social life of health information. Pew Internet and American Life Project. Retrieved 5 November 2010, from the World Wide Web: http://www.pewinternet.org/Reports/2009/8The Social Life of Health Information/01 Summary of Findings.aspx?r=1. French, J. & Raven, B. (1959). Ott, J., Parkes, S., & Simpson, R. (Eds.). (2003). The bases of social power. Classic Readings in Organizational Behavior 400409. Belmont, CA: Wadsworth. Gelineau, S D (1979). Hospital public relations: A contemporary profile. Public Relations Quarterly, 24 (1), 10 15. George, G., & Sleeth, R. (2000). Leadership in compu ter mediated communication: Implications and research directions. Journal of Business and Psychology, 15 (2), 287310.

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74 BIOGRAPHICAL SKETCH Christina Bosilkovski is a public r ela tions graduate student with a Bachelor of Arts in w riting from Ithaca College. She currently lives in her hometown of Buffalo, N ew Y ork where she plans to seek employment in hospital public relations. Prior to coming to the University of Florida, she served as Circulation Assistant at Cornell Alumni Magazine.