Influencing without Power ” Currency in Inspiration Labs — A Case Study of Hospital Emergency Beds

Most of literatures on currencies of “Influencing without Power” focus on skills, internal organisation command chain, convincing, indirect power, or what makes people do specific task and to have attitude to cooperate with others to reach gaols. In this case study paper currency of “influencing without power” is investigated in one of the inspiration labs carried out and then compared to current literature available on the concept of influencing without power or extra resources. The paper focuses on understanding how inspiration economy “influencing without power” currency has differentiated itself to leave an outcome not only results or improvement of enabler skills. A model of “Influencing without Power” used in inspiration labs was proposed followed by application on a complex case study about a regional hospital with a problem of scarcity beds limitations for emergency cases. The hospital was selected to experiment the concept of “influencing without power” and its currencies through inspiration lab. The research method consists of the analysis of the case-study specifically in its role in creating positive influence through approaches that shows how the waves of influence are triggered and what results or outcomes its creates. A discussion is done on the differentiation that inspiration labs offer to the knowledge community in comparison to current literature about influencing without power, or resources, or authority. The paper concludes about how currencies of inspiration economy focus on influencing the mindset and changing the way things are approached in dealing with problem solving, or overcoming challenges. The paper shows how effectiveness of “influencing without power” generate currencies that change the attitudes towards stages of synergy and opens new path for more research on both inspiration economy labs and the socio-economic value of influencing with minimal resources and limited or no power. How to cite this paper: Buheji, M. (2018) “Influencing without Power” Currency in Inspiration Labs—A Case Study of Hospital Emergency Beds. American Journal of Industrial and Business Management, 8, 207220. https://doi.org/10.4236/ajibm.2018.82014 Received: January 16, 2018 Accepted: February 8, 2018 Published: February 11, 2018 Copyright © 2018 by author and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/

1. Literature Review 1.1.Introduction While Kendrick [1] focused on desired behaviours, IE focuses on way of implementation to change behaviours.However, Hogg and Cooper [2] focused on what happens in diversified communities, or people with different backgrounds, multi-discipline and different interest.
When we read the current available literature about influencing without power, or authority, or resources, we rarely hear the word capacity, and rather tend to see the word skills and competency, [3].This gap was addressed with the recent literature that came from the projects of inspiration economy which focused on "influencing without power" that leads to raising the capacity vs. demand.So here, it is not only about influencing a project team, or developing skills, or influencing fellow employees, it is much beyond that.It is about an influence that create an outcome and that leads to legacy which means realising actual sustained change into the socio-economy [4] and [5].
In the coming sections, the author reviews among the huge literature what influence means on the society, i.e. beyond the personal influence which is the focus of most of the literature so far.Ways of influence to the extent leaving a major sustained change, called in this paper legacy is also presented.The importance of "influencing with power" as a concept and a mindset and especially in instable socio-economies today are discussed.

What Influence Means?
Real influence provokes change.Influence is only valuable when it provokes change in how people operate and think; when it inspires them to take required action [6].
Influence is more about reciprocity (give and take) between you and another person(s) or between organisations and communities which enables change to happen or attitudes, opinions, or behaviours to be reinforced as per Cohen and Bradford [4].
Johnson [7] mentioned about the influence that is built on gaining access to resources needed carried out by unusual efforts.For example, gaining access to resources needed with minimal investment of efforts, using more sound evidences.Johnson that influence clearly happens when doors swing open freely to those key players whose cooperation needed most.That time we'll feel we've achieved central purpose while catalysing valuable change for the targeted community.

Ways to Influence
Lauren Johnson [7] mentioned about 8 R's as eight ways to create an "influence without power".These eight R's start with Reasons, Research, Resonance, Repetition, Resources, Rewards, Real-world events and Resistance.While Linda Hill [8] seen that there are mainly only two ways to influence without power that is empowering others and cultivating networks.
Brown et al. [9] defined how to create an influence by four I's.The first I is about individualized personal attention to others, making each individual feel uniquely valued.The second I is about intellectual stimulation where people are actively encouraged to a new look at old methods, to stimulate their creativity and encourages others to look at problems and issues in a new way.The third I is about inspirational motivation where people optimism increased through enthusiasm for possibilities not previously considered.The last and fourth I is about idealized influence where a sense of purpose build more trust and confidence from followers.

Why "Influencing without Power" It Is Important Today?
Influencing without power found to create more impact and lasting effect in relevance to socio-economic problems as poverty, low aspirations, quality of life, youth demands, social and political instability, low productivity, business instability and issues of migrations.If we influence with minimal resources and without using any official power people would be more committed to create more differentiated results and outcomes compared to what is expected [4].Buheji and Thomas [9] mentioned about more demand being more frequent waves of innovation and with the spread of instable coexistence or resilience, influencing without power and with minimal resources can create more differentiation for communities' outcomes.
Influencing without power is highly needed as both a principle of life and mindset, as it enhances our survival and competency chances in a very turbulent socio-economy such as the one we are witnessing more today.

Examples of "Influence without Power"-from School of Ghandi
Vora [6] mentioned about the secret of Mahatma Gandhi "influence without power" which can be summarised in one word "simplicity".Gandhi was independent of all the influence resources i.e. the position, the wealth, the power and the authority.Yet, Gandhi influenced the whole empire and influenced the hearts, spirit and minds of so many people across the world more than 80 years now.
Vora confirms that Gandhi simplicity confirms that no matter who you are, or where you are in the order, you can make a difference.Gandhi as per Vora worked with others and through them to achieve his objectives, but he never compromised on his own principles.Actually, as per per Vora, these principles American Journal of Industrial and Business Management were the substance that Gandhi generated his influence on others.Therefore, one could summarise that having real accomplishments, experiences, passion and credibility were the real formula of Ghandi's sustained influence.This formula raised people trust on Ghandi, and thus it became one of his influence currencies.
Ghandi also used other way trust, i.e. trusting people around him.Ghandi knew that when people get trusted, they get influenced as they change when they feel being trusted.

Barriers to "Influencing without Power"
There are many type of barriers to effective influencing.Most important barriers however are relevant to organisational culture.Hierarchical communications and styles tend to prohibit influencing without authority.Studies shows product or service complexity control the level of learning that can be done and thus inhibits the ability to influence [3] [5].Limitation of time dedicated for discovery also found to inhibit people to see and verify the requirements of type of reflection and thus affect their participation.With lack of people participation or inconsistent participation, it is hard to "influence without power".Hence by employing a consultative approach, project professionals can gain the needed influence to facilitate positive project outcomes.

Research Method
The method in this paper consists of an analysis of an initiatives carried in one of largest government hospitals, which needed to explore a change without extra resources or authority.Therefore, a focused influencing without power research is carried out in-depth followed by a proposed model from inspiration economy and labs is presented.Then a case Study of secondary care regional hospital was selected to explore the "influence without power" currency.Then a comparative analysis is done in the discussion and conclusion.The identity of the hospital is protected due to contractual agreement about the sensitivity of the issue sociopolitically.

The Proposed Model
Based on the experimental theories that were developed from inspiration economy and inspiration engineering a model for influencing without power or with minimal resources is proposed.The following sections explains the theoretical background of the model and its constructs.

"Influencing without Power" as a Type of Inspiration Currency
Cohen-Bradford [4] proposed a model that reflects how influence create currencies.The Cohen-Bradford seen that influencing without power creates inspiration for building vision, excellence, morality/ethics.Through such influence currencies we build tasks for resources, information, assistance and support.
With influence currencies we build a type of inspiration currencies as position advancement, recognition, visibility, reputation, networks/contacts and we appreciate the importance of insiderness.Also, Cohen-Bradford [4] seen that relationship built on acceptance, personal support, understanding, and inclusion help people to see self-concept, feel the importance of managing together challenges, with ownership, gratitude and with more involvement with reality [10].

Why "Influence" Is Important for Inspiration Economy?
Inspiration economy is about the ability to create positive socio-economic change through utilising the intrinsic powers of the individuals, the organisations and the communities.Once intrinsic powers can be utilised then the organisation can use these powers to influence a change with being more independent from the resources.This needs first a ready mindset that appreciates the importance of this change.Influencing the mindset make organisations and communities get more engaged to create a focused outcome towards a targeted legacy (Hogg and Cooper, [2]; Mathieu et al., [11]).The level of influence is very important for inspiration based economy, as without such level of influencing people can't see how inspiration would leave an impact on the economy and on the socio-economy [9] and [10].
In today busy life we need to influence with minimal resources and quick impact that can be felt by more people.When we prove we can influence, even if we don't have the power on others, this means we minimize the excuses.Actually, as per Johnson [7] people won't interact enough unless they stop procrastinating, or stop hesitating, or stop having the feeling that they don't have the power, or the authority, or the resources to influence a change.With the increasing rapidity of technological change and shortening of products/services life cycles that are making the competition more intense, influencing without power is very important to attract their attentions and to utilise the failures, the challenges and turns them to sources of inspiration which we call opportunities.
Hence, in inspiration based economy influencing without power is part of problem solving and problem finding that lead to overcome complexity and creation of development.
Figure 1 shows how inspiration engineering labs create different currencies as influencing without power, inspired mindsets, inspiration currency and lifelong learning that create sustained legacy which shows the importance of inspiration economy.

Inspiration Labs Influence
Inspiration labs is considered to be a technique where people are brought together to explore and collect field observations about a specific chronic, or complex or challenging problems and then explore further how turn it into opportunities, as illustrated in Figure 2. Inspiration labs is therefore considered to be a American Journal of Industrial and Business Management  .The more we manage to influence others, the more we own the currency to change them, or at least create in them the will to take action.However, experience from inspiration labs shows that sustained influence need to be linked to paths of learning created that lead to currencies of inspiration.The more we influence, the more we will be able to build sustained communication.
Influence is about exchanging something another person values.It depends a lot on perception and expectations as well as the spirit.Using the spirit of attempting to "influence without power" in inspiration labs found to create pull thinking that make the participants identify and then extract opportunities and benefits that create positive change with minimal resources.Through executing the radical changes that inspiration labs usually produce, we show that influence does not require formal authority or power; however, it does require trust and good relationships at different stages in the lab which supports the work of [9] and [6].
Through reflection of inspiration labs experience in the last three years, the power of influence found here to focus on converting the power towards others through empowerment and the utilisation of networks [9].
Since beliefs influence behaviour, inspiration labs focus on creating beliefs through problems findings which create new mindset once problems are solved and became a source of inspiration.Hence, the influence power is very relevant to the opportunity finding rather than the capability of solving problems only.
In order to create a sustained inspiration lab, influence we need to improve the level of visualisation which would improve the accuracy of hit rate.Both visualisation and better hit rate would enhance the direction focus and create a selective mindset that help to discover and create new learning, as shown in differentiation in relevance to its ability to create better capacity vs. demand. [10].

Currency of "Influencing without Power" in Inspiration Labs
Currency means something valuable that we possess and that we can trade for something we want or need.Currency is valid if we have something to offer that others want.So, having a strong currency means that we can create an influence with it or even drive change through utilising it effectively.Examples of currencies other than money are having specific technical expertise, specific organisational knowledge, political will, or knowledge about clients, etc. Gratitude, recognition, appreciation, listening, respect, assistance with tasks, are also considered small currencies.Grants and budget al.location are also considered types of currency.
The currency of "influencing without power" generated in inspiration labs helps to change the mindsets of people by selected repetition that affects the logical mind and, at the same time, embraces analogical thinking.This type of currency is enhanced by both failure and an appreciation that creates empathetic thinking.Once this cycle is completed, personal inspiration currency becomes even stronger and more focused allowing the creation of positive change in the socio-economy [10].
Cialdini [12] talked about using emotional intelligence and empathetic thinking as currencies of "influencing without power", giving examples on shopping store staff being cheerful, or when they offer free sampling to taste.This type of influence is part of the art of persuasion.
Currencies of influencing without authority is more effective when there is no direct benefit for the stakeholder you need the help from and is based on "trading favours" within your network of influence and as a consequence increasing the power of this network.
Finding the right Inspiration Currency is easy, but it need focus in setting the right question.The currency of inspiration come through the main practice of Inspiration Economy that is observation.With Observation we find Inspiration American Journal of Industrial and Business Management Opportunities which once open up to be the right match of what we are passionate about it becomes our currency that we are going to use again & again to create an influence.
When the target is to inspire and influence people, organisation and society; raising the capacity to shape what happens next and its effect on the actions, behaviour or opinions of others.Here the inspiration currency is about having the focus and curiosity to explore what is happening.Buheji and Thomas [9] mentioned about the importance of inspiration currency as being a source for raising the capacity to influence through learning generation.Leo van Lier [12] focused on the importance of the learning generation and mentioned the importance of noticing things in order to learn from them effectively.Once we notice things or ideas then we enter an awareness stage and accept their existence.More noticing means more influence and more learning and this means we enter the stage of realisation where we are able to translate concepts into reality and this differentiates the level of influence achieved.

Introduction to the Regional Hospital
One of the major regional hospitals in Gulf Cooperation Council was explored to see how its long time chronic scarcity of emergency beds can be tackled without extra resources and without authority.The project targeted to inspire the organisation to improve its total lead time for emergency beds and ease admissions in the hospital.The case focused on understanding the basis and the level of urgency of the cases, which is one of the most challenging issues in any healthcare institution, especially if this is to be accomplished with no extra resources: i.e. minimising waiting times without extra resources of beds or staff.
The case study has gone through the following stages to create an effective change through influencing without the need for power:

Understanding the Challenges and Opportunities in the Regional Hospital
This GCC regional hospital had the following challenges that can be turned to opportunities as per inspiration economy.
• Despite the hospital had many expansions in the last decade, and its reached a capacity of more than 1600 beds, still the hospital failed to provide the necessary beds for emergency patients on time.• There was no proper basis for the data relevant to the availability and management of beds, beds quality services and therefore there was no real time data that help for beds vacancy management.
• Emergency Patients wait on average more than 12 hours and sometime they might reach 72 hours till they can be admitted as emergency case.• The level of the culture of hospitality services in hospital in general was very low.
• The main service provider for emergency cases is the Medical Departments where they have one fourth of the total hospital bed capacity and get more than one third of the emergency admitted patients.

Studying How to Motivate and Inspire Residential Physicians with Minimal Power and Without Extra Resources
The following motivation were done in order to excite some of the stakeholders of the emergency bed cases service providers: • The Medical Department was approached to be the focus of this case study, with promise of minimal time and efforts would be given from the senior staff to the case study process and not to lose the focus on the core of the service, that is patients quality care.• The case study facilitator explained to the Medical Department resident physicians why they were chosen instead of consultants to be main partners and team for this management of this project.The Medical residents were mostly young below 30 years old and mostly connected to patients on day and night, besides they are the ones mostly available near patients and usually have better communication abilities with all types of staff, with more patience to manage change.
• After a deep dialogue about the importance of project to their administrative abilities to manage change, the resident physicians were motivated to create a team to carry out data collection, data analysis and auditing.

Defining the Type of Inspiration Lab Project
This organisation was selected to be the case study to test the proposed model based on its complexity.This organisation is unique due to its being very resource dependent, managed by professional bureaucrats as medical consultants and senior nurses.The organisation also is very important since it is relevant to critical life services, with multi-discipline staff and with very costly services.Therefore, this inspiration lab was selected to measure how "influence without power" while defining accurately the inputs and outputs of the project as follows: • This hospital is unique as only 16% of the world hospitals have more than 500 beds.
• The hospital accepts many patients who are 65 years old and above who represent the majority of inpatients, even though they are the minority group in our community.
• Even though the majority of patients in this general hospitals would be ad-American Journal of Industrial and Business Management mitted to a medical department, there is no information for patients' admission and discharge.
• The amount of complaints in this hospital, especially about the quality of treatment in A & E and waiting for admission in medical department is alarming.
• No proper communication plan between departments that would help to ease the complexity of the hospital issue in relevant to being more prepared for emergency cases.

Setting the Scale of Observation for the Project
The following observations were collected to see the sources of influences in the hospital: • The hospital has "vertical thinking" (every physician and every department have their own system for patients' discharge).
• The hospital has "horizontal thinking" between departments to collaborate in order to create better quality of life for admitted patients.
• The hospital has "integrated thinking" that depends on reporting between multidisciplinary teams.

Exploring Inspiration Opportunities
Since there are many demands coming up in the healthcare industry that can be either met by more power, supply or building up of better capacity, the inspiration lab helped to explore the following opportunities: • An opportunity to speed up the availability of beds that leads to lower waiting times to receive an emergency service.
• An opportunity to build a model for bed turnover focusing on available improvement techniques to raise the capacity by more 220 beds to accept more patients per week.This would especially viable for meeting a country demand with limited resources.
• An opportunity for increasing the level of medical and health care services provided to patients, since the average age of citizens has increased and there is greater awareness of patients' rights.
• An opportunity for enhancing the level of services must meet hospital accreditation requirements.This means with these opportunities we can increase the capacity to meet al.l of these demands without extra resources and/or without authority: i.e. without changing roles and regulations, or losing level of patients' confidence in the services.

Developing the Way We Think
In order to create the currency of "influence without power" in the regional hospital, we need to influence about the way people think and act, thus we need to: • Start collective teams' observations of the work style of medical wards.
• Collectively realise the different patients' treatments are planned.
• Collectively understand the way resident physicians' time is being managed.
• Collectively realise the methods of communication between the wards and other service departments, such as pharmacy, labs, admin and the bed scheduling team.
• Collectively assess how emergency patients need fast services to be available near the beds they need, in order to speed up the freeing of beds by recovering patients, thus increasing the number of available beds.
• Build team spirit to create better integration of departments through dash board monitoring of bed turnover per physician.
• Specify which resident physicians prepare the patient release documents.
• Study common disorders that cause patients' demand for beds in the model department which is in this case the medical department.This can be supported by creating clearer protocols and care regarding discharge planning and home follow-ups.

Applying Behavioral Economics
"Influencing without power" is about Behavioural Economics (BE).In order for BE to occur we need to: • Enhance the readiness of culture by changing the measures of delay for discharge or bed occupancy from days to hours.
• Establish online synchronisation between medical wards and A & E.
• Set up realisation about the importance of pre-discharge plans.
• Since 78% of patients come from A & E and the discharge time takes more than 10 hours, we need to speed up patients' discharge.
• Most patients stay after 5pm and even over weekends because no discharge plans have been issued by consultants.
• About 40% of patients in A & E are transferred to medical wards.However, they sometimes need to wait for more than 6 hours; this might be up to 3 days.
• There are high bed occupancy ratios and slow bed turnover.
• Poor facility utilisation and efficiency.

Continuously Reframing the Mindset
Since the ultimate goal of inspiration lab is to create currency of "influencing without power" by changing the mindset of hospital targeted community, this could be realised by working on: • Values transparency, through maintaining more fairness and empathy.
• We need to have beds for the neediest emergency cases.
• The availability of beds for these cases needs to increase.
• Reduce waiting times for arrival and discharge days.
• There is much instability in the utilisation of beds and turnover in all the wards of medical depts.

Shifting Measures from Outputs to Outcomes
The inspiration Lab techniques mentioned in this case managed to show influence role in transforming the measures from being output (results driven) i.e. to have a bed available however after more than 16 hours, towards being more outcome driven, i.e. the availability of beds guaranteed for emergency patients and specially in Medical Department.
The main root towards "influencing without power" currency in this case helped to speed up the availability of emergency beds through: 1) Restoring the most optimised measures for admission and discharge that would balance between patients' rights that usually have the Quality-Cost-Delivery build on it.
2) Setting up a pre-discharge communication plan with patients' relatives.
3) Setting up pre-discharge drugs' delivery.4) Utilising Total People Involvement (TPI) with both patients and families in the discharge decision.5) Provision of pharmacy, labs and transport services.

Discussion & Conclusions
A detailed case study has been discussed in relevance to the proposed model of "influencing without power" in inspiration labs.The case study shows innovative approach through different techniques which organisations and communities can use to create great influence with minimal resources and less authority.
The other uniqueness of the case is that the conducted influence even more sustainable compared to conventional influence.In this work, the currencies of "influence without power" model found to develop more opportunities for organisations and communities to get their inspiration economy outcome.
Further influence tools as improving the hospital cleanliness and management of the beds to the highest level of patients' satisfaction and reducing the bed costs, are not included in this case study reporting.However, many outcomes can be seen as "influencing without power" currencies for this case specifically which helped to 60% improvement in emergency patients beds availability, such as development of discharge checklist.As a result, 90% of the discharge time reduced to before 12 pm daily.This helped to influence the reduction of the average waiting time for the bed to be 1.5 hours.
Other "influence without power" currencies were pulled along with these outcomes as improving the quality of life of patients during bed occupancy and reduction of average waiting time from more than 79 hours to less than 10 hours.A bed management business model was built and proposed that it is more independent of resources and less cost driven.
The case study shown that "influencing without power" in inspiration labs create even more peer to peer support while increasing the "hit rate" by having more intelligent planning achievements.This inspiration influence creates a unique currency of competitiveness that is reflected in the accuracy of forecast-

Figure 1 .
Figure 1.Illustrate the different influences generated by inspiration Economy mechanisms.

Figure 2 .
Figure 2. Illustrates the concept of inspiration lab and its influence.

Figure 3 .Figure 3 .
Figure 3. Once the inspiration lab starts to create the outcome we can realise it

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The continuous improvement of emergency services and expansion of Accident and Emergency Department, called here for short A & E, needed to ac-M.Buheji DOI: 10.4236/ajibm.2018.82014215 American Journal of Industrial and Business Management commodate patients waiting for beds inside hospital wards is available.• There was no consistency of peer reviews and patient satisfaction programmes in relevance to emergency beds turnover.