This summer's pay agreement between the government and junior doctors in the UK is just one example of why there are few sectors where negotiation is as important today as healthcare.
Doctors and clinicians negotiate every day. They meet with families to discuss treatment plans. They encourage patients to follow a recommended course of action or undergo uncomfortable screenings, such as colonoscopies and smear tests. They negotiate with colleagues on care decisions and resources with the number of clinical staff responsible for the average patient having increased significantly over the last few decades.
Ultimately, clinicians are looking to integrate their own expertise, the patient’s values, colleague opinions and the best available medical information to guide their decision-making in what can be a highly complex often multi-party, multi-issue negotiation. Healthcare is a team sport.
It’s also not just clinicians who need to negotiate. From healthcare leaders seeking to establish integrated systems between central providers and local bodies to managing change, harnessing the power of AI, coordinating across mental and physical health, or managing board or local and central government expectations, negotiation is essential to delivering quality and affordable healthcare for all.
I recently spent eight hours in my local A&E with a family member and whether it be consultants, doctors, nurses, hospital administrators, X-ray specialists, cardiologists, anaesthetists or local ambulance teams, what I witnessed during that time was a long series of negotiations.
Yet, despite its importance, few healthcare practitioners – clinical or non-clinical – receive formal instruction on how to negotiate.
So, notwithstanding the brilliant jobs so many healthcare practitioners do in both clinical and non-clinical settings today, how can they negotiate more effectively?
Four key principles behind successful negotiations
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Focus on the ‘We’
One of my favourite definitions of negotiation is that it addresses the question – ‘How might we engage with others in a way that yields better outcomes and understandings?' A question healthcare professions are faced with every day of the week and where the only answer is through relationships, trust and collaboration.
Asking an investor to invest millions in a new drug line; encouraging a patient to test out a new therapeutic; or a hospital procurement board to purchase new radiology equipment all requires a reframing of the interaction so that is not so much a negotiation – a ‘me’ against ‘you’ dynamic – but rather a joint problem solving exercise where we’re all working together towards a common goal.
‘We’re all working together to improve service delivery’ or ‘We’re all working together to reduce waiting times’.
When negotiators take steps to ensure that the negotiation conversation becomes a collaborative dialogue – the ‘we’ rather than the ‘me and you’ – the negotiation becomes more productive and creative.
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Fairness and justifications
In any negotiation, there are two key elements – the objective value in a negotiation, the actual terms of a negotiation and how you objectively do; and the subjective value – how you emotionally feel at the end of a negotiation.
If your counterpart can come out of the negotiation thinking I’ve got respect, I believe that I'm competent or we engaged in a good interaction; then they are going to feel much better about themselves and if you negotiate again, it’s likely to lead to better objective outcomes and more sustainable deals.
So whenever you negotiate, think about how your counterparts are likely to feel and whether they have been treated fairly. Does your patient feel that they have been respected or listened to? Does your supplier feel like they have signed up to a fair deal with mutual benefits? Remember the best negotiators achieve great deals for themselves but leave their counterparts feeling the same.
Linked to this idea of fairness is the importance of justifying your offers or recommendations. Create a strong rationale behind your proposals – ‘this is why we think you should go on blood thinner medication’ or ‘this is why we need to invest in frontline nurses or purchase this new ECG equipment’.
Justifications not only make people feel like they are being treated fairly but also give them the very reasons they can tell their stakeholders why they should accept what you’re proposing. You’re helping them to right their victory speech.
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Listen!
How long does a patient have to explain their condition before the doctor interrupts? According to a 2018 study from the University of Florida, it’s just 11 seconds! [i]
My third principle which is so crucial to negotiation and healthcare is that of listening. We are never going to build relationships, understand our counterpart’s motivations or achieve our goals if we don’t listen.
Yet too often health professionals fall into the trap of thinking that there is just one correct solution, diagnosis or prescription and are more concerned about what they are going to say next rather than properly listening.
Deep listening, supported by powerful, open questions (the same University of Florida survey found that only 36% of doctors asked an open-ended question to enable patients to talk) can be a game changer in healthcare negotiation, unearthing a rich source of information as well as strengthening the relationship.
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Interests not positions
Be honest. When it comes to a negotiation, how often do you focus on what your counterpart wants – their positions – rather than why they want it – their interests. What price are you looking for with this drug? What role would you like in the emergency theatre?
Yet, if you ask the question ‘why’ they want something and you can unlock the beliefs, motivations and genuine interests behind those positions and find compatible and common ground accordingly. That’s why my fourth principle is focusing on interests rather than positions – the ‘Why’ rather than just the ‘What’.
Another department might want your MRA scanner which you aren’t willing to give away but when and why do they need it? Can you share patients? Can you even share costs?
What about the different players who are wanting to be in an operating theatre? Why? What are the roles they want and can they complement each other? What about a patient who wants to discharge themselves early? Have you properly asked why they want to do it? It could be pressures at home or a meeting they feel they need to attend.
At its heart, negotiation – like healthcare delivery – is a process of inquiry, investigation and then action to create better outcomes and better understandings. Anyone who wants to reach the heights of the healthcare profession must be an effective negotiator as well.
Background
Paul Fisher is an Associate Fellow at Saïd Business School and also Programme Director of the Oxford Programme on Negotiation, held twice a year. He also teaches negotiation on the Oxford Healthcare Leadership Programme.
[i] Eliciting the Patient’s Agenda- Secondary Analysis of Recorded Clinical Encounters