Preserving and Strengthening Relationships in Physician Negotiations: Lessons to be Learned from the February 2019 Executive National Emergency Declaration.
It’s ironic. It really is. All of my Physician Leader friends can’t believe that President 45 declared a national emergency after negotiating an agreement with Congress.
“How dare he! How dare he make them got through all that work and all those promises, just to go behind their backs and do what he intended to do all along! And, without the considered backing of his constituents!” The irony, of course, is that I have seen each one of these Physician Leaders do the exact same thing, often dozens of times.
As I write this in post in February 2019, President number 45 has just declared a National Emergency regarding the southern border.
This occurs after a long shut down that I discuss here and here. After 2 weeks of negotiations with congress, an agreement was made. After signing the agreement, the national emergency was declared. By the time you read this blog, this issue may be long forgotten.
Now, this is not a political post. I’m not interested in discussing whether this is the right thing to do. Only posterity will decide. Sometimes, people overreach and they fall hard. Sometimes, the bold and the brave take risks and they come out ahead. If you wish to discuss the political implications, I suggest you find any numerous political blogs where your input will be most appreciated.
As a negotiation blog, I am more interested in the lessons that can be learned from events.
I also want to point out how often physicians do the exact same thing, even the ones who are furious about what’s going on in the world of politics.
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In physician negotiation, 75% of the outcome is the relationship.
Physicians are unlike Attorneys who use conflict to obtain concessions, Salespersons who focus on closing the deal, or administrators who look at the entire model to develop positive revenue streams.
In physician negotiation, the most important outcome is preserving and strengthening the relationship through the negotiation process.
I recommend that you be willing to only get 25% of what you want if the relationship is at risk. That’s less than splitting the difference, which some non-physician negotiators will tell you to never do! The reason why this is a win, is that 75% of the value is in the relationship.
Why is the relationship so important for physicians? It has to do with the nature of medicine. We are professionals who enter into a noble and long-storied calling. Everything we do must be based on the good of others, self-sacrifice, honesty, and integrity.
Imagine a physician who uses the attorney model of conflict – bullying you and threatening you into making concessions. Would you work them again? I have lots of physician colleagues who pretend they know they law and try to bully me with threats of lawsuits or malpractice. When they don’t get their way, they write long and meaningless notes in the chart. Everything they do is based more on self-preservation than patient care. You might know some of these as well. Maybe you are one. I won’t work with you beyond the absolute minimum.
How about a physician who plays salesperson? Promising you everything to seal the deal. Once, the agreement is made the promises fly out the window? And we’ve all dealt with administrators or MBA’s who put patient care at risk for a few extra bucks…
This negotiation tactic has one common theme. You make an agreement. And then the agreement is changed because a higher power- “the board”, “the boss”, “the legal team” decides that they “don’t agree with it” and they will go with a new deal and you can’t do anything about it, since they are “in charge”. Sound familiar?
A medical example of Deference to a Higher Authority
Think this only happens in politics or with bad guys in movies? Guess again, I see it constantly in medicine. It’s probably one of the biggest causes of promising talent “going silent” and losing interest in participating in administration.
Here’s a hypothetical example:
- You work at a hospital that wants to develop a plan to prevent re admissions for Congestive Heart Failure. What luck! You’ve done several similar projects elsewhere and have a ton of experience dealing with exactly this problem!
- You are asked to join a committee to come up with a plan. Using your experience, you take the lead role. You do a multivariate analysis and find three common links to readmission- medication errors, fever during hospitalization, and going to a non-system sub-acute rehab. You also find something that’s interesting- 75% of patient who are readmitted do so on days 4-8.
- Working with your team, you develop a protocol to address these issues, including getting the resources to start a NP lead initiative to see all Congestive Heart Failure at day 4 or 5 post discharge to catch the patients at their highest risk status.
- You and your team are excited. It feels like this may really work! And, it’s a cool approach. You really feel proud of the things you accomplished and the team that you lead.
You present your results to the chairman:
- The chairman doesn’t even look at you during the presentation. He actually gets up and turns his back to you while going over to the laptop to show his presentation. You finish, He doesn’t acknowledge any of the work you’ve done.
- The chairman then fires up a power point. He wants you to do a chart review of the last 6 months of patients. You, a high-level physician assigned to a crappy project that even med students won’t do anymore. No one believes those results. They are never published or trusted. You mutter something about, “the love of small numbers is a folly…”
- Afterwards, you can’t help but wonder why he even asked you to do all this work in the first place. You think of all the dinners and time with your kids you missed wasting your time and talents on this joke of an assignment...
- He had an idea in mind and it was going to be that plan no matter what you did. It was all a show. Like he pretended you and your ideas matter. But that was never the case.
- The next project you are assigned to you, you half-ass it. The one after that, you conveniently forget to respond to the email. You show up late to meetings and barely care. In the end, you decide that if they don’t value you or your opinions, why should you try?
Does this sound familiar?nd produce "disruptive doctors"!
It may not be the exact same series of events. It could be that you bring a serious quality, safety, or staff concern to your bosses only to be ignored or flat out lied to. I interview physician all the time who complain that they are leaving their current job “because they get no support”.
What went wrong?
The five core concerns of emotion based negotiation.
In the book “Beyond Reason: Using Emotions as You Negotiate” by Roger Fisher and Daniel Shapiro, the concept of the emotional and relationship elements of negotiations are discussed. Central to the discussion are the “five core concerns”.
Loosely paraphrasing from this excellent book, here are the five core concerns, what they mean, and what how they can be supported or turned against the relationship.
- Appreciation: you and your work are considered valuable. Your time is not squandered. Your input is publicly noted and praised. When you feel appreciated you are enthusiastic and caring and want to cooperate. You consider the other party to be “friends” or “family “. When you are unappreciated you are angry. You have reason to act negatively and will often oppose suggestions. You consider the other party to be “enemies” and “glory stealers”.
- Affiliation: you are considered part of the team and welcomed as an equal partner. You are invited to all important events and meetings. When you feel affiliation you are compassionate and content and desire to work together. When you are non-affiliated you are excluded. Decisions and meetings occur without your knowledge. You feel indignant and resentful. You decide to go it alone without the other party.
- Autonomy: your freedom to decide is appreciated and respected. You are allowed to come to your own conclusions and decisions. If failure occurs, it is seen as a learning event and not one for blame. When you are given autonomy, you feel comfortable and confident. You desire to think creatively and are excited to develop innovative solutions. When your autonomy is not respected, you feel afraid to fail and limited in your problem-solving options. You will think rigidly and avoid the effort of new solutions.
- Status: your experience and expertise are recognized where deserved. You and your past accomplishments garner respect and have “weight”. When your status is recognized, you feel proud and important. You will be trustworthy and emphasize integrity. When your status is not recognized, you are put down. You feel embarrassed and sad. You believe the other party is not worthy of their status and believe your rightful place has been stolen through unethical means. You will tend to act without integrity or honesty.
- Role: you feel that your job is at the level of your abilities. You are making a difference and see the opportunity to improve yourself. When your role is right you will feel content, hopeful, and appreciated. You will desire to stay with that group When your role is inappropriate you feel unappreciated, bored, and powerless. You are envious of others who have a role you feel you deserve and you are anxious because you don’t feel your role is secure. You don’t consider this group as anything more than a stepping stone or paycheck.
If you’ve been unhappy or"burnt out" in medical relationship, I’m certain one or all of the above will feel very real to you.
You’ve did 20 years of schooling and 3-7 or more years of training, along with boards and other professional skill development to get where you are today. And, you are treated like a fool, put down, with non-physicians having authority over you and having to listen to demands from people you don’t respect without any say in the matter. Does any of that hit home?
So, how do you maintain physician relationships through negotiations and other personal interactions?
Make a list of the five core values and try to hit each one during the interaction, without sounding insincere.
- Appreciation: “Dr Jones, I can’t tell your how much we appreciate you taking time to assist us.”
- Affiliation: “I want to welcome you to the team. We know that your hospital and ours compete on an economic level, but the commitment to quality patient care is a shared value that joins us all.”
- Autonomy: “What I’m really excited to hear is every idea you may have, even if they are zany! With the exceptional talent in this room, I know we can come up with something innovative and great. Something that could even have international interest.”
- Status: “I’d like for you all to meet Angela. You probably know Angela as a nurse. What you may not know is that Angela is probably the most experienced Joint Commission expert in the room. Heck, I’ve been through a dozen Joint Commission audits and I still go to Angela with questions and am blown away by her knowledge.”
- Role: “You’ve really seemed to hit your stride and are producing great work. I’m thinking you have a great future with us and my goal is to help you reach your potential”
By avoiding hard negotiation tactics, being honest as to your interest and goals up front, and keeping Fischer and Shapiro’s five common core values in mind, you’ll be able to negotiate to good outcome while building relationships at the same time. That’s the way to personal and professional fulfillment.
One of the most important assets to reach your financial and professional goals is to master the art of negotiation. Be sure to check out Negotiation MD.
Check out the rest of our blog for other posts that may interest you.
So, what do you think? Have you ever faced this tactic before? How did you deal with it? Do you know the the textbook approach? Are you guilty of doing the same? Let us know in the comments below.