Jim Camp

The first question we usually ask physician negotiators might sound simple, but it isn't. When you're in a negotiation, whether with a payer, employer, or other entity, whose perspective are you using? Whose needs and problems are you considering throughout the negotiation? Whose viewpoint are you thinking about?

As physicians, this thinking is natural in the clinical environment. When speaking with a patient, whose perspective do you have in mind at that encounter? Whose needs are you focused on at that time? Naturally, we are focused on the patient's needs and work to find a solution to their problems.

You might not realize it, but you are already practicing two important aspects of negotiations: Keep the proper perspective and have a mission and purpose statement focused on the other individual. As we went through medical school and residency, we were trained to act with the other's best interest in mind as we make decisions in the clinical setting. These same skills can be very useful to us at the negotiation table.

Understanding of Patients and Negotiating Parties

If you had the other side's best interest at heart, how do you think you would approach their problems? What if you honestly desired to find a solution for their needs? What if you aimed to solve their problems?

It seems to us, whenever we begin to talk about negotiations, our human nature creeps in and takes hold. Our own self-interests begin to bubble to the surface. We become focused on ourselves - on our needs. Sometimes, we are so focused on our needs and problems, we fail to see how we can solve the other side's problems. We miss the point of being at the negotiation table.

Who we are focused on is vitally important to a successful negotiation. Many skilled negotiators work to manipulate and leverage our own self-interests for their benefit. They may dangle all sorts of carrots in front of you because they're focused on themselves and want to benefit themselves by manipulating you. You may use sticks instead of carrots. Neither side makes much progress. It can also be difficult for you not to do the same to them. How good do people feel after they perceive they've been manipulated? How successful will the performance of a contract be if either party feels manipulated or had leverage used against them?

So, what's the alternative? To be completely focused on their needs. We do this as physicians each and every day. The same sort of results can occur in any negotiation too.

A recent example of this comes mind. A practice was negotiating a service agreement with a moderate-sized hospital for a particular call service. The hospital desired to pay less for the call services than the practice was willing to offer. The practice felt the scope of the service proposed by the hospital was too large for the payment structure. Rather than focusing on their needs, the practice sought to better understand the needs of the hospital. They asked probing questions so they could understand the real needs of the hospital. They were not certain the hospital's administration truly understood their own needs. Rather than fighting with the hospital for a dollar amount the practice wanted for the proposed scope of call, they approached the situation from the hospital's viewpoint.

In doing so, they were able to uncover the real needs of the hospital. By asking good questions focused on the hospital's needs, the practice discovered that the decision makers in the hospital had two different ideas about the scope of call services needed. However, these decision makers had never discussed this amongst themselves. By focusing on the hospital's needs, the practice was able to help the hospital administrators see what they really needed in call services. If the practice had been focused on their needs only, they would have missed the needs of the hospital and probably fallen short in their service to the hospital. Ultimately, both sides would be unhappy with the agreement. However, in the end, the practice and the hospital agreed to a smaller scope of call services at a payment amount the practice wanted.

Similar to interactions with patient, we must put the adversary's needs at the top of our list. Ask, "How can I best serve this customer and solve their problems?" As you begin to ask good questions, you give them the opportunity to develop a picture of their problem. Once they have communicated their problems, you can then match your solution to that problem in terms of the features and benefits you offer.

Physicians are actually lucky in that we already think of others first. How many nights, weekends, and holidays are we sacrificed for others? We are taught to place our patients first - their needs rank highest. When we give our therapy recommendations, we do so because we want them to get better, healthier, and happier. We give advice based upon what's in their best interests, not ours. I believe the majority of physicians are altruistic in nature and genuinely want to help others. However, when it comes to the negotiation table, that altruism seems to dissipate. But bear in mind, there's a wide difference between true altruism and absolute self-sacrifice. Never feel you have to save the other side. Never sacrifice yourself for them.

As we approach a negotiation, our mindset tends to veer towards ourselves and our needs. And as long as we come to a negotiation with a mindset of scarcity, we then focus on our own needs rather than the other person's. That is when each and every word or action becomes an affront to us personally. We become emotional. We get so focused on our needs and what we want out of the negotiation, we fail to really discover their problem and help them solve it. We don't take the time to ask the right questions and discover the other side's needs.

The opposite of this, and the solution we present, is to approach a negotiation with a growth mindset. This allows us to focus on the needs of the other party because what we want is to help them. When that is the goal, it's easy to get what you want.

An important tool to assist us stay focused on them is a mission and purpose statement.

A mission and purpose statement guides our mindset and allows us to focus on the needs of others. Creating a mission and purpose statement is the first step in any negotiation. First, we determine what needs of the adversary we want to discover. Then, we determine how our features and benefits will fulfill those needs. We revisit this statement before each and every event during the negotiation. It can change over time as we progress in a negotiation and that's OK. However, it is this statement that keeps us focused and prevents us from being taken off track or down some inconsequential path.

making assumptions and asking good questions

. When we focus on the other party, we understand that we don't know everything about them - who they are, what their circumstances are, etc. - and therefore must ask those pointed questions. We also use questions that are based upon our mission and purpose statement to guide our discovery process.

When approaching a negotiation, remember to focus on the needs of the other side. Ask, "Do I really know what their real problems are?" Then, ask, "How do my features and benefits meet their needs?" As a clinician, your statement might be, "To provide the patient with the opportunity to improve their health." During the interview with the patient, we discover what the problem is through questions. A physical exam follows and confirms or eliminates diagnoses. Eventually, we offer a solution to their problem. But each decision and question we ask is based upon a mission and purpose statement. We might not actually have it written down, but it is engrained in our minds.

At the negotiation table, it is a little harder. Frequently, human nature will get away. We can be tempted to focus on our needs. Using a mission and purpose statement, we can stay on track and work to help the adversary. We have been placing others' needs first for our entire careers. To be successful in negotiations, physicians much approach negotiations as they would a patient: be focused on the adversary's needs and problems.

Do this, and you'll begin to have more successful outcomes.

Articles

In any negotiation, it's important to consider the needs of the other side. But there's a difference between true altruism and absolute self-sacrifice.

Patient Care Skills Can Aid Physicians at Negotiations

We have aided clients as they negotiate agreements many times and have noticed two big errors everyone - including physicians - make in negotiations. No matter what brings you to the negotiation table, whether it is an employment agreement, the purchase of a practice, a provider agreement, or insurer contract, physicians can benefit by avoiding two common mistakes – showing neediness and making assumptions. Either one can sour any negotiation. They are deadly enemies that work to keep you from getting what you want. They work behind the scenes and act covertly against your desired outcomes. Fortunately, you can control both of these behaviors and guide your negotiations to success.

Neediness is a behavior we display when we are fearful. Needy behaviors send signals to the other side that we are afraid of something. We may or may not realize where the fear comes from, but the manner in which we speak, act, and think can provide the adversary with valuable information about us.

Neediness could be defined as the physical manifestation of fear. Talking too much and sharing important information are examples of needy behavior. Sometimes, neediness originates from a desire to be liked and accepted. Many people will agree to items that will hurt their team in an effort to be liked and viewed as "team players" by the other side. They accept less than perfect terms because they want to focus on the relationship and be liked. Little do they know those concessions will eventually hurt not only them, but the adversary as well.

One of the most important pieces of advice we would offer is to not let fear ruin your negotiation. Fear is a powerful emotion. It will hijack the entire decision-making process and cause you to give too much away. It is challenging to think clearly if you are afraid. Emotions will take control of your thought processes and yield unfavorable results. It is absolutely imperative that you know and understand your fears.

One of the most effective methods for controlling your emotions and fears is to use a solid system in negotiations. Always have a plan before you enter into any discussion, no matter how small or insignificant you might think it to be. By using a system, you are able to stay on task and remain focused on your objectives. Write everything down, and keep a log of your encounters. It will provide useful information and insight as you review your notes to prepare for the next engagement.

Another big mistake we see people make at the negotiation table is to make assumptions about what the other side wants, what the other side needs, and what they will agree to. It is impossible to know everything about everyone, what they are thinking, and how they will behave. To overcome this, we must not make assumptions during the negotiation. Assumptions can lead us down a dangerous path and toward less-than-optimal results from the negotiation process.

One of the reasons people make assumptions is that they believe themselves to be especially knowledgeable; that if they know a lot in one area, that knowledge somehow automatically transfers over to other areas in their lives. It's not their fault; it's the way our psyches are wired. But that natural wiring actually works to impair your negotiations. How many times have you made assumptions about a patient or staff member? What happened? You might walk into a room with a preconceived notion of what is going on and leave with a totally different diagnosis. That same thing can happen with negotiations.

How did we find the right diagnosis? We asked questions. We accepted the hypothesis that we may have incomplete knowledge and sought to fill in the gaps. The same thing happens at the negotiation table. How many times have you been surprised during a negotiation? You didn't expect the other side to make that offer or accept your proposal - i.e. you were caught off guard. Why? Because you tried to predict the future behavior and thoughts of another human being. If weathermen cannot get the weather right all the time with their mathematical models, how can we possibly think we can predict human behavior with greater accuracy? So, make it easy on yourself and refrain from guessing.

What's the best way to find out what the other party is thinking or what they want? Simple: Ask them questions. As physicians, we are taught to ask our patients hard questions. We usually have no issue asking about tough personal issues. We claim it's in their best interests. The same principle applies to negotiations. We should ask the hard questions. Set the tone for the hard questions by seeking permission to bring up the topic. Explain it is in the other side's best interest to ask this hard question so that we fully understand their point of view. You would be surprised how much information you can gather by asking the hard questions.

 is an anesthesiologist at Wichita Anesthesiology Chartered in Wichita, Kan.; the owner of the Center for Professional Business Development, which aids and educates physicians and other small business owners; and a member of the 

 is an expert negation coach and the author of the best selling book "Start With No". He is also the founder of the 

 and the creator of the software platform, Negotiator-Pro. During the last 27 years, Jim has coached CEOs of multi-national corporations on every continent. 

Asking questions - especially the hard ones - benefits you as a physician and can do the same in negotiations.