Patient Care Skills Can Aid Physicians at Negotiations

May 17, 2015
David J. Norris, MD

,
Jim Camp

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.

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.

A Needs-Attentive Approach

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.

The 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.

In our last piece, we talked about 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.