Top TipsNegotiation in Healthcare

NHS Skills Development Developing Today to Influence Tomorrow

The word “negotiate” is so often misused, by definition it implies that

there must be choices, options, and room for movement all achieved

through discussion. It is the art of conversation, not an endless

bouncing of emails.

Some technical early parts of formal processes may not be face to face,

for example, procurement may be online. So how approachable is the

language you are using? How easy is it to navigate any system and

what does it tell the other party about the kind of organisation they

may be entering into a relationship with?

Yet when it comes down to negotiation it is a people thing,

organisations don’t negotiate with organisations, people negotiate

with people. So how good are you or those you work with at entering

productive discussions?

Captured somewhere in most definitions of negotiation is the

word discussion:

• Obtain or bring about by discussion.

• To attempt to reach an agreement or conclusion by discussion.

• To find a way over or through an obstacle challenge or difference.

If there isn’t room to move, then ask yourself is this really a negotiation?

If not, don’t use the word as it leads to misunderstanding and

frustration for everyone. So if, whatever the issue or for whatever the

reason, it is NOT negotiable then don’t imply it is by using the word.

Of course the outcome may not be negotiable and is often set outside

the sphere that we can influence. What we can often negotiate is the

how, the methodology or approach to be undertaken in the process of

achieving the outcome.

This is important as we can’t talk about influencing and negotiating

with others unless we understand both our own position, the

other party’s and the wider context. The following ten tips will

go somewhere to improving negotiations and ensure a greater

opportunity of finding an agreement.

It’s all about relationshipsNegotiation in Healthcare isn’t about winning or getting one over on someone, it’s far more important than that and far more complex. We negotiate all the time with colleagues, neighbouring organisations, suppliers, providers, patients, and the list goes on. You may consider you have a good approach to negotiation or you may consider yourself too soft or too tough, the fact is that in such a complex working environment no one style fits all. There are some pretty simple things to remember that often in our busy world get neglected or overlooked and can lead to misunderstanding or breakdown sometimes before a negotiation process has even started.

1. Manage expectation from the off

Just what component is negotiable?

• The outcome?

• The way/method to achieve the outcome?

• Or both the outcome and the method to achieve it?

It is essential to manage expectations from the start, if someone says

they are coming to you to negotiate a particular issue or outcome with

you, the immediate expectation is that somehow you have an influence

and that there will be an agreement or way forward found, that is

somewhere between what they and you wish.

2. Be committed to the process

The healthcare negotiation environment is particularly complex, which

at times can create tensions between individuals, departments and

organisations. So commit to the process, prepare yourself well, your

knowledge, your position, and most importantly the emotional state

you need to be in to take on a challenging situation that may include

awkward or uncomfortable conversations.

Remember, uncomfortable conversations are a consequence of the

context and challenges we are working with, not necessarily of your

making. Most humans fundamentally don’t want or like conflict, we

seek harmony in our lives. So the temptation is to consciously or more

often unconsciously avoid situations that are uncomfortable, be aware

of this and don’t be drawn into avoidance techniques, cancelling

meetings, being too busy (we could all always be too busy), leave

things until the last moment, suddenly have to leave because of an

emergency etc.

Get your diaries out -

Good negotiation takes time so commit that time and plan ahead.

Is it important? Then it deserves the time. Many aspects of formal

negotiations are predictable, timetabled, yet far too often still get

agreed in a frenzied last two week dash.

Stop, think strategically, diary well in advance. Not just the formal

aspects of meeting or writing things up and signing things off, but

also the important preparation time you need. Decide where and when

you will meet informally to attain an understanding of each other’s

perspectives and positions.

Good negotiation takes time so commit that time and plan ahead.

3. Negotiate the conditions of the negotiation

Prior to any negotiation, conversations need to take place in order to

ensure before you start what will make it more likely to achieve the

desired outcome of each party.

It is really productive to spend time, usually in an informal environment,

when you can sit down and check off how you wish the process to run

both technically and interpersonally.

• Where do you plan to meet?

• Agree terms of engagement - what professional behaviours do you

expect of each other, how you wish to talk to each other and what

should you do if your agreement is breached in any way?

• What would success look like? Be careful not to get into the detail

of negotiation yet try to understand up front where the other

party’s end point might be.

• Who should be involved and who should not? Be careful not to fall

into hierarchy here,’ I should do it because I am the boss’ etc.

Four fundamentals to selecting the right negotiators for you:

1. Do they have the right skills and knowledge?

2. Do they have a healthy attitude both towards the issue and the

specific people you will be negotiating with?

3. Do they have the right existing relationships with the other party –

or could it be damaged in anyway due to previous encounters, is

there ‘TRUST’?

4. Do they have, or could they be given the right level of

accountability to authorise any final decision?

4. Sometimes people just need a good listening to

With the pressure on to get results often meetings get straight to the

point, and miss the point. Think what you need to do to understand

their position, you may think you do, and yet they may need to tell

you. Take time to focus on the other party’s pressures and the context

they work in. The quality of your relationship is fundamentally what

will allow agreement to be sealed or not. Know them, know their

issues and what it means to them.

Successful negotiators look at the situation from the other sides

perspective.

Everyone looks at the world differently, so you are way ahead of the

game if you can figure out their perception of the situation. Instead

of trying to win in any negotiation, seek to understand the other

negotiator and show them ways to feel satisfied. If you help the other

party to feel in some way satisfied, they will be more inclined to help

you satisfy your needs. That does not mean you should give in to all

their positions, satisfaction means that some of their interests have

been fulfilled, not that all their demands are to be met.

Many conflicts can be resolved easily if we learn how to listen. In our

pursuit to ensure that people hear what we have to say we can forget

to listen.

You may have to challenge the validity of the other sides position and

you can’t do that until you really understand it and have challenged

the validity of your own position.

5. Preparation is everything

There is an old adage: it is 90% preparation and 10% negotiation.

Although conversations are crucial to reaching agreements, without

the right information to hand in advance it is almost impossible to

reach fair, considered outcomes.

It is important that the lead negotiator and those around them have a

good understanding as to where any movement can be made.

‘Know what you want’ and ‘know what you don’t want’

It is essential to create a settlement range in negotiating, so you can

start to see where there is room for movement and where agreements

can be settled. To do this you need to know as much detail of what

you want as what you don’t want.

When wanting to negotiate something you really want to achieve be

careful not to spend too much time planning what it is you want and

less on what you don’t want – make sure there is as much detail on

either position.

Likewise if you are going into a negotiation on something you are less

favourable about, don’t just produce a list of things you don’t like,

don’t want and are unhappy about.

Too often people entering negotiation have a clearer picture of one or

the other. Yet without the balance on either side no middle ground is

created and in fact you may well create an argument, or a place hard

to move from.

So put together a list of what you want and what you don’t want,

with an understanding of all the issues from the differing perspectives.

Now look down the list and notice just what movement there could

be, where could a settlement range start to shift current positions on

both sides. You are now in a more empowered place to commence

your negotiation.

Undertaking this simple approach can be used in any form of

negotiation and is powerful preparation if the whole team participate

in the discussion.

Successful negotiators look at the situation from the other side’s perspective.

Settlement rangeK

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Influencing factors

Political • Economic • Social Technical • Legal • Environmental

Bottom line

Settlement range

Now with the list we can explore the settlement range, and have those

new conversations:

• Could you wait 6 months for implementation if what you are being

assured is a 5 star service?

• Could there be a cost alteration upwards if efficiencies are

implemented, a reduction in follow ups are achieved and

monitored?

• Could you consider accepting a 3* service and yet insist a maximum

seven week waiting period?

This approach usually leaves more options available and widens the

conversations increasing the possibility of a negotiated settlement.

It is important to note that, as you enter your discussions, your

bottom line is purely for you to be aware of, and not to be disclosed,

until it absolutely needs to be. Do not be tempted to say something

is your bottom line when you know it isn’t. If you declare a bottom

line, and then move from it, you have disabled yourself for any future

negotiation, you don’t ‘mean what you say’.

If you are widening the range of influencing factors (see diagram),

consultation and preparation prior to negotiating may increase the

need to involve stakeholders and ensure they are in line, so colleagues

from a clinical background, or with quality focus, or governance

perspective, or even at times knowledge of estates strategies etc. may

all have to be consulted.

Take this purely as an example spreading the ‘what we want’ and

‘what we don’t want’ across the whole range of matters that impact

on a good outcome, quality, quantity, cost, accessibility, whatever.

What you want What you don’t want

To commence in the next 2 months 4 months Commencement no more than 6 months

To be an identified 5* service ** Not meet the 3* minimum quality identified by NICE

All referrals to be seen within 6 weeks 8 weeks Not to exceed a 14 week referral time

Price per new appointment £65 £15 Price per new appointment not to exceed £80

Follow up maximum 3 at £50 2%DNA £10 (6% DNA) Not to exceed 3 follow up at £60 (DNA less than 8%)

90% measured patient satisfaction 10% Not to drop under 80% patient satisfaction

Cancellation rate under 5% 10% Not to exceed 15%

Do not be tempted to say something is your bottom line when you know it isn’t.

6. What are you going to stop doing or to start doing differently?

It is not all about acquiring new skills or attitudes, sometimes that

can even be the easy part. Go and get some training or awareness,

practice, observe others, read about various techniques.

Noticing what we need to do to improve our skills is important, yet

equally important is acknowledging what we don’t need to do, what

has been less helpful in the past, how in any way has your involvement

in negotiations hindered any aspect of the process? These healthy

reflections will play a key part in creating a great negotiator.

Create a space to reflect and learn, individually or within your

department. Always debrief after any negotiation intervention, notice

where the learning is in an environment of curiosity to learn rather

than blame or apportioning fault.

Ask questions like:

• How prepared did we feel?

• What went well?

• What could have gone better?

• Whose contribution was most impactful and what made it so?

Practice, practice, practice

As with everything else in life, we get better with practice.

If you have control over what is coming your way ‘PRIORITISE’ work

with the smaller manageable projects that will give you insights not just

into the process of negotiations but yourself and how skilled you are.

• Start with achievable negotiation projects.

• Make time to recreate a potential negotiation matter and practice

with a trusted colleague.

• Access local training events.

• Set up negotiation learning groups to share best practice.

Create a space to reflect and learn, individually or within your department.

7. Language matters - Avoid Jargon

Keep language simple and understandable for all.

Do not be tricked into thinking that any technical knowledge or

insights that you have that the other party does not, somehow gives

you the upper hand or any form of advantage. It may in fact distance

them from you and interrupt the establishment of ‘TRUST’. Whatever

you do know to a different level to them merely sets you a challenge of

how to explain it in an accessible way so that they can understand and

follow you.

Watch out for launching into pseudo-business language, if you enjoy TV

or film plots about high powered business, leave what you hear on the

screen. It is a sure way to disconnect with others, especially clinicians.

Avoid the word compromise – keep talking about

where you agree and common objectives, it is true

that to move forward both parties may have to make

compromises, yet somehow it is an unhelpful word. No one

likes to be ‘compromised’.

8. Change the place of negotiation regularly

Ever go to a meeting regularly that you find boring or challenging or

uncomfortable? Ever notice that it is in the same room, around the

same table and you even find yourself sitting in one or two of the same

seats? As you sit down you take on the same posture, thoughts and

feelings each time?

We can associate the spaces we work in with the previous or

regular experiences we have had in that place. For this reason good

negotiation moves. It should move venues, offices, furniture etc.

on a regular basis, preventing the onset of places that somehow

become ‘polluted’ by previous experiences and moods. If you are in

any negotiation process and notice this happening break the cycle

and change the space. If this sounds a little odd, try it, much of this

can take place at an unconscious level. When negotiating challenging

issues you need every advantage working in your favour and once the

space you meet in starts to work against you it is hard to reverse, so try

preventing it from the off.

TOP TIP

9. Stay resilient

Don’t take the issues or the other person’s behaviour personally. All too

often negotiations fail because one or both of the parties get distracted

by personal issues, ‘I didn’t like the way they talked to me’. Remarkably

very few people in healthcare are trained in negotiation, they can feel

stressed at the mere thought of it, let alone following through and

sitting across from other people. So, they get it wrong, yet they usually

don’t mean to, they want the best.

Look after yourself, if you are physically and emotional well you will be

a better negotiator.

Successful negotiators focus on solving the problem, concentrating on

the issue and trying not to get involved or distracted by the noise that

is going on in the system.

10. Aim high and expect the best outcome.

Successful negotiators are optimistic even in challenging times. ‘If you

expect more, you’ll get more’ is proven strategy for achieving higher

results. What you don’t want to do is be so unrealistic that others

around the table don’t take you or the issue seriously.

When you are stuck in the minutiea of the detail, never lose sight of

why you are doing what you are doing, if you do it well the system

works well, when the systems work well our public get the very best of

healthcare we are able to provide.

So however far it may feel from direct patient care, it isn’t. Think big,

aim high, what you are doing matters.

Successful negotiators focus on solving the problem, focussing on the issue and trying not to get involved or distracted by the noise that is going on in the system.

This document has been produced in conjunction with

Dave Thornton. Dave works as a successful and sought after

Executive Coach and ‘top team’ developer for a range of

organisations across the UK. Dave and a small team of trusted

associates provide a range of bespoke interventions around

leadership development, conference talks, senior team/Board

development and individualised Coaching.

If you want to discuss how Dave Thornton can help you

and your team to develop successful relationships at work,

then please call us on 07899 953407 or visit the website

at www.davethornton.org

• Dealing with Change

• Increasing Productivity

• Team Building

• Making Partnerships Work

• Communicating Financial Information Effectively

• Stress Management

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