The Art of Negotiating
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This document provides an overview of negotiation strategies and techniques for public health and primary care collaborations. It defines negotiation and differentiates when it is and is not appropriate. Key aspects of preparation are discussed, including understanding different decision-making styles. A model for successful negotiation emphasizes separating people from problems and focusing on interests rather than positions. Techniques like reading nonverbal cues and inventing mutual gain options are presented. The document aims to help participants effectively engage stakeholders in implementing evidence-based interventions.
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The Art of Negotiating
- 1. Tricks, Tips, and Tools for Public Health and Primary Care Collaborations- The Art of Negotiating Don Bradley, MD, MHS-CL Brian Castrucci, MA Denise Koo, MD, MPH Lloyd Michener, MD
- 2. Objectives • Define negotiation, (contrasting what it is and what it is not) • Differentiate situations in which negotiations are likely to be successful (or not) • Discuss key issues in preparing for a negotiation • Anticipate decision making styles of key stake holders -“the players” • Describe specific techniques that may be used in negotiation • Apply a model of negotiation
- 3. • August 31, 2016 • National Association of Chronic Disease Directors
- 5. Introduction • Think about two negotiations in which you have participated; one with the best and the second with the worst outcome
- 6. What about the situations made you think you were in a negotiation?
- 7. What about the situations made you think you were NOT in a negotiation?
- 8. Definition of Negotiation • Whenever people exchange ideas with the intent of changing relationships (Nierenberg) • “It’s not a game…it’s a cooperative enterprise”
- 9. When is it not “appropriate” to negotiate?
- 10. When is it not “appropriate” to negotiate? • Emergency “control and command” • Unwilling partner • Predetermined outcome (though may be able to bring negotiate into “how or when” to come to the outcome)
- 11. Model for Successful Negotiation- “Principle Centered” Negotiation (Ury) What is Wrong What might be Done In Theory In Real World
- 12. Practice the model (1): • Individually, write down as many creative uses for this object as you can- 3 minutes
- 13. Practice (2): • Divide into four groups. • Decide which use is the most creative use amongst those generated individually- • 8 minutes
- 14. Practice (3): • Two groups negotiate between the two options selected by each group- 8 minutes X 2 groups
- 15. Debrief • What worked? • What didn’t work? • What was the point of the negotiation?
- 16. Consider a negotiation you believe will come up in the next month with a payer or healthcare system. You’d like them to implement CDC 6:18 recommendations for one of the targeted conditions
- 17. Promote adoption of evidence- based interventions in collaboration with health care purchasers, payers, and providers High-burden health conditions 6 18| Evidence-based interventions that can improve health and save money www.CDC.gov/sixeighteen Hester, J. A., J. Auerbach, L. Seeff, J. Wheaton, K. Brusuelas, and C. Singleton 2015. CDC’s 6|18 Initiative: Accelerating evidence into action. National Academy of Medicine, Washington, DC. http://nam.edu/wp-content/uploads/2016/02/CDCs-618-Initiative-Accelerating-Evidence- into-Action.pd
- 18. Six High-Burden Health Conditions High-burden Preventable Scalable Purchasers & Payers Costly www.CDC.gov/sixeighteen
- 20. Sustainability of the 6|18 Initiative Sustain 6|18 partnership approach: 1. Identify high burden conditions 2. Define intervention 3. Establish evidence base 4. Align epidemiology to payers 5. Make the case 6. Actively engage and promote Understand payer/provider context 1. Prioritize high burden condition 3. Assemble the Evidence 2. Define the Intervention 4. Align Condition with Insured Population 5. Make the Case 6. Engage with Partners www.CDC.gov/sixeighteen
- 21. Key Take-Aways Strong evidence is critical Understand payer priorities Insurers value bundled interventions/strategies Build on payers’ existing efforts Promote better utilization of insurer’s existing services www.CDC.gov/sixeighteen
- 22. How are you Preparing?
- 23. Preparation • Single v. Team • Issues v. Positions • Meeting site and environment • Agenda • Facts v Assumptions • * BATNA—yours, other side * Best alternative to a negotiated agreement
- 24. Principles • Don’t Bargain over Positions • Separate people from problem • Focus on Interests not positions • Invent other options for mutual gain (the third side) • Insist on Objective Criteria • Other principles……
- 25. Negotiation Mistakes • Neglect the other side’s “problem” • Focus on price • Let positions drive out interest(s) • Search too hard for common ground • Neglect BATNAs • Fail to correct for skewed vision • Others?
- 26. Assume you are dealing with decision makers • Who are they? • What are their characteristics/styles of decision making?
- 27. Characteristics/styles of Decision Making ”default styles” • Charismatics • Thinkers • Skeptics • Followers • Controllers
- 28. On the post it notes….. identify at least 3 well known “leaders”: (business, the movies, TV, a book, pop culture)
- 29. Five styles of decision makers Williams GA Miller RB Change the Way you Persuade Harvard Business Review Reprint R0205D May 2002
- 31. Williams GA Miller RB Change the Way you Persuade Harvard Business Review Reprint R0205D May 2002
- 32. Reading other negotiators • Deciphering Non-verbals • Facial expressions and reactions • Sounds and silence • Gestures • Gender impacts • Comfort • Showing aggression • Emotions • Humor • Listening and Questioning • Use of Data
- 33. What is the key learning you can apply in your setting?
- 34. Thank you!
- 35. References • Articles • Babcock L Laschever S Gelfand M Small D Nice Girls Don’t Ask Harvard Business Review Reprint F0310A October 2003 • Ertel D Getting Past Yes, Negotiating as if Implementation Mattered Harvard Business Review Reprint 40411C November 2004 • Lawrence PR How to Deal with Resistance to Change Harvard Business Review Reprint 69107January February 1969 • Sebenius JF Six Habits of Merely Effective Negotiators Harvard Business Review Reprint R0104E April 2001 • Weiss J Donigian A Hughes J Extreme Negotiations. Ideas in Practice Harvard Business Review http://hbr.org/2010/11/extreme-negotiations/ar/1 • Williams GA Miller RB Change the Way you Persuade Harvard Business Review Reprint R0205D May 2002 • Brooks AW. Emotion and the art of negotiation: how to use your feelings to your advantage. Harvard Business Review December 2015 • Books • Fisher R Ury W Patton B Getting to Yes: Negotiating Agreement Without Giving In Penguin Books NY May 3, 2011 • Nierenberg GI Calero HH The New Art of Negotiating: how to close any deal. Square One Publishers September 15, 2008 NY • Ury W The Third Side Penguin Books; Rev Updated edition (September 1, 2000) • Other • Ury W Ted Talks The Walk from No to Yes http://www.ted.com/talks/william_ury • CDC Six Eighteen Initiative- www.cdc.gov/sixeighteen
Editor's Notes
- Many years ago, a man died and left his camels to his three sons; one-half to the oldest, one-third to the second son, and one-ninth to the youngest. However, there was a problem--he had only 17 camels.A dispute quickly arose among the brothers. The eldest son argued that the father's will was in error because one-half, one-third, and one-ninth do not add up to a whole. He felt that he should receive all the camels because this was the tradition in the community. The middle son said his wife had the potential to be very ill and pleaded for an extra camel so that he could sustain his family. Although the story was not true, it seemed like a good idea at the time to get that extra camel at all costs and deal with the family fallout later. The youngest son argued that what was allocated to him was actually one-sixth because a number reversal had occurred.The adversarial negotiation escalated. The feud became so heated that the families did not speak to each other. The brothers no longer allowed their children to play together and terminated all joint ventures between themselves. One of the siblings even thought of killing some of the camels or one of his brothers. The brothers desperately needed to resolve this conflict.
- They finally agreed to go to a wise old woman in the community and tell her of their problem. They gave her the right to arbitrate their dispute and to dictate a solution. She said, "I am old and unable to ride my camel anymore. Why don't you take my camel? Then you will have 18 camels and you can divide them among the three of you.“ The brothers gave half (or 9 of the 18 camels to the eldest son, a third (or 6) of them to the second son and a ninth (or 2) of them to the youngest son. One camel remained. The brothers were able to agree that they should return it to the old woman.
- Requires at least two parties who wish to find a solution Differentiate from debate [discussion, as of a public question in an assembly, involving opposing viewpoints], mediation [action in mediating between parties, as to effect an agreement or reconciliation], arbitration [the hearing and determining of a dispute or the settling of differences between parties by a person or persons chosen or agreed to by them]
- When not to negotiate: Emergencies Unwilling partner Pre-determined outcome, e.g. regulation (though may negotiate HOW or WHEN to get to outcome
- CDC has developed the 6|18 Initiative to promote adoption by health care purchasers, payers, and providers of evidence-based interventions to improve health and control costs in less than 5 years. The name “6|18” comes from the initial focus on 6 high-burden, high-cost health conditions and 18 evidence-based interventions that can improve health and control costs. Because this initiative is intended to increase collaboration between public health and health care. CDC can assist health care purchasers, payers, and providers in determining which preventive interventions would lead to improved health and cost. Through this initiative, CDC is engaging payers nationally, through strategic communications and messaging, and locally by working directly with payers to evaluate their implementation of interventions. CDC is also working to promote provider uptake of interventions including: aligning interventions to payment incentives; documenting the operational steps needed to deliver care; and providing sufficient information for initiative adoption.
- The 6 in 6|18 represents the initial conditions, including: Tobacco Use, High Blood Pressure, health care-Associated Infections, Asthma, Unintended Pregnancies, and Diabetes. These conditions were selected because they meet the criteria: They affect a large number of people They are associated with high health care costs There are evidence-based interventions to prevent or control these conditions The interventions are scalable And finally, the evidence-based interventions can be implemented by the health care sector- health care purchasers, payers and providers.
- The 18 in 6|18 represents a set of evidence-based interventions associated with each of the 6 conditions that health care purchasers, payers, or providers can implement.
- In its phased approach, CDC is moving from design to testing and implementing the 6|18 Initiative, using a replicable and sustainable approach that others can use. Underpinning the approach is what we’ve learned about the context, culture, processes, language, and priorities of payers/providers. The following readiness steps can be used to assess health conditions and their associated prevention interventions in order to recommend them for uptake by the health care delivery system: Identify as a high burden condition Define the intervention Where possible, interventions across all three buckets should be considered Establish health and cost impact evidence base Align the epidemiology of the condition with the insured population Make the case Actively engage and promote This approach is relevant to other health issues than those currently covered under the 6|18 Initiative, and CDC plans to use this approach for additional content other over time.