Tricks, Tips, and Tools for Public Health and Primary Care

Collaborations-The Art of Negotiating

Don Bradley, MD, MHS-CLBrian Castrucci, MA

Denise Koo, MD, MPHLloyd Michener, MD

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

• August 31, 2016

• National Association of Chronic Disease Directors

Introduction

• Think about two negotiations in which you have participated; one with the best and the second with the worst outcome

What about the situations made you think you were in a negotiation?

What about the situations made you think you were NOT in a negotiation?

Definition of Negotiation

• Whenever people exchange ideas with the intent of changing relationships (Nierenberg)

• “It’s not a game…it’s a cooperative enterprise”

When is it not “appropriate” to negotiate?

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)

Model for Successful Negotiation- “Principle Centered” Negotiation (Ury)

What is Wrong What might be Done

In Theory

In Real World

Practice the model (1):

• Individually, write down as many creative uses for this object as you can- 3 minutes

Practice (2):

• Divide into four groups.• Decide which use is the most creative use amongst

those generated individually- • 8 minutes

Practice (3):

• Two groups negotiate between the two options selected by each group- 8 minutes X 2 groups

Debrief• What worked?• What didn’t work?• What was the point of the negotiation?

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

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

Six High-Burden Health Conditions

High-burden

Preventable

Scalable

Purchasers & Payers

Costly

www.CDC.gov/sixeighteen

Eighteen Evidence-Based Interventions

www.CDC.gov/sixeighteen

Sustainability of the 6|18 Initiative

Sustain 6|18 partnership approach:1. Identify high burden

conditions 2. Define intervention3. Establish evidence base 4. Align epidemiology to

payers5. Make the case6. 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

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

How are you Preparing?

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

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……

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?

Assume you are dealing with decision makers

• Who are they?• What are their characteristics/styles of decision

making?

Characteristics/styles of Decision Making ”default styles”

• Charismatics• Thinkers• Skeptics• Followers• Controllers

On the post it notes…..

identify at least 3 well known “leaders”: (business, the movies, TV, a book, pop culture)

Five styles of decision makers

Williams GA Miller RB Change the Way you Persuade Harvard Business Review Reprint R0205D May 2002

ControllersControllers

Williams GA Miller RB Change the Way you Persuade Harvard Business Review Reprint R0205D May 2002

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

What is the key learning you can apply in your setting?

Thank you!

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