What You Need (and Don't Need) to Negotiate Successfully
The published "techniques of successful negotiations" fill many volumes
in the average library. Some techniques are more appropriate for unique
negotiation settings, such as international diplomacy or collective
bargaining with labor unions. Not all techniques are sound or appropriate
in the setting of the average Case Manager. However, the following
examples of techniques or actions are considered necessary to carry on
most successful negotiations.
InformationThe coin of the realm in negotiations is information, not power, influence,
or advantage. A successful negotiator knows what his or her interest is in
the discussion with the other party. A successful negotiator knows what
she or he hopes to get out of the discussion with the other party. Here are
some questions a successful negotiator might ask when preparing for the
negotiation:
• Is it merely a lower price the other party wants, or does the speed of
delivery or quality of service matter?
• Does the party want a visiting nurse to check a patient's vital signs
at home on a daily basis, or does he or she want the visiting nurse
to improve the patient's health and keep the patient from being
readmitted to the hospital? Is the party willing to pay for that
difference?
• Does the party want a facility that has the lowest bed rate for a
hospitalization, or the facility that has vast experience with the
patient's disease and will treat the patient efficiently and, thereby,
decrease the overall length of stay and costs?
• Does the Case Manager want the absolute lowest price on a piece of
durable medical equipment, or does he or she want a fair price and
a responsive partner in serving the many needs of his or her
patients?
Other examples of important information to know before a negotiation
starts are as follows:
• Who else in the area provides this service or sells these items?
• Is the vendor accredited or bonded?
• What is their service like?
• Do they deliver on time?
• Do their nurses show up late at a client's home, or not at all?
• What are the "usual and customary" charges for these services?
Are there other benchmarks for these charges? (Medicare fee schedule? Major insurer's fee schedule?)
• Have these vendors been used before?
• What price was paid in the past?
• Were there quality issues then?
Obviously, there is a large amount of information. Is it worth tracking this
information for future negotiations? Most negotiation experts would say so.
Best Alternative to a Negotiated Agreement
A very important piece of information for the Case Manager to have
during a negotiation is the best alternative to a negotiated agreement, or
BATNA. This concept was explained in the book Getting to Yes by Roger
Fisher and William Ury.
10 BATNA is an exercise in imagination and
research that should occur before any substantive negotiation. It is an
exploration of what happens when there is a negotiation impasse and no
agreement can be reached. For example, assume surgical services are
necessary for a patient who is 3 years old. In preparation for a negotiation
with a provider, it is discovered that there are more than 30 pediatric
surgeons in the community who perform this type of surgery regularly.
Thus, the best alternative to an impasse in negotiation with the first
surgeon is to go to another surgeon for this surgery. This is a powerful
piece of information during the negotiation and will affect how
aggressively the surgeon's fee can be negotiated. If, on the other hand, the
prenegotiation research indicates the patient requires a unique type of
surgery and only one provider on the East Coast regularly performs this
rare type of surgery, the BAT NA is to either pay the surgeon her "full
charges" or incur the cost of sending the patient to the West Coast for the
procedure. A Case Manager would then negotiate the procedure cost much
less aggressively.
The use BAT NA in these situations allows the negotiator to
anticipate the outcome to a failure in negotiations and think of alternatives
to likely unfavorable outcomes. For example, in the case of the only
provider of the surgical service who wants a fee that is much higher than
is usual and customary, she may be the only provider of the service, but
she is interested in getting paid as soon as possible with as little additional
effort as possible. In discussing with the provider the complex process
necessary for authorization of her nonstandard fee, the additional reports
she will have to provide, and the expected delays in payment, the provider
may be encouraged to accept a lesser fee to expedite the payment. Using
BATNA on both sides of the negotiating table allows the parties to
explore these alternatives for their mutual benefit.
Avoidance of "Irritators" in Communications
"Irritators" are terms that, intentionally or not, are judgmental and cause
the other party pain or embarrassment. They are not conducive to a
dispassionate discussion of the items of interest and do not advance a
mutual goal. For example, during a price negotiation on a surgical
the Case Manager states the surgeon should accept the offered
price because it is "fair" or "reasonable" (implying that the surgeon's
charge for the procedure is unfair or unreasonable}. This would irritate the
surgeon and make him less willing to work with the Case Manager to
arrive at a mutually satisfactory price. As an alternative, the Case Manager
might explain that the surgeon's fees deviate from the usual and
customary charges and that company policy only authorizes prompt
payment for usual and customary charges. This allows both parties to save
face and continue negotiations. Another example of the use of irritators in
negotiation occurs when a Case Manager wants to negotiate an increase in
performance from a provider of care. To characterize a provider's work as
"unprofessional" or "shoddy" will only anger the provider and not resolve
quality issue. Stating specifics, such as "the respiratory therapist
arrived late and left paper wrappers and puddles of water on the patient's
floor" provides the other party with information he or she can use to
improve the provider's care and avoids emotional reactions and further
conflict.
Active Listening ( one of the toughest things to do)
Inherent in the process Of communication is listening to the interests of the
other party. Often, these are not stated directly but must be culled from
facial expressions, body language, and tone and nuances of speech. It is
common for an inexperienced negotiator to be busy formulating another
argument while he or she quietly waits for the other party to stop
speaking. Active listening requires more than just silence on the part Of the
listener. It requires the listener to hear and understand what is being said
and to think about the content and the implications of the other party's
statements. When actively listening, encourage the other party to fully
explain his or her ideas and then restate them in your own words. This not
only ensures you have heard the other party correctly, but tells the other
party you were listening closely. Repeating the major points stated by the
Other party also allows you to rephrase their Statements slightly to explore
possible alternatives: for example, "You have mentioned price and service
as important to you, is there anything else?" or, "You mentioned
promptness of delivery as something that is very important to you. Do you
want to expand on that topic?"
Trust/Trustworthiness
When negotiating with another party, a certain level of trust must exist or
the scope of the negotiation becomes very narrow and bogged down with
needs for assurances and indemnifications on both sides. Trust can be built
Over time with a history of successful negotiations. From the Case
Manager's perspective, this means scrupulous adherence to the tenets of
the agreement. Be timely; look to streamline further approvals or
payments if appropriate. Mail, fax, or e-mail a written copy of the verbal
agreement as soon as possible to the other party. Act rapidly on all agreed
on approvals or the issuance of checks. This should be easy for a Case
Manager, and it will win points with the other party. A Case Manager
should expect the same treatment from the other party. If a Case Manager
finds his or her trust is misplaced, he or she should find another vendor or
provider of services.
Respect for the Other Party
A good negotiator respects the other party. For a Case Manager, this
means timing the negotiation so it is most convenient for both parties. For
example, calling a physician in the middle of the day while she's seeing
patients and expecting her to drop everything to enter into a lengthy
discussion about prices or services may be unfair. Calling beforehand and
setting up an appointment so both parties are prepared to discuss the issue
is ideal.
Dr.Hariharan Ramamurthy .M.D.
Howard County Community Clinic, Big Spring, TX , USA
IRSI /Quality Healthcare and longevity
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