Negotiation. Society for Academic Emergency Medicine Definition of Negotiation u Compromise:...

Negotiation

Society for Academic Emergency Medicine

Definition of Negotiation

Compromise: concessions on the part of both parties

Confer and discuss to reach an agreement


Why Physicians Don’t Negotiate: Excuses

No time Embarrassed Not comfortable Don’t like conflict Feel that asserting themselves during

negotiations isn’t professional Physicians want to be liked


What type of things have you negotiated for in the past?


Typical Physician Negotiations during their Career

Salary Home Car Legal/financial/accounting fees Equipment Purchases Consumer goods

Purpose: Empower you to save 5-10% when negotiating


Negotiation Case

While on vacation you go into a jewelry store and see an attractive looking watch. You ask the store’s owner how much it costs and he replies $495.67. How much would you offer to pay for this watch?


Two Types of Negotiations

Cooperative: Long term relationship Competitive Negotiation: One time deal


Cooperative Negotiation

Search for a “Win-Win” solution*Find best deal for both parties

*Find ways to make a bigger pie to divide

*Invent options for mutual gain Sensitive to the other’s needs: listen Build trust: integrity Stress looking for a long term relationship


Competitive Negotiation

Opponent wishes to: WIN

*Discloses little information as possible

*Shows little concern for you

*Manipulates you

*Uses variety of negotiating tactics to win


Principles of Negotiation

You negotiate all of the time Willing to practice Negotiation skills don’t change as the negotiation

gets bigger & more important Avoid thinking you have the weaker position Options give you power: BATNA Worst thing you can do: let the other side know

how much you care Point of time decision at time it exists



Two way affair Understand cultural differences of

negotiation Concentrate on the issues Remove the personal from the issue Don’t be confrontational Avoid positional negotiation Allow the other side to save face



People believe in what they see in writing more than what they hear

Specific numbers have credibility Follow the law of probabilities Find person who can make the decision



Body language: watch CHANGES in body language Dumb is smart:

*If too smart: want to compete against you*If dumb: people want to help and educate you

Never change your offer*Except in response to specific counter proposal*Preferable in writing

Don’t close deal until all of the issues are settled Contract rules:

*Read ENTIRE contract every time it is returned*Write the contract


Personal Power: Don’t let it intimidate you

Legitimate: power of the title, position in he marketplace Reward: power to reward you Coercive: power to punish you Reverent: consistent set of values Charismatic: power of the personality Expertise power Information power: side with the most information usually

does better Situational power: if you have to make the concession

anyway, do it immediately & nicely; maintain goodwill


Informational Power: Active Listening

Active Listening*Ability to hear

What is said What is omitted Equivocal statements Verbal leaks

*Prevent misunderstandings


Informational Power: Want your Opponent to Like You

Needs: *What are they looking for*Need to be successful

Interests: Find compatible interests to build on*Values*Family (children, pets, spouse)*Professional achievements*Hobbies*Athletic achievements*Travel


Informational Power

Ask tough questions: they may answer them People are reluctant to admit they don’t know Most people like to talk about themselves Appear ignorant of certain matters: people love to teach Chance to judge their reaction Ask away from the workplace Search for commonality: people share information across:

*Peer groups*Professions

Don’t be elitist: obtain information from clerks, secretaries, janitors, patients, peers, former workers


Informational Power: Do your homework

Search the internet, public filings, company catalog, annual reports

Ask for informational packet from the other negotiation team’s representative

Have facts, documents, figures available Demonstrate that your proposal or terms are the

industry standard or accepted practice Power of precedents and policies


How to Deal with Difficult Questions

Defer Defect Delay Decline Rule the question out as improper Ignore the question Respond generally to a specific inquiry Plead ignorance Plead irrelevance State the question is too personal Answer with or answer a different question


Three Stages of Negotiation

Develop a relationship of trust

*Don’t offer anything you cannot follow through on

*Let them air their options

*Focus on mutual interests

1. What do they want?

2. Gather information

3. Win/Win negotiation


Beginning Moves

Never jump at the first offer

Ask for more than you expect to get

Flinch at the other side’s proposal

Avoid confrontational negotiation


Beginning Move: Never Jump at the first offer

Want the other side to feel they won Otherwise the other side wonders “what’s wrong” Don’t form opinion how the other side will

respond


Beginning Move: Ask for more than you expect : Bracket your objective

Probably will end up with less than you ask for You may just get it You don’t’ know what the bottom line is Raises perceived value of your service Creates a climate where the other side can win Prevents deadlocks when dealing with an

egotistical person


Beginning Move: Asking more than you expect : Bracket your objective

How much more should be asked for than we expect to get? Assume that you will end up midway between your and their opening positions

-Must get them to commit first to their very best position: bracket them so the midpoint

is what you really want

-If they get you to commit to your best position: they bracket you so the midpoint

is what they want


Beginning Move: Flinch at their proposal

React visually = shock at their proposal Often other side is watching for reaction Visual reaction overrides auditory in most

people

Exercise: picture your medical school graduation


Beginning Move: Avoid Confrontational Negotiation

Arguing increases people’s wish to prove themselves right

Forcing them to defend their position

Use instead: feel/felt/found


Middle Negotiating Moves

Time Pressure Remove their resort to higher authority Decision at point of time Patience is a virtue Silence is golden Information power



Never be pushed into making a decision*Vague higher authority

I have to check with the board or committee

*I have to check to see if this creates conflicts of interest for me

*I want to avoid even the appearance of impropriety

*Offer to make decision but let them know it will be negative if you have to make it now



Remove their resort to higher authority*Appeal to their ego

*Get their commitment that they will recommend it to a higher authority



Never offer to split the difference*Encourage other side to split difference

If you make a concession, get reciprocal concession immediately

Handling an impasse: set aside technique



Deadlock: neither side sees any point in talking to each other because its not going anywhere any more*To Resolve: Third party: must appear neutral

Arbitration: Winner, loser Mediator: Facilitates solution: no power


Middle Negotiating Moves: Concessions

Everything you give up is a concession Need to understand the value of any concession to

your opponent Try to get something of equal or better value in

return for every concession you make Try to get opponent to make first concession Start with the largest concessions first and reduce

the size Story of concessions: make the opponent look like a

hero to their organization



Trading Off: If we do this for you what can you do for us?*Reasons to do this:

May get something Elevated the value of the concession Stops grinding away process *


Ending Moves

Defense*Good guy/bad guy:

Try to equal size of negotiating team Identify the tactic to the other side

*Nibbling: make them feel cheap

*Be prepared to walk away: Have options


How to Say “NO” Politely

I would love to but I’m swamped I am honored, but I am focusing on other areas Sounds interesting, could you send me a written proposal I am not an expert in this area, but I can refer you to Dr. X Let me check my schedule & get back to you I’m sorry but I have a previous commitment


Negotiation Case

Divide into 2 groups Take a yellow or blue sheet depending on

your assigned role Paper and pen required


Negotiating Case

Division Director*You are looking to hire a junior faculty member for a position in your Division.*You need to hire a physician to work as a clinician educator in your Division as your

current faculty members feel clinically overworked.*You have plenty of senior faculty members in your Division that are in administrative and

research positions.*Your facility is not located in an attractive area of the country but the area is family

friendly and the cost of living is low.*You are competing for subspecialty physicians with two other institutions within a 50 mile

radius. Your institution has a better academic reputation than the other two institutions and there is low turnover

of faculty as the institution is known to be physician friendly. Your institution pays less than the other two institutions.

*You are interviewing an excellent candidate who will complete fellowship training in 6 months.

*The Chairman of your Department has permitted you to hire only one physician and you feel that your Division will still be understaffed.

*The institution will not allow you to pay this new physician more than $150,000 per year.*All salaried physicians working for the institution receive 4 weeks of paid vacation time

and are given $3,000 and one week off for CME per year.


Negotiation Case

Junior faculty candidate*You are completing your fellowship training in a few months and looking for a junior

faculty position.*Your spouse plans on not working outside of the home to care for your infant son.*You have $150,000 in medical school debts.*You are an excellent candidate as you have published 2 clinical research articles and

have an outstanding reputation as a clinician at your training institution.*You are interviewing at Institution X:

Your spouse’s entire family lives in the region and you have agreed to move there. The institution has an excellent academic reputation and is known to be physician friendly.

*There are two other hospitals in the region that are actively recruiting for physicians in your field. Both hospitals are non-academic institutions but pay a higher salary. One institution advertises a starting salary of $160,000 per year. The other two institutions are unable to provide you with any clinical research opportunities.

*You would like a position that would give you 80% of protected research time as you enjoy research and wish to advance professionally in your field.

*You cannot support your family or pay off your medical student debts if your salary is less than $130,000 per year.


Bibliography

The Successful Physician Negotiator: How to Get What You Deserve by Babitsky and Mangraviti, S.E.A.K, Inc. Legal and Medical Information System, Falmouth, MA, 2001

ACPE: Negotiation Course by Roger Dawson


Author Credit – Negotiation:Maria Ramundo

Questions


Postresidency Tools of the Trade CD

1) Career Planning – Garmel

2) Careers in Academic EM – Sokolove

3) Private Practice Career Options - Holliman

4) Fellowship/EM Organizations – Coates/Cheng

5) CV – Garmel

6) Interviewing – Garmel

7) Contracts for Emergency Physicians – Franks

8) Salary & Benefits – Hevia

9) Malpractice – Derse/Cheng

10) Clinical Teaching in the ED – Wald

11) Teaching Tips – Ankel

12) Mentoring - Ramundo

13) Negotiation – Ramundo

14) ABEM Certifications – Cheng

15) Patient Satisfaction – Cheng

16) Billing, Coding & Documenting – Cheng/Hall

17) Financial Planning – Hevia

18) Time Management – Promes

19) Balancing Work & Family – Promes & Datner

20) Physician Wellness & Burnout – Conrad /Wadman

21) Professionalism – Fredrick

22) Cases for professionalism & ethics – SAEM

23) Medical Directorship – Proctor

24) Academic Career Guide Chapter 1-8 – Nottingham

25) Academic career Guide Chapter 9-16 – Noeller

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