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Negotiation in Health Care- Opportunity Not Obstacle

Dr Swapnil Pawar September 30, 2017 676

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In life you don’t get what you deserve, you get what you negotiate for, says Ziad Abdelnour.A day doesn’t do by where we don’t negotiate. We negotiate with our partner/spouse, kids & sometimes even with your self. In hospital settings, we negotiate with an organisation for better work-life balance, we negotiate with colleagues for swapping shifts and we negotiate with families over treatment limitations. However, often our notion is “negotiations are tough and need special skills”. Thus we try to avoid them. One of the reasons for this apathy is lack of training and lack of understanding of principles.

What is Negotiation?

According to Fisher & Ury, it is back and forth communication designed to reach an agreement, when you and other side have some common interests that are shared and others that are opposed ( as well as some may be simply different).For me, it is basic means of getting what you want from others.

Approach to Negotiation 

The most important tip – Do not equate Negotiation with Battle. Consider it as an opportunity to progress from the current situation.There are various resources and workshops out there, but I am going to share a simple approach that helped me.it’s 3 stage approach – SET, DIALOGUE & CLOSURE.


This is the most important part. Successful negotiation requires lots of preparation. The more you know about the other side, more are the chances of the fruitful outcome.

Before you sit down to negotiate, do your homework. Find out what are your interests and what can be other’s interests. Not knowing the interests is like shooting in the dark. think about various possible options to achieve both interests. Remember you have a common problem and you can solve it together. Open up the chain of communication way before you sit down for final negotiation ( though it may not be possible in all instances). If possible, catch up for coffee or drinks or at some social event. Any form of rapport building exercise is useful. Don’t rush, if you got time. The options that you will suggest should be 100 % legitimate otherwise you will loose your credibility.Always prepare your BATNA ( best alternative to negotiated agreement) before you commence negotiation. This is the bottom line. However, if you mange to achieve this at least, you should be happy.


A lot of people give undue importance to this component. If your preparation is adequate, usually dialogue part is not difficult. Be calm, confident and be yourself. Following psychosocial principles are the key –1) Negotiate over Merit – Consider each option presented to you on its merit. Remove the emotions and present objective evidence to your stand.2) Separate People from the problem- Remember, always Problem is the Problem, not people. Try to uncover their frame as to find out the reason behind their actions.3) Don’t climb the ladder of Inference, Climb the ladder of reflection.

4) Focus on Interests, not on the positions –Positions – Statements or demands framed as the solution.Interests- The reasons behind the position. They encompass things like need, concerns & hope.e.g I want 20,000 AUD because I want to set up dialysis service in ICU.Statement before “ Because” is the position, while statement after “Because” is interest. Often interests are bigger than positions, so don’t get fixated on positions.

5) Invent options for mutual gain –  Don’t be selfish. Always remember it’s 2 of you who are solving the problem “ TOGETHER”

If you can not achieve the outcome that you want, at least try to settle for BATNA ( best alternative to negotiated agreement). It’s important to close the negotiation on healthy relation irrespective of the outcome. It always helps to keep the lines of communication open.
How to improve –
It takes time and practice to get better at Negotiation. It’s an ongoing process. One of the ways that I learnt from my simulation mentors, is by reflecting on your performance by using Learning pathway grid.
In this exercise, you walk backwards and try to uncover the underlying frames that lead to an unsuccessful outcome. Once you uncover frames, all you need to do is reframe the situation.

References – Based on reading from
1) Getting to Yes – by Roger Fisher, William Ury & Bruce Panton ( https://www.amazon.com/Getting-Yes-Negotiate-Agreement-Without/dp/0743526937)
2) Elephant in the Room – by Diana McLain Smith (https://www.amazon.com/Elephant-Room-Relationships-Success-Organizations/dp/1118015428)

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