By: The Generation Y Surgeon (@GenYSurgeon)
Yes, You Negotiate Every Day
Whether you know it or not, negotiation takes up a huge part of your day. You negotiate with other attending or consulting physicians, nursing, administrators, insurance companies and even with your patients. Negotiation is an invaluable skill, and learning how to negotiate will save you time and headaches. I strongly recommend reading Getting to Yes and/or Getting Past No by William Ury. Both books are short, easy reads and are quite fun to apply to your daily interactions.
Over the years I have learned what works (and what doesn’t) when I interact with my patients and, to some degree, with my colleagues. It wasn’t until I read Getting Past No that I was able to put it into words. If only I had read this earlier!
The Golden Bridge Technique
The entire book is gold, yet learning how to build a “golden bridge” remains my favorite tool. I find it most useful when I’m in disagreement with a colleague or when dealing with difficult families. What does it mean to build a golden bridge? It refers to making sure you have satisfied the demands of the four most common obstacles in coming to an agreement:
(1) involving the other party (or parties) in devising a solution
(2) meeting unmet interests
(3) helping them save face
(4) and making the process as simple as possible.
Building The Bridge
Now think of all the situations to which you can apply this skill. Think of your last interaction with a difficult patient or decision maker. Were they overwhelmed and feeling powerless? Did they truly understand the situation and consequences? Were their expectations reasonable or unreasonable? Was there something about the patient or their family that was important to them and unknown to you? Had they previously acted in a way that was embarrassing or damaging? Had they somehow offended you or your staff during a stressful situation?
…For The Patients
We have all dealt with patients (or their families / representatives) who have felt like this. One way to augment your interaction with them, especially in times or stress, is to build that golden bridge. Involve them in the decision making process by asking about their expectations and realigning them early on. Prod them for information on their concerns and wishes so that you become aware of any unmet needs. If they acted rudely or made outrageous demands, then let them know it’s ok. Give them a chance to save face by allowing them a fresh start and by all means, do it with empathy. Chances are this is the worst day of their life (and just another regular day in yours). Finally, boil the options and interests down into a few simple choices. When you are able to provide your patient with a few simple choices (that they “helped” to create) you will find that everyone is happier with the outcome.
…And For The Docs
Now think of the last time you disagreed with another provider…no matter how hard you tried, you couldn’t convince them to accept your idea or plan. They resist because they weren’t involved in the creation of such a great idea, and allowing you to be right may make them feel like they’re in the wrong. Their interests in maintaining control over the patient or care plan is not met by accepting your plan as the best, and of course that takes a bit out of their ego. Next time you encounter this situation, try building a golden bridge. The conversation may go something like this:
” Dr. Bossman, do you remember when you taught me about Treatment-X? We applied Treatment-X to Patient Y and it really worked great. Could we talk about how that may work for our current patient?”
…and voila. You’ve engaged them in the decision making process while allowing them to both maintain control and save face in front of the group. As an added bonus, you’ve reminded them of another time when they made an excellent choice which will also increase your influence over their present decision because they will want to be consistent with “their” previous choices. Wouldn’t it be nice if all your negotiations in hospital could go this well?!
Build The Bridge…For Their Needs And Your Success
In closing, I will again urge you to invest some of your time into reading a little more about negotiation. It’s a skill that most providers undervalue even though they use it everyday. In the beginning, using advanced tools like the golden bridge may feel like manipulation–however it is NOT. Yes, we all know that the surgeon’s ego is strong (and it has a purpose), but this technique is about influencing things when, at times, other people’s issues may be getting in the way of the best outcome. Negotiation is not about winning arguments or getting what you want, it’s about coming to a solution that maximizes results for everyone. Try it!