Annotated Bibliography

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Course Learning Outcomes for Unit III

Upon completion of this unit, students should be able to:

3. Describe methods of managing conflict in the healthcare organization to include concepts of negotiation and third-party intervention.

Reading Assignment

Chapter 8: Understanding the Psychology of Collaborators, pp. 137-165

Appendix: Leadership Personality Survey, pp. 311-317 Social Character Questionnaire, pp. 318-319 Understanding Leadership Personality, pp. 320-321

Unit Lesson

In this unit, our learning objectives will explore conflict management in healthcare organizations, including the concepts of negotiation and third-party intervention.

Conflict Overview

As we look at conflict, let’s consider how this is unique in a healthcare delivery setting.

 Healthcare employees are often managing high stress situations (procedures, etc.) where the stakes are high.

 Patients often do not feel well and are not acting politely.

 Coworkers consist of a wide range of personality types, each with his or her own educational and socioeconomic backgrounds and respective paradigms (ways of thinking). This wide range of coworkers include housekeepers, aides, technicians, nurses, coordinators, managers, directors, doctors, and officers.

Clinical practices in health care are governed by laws respective to scopes of practice. For example, only a Doctor of Advance Practitioner (NP, PA) can give the orders, just as a Physical Therapist gives the orders to a Physical Therapy Assistant, an Occupational Therapist to an Occupational Therapy Assistant. Given these unique factors affecting healthcare delivery, this unit lesson will explore practical tips for successfully managing conflict specific to health care. You will also explore meaningful material on negotiation and third- party negotiation.

Successfully Managing Conflict

Conflict is not a bad thing if handled correctly. In fact, academic challenge is needed in medicine for professional boundaries and parameter setting in work relationships. This section will give practical thoughts on managing conflict from the book Winning and the book Crucial Conversations: Tools for Talking When Stakes are High.

The term called professional candor was coined Jack Welch (2005) in his book Winning. Welch was the former CEO of General Electric, he transformed the organization’s culture and led it from bankruptcy and silos

UNIT III STUDY GUIDE

Managing Conflict and Negotiation

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Title to profit and collaboration. Welch (2005) gives the formula for professional candor and quotes the philosopher Kant on self-interest:

Lack of candor blocks smart ideas, fast action, and good people contributing stuff they have got while candor gets more people in the conversation. I most often hear that candor is lacked from performance appraisals. When you tell it like it is, you create less confusion…and resentment. Immanuel Kant gives powerful arguments for the view that not being candid is actually about self-interest and making your own life easier, which ironically can actually erode trust. To get candor you reward it, praise it, and talk about it. Most of all, you yourself demonstrated it in an exuberant way. (p. 354)

Welch’s idea that professional candor is good is also in a must-read book for managers, Crucial Conversations: Tools for Talking when Stakes are High (Switzer, Patterson, Kerry, Grenny, & McMillan, 2002). One of the tools in the book is “Sharing Risky Meaning,” or the idea that the best people at dialogue speak their minds completely and do it in a way that makes it safe for others to hear what they have to say and respond to it as well. They are both totally frank and completely respectful (Switzer et al., 2002).

Have you known such people who are so good at saying things with professional candor in a frank but respectful way that others feel safe? These are big skill sets for a successful leader to possess, and I strongly encourage you to read the books noted above, particularly Crucial Conversations: Tools for Talking when Stakes are High. Some helpful tips on how to successfully manage conflict include the following:

1. Mind: Be positive in your thinking and picture positive outcomes. Eventually your thoughts will express themselves in your words or body language. What do you want from the conversation? Is your intention pure and for mutual benefit?

2. Approach: Have good intentions and be tactful, choosing your words wisely. 3. Conduct: Your words and actions are remembered and your staff have high expectations of you as a

manager. Your conduct must be that of an officer (gentleman/lady). If you have 100 conversations this week, all 100 need to be 100% professional. It only takes one joke or comment to get a manager in trouble.

4. Maturity: Know your triggers and control them. Your actions give others license to do the same. Consider the following questions: a. Does your face get red, or can you control your facial expressions? b. Does your tone of voice raise, or do you remain calm? It does not matter who is right or wrong, it

matters how we engage. c. Do you immediately respond, or do you choose to consider the matter? d. Do you “speak your mind” and regret it later, or do you take time to reason and choose the best

response? e. Do you get defensive and internalize what the person is saying, or do you try and see things from

their point of view? Try to understand the person and assume their best intentions. Rather than being upset by what the person is saying or how they are saying it, realize that it is just their way of getting things done. Do not respond to the person’s emotion, respond to the issue at hand.

f. Do you have a pity party and speak badly of the other person with a confidante? We all get frustrated, but it is our choice to let it irritate us or to become irritable. People lose respect for others if they hear them speaking badly of another, even if they are right and the confidante shares the same views. Officers/leaders should not speak badly of others but should operate at a high level of mindful conscience and reason. Choosing to not speak badly of others shows a level of maturity. There is a famous saying from WWII, “Loose lips might sink ships.” Similarly, do not speak badly of others and risk sinking your career ship.

5. Perspective: Realize that the heat of the moment will pass and it is best not to react when upset. It is the small conversations and conduct which define character and a good reputation as managers.

Healthcare managers strive to create an environment of care. Therefore as managers, they must be examples of caring. There are few ways better to demonstrate such care than in how others are treated. When you are professional and calculated in your response, you turn conflict into opportunity. Conflict can

(Office for Emergency Management, 1941)

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Title lead to mistrust and ruin, or with proper management the pendulum can swing the opposite direction and can lead to trust and respect.

Negotiation

There are many techniques one can follow.

1. Strive for mutual benefit: If one party derives more gain from the other from the transaction, by nature the agreement will be imbalanced. There must be mutual benefit to an agreement, just as a ladder can only stand if both legs are equal. When looking at enforceability, courts often look for this principle of mutual benefit in a contract. Negotiation is not about getting all you can, it is about realizing the intersection of common interest and self-interest.

As an example of mutual benefit, there is a story of Utah settler, Jacob Hamblin, who learned the language and customs of his Native American Paiute neighbors and treated them with respect. Hamblin sent his young son, who was coming of age, to trade a horse for blankets with his good friend, Chief Frank of the nearby Paiute tribe. Hamblin was in his barn working when his son came home beaming with pride, his hand wagon piled high with blankets. Hamblin looked at the big stack of blankets, shook his head in sorrow and said to his son, “My dear boy, you’ve cheated my good friend Chief Frank; you must go immediately and return 1/3 of these blankets to him.” The son immediately did so, and while traveling back he saw Chief Frank waiting for him halfway to the Paiute Camp. Chief Frank greeted the boy and said, “I knew your father would be sending you back so I met you halfway. Your father is a friend and brother to my people” (Sullivan, 1984, para. 6).

2. State common interests: Try to understand where the other party is coming from, and ask them questions of where it is they want to end. In so doing, they will be more likely to listen. Restate their interests or concerns to ensure they are properly understood. In an agreement, these common interests become your recitals and they tell anyone reading the agreement why both parties are interested in executing and proceeding. These are the “Whereas” sections at the beginning of an agreement.

3. Be calm and logical: Do not be too anxious or excited to execute the deal, even if something is very exciting. Hold your emotion and keep it in check, as you do not want the other person to feel you have the advantage. So much of negotiation is simply emotional. Do not argue, be polite and stick to the issues and terms.

4. Let the other person lead: Try to get the other person to make the first offer. They will naturally lead high but it will provide a range point of where they are. Usually the person who leads out first is either in a weaker position, or they are unaware of this technique. Do not accept the first offer, as it is usually holding back of something better they will offer in a banter or repartee. People rarely offer last resorts in their first offer; there is room for give and take.

5. Restate the terms: If there is an initial conversation, restate those terms. It is not uncommon to follow up with emails of outlined points or a Memorandum of Understanding (MoU) that both parties will agree to engage in negotiations with the points as guidelines.

6. Defer and reset: If necessary, put time between you and aggressive terms being thrown at you, defer to your partner or manager, and indicate you will need to check with that person. Sometimes a reset or different time can lead to a better outcome.

7. Walk away if needed: The first one to walk away from negotiations is usually either the most emotional (upset), or the least interested. If someone is hanging on, you will have more reason to believe they are interested. This being said, be genuine and do not play games. It is about mutual interest, not a game for gain.

8. Acknowledge character revealed: The nature of negotiations often shows the nature of the person with whom you are dealing. Is he or she asking questions and seeking mutual benefit, or is he or she being hard nose and one-sided? If you gain too much, sometimes you have more to lose.

Negotiating employment agreements can be very challenging. For example, a nurse practitioner who was extremely tough in her stance, gained more benefits from the healthcare manager she was negotiating with than any other practitioner in the group. The process was fatiguing, and because she wanted so much, the manager expected much more from her. It was a very disappointing situation, because of the process (her

Jacob Hamblin (Canyonconnections, 2010)

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one-sidedness), as well as her subsequent performance after she started, because she was more about entitlement than productivity. She had negotiated a 90th percentile deal and she performed at the 50th percentile. That gap seemed even wider due to the tough nature of her negotiation.

Negotiation occurs every day, from small interactions with people to large contracts. The key in negotiation is mutual benefit and respect, trust and character, which is no different from all relationships.

Third-Party Negotiation

This section will briefly highlight three types of third parties who commonly negotiate with healthcare leaders:

1. Insurances: Third party payers are an institutions or companies that provide reimbursement to healthcare providers for services rendered to a third party (i.e., the patient) (Medical Dictionary, 2015). As a healthcare providers, we feel schedules are negotiated with the insurance company, which represents the healthcare interests of their members. For example, the best insurance contracts are usually from commercial payers (Blue Cross, Cigna, Aetna, etc.), who may give healthcare providers 135-165% of Medicare fee schedule. The least profitable fee schedules are usually from Medicaid, which pays about 40-80% of Medicare fee schedule.

2. Human Resources: In our internal operations as employers, if our operation is big enough, we usually have a Human Resource (HR) department that acts as a neutral third party. To maximize true objectivity, the organizational reporting structures (discussed more in Unit V) should have the HR department not reporting to management. The HR department should neither sway in interest toward employees or toward management. They should not be the employee’s advocate nor should they be a tool of management; they should be neutral.

3. Labor Unions: Depending on the State in which you will work, you may deal with service labor unions as a healthcare manager. In these circumstances, it is extremely important to only speak with employees about their performance with that employee’s union representative present. Great unions do not strive to create an adversarial divide between employees and management (thereby making themselves needed); they strive to create unity and common interest. It can be very involved, as a healthcare manager, to effectively work with unions, as their interest is clearly stated as the employee’s representative and mutual benefit is often hard to find when one party is very self- interested.

References

Canyonconnections. (2010). JacobHamblin [Image]. Retrieved from https://commons.wikimedia.org/wiki/File%3AJacobhamblin.jpg

Office for Emergency Management. (1941). Loose lips might sink ships [Image]. Retrieved from https://commons.wikimedia.org/wiki/File:%22Loose_lips_might_sink_ships%22_-_NARA_- _513543.jpg

Sullivan, M., (1984, October). Friend and brother: Jacob Hamblin, man of peace. Ensign Magazine, 14(10). Retrieved from https://www.lds.org/ensign/1984/10/friend-and-brother-jacob-hamblin-man-of- peace?lang=eng

Switzer, A., Patterson, K., Grenny, J., & McMillan, R. (2002). Crucial conversations: Tools for talking when stakes are high. New York, NY: McGraw-Hill.

Third-party payer. (n.d.). In The Free Dictionary [Web page]. Retrieved from http://medical- dictionary.thefreedictionary.com/third-party+payer.

Welch, J. (2005). Winning. New York, NY: HarperCollins.