Patient Care

Group Leaders Can Shift the HM Negotiation Paradigm


Whether hospitalists like it or not, the art of negotiation has a significant impact on their daily activities. Negotiations take place with consultants over what the perceived optimal plan of care should be. Discussions are held with patients on how best to overcome the social, financial, and psychological barriers that may impede their health. Hospitalists negotiate with administrators over schedules, benefits, and responsibilities.

Quite frequently, negotiation is viewed as a process where one party wins and the other loses, a zero-sum game, like chess. The spoils may be financial (e.g., better reimbursements) or they may be cognitive (e.g., success in convincing someone of your particular viewpoint). Significant value that could potentially benefit both parties may be lost if the negotiation is approached with a win-loss mentality. However, with proper preparation and insight, a hospitalist can create value in a negotiation that otherwise may be lost by shifting their negotiation paradigm to a collaborative strategy.

A collaborative strategy is when the relationship—and not just the outcome—is important. This would apply to most negotiations that hospitalists take part in.

A significant part of this strategy involves listening and allowing the other side to divulge their interests and positions. Information must flow freely. Once the problem is identified, it must then be detailed further, ensuring both parties understand each other.

Only once both party’s issues are presented can an alternative solution be contemplated that will be win-win in nature. The parties then must both agree to choose that solution and move forward.

The optimal result is that the chosen solution appeases both parties and has a greater total value than if both sides were solely vying for their own interests.

Riyad Fares, MD,


Adventist Hospital, Portland, Ore.

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