Quality and safety improvement is as much about communication and relationships as it is about protocols and techniques of process improvement. That was my message today at Ipswich Hospital as I conducted an afternoon seminar on strategic negotiation. About 40 people attended, from all types of positions in the hospital, to learn principles of negotiation. These included the concepts of BATNA (best alternative to a negotiated agreement); interest-based versus positional negotiation; trading on differences; and how to recognize the structural, contextual, and personal aspects of a negotiation environment.
One of my favorite exercises to illustrate the last point above is a game called "Win as Much as You Can." This was developed by my friend Michael Wheeler and is technically described as a four-person, simplified, iterated prisoner's dilemma exercise. A group of four participants display index cards marked with "X" or "Y" to try to win the (virtual) prize money available in the game. The payout depends on how many people put down an "X" and how many put down a "Y" over ten rounds of play. The structure of the game encourages people to play "X," even though doing so causes them all to lose relative to the case in which everybody plays "Y." This causes some good-humored strife within each group of four players, with some players (above) chortling as they win by reneging on the deals struck with the others, and others (below) expressing shock that their colleagues could ever do such a thing to them.
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