Wednesday, September 25, 2013

Negotiating on Purpose

I am honored to post guest blog articles on Athenahealth's Leadership Forum, and the latest one just went live.  I'd be very pleased if you clicked over there to read it.  The title of the article is "Negotiating on Purpose."  Here's the lede:

After her fifteen year-old son Lewis Blackman died from a series of preventable medical errors, Helen Haskell diagnosed the problems in the hospital by saying, “This was a system that was operating for its own benefit.”

What she meant was that each person in the hospital was unthinkingly engaged in a series of tasks that had become disconnected from the underlying purpose of the hospital. They were driven by their inclinations and imperatives rather than by the patient’s needs. Indeed, they were so trapped in that form of work that they could not notice the entreaties of a seriously concerned mother as her son deteriorated.

From there I go into a discussion of the role of a leader in conducting what can be viewed as a negotiation with the doctors and other staff of a hospital to help the institution's constituencies understand that their interests are coincident with the purpose of the organization and to help them jointly decide on the actions needed to carry out that purpose.

Some might read the article with a view of negotiation as a kind of transaction or a form of haggling.  That is a narrow view of the term.  A more expansive view, and the one I attempt to portray, is a respectful process that provides a means of satisfying parties’ underlying interests by jointly decided action.

I'd welcome your comments, either at the Athenahealth site or here.


Anonymous said...

Medicine, teaching, government, foundation work. They used to be fields which people did "at a discount" so they could help others.

In many of these fields the helping others is no longer the goal. The goal is to make as much as we can for ourselves. Medicine is now certainly one of these. The selfless family physician who goes on hours calls to see sick patients has transformed into a machine that can produce multiple billions of dollars in "profits" for one non-profit hospital in the west end of Boston.

What has happened to the MGH, has happened to medicine in general and higher education and many other "so-called" non-profit fields.

The problem in other words is the culture.

Many non-profit dominated fields do not face international competition. Without competition and with pressure on government to fund "good works" in unlimited ways, we end up with a world where we pay 17% plus in GDP to do what most other countries in Europe do better (universal care and better health outcomes) with 10%.

In terms of higher education (as opposed to research), the same can be argued, European countries educate more college students better for less money. Governmental services are also more efficient in places like scandanavia, which should shock (based on our historical depiction of socialist scandanavia) but mostly people here just don't seem to care.

Health professionals, professors and others went from "caring about others first" to taking care of themselves first.

We now face a crisis in funding healthcare. Our next crisis is believed to be enormous student debt for college educations that can not be repaid. We also face crises in places like Detroit where public employee unions have gotten sweetheart deals on benefits that cities can not repay. And it is not only Detroit but many other cities and states have run up huge bills for things like health benefits, pensions etc that can not be repaid.

It used to be that public sector workers were paid less than those in the private sector, so had better job security, retirement and benefits. Now they make more than the private sector and still have the job security, retirement and benefits.

In my view it is all part of a pattern of greed in our "non-profit & governmental" culture.

Real competition can help. That was one of the underlying goals of what was Romneycare and become Obamacare.

I worry about the world my son will inherit, if we don't do a better job before we are done.

Barry Carol said...

Perhaps there should be a negotiation between the hospital CEO and his or her Board of Trustees that would move senior management bonus compensation metrics away from revenue and profit generation and growing market share toward patient safety metrics like minimizing infection rates, preventable readmission rates and maximizing risk-adjusted surgical outcomes. We all know that hospitals need to at least cover their costs to stay in business but cultural change, if needed, has to start at the top.

Nurses and technicians need to feel empowered to speak up if they see a doctor making a mistake and they need to perceive that management will support and protect them if the doctor reacts badly.

Finally, maybe there should be a mechanism to allow family members to summon an emergency team if their family member appears to be in significant danger. As I understand it, this is one of the changes that came out of the tragic death of two year old Josie King at Johns Hopkins a number of years ago.

JRes said...

I agree that negotiation is a good way to describe the role of a leader to persuade others to act in ways aligned with the organization’s purpose. A key to effective negotiation is that leaders must demonstrate authentic passion for and commitment to quality. In a study of 12 high performing health systems, my colleagues and I found that the CEO and many of the organizations other leaders devoted a great deal of effort to inspire and motivate staff, often leading by example through personal involvement. For example, at one site the full senior leadership team (including the CEO) began every day with patient rounding in which team members asked patients and frontline staff specific questions about their experiences. They then engaged in a debriefing session to identify issues needing resolution and assigned responsibility to a senior leader to ensure that would be done. These leaders served as champions for improvement projects, with responsibility for linking the team to other senior managers who could help to overcome obstacles. This engagement of the senior leadership team facilitated cultural change, leading to the view that quality is everyone’s job and, over time to measurable improvement in the organization’s performance.