Striking a deal: The criterion for success

Commentary. By Leonard J. Marcus, PhD, and Barry C. Dorn, MD, amednews contributors. Jan. 29, 2001.

COMMENTARY

Observations on the state of medical practice and medical life

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In the real world of medical practice, doctors are negotiating the give and get of their work all the time: with colleagues, medical administrators, hospitals, insurers and patients. In the best sense of the word, we are all dealers.We exchange services, goods, materials and relationships. How do we distinguish the "good deal" from the "not such a great deal," or even worse, the "bad deal"?

Not as easy a question as it first appears. Why? Because when we deal, we do not exchange exactly the same thing. To illustrate the point and then its complexity, we start with a very simple analogy.

You give me five logs: I give you $5. That's a deal. What we exchange is dissimilar.

You give me five logs: I give you five logs. That's not a deal. Unless there's some clear difference between all these logs, the effort is pointless.

One measure useful in distinguishing the "goodness" or "badness" of a transaction involving dissimilarities is a tool to assess the value of what we are exchanging. The problem is that it is often difficult to put a dollar amount on the value of what we swap with one another. And what might be a great sum of money to you could well be a paltry figure to me. We often use prior benchmarks to impose a monetary value on things -- for example, what doctors in similar practices are getting -- and time -- the standard fee per hour for the capabilities of a surgeon, internist or consultant.

Let's return to the log analogy. Is a dollar a log a good deal? If others are selling the log for $5 each and I just got it for a buck, well, that could be a great deal. If others are selling it for 10 cents and I just paid a buck, well, that's a lousy deal. Same price: very different assessment.

A pretty straightforward picture if we depend on the "market" alone to determine what is the value of what we exchange. What is the real value of the health you provide your patients? In some ways, its value is whatever someone is willing to pay for it.

Certainly, this monetary value is one useful starting point and a handy frame of reference. But, as a sole frame of reference, the market price has its limitations.

There are many dimensions to consider when evaluating the quality of a deal: progress, fulfillment, satisfaction, respect, recognition, appreciation, gratification and dignity, among many others. Your negotiations will be richer if you recognize these abundant qualities and make them part of your exchanges.

An analogy: A deal is to "short term" as success is to "long term."

Success itself is more than just the good deal. It is accomplishment and achievement. It is what you attain and the delight and contentment you derive from it.

How do we define success?

Negotiating as a game

Game theory -- a discipline seeking to understand what factors influence people's decision-making -- offers important insights. Think of negotiation as a game. In part, you define through your transactions the game you are playing and the criteria for determining success.

Over the years, we have used a simple exercise to illustrate this point. We interrupt our speaking to say, "What I would like you to do is link up with the person sitting next to you in an arm-wrestling position. Your goal is to get the back of the hand of your partner down as many times as possible in 30 seconds. Count how many times you get the other person's hand down. Now, wait until I say 'Go.' " Then, people link up, we count five seconds, shout out "Go!" and the room erupts into a noisy cacophony.

There are some physicians in the room who treat the exercise as a contest. They strategically position their elbows on the table trying to get as much leverage as possible. When we say go, they push as hard as they can, sometimes to the point of shoulder pain. The partners put up forceful resistance to one another and the result is few or no points for either player.

When we ask for results, these people report the score as what "I" got.

Other physicians frame a very different game for themselves. The two partners negotiate an alternative definition of success. Recognizing that they are both trying to accomplish the same objectives, they define success as a mutual enterprise. Having established a modicum of trust with one another -- a basic tenet of constructive negotiation -- when we say "Go," they start swinging their arms rapidly back and forth.

When we announce "Stop" to end the game, these people report their score very differently. They proudly report together what "we" got: They invested less effort, felt far less pain and achieved far more productivity because of the way they formulated "success" and played the game.

The arm-wrestling lesson

Although we are often not conscious of it, there are many opportunities in real life to negotiate what are the criteria for success. When we do, we often are more likely to work together constructively, find innovative ways to engage with one another, establish and demonstrate confidence in one another, derive outcomes from our negotiation that accomplish mutual goals and achieve results that exceed what we would expect to achieve. We are also less likely to impose resistance to one another, fight against one another or find our goals and objectives to be mutually exclusive.

In pragmatic terms, this process and outcome can be achieved by discussing what each of the parties is hoping to achieve and how they would describe a successful outcome of their negotiation. By clarifying early and often just what "success" is for you and your fellow negotiators, in the long term, you are far more likely to deem your practice, your career and even your life a "success," however you resolve to define it.

Note: This column originally appeared in print as "Renegotiating Health Care."

Dr. Marcus is director and is associate director of the Program for Health Care Negotiation and Conflict Resolution at the Harvard School of Public Health, 617-496-0867. Dr. Dorn is CEO of Health Care Negotiation Associates 781-861-6116. The paperback version of their book, "Renegotiating Health Care: Resolving Conflict to Build Collaboration," is available for through Jossey-Bass Publishers, 800-956-7739.