For every problem there is a zone of possible solutions

Commentary. By Leonard J. Marcus, PhD, and Barry C. Dorn, MD, amednews contributors. May 7, 2001.

COMMENTARY

Observations on the state of medical practice and medical life

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When people are enmeshed in conflict, it is only natural that they see the problems from their own point of view, just as they see the array of potential solutions in light of their own desires and preferences.

If you were to arrange the scope of acceptable solutions for each side, you would find that there is a zone of options acceptable to your side, a zone of options acceptable to the other side, and hopefully, some overlap between the two that constitutes your zone of agreement or settlement. The wider the zones of acceptable options early in the process, the greater is your likelihood of eventually finding mutually acceptable solutions in the end.

How does a "zone of agreement" differ from a "point of agreement?" And how do the two reinforce one another?

Generating options

Picture a zone in your mind: it is not endless; it has bounds and boundaries. It is also not specific. It is an area, an expanse: ill defined and perhaps not fully apparent.

In due course, when parties to a negotiation reach the latter stages of their deliberations -- what we call the "aligned interests" phase of the process -- then it is time to focus on specific points of agreement. These are the explicit, decisive, and conclusive outcomes of the negotiation process. These are the details of a contract, a consensus upon which people have deliberated and which they are prepared to adopt.

It is premature at the outset of a negotiation -- during the "enlarged interests" stage of the process -- to get too specific too soon. Why?

There are many advantages to intentionally exploring the full range of opportunities and possible agreements that are available to you. Through this process, you discuss and test options without concern for having to commit to them. If, early in a negotiation process, you were to get too fixed on final points of agreement or contention, you likely would miss some useful and resourceful opportunities: You would jump toward a premature conclusion.

What emerges from the conversations that occur during the enlarged interests phase? You craft with others the flexible borders of your zones of agreement. The question is whether there is overlap in these zones, ways you can stretch what is acceptable to create an overlap, or even create entirely new options to expand your zones of agreement.

For all of the negotiators, there is the opportunity to express just what is within the range of the acceptable and what is outside that range.

There is discussion about what actions or statements could shift the borders in one direction or the other. With this, each of the negotiators begins to appreciate what others are hoping to achieve in the process: that implicit or even explicit expression of what might be a shared "successful" outcome.

Emerging from the discussion is a realm of options: a zone within which reasonable alternatives reasonably can be raised and seriously considered, as well as the bounds outside of which consideration is unlikely. There is much to discover: You might encounter possibilities that you hadn't before considered.

Inventing overlapping zones

One class we teach at Harvard is part of a master's degree program in health care administration, designed for middle and late career physicians. The experience of the most recent class demonstrates one of the important lessons imbedded within this process of interest-based negotiation.

Following a month of summer classes during which they studied the model and method, the students returned home for two months with their assignment: They were to select a problem, conflict or issue in their institution and use interest-based negotiation to work with the stakeholders toward a resolution. While it was hoped that they would solve the problem, their course evaluation was based on the cogency of "lessons learned" in the process.

They returned in the fall, laden with stories that had common threads woven through the lessons they learned. In most cases, the student was a stakeholder in the problem.

Most jumped into the process with a likely and feasible solution in mind, confident that the newfound negotiation skills would allow them to persuade others of the wisdom of their "fix."

That, however, did not happen.

They found, in the course of engaging others in the process, their conception and understanding of the problem and the ideal solution was significantly changed. This adjustment happened in large part because they changed. The process opened them up. They were better able to hear the perspectives, concerns and ideas of others and a new range of solutions was generated that they had neither imagined nor considered.

Rather than merely working to persuade others of the wisdom of their solutions, they were sufficiently persuaded by the process itself to ponder options that they had not previously envisioned.

A pragmatic case example

One case was particularly intriguing. Dr. Jones is chief of cardiac surgery at a large teaching hospital. The problem he presented and hoped to solve pertained to time in the operating room for his surgeons.

A transplant surgeon recently had been appointed as the new chief of surgery at his institution. The new physician attracted a good deal of attention and new business to the hospital, as hospital administration had hoped, and with it, transplant surgeons were utilizing more OR time. This new bout of business created a crunch on the availability of the finite operating room time.

Cardiac surgeons, themselves busy and lucrative for the institution, were getting squeezed out, or only getting the least desirable hours for their procedures.

Dr. Jones returned to the institution committed to negotiating a better deal with the new chief for the allotment of OR time. He wanted a new block of OR time reserved solely for cardiac procedures.

Once they embarked on the process and defined their zones and options, the parties discovered a resource they had not considered before. The hospital had recently merged with another smaller facility not far from the main campus that also had operating rooms, though they were for the most part underutilized. A number of the day procedures performed by the cardiac surgeons could just as easily be performed at this alternative location.

Dr. Jones had not considered this other site in his initial thinking about the problem. The option emerged as they engaged in their process of interest-based negotiation. The challenge would be to persuade the cardiac physicians of the wisdom of moving themselves, on occasion, to the other facility.

A combination of free parking, free coffee, and other relatively inexpensive amenities were packaged together in order to lure the cardiac surgeons to this other facility. The surgeons became so happy with these small perks that they did not want the other surgeons to find out about them, lest the others consider transferring their procedures.

Building agreement

Dr. Jones' case presented an important "lesson learned." The alternative site option was a strategic choice that he had not even considered when he first mapped out the anticipated outcome of the process.

The zone he originally anticipated was within the confines of the existing operating rooms and the time available within them. He was likely on a collision course if that remained the only option. Creating a new zone of agreement, literally an additional space, offered an option acceptable to all the stakeholders.

The case is an illustration of the importance of envisioning and enlarging your zones: Often there are more possibilities than originally meet the eye.

Much of the attention during an interest-based negotiation is focused on how the parties frame and might reframe their zones of agreement.

The wider the range of possibilities and the more creative the thinking about their enlarged dimensions, the more options you eventually will create. And with that, you increase the likelihood of finding a workable settlement to the conflict that brought you to table, some options upon which you can all agree.

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.