Getting To Yes

Negotiating Agreement Without Giving In

Roger Fisher and William Ury

Who should read: If you need to reach an agreement between two parties. Pretty much all veterinary personnel!

Favorite quotes:

“Separate the people from the problem.”

“Focus on the interests, not positions.”

“Don’t deduce their intentions from your fears.”

Why I feel it is important to veterinary medicine: Whether we want to acknowledge it or not, a large part of our client education and client service hinges on communicating and negotiating the care the animal receives. Negotiation is a part of communication, whether intentional or subconscious. Knowing how to do it well serves us and our patients better.

I have a list of classes that I’m dismayed were not included in the veterinary curriculum. A few included are: 1. Boundaries 101, 102, 201 and 202; 2. The Language and Art of “No“; 3. High Stakes Negotiation: Fighting for a Life.

I find myself weekly (sometimes daily) in a hostage negotiation- the hostage being the pet, the counterparty usually being the wallet or the “spouse”, and the owner (hostage taker) being stuck in the middle of you and the counterparties, hoping for the best for their pet. (Yes, I’m ignoring the terrorist owners for now, because there isn’t reason for those fiends!)

It feels weird to consider ourselves negotiators. Perhaps even salesy and icky… But….. Let’s look at our bottom line: To provide humane and excellent treatment for the animals we care for. We know from experience that not every client that walks in the door knows the value of the services we offer. Whether it’s our time, diagnostics or therapy, we will have to justify that value a few times a day. In a sense, this is a negotiation. Or, at a minimum, we can use negotiation strategies to do our due diligence in educating that client.

I had two big trains of thought reading this book. 1. The application in our clinical practice- predominately with clients. 2. The application in managing our own career. While most of the info was relevant to the second application, there was a narrower chunk that was relevant to clinical practice. So, I’m going to split this Book Rounds out into two versions. This version distills the pertinent details for our clinical use. The next edition will use these details as a foundation to expand on negotiation strategies for our contracts or protecting our well-being in our profession.

This book is the summary of a Harvard project on ethical negotiation practices, and as such tends to be more academic in it’s terminology and descriptions. So understand that I’ve taken a lot of liberty in reframing and rewording. If the topic interests you, it’s worth the time to read yourself!

Substance vs Strategy

There are two focuses that drive people while negotiating. Understanding your client or colleague’s focus can help you understand their motives and goals. They are:

1. The substance: A specific principle or endpoint
2. The relationship: The social and personal obligation or loyalty to the people involved

People may naturally value one focus more than the other, or may even view one as a negative driver rather than a positive driver. Common substantive drivers in vet med include money, a specific outcome, a specific worldview, time or answers. Relationships may be focused on the pet, the client, the staff or colleagues.

Principles vs Positions

The book draws a very clear distinction in defining someone’s negotiation style and strategy. Stereotypically, people probably think of positional negotiation– I have an end result that must occur, and I will either win or lose this position. The authors strongly favor and encourage principled negotiation. A principled negotiator is focused on identifying mutual gains, collaborative outcomes and stringent evaluation of the merits of proposed outcomes. They are “soft on people and hard on the merits”, whereas positional negotiators tend to either be soft (conflict avoidant) or hard (win regardless of impact on the relationship). Prioritizing the individual and the relationship is central to a principled negotiation. Loyal pet owners are the backbone of a veterinary practice. Utilizing the principled negotiation style protects and preserves that relationship, which helps you explore and understand why they may have reservations about a recommendation, rather than alienating us from their trust.

Taking a principled approach also allows greater creativity and openness to solutions. For example, rather than seeing a binary result from a recommended FeLeuk/FIV snap test (accept or decline your recommendation), if you take the time to explore any reservations you may discover that they are not apposed to running the test if another test is negative. But, finding a mass on FAST scan of the abdomen is sufficient information for them to conclude that humane euthanasia is the right choice for their family. So proposing a step-wise estimate and diagnostic approach may be more appropriate, while achieving the mutual goal of finding a humane treatment for their ailing pet. Or perhaps they weren’t aware that you were recommending the test to evaluate for heart worm disease, because the item code doesn’t include that information, and they really do want that test.

Success in Principled Negotiations

There are four main keys to successful principled negotiations:

1. People- separate the people from the problem, and work side by side. You are not frenemies. You are working towards a common goal!
2. Interests- understand the reason behind their objections. This provides context and allows exploration of alternative solutions. Ask questions. Listen.
3. Options- invent options! It’s really easy to approach a problem with a black and white list of solutions, particularly in a very busy situation. But there are often many more solutions in existence if we use our imagination and understand the underlying interests.
4. Criteria- identify objective, fair standards and measure solutions and outcomes against that. This clarifies expectations, and provides a solid reference in the negotiation process.

Challenges to Success

Perception: Failing to understand the other’s perception will be a barrier to reaching a mutually beneficial outcome. Perception creates the problem, but is also the key to the solution!

• “Don’t deduce their intentions from your fears.”

• Don’t blame. Be curious, open and explicit in your understanding of their perception.

Emotion: Failing to recognize theirs and yours, and how they are influencing positions. Emotions are typically more influential than logic.

• Don’t react to emotional outbursts.

Communication: What is said, is often understood differently than the intention. There are three ways that communication can break down.

• Not talking to each other.

• Not listening.

• Misunderstandings.

*The following are the views and opinions of the author of this blog, not the author of the book, and are specific observations to vet med.

• Imposing a black and white worldview on a grey world.
  • There are so many cultural, economic and relational factors in existence, that you cannot possibly know them all. Your belief system is likely biasing your perception (see above) of the situation, and is probably limiting your view of the options.
• Unclear ethical boundaries.
  • Not defining or understanding your boundaries in ethical behavior may land you in a situation of regret. Provided the welfare of the animal is not being abused, there may be other colleagues or solutions that can achieve the goals of the owner. It is AOK to send someone on their way to some other veterinary resource if participation is in direct conflict with your ethics.
• Poor well-being.
  • The more exhausted or burned out you are, the less support and autonomy you experience in your work-place, the poorer your boundaries, the more likely a negative outcome will be a final result. Our emotions may overtake the situation; our fear or anxiety may muddle our perceptions; our lack of support may corner us into feeling we cannot take a stand on our ethics.

Having an awareness of when these factors are at play gives you tools towards success!

Stay tuned for another episode of negotiation skills, at the same bat time, same bat place. We’ll focus on skills for advocating for yourself in self-interested negotiations, and how to handle dirty, dirty negotiation tactics!

Where do you find yourself negotiating the most in a clinic? Where do you feel you could use the greatest improvement in skillset? Share with us! It might just be included in the next Negotiation episode!

Practical Implementation Exercises: 

1. Think back on a few client interactions you wished had gone differently. Can you identify which key success points were missed? Can you identify any of the listed challenges that occurred?
2. Identify a colleague you consider skilled in negotiating patient care. What tactics and skills are they using that you want to hone?

Additional resources:

Boundaries

Managing rejection

The art and skill of listening

Food for thought for when negotiation may be in apposition to your personal morals. Thanks Dean Scott for this thought-provoking article!

Illustrations provided by the very talented Dr. Dean Scott!