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PubMed2004

Budget negotiation for industry-sponsored clinical trials.

The specialty of anesthesia is well suited to attract industry-sponsored clinical trials and research revenues because of its fundamental contributions to surgery, critical care, and pain medicine. However, the performance and budgeting of industry-sponsored clinical research over the past decade has been significantly altered by the rapid growth of commercially oriented networks of contract-research organizations and site-management organizations. Further, the competitive nature of today's clinical research climate can make the planning and negotiating of study budgets and contracts stressful, time consuming, frustrating, and full of pitfalls. Because a clinical trial contract is a fixed-price agreement, investigators are obligated to perform the work described in the contract, even if the actual costs exceed the study contract. Successful budgeting for the performance of an industry-sponsored clinical trial thus requires a thorough understanding of the direct and indirect costs associated with performing clinical research. We reviewed budget and contractual considerations for the successful negotiation and performance of industry-sponsored clinical research.

Budgets↗
PubMed2001

Negotiated safety and other agreements between men in relationships: risk practice redefined.

This study examines patterns of agreement, knowledge and practice which can prevent or facilitate HIV transmission among men who are in regular ('primary') male-to-male relationships. Data are from a national volunteer phone-in survey of homosexually-active men in Australia. A sub-sample of 1070 men from a larger sample (n=3039) were found to have one or more regular partners for longer than 6 months. Self-reported HIV serostatus of survey participant and his regular partner, type of agreement regarding anal intercourse both within and outside the regular relationship, and engaging in unprotected anal intercourse with regular and with casual partners were examined. Risk practice was defined as unprotected anal intercourse with a regular partner of different or unknown serostatus and/or unprotected anal intercourse with a casual partner. Agreements were classified as: negotiated safety (28.8%); no unprotected anal intercourse (33.6%); unsafe (10.6%) and no agreement (17.0%). Risk practice was reported by 17.8% of the men. Type of agreement was found to be the strongest predictor of risk practice. Negotiated safety agreements were common, and were kept on the whole. Men with unsafe agreements, although only a small proportion of men in relationships, had high levels of risk practice.

Australia↗
PubMed2003

Negotiating for change. The healthcare manager as catalyst for evidence-based practice: changing the healthcare environment and sharing experience.

This paper addresses the problem of the implementation of both clinical and managerial evidence-based decision-making in healthcare. The lack of implementation of research findings in clinical and management practice has been identified as a key failure in healthcare. Many await the development of better methods of research transfer led by academics and clinicians. Research transfer has become one of the highest priority are as for health services research. In this paper, the authors propose that the healthcare manager is well positioned to advance the research transfer process within the individual healthcare environment through two main mechanisms. First, healthcare managers can align decision-making structures within their own environment to facilitate evidence-based practice. This can occur by managers demonstrating a commitment to processes for the measurement and management of knowledge (identifying knowledge stewards) to the same extent that they demonstrate commitment to the measurement and management of finances. Within such a framework, the healthcare manager can build an environment in which there is an explicit "negotiation" between "knowledge stewards" (usually clinicians) and "financial stewards" (usually administrators) to achieve a common goal. The negotiation is an explicit, documented process that addresses the trade-offs that are made to avoid both financial and quality deficits in the organization (the quality deficit is defined as the gap between knowledge and practice). The second way in which healthcare managers can act as catalysts for promoting evidence-based practice is through cataloguing and reporting, using documented stories, the unique barriers to evidence-based approaches that are peculiar to their specific healthcare environments. It is hypothesized that local contextual circumstances, which can be expressed only through stories, are the most powerful barriers to research transfer within specific organizations. This has implications for what we count as useful knowledge as we try to better understand how rigorous research on the one hand and research and stories on the other contribute to strategies for research transfer at the organizational level.

Decision Making, Organizational↗
PubMed1999

Negotiating worker-client relationships: a necessary step to providing quality home health care.

A qualitative study was conducted to investigate definitions of quality home health care and how good quality care was achieved from consumer and provider perspectives. Using semi-structured interviews, members of sixteen families and their home health aides described the skills required for good quality care. While able performance of essential tasks was considered part of quality care, relational skills of home health aides were crucial to good quality care. Relationships were negotiated between worker and client that were characterized as close and preserving of client autonomy. When such relationships were achieved, workers were frequently described as insiders in client families. High performing aides also undergo a process of intrapersonal negotiation in order to give meaning to their work. Implications for recruitment and training of home health aides and for measuring quality care in home health are discussed.

Aged↗
PubMed2005

Peace Talk: a relational approach to group negotiation among Arab and Israeli youths.

In response to conflict in the Middle East, a group intervention for Arab and Jewish youths has been developed to promote communication and healing. Using ethnographic observations of this relational, group-based program, this study examines the complexities involved in peace negotiation group work. There was evidence that although this program is met with real-life challenges and oppositional forces, such as genuine danger in negotiation between Arabs and Jews, the program showed success in encouraging otherwise untenable communication. Using this program as a starting point, this study engages the wider issue of the inherent difficulties faced by interventions that pursue mutual empathy, empowerment, and conflict tolerance between individuals and groups that are historically and politically at odds.

Adolescent↗
PubMed2000

Negotiating cultural consensus in a breast cancer self-help group.

This article describes a shared model of the breast cancer experience negotiated by the members of a spontaneously organized breast cancer self-help group in eastern North Carolina. In the course of sharing their personal experience narratives with one another, these women worked to negotiate points of agreement among the varying sources of knowledge and oftentimes conflicting belief systems they held about breast cancer. The synthetic model they created rejected many of the assumptions underlying the dominant biomedical view of cancer "survivorship," particularly its emphasis on the autonomous individual as decision maker and its attendant male-gendered sports and military imagery--assumptions that often implicitly structured the agendas and topics discussed in the formal, medically sanctioned support groups these women found unappealing. The implications for theories about the construction of shared cultural models and for continuing efforts to design support groups to meet the needs of a diverse patient population are explored.

Black or African American↗
PubMed2004

[Safe sex negotiation on TV: gender discourses among female community health workers under the Family Health Program in Porto Alegre, Rio Grande do Sul, Brazil].

This paper analyzes the understanding among female community health workers in the Family Health Program in Porto Alegre, Rio Grande do Sul State, Brazil, concerning the notion of safe sex negotiation promoted by the Brazilian government in AIDS prevention campaigns targeting women. The paper is based on empirical data gathered in 2003. The study focused on TV advertisements used in campaigns by the Brazilian Ministry of Health from 1994 to 2000. The analytical approach was informed by feminist and cultural studies, taken from a post-structuralist and Foucauldian perspective. The research aimed to produce knowledge to support a critical reading of such education for HIV/AIDS prevention, especially concerning gender relations. The paper argues that knowledge and practices permeating the "safe sex negotiation" discourse incorporate, reproduce, and/or transmit hegemonic representations of masculinity and femininity and that these representations differentiate and highlight hierarchical positions of women in relation to men and/or women in relation to other women, producing and/or reinforcing prejudices and inequalities.

Acquired Immunodeficiency Syndrome↗
PubMed2006

[Influence of socio-cultural context on risk perception and negotiation of protection among poor homosexual males on the Peruvian coast].

This paper focuses on risk, conceived not as an individual action, but considering its social dimension, analyzing the various forms in the socio-cultural context related to internalized homophobia and hegemonic gender norms that allow barriers to be constructed in risk perception. Such barriers hinder negotiation and protection among homosexual men that have adopted a female gender identity, living in low-income barrios of Lima and Trujillo, Peru. Risk perception is analyzed on the socio-cultural plane, allowing one to explain the limited negotiating capacity of this population, even though they have extensive knowledge of HIV/AIDS and its consequences.

Adolescent↗
PubMed2001

Tolerance of ambiguity, information, and negotiation.

This study examines the relationship between the tolerance of ambiguity and the outcomes of negotiation and the misrepresentation of information. The data were obtained from 98 middle managers of a bank in Turkey. A positive correlation of .74 (p < .01) obtained between scores on tolerance of ambiguity with the outcomes of negotiation and a negative correlation of -.66 (p < .01) with misrepresentation of information.

Adult↗
PubMed1995

Physician executive contracts: negotiating the future.

Once viewed as a matter of standard protocol, physician executive contracts have become as complex as the health care industry itself. Historically, hospital administration and physicians negotiated a few key points, then sent the ideas to an attorney for insertion of standard legalize and boilerplate. Today, physician executive contracts are an important part of the changes in health care. They not only cover traditional hospital and physician relations, but increasingly apply to new types of relations (such as employment) between hospitals and physicians, physicians and physicians, and health plans and physicians. In this article, we will explore both the "content" and the "context" of physician executive contracts. Content will deal with the specific provisions typically included in contracts. Context will address issues associated with preparing for and negotiating a contract.

Contract Services↗
PubMed1996

Negotiating. Biases physicians bring to the table.

What are some of the obstacles that physicians face as they seek to become more effective at the bargaining table? The author's thesis, based on experience in both the classroom and the front lines of medical practice, is that physicians face a set of systematic "biases" derived from physician training and professional culture that make negotiation especially difficult for them. They outline the biases they have observed, explore some possible explanations, and suggest solutions for physicians who wish to negotiate more effectively.

Cooperative Behavior↗
PubMed1997

Evaluating and negotiating a profitable capitation contract.

Evaluating the financial terms of capitation contracts and negotiating their nonfinancial provisions are becoming increasingly important responsibilities for healthcare financial managers. To evaluate the financial terms of a contract, financial managers must understand both incremental and replacement pricing strategies. They also must understand when strategic positioning objectives make a capitated plan attractive despite limited financial rewards. Before a contract is accepted, financial managers can take steps to increase its potential profitability by negotiating the nonfinancial provisions that can help control contract expenses. These provisions are related to services to be provided, payment terms, withholds and risk pools, access to data, provision of eligibility data, utilization review and quality assurance procedures, filing of grievances, contract renewal terms, and contract termination.

Capitation Fee↗
PubMed1995

Strategies for negotiating preemployment agreements.

Though the long-term effects of preemployment agreements on career development are unknown, these guidelines are suggestions to ensure responsible interactions among facilities, health information management students, and academic programs. Preemployment agreements meet personal, educational, professional, financial, and institutional goals. Long-term implications warrant additional study. Preemployment agreements are increasing because they mutually benefit HIM students and employers. This emerging process, however, is creating new ethical and legal dilemmas for academic programs and other involved parties. The intent of this article is to identify potential issues and dilemmas involved in student-employee negotiations and preemployment agreements. The issues and proposed guidelines may not be germane to all situations. Many successful relationships, primarily those that include the guidelines discussed here, have been negotiated. Terminology for preemployment agreements is different from terminology for financial aid. Consistent use of terminology, and knowledge regarding these agreement processes including guidelines for their appropriate use, is necessary to avoid ethical and legal problems. Exploration of the impact of preemployment agreements on future career decisions and professional development is needed.

Education, Continuing↗
PubMedDate not supplied

Negotiating or renegotiating managed care contracts.

When negotiating or renegotiating a managed care contract, medical groups need leverage. Medical groups have to offer the managed care company something it can't get anywhere else in order to get the most advantageous contract. Leverage can come by offering a large provider panel, geographic coverage or superior quality, among other things. In every case, physicians benefit by being proactive as they negotiate managed care contracts.

Contract Services↗
PubMed1999

Negotiating optimum capital equipment acquisitions.

Healthcare organizations planning capital equipment acquisitions should negotiate with more than one equipment vendor and determine the equipment purchase price, service agreement price, and financing or leasing option rate separately to avoid hidden costs. The purchase price should be negotiated first. A long-term service agreement should be locked in, or service insurance purchased, for the length of the financing or lease agreement. The equipment vendor's financing agreement should be compared with offers from third parties, who may have more beneficial financing options or more flexible lease arrangements.

Capital Expenditures↗
PubMed1999

A taxonomy of requests by patients (TORP): a new system for understanding clinical negotiation in office practice.

BACKGROUND: The goal of our investigation was to facilitate research on clinical negotiation between patients and physicians by developing a reliable and valid classification system for patients' requests in office practice. METHODS: We developed the Taxonomy of Requests by Patients (TORP) using input from researchers, clinicians, and patient focus groups. To assess the system's reliability and validity, we applied TORP to audiotaped encounters between 139 patients and 6 northern California internists. Reliability was assessed with the kappa statistic as a measure of interrater agreement. Face validity was assessed through expert and patient judgment of the coding system. Content validity was examined by monitoring the incidence of unclassifiable requests. Construct validity was evaluated by examining the relationship between patient requests and patient health status; patient request fulfillment and patient satisfaction; and patient requests and physician perceptions of the visit. RESULTS: The 139 patients made 772 requests (619 requests for information and 153 requests for physician action). Average interrater agreement across a sample of 40 cases was 94% (kappa = 0.93; P <.001). Patients with better health status made fewer requests (r = -0.17; P = .048). Having more chronic diseases was associated with more requests for physician action (r = 0.32; P = .0002). Patients with more unfulfilled requests had lower visit satisfaction (r = -0.32; P <.001). More patient requests was also associated with physician reports of longer visit times (P = .016) and increased visit demands (P = .006). CONCLUSIONS: Our study provides evidence that TORP is a reliable and valid system for capturing and categorizing patients' requests in adult primary care. Further research is needed to confirm the system's validity, expand its applicability, and explore its usefulness as a tool for studying clinical negotiation.

California↗