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You worked hard to search for a job--sending out resumes, networking with your peers and contacting recruiters. But when the offer finally comes, your work isn't done. Now it's time to negotiate the best salary and employment contract. Take a look at today's standard compensation packages, including bonuses, stock options, relocation expenses and other features. What's negotiable and what's not?
The use of new technology in an existing healthcare service can have a far-reaching impact on a hospital's financial health. An understanding of the financial impact of a service before new technology is added is helpful in preparing to negotiate for appropriate payment for the new technology. The indirect financial impact of new technology on related and unrelated healthcare services should be projected for use in managed care negotiations. Managed care payers seek proof of immediate savings when deciding on payment increases for new technology.
Most experienced negotiators are comfortable working out the terms of an economic contract--they bargain for the best price, haggle over equity splits, and finesse detailed exit clauses. Yet these same seasoned professionals spend so much time ironing out the letter of the deal that they often pay little attention to the spirit of the deal--the social contract. And that can lead to major problems, say the authors, because even though the parties agree to the same terms on paper, they may have very different expectations about how to meet them. Those on one side, for instance, might think they're entering into a long-term partnership, while those on the other believe they're simply making a series of discrete transactions. Because the parties have failed to have a true meeting of the minds, they sign a deal that is likely to fall apart. To avoid such a disastrous outcome, negotiators should explicitly discuss the details of their social contract before inking the deal. They should talk about the underlying social contract, which answers the question, What? For instance, what is the real nature, extent, and duration of the agreement? And they should discuss the ongoing social contract, which answers the question, How? For instance, in practice, how will we make decisions, handle unforeseen events, communicate with one another, and resolve disputes? Drawing on real-life examples, the authors explore the problems that arise when the letter and spirit of the deal are at odds and suggest ways to dovetail them so they are both independently strong and mutually reinforcing. They also highlight risk factors that can lead to misunderstandings and expose common misperceptions about the social contract.
Good negotiation reaps its own rewards. Participants have better buy-in and morale because they are part of the process, rather than just being told about the resulting situations. Being able to negotiate skillfully improves with practice, just like any other skill. In the end, it is helpful to remember Thomas Fuller, a 17th century clergyman and historian, who is attributed with the saying: 'Life does not consist of holding good cards but of playing a poor hand well'.
Resolution of hostage crises may take hours or days of intensely focused and stressful negotiation, requiring the use of virtually every crisis intervention strategy known to psychology and law enforcement. This article describes the nature of hostage crises and the factors that contribute to prospects for a successful resolution. Outlined are basic strategies of hostage negotiation and crisis management culled from the psychological and law enforcement literature. Recommendations are offered to civilians for surviving a hostage crisis. Finally, the article emphasizes the collaborative working relationship between mental health and law enforcement professionals that can have a lifesaving impact for citizens in peril.
BACKGROUND: Volume overload is common in diabetic patients on continuous ambulatory peritoneal dialysis (PD), especially when the patient's residual renal function decreases with time on PD. Due to the higher dietary salt and fluid intake, diabetic PD patients tend to use more hypertonic glucose solution to remove excess fluid, which in turn may lead to increased membrane permeability. In the present study, we investigated the effect of negotiated care on fluid status in diabetic PD patients. METHODS: All diabetic PD patients who had been on PD for at least 3 months by the end of year 2002 in the First Hospital of Peking University were included in the present study. A primary nurse was assigned to each patient and intensive patient education was implemented, focusing on the importance of dietary salt and fluid restriction, the detrimental effect of using more hypertonic glucose solution, and the consequence of fluid overload. Decisions on dialysis prescriptions were made after extensive discussion among the primary nurse, nephrologists, patients, and patients' families. A patient support group was also involved when it was necessary. All the patients were followed for 1 year and fluid status, compliance to dietary restriction, and dialysis prescription were evaluated before the start and at the end of the study. RESULTS: There were 30 diabetic PD patients (age 65.4 +/- 10.3 years; on PD for 24.5 +/- 19.9 months, range 3 - 66 months) included in the study when it was started. During the 1 year of follow-up, 4 patients died of diabetic complications, 3 patients were transferred to hemodialysis due to resistant peritonitis, and 2 patients were transplanted. By the end of follow-up, 21 patients remained on PD, among whom 15 had improved fluid status, 4 did not change, and 2 had worsened fluid status as assessed by clinical and bio-impedance evaluation. Patient compliance to dietary salt and fluid restriction had increased from 19.5% to 76.2%. During the follow-up, 8 patients were anuric at the beginning of the study and the remaining 22 patients had declining residual renal function. Only 4 patients increased their use of hypertonic solution including 2.5% (3 patients) and 4.25% (1 patient) glucose, whereas 5 patients decreased their use of 2.5% dialysis solution. By the end of follow-up, only 1 of the 21 patients was using 4.25% glucose solution and all the patients had good blood glucose control. CONCLUSIONS: Our results suggest that negotiated care can be successfully used in diabetic PD patients. It helps to minimize the use of hypertonic glucose solution and improves patient compliance to dietary restriction of salt and fluid intake, and thus improves their fluid status.
The recent focus on collaborative relationships in health care means that people and groups must cooperate to accomplish clinical and management tasks. This increasing interdependence may also cause increased organizational conflict. The management of conflicts is critical to the effectiveness of an organization. Negotiating strategies, based on Fisher and Ury's method of "principled negotiation," include establishing superordinate goals, separating the people from the problem, focussing on interests, inventing options, using objective criteria and defining success in terms of gains.
In this qualitative study, pediatric home health nurses described the solitary, ambiguous, and unprogrammed nature of home health nursing. As employees of the family, the nurses in this study found it necessary to negotiate their work tasks and working conditions with family members. In describing the meaning of their work, the nurses emphasized differences between hospital and home health nursing with regard to their authority for care decisions, methods of child discipline, parental control of care, and innovations of nursing routines and interventions. Characteristics of pediatric home nursing are identified in order for these to be communicated to prospective home care nurses, to pediatric nurse educators, and to home health managers. With knowledge of these characteristics, a new home health nurse will be better prepared to negotiate shared patient care responsibilities with the client's family.
People of many cultures explain and treat illness in ways that are different from and that may conflict with the biomedical beliefs and practices on which the American health care system is based. Eliciting clients' health beliefs and negotiating treatment plans with them can help avoid problems caused by discrepancies in belief systems. This article presents three major categories of belief systems commonly found in the United States as well as other countries. Questions designed to discover clients' health beliefs are included, along with guidelines for arriving at plans of care that accommodate those beliefs. Case studies are provided that illustrate this process of negotiation.
Successful negotiation is the art of gentle persuasion, not a "winner-take-all" showdown. Accordingly, it is essential to begin the process with a positive outlook and with the goal of reaching an agreement that is acceptable to all parties involved. Although the term "opponent" is used in this article to describe the person or group with whom you are negotiating, it is not used in the adversarial context. It is important to maintain a non-adversarial relationship, to the extent possible.
We present 3 studies that examine the process of partner selection in negotiations and the influence that relationships may have on the partner-selection decision. In Study 1, we present a simulated matching market experiment in which we compare the matching process when relationships can influence the partner-selection decision with the matching process when relationships cannot influence this decision. We find that when relationships are not allowed to influence the matching process, there are more economically optimal agreements, a larger market surplus, and more search activity. In Study 2, a simulation of a naturally occurring market selection process provides additional quantitative support for the findings from Study 1 and offers qualitative data on the reasoning process behind partner selection, including the social factors that are influential in this decision. Study 3 utilizes a repeated trial experimental simulation to offer further support for the negative relationship between relationships and economic outcomes and to suggest that the relative power of the negotiators influences the extent to which relationships help versus hurt individual profitability. Implications of these findings are discussed. Copyright 1999 Academic Press.
The negotiation of the illness experience by ayurvedic vaidya and South Kanarese patients suffering from specific sources of psychosocial distress is examined in light of the cultural patterning of illness and communication within the clinical context. The negotiation process is initiated by the posing of rhetorical questions about somatic and affective states and structured by a conceptual framework which relegates such states to humoral interrelationships. By establishing a humoral explanatory model for an illness episode or affective state which takes into account environmental and constitutional factors over which one has little control, responsibility is mollified and dialogue about personal problems eased. A comparison of the interaction between ayurvedic practitioners and patients and astrologers and clients is made in this regard. The socially integrative and adaptive consequences of ayurvedic therapy is considered vis a vis a portrayal of a popular vaidya therapy for a number of illnesses associated with the somatization of psychosocial stress.
Since beliefs, interests, needs and values vary among individuals, potential for conflict or dispute exists in all areas of human endeavor, including a patient-physician relationship. Conflict- or dispute-resolution requires diligent and directed negotiation, which ideally is amicable, efficient, and sustainable, if the participants acknowledge the identity, individuality, and integrity of all parties involved. In this essay a concept of principled negotiation is extrapolated to a patient-physician relationship and is exemplified by a case study. In addition, the validity of a concept of tract two diplomacy is discussed, relevant from the perspective of strained or fractured primary relationships.
This paper addresses the challenges and opportunities that face the public in negotiating the health care system (both medicine and public health) in the 21st century. It addresses three issues: how consumers exercise choice, with special attention to the choice of health care coverage; how patients and communities interact with clinicians and public health professionals; and whether and how the public's "voice" is heard as health policy decisions, at the societal and institutional levels, are made. With respect to each of these issues, the paper describes the current status of public influence and articulates a vision for the future. These three related visions are (1) that empowered, informed, supported consumers make decisions about health plans, clinicians, treatments, and their own behavior; (2) that clinicians and public health professionals, working as partners with patients and communities, are in a position to "standardize the customization of care" so that all aspects of care are tailored to the needs of the individual, family, or community in question and social, economic, and cultural factors are taken into account in the day-to-day practice of medicine and public health; and (3) that the ability and willingness of the public to negotiate and shape the health care environment is supported by an independent infrastructure that permits enhanced public involvement in health policy making and governance. The paper identifies key elements of this vision, discusses challenges to pursuing and achieving each vision, and identifies opportunities that may support the pursuit of the vision.
OBJECTIVE: To describe the responses of family doctors and nurses to applying an innovative clinical technique and technology in the context of a randomised controlled trial. DESIGN: Multi-faceted descriptive analysis of professional responses in the experimental arm of the trial. SUBJECTS AND SETTING: 29 family practices involving 30 doctors and 33 nurses over a 3-year time scale and 200 patients with type II diabetes. INTERVENTION: A new visual agenda-setting technology and other visual aids applied using the techniques of negotiation and motivational interviewing. OUTCOME MEASURES: Uptake of training, use of the method, group discussions, willingness to accept consultation recordings. RESULTS: 100% of clinicians welcomed two or more formal training sessions. The agenda-setting technology was used frequently by 71% of clinicians and occasionally by a further 22%. High levels of engagement with the method occurred among nurses but many doctors also reported benefits. CONCLUSIONS: Family doctors and nurses in Wales have found a new technology to facilitate negotiation in diabetes consultation acceptable and useful. Analysis of outcome is now awaited.
The aim of this study was to compare centre of mass (COM) motion and its separation from centre of pressure (COP) as 13 young men (aged 23-36 years) and 15 healthy, community dwelling older men (aged 73-84 years) ascended and descended a three step staircase at a controlled cadence of approximately 90 steps/min. Centre of mass was obtained from whole body motion analysis, and simultaneously, COP was obtained using force plates built into the steps. The following variables were investigated: medio-lateral COM range of motion; peak antero-posterior and medio-lateral COM-COP separation; and peak antero-posterior, medio-lateral, and vertical COM velocities. No significant differences in these variables between young men and older men were present during ascent or descent. It was concluded that frontal plane dynamic stability during stair negotiation is well maintained in healthy older men, and that healthy older men do not exhibit an altered strategy in traversing the COM in the plane of progression during stair negotiation.
Within medical geography there has been a surge of interest in applying critical concepts in social theory to empirical settings, including those for persons with disabilities. The ways through which persons with disabilities negotiate space vary widely according to material and social experiences of being disabled. For older women, chronic illness as a type of disability shapes the way in which they approach their daily lives with respect to both the physical and social aspects of their home environments. In the first half of the paper, conceptually, I take a relational view of space and argue that household, as a narrow reading of domestic space, needs to be replaced by home environment which incorporates more fully age- and ablement-sensitive readings of the spaces constitutive of domestic space. This lays the basis for a contextualized socio-spatial understanding of the ways older women with chronic illness negotiate the spaces in home environments because it accounts for the disadvantaged positionings of access to power and resources as well as the uneven distributions of income based on gender, age, and (dis)ability. It also takes into account the material and social aspects of being disabled. In the second half of the paper, I present case studies of three older women diagnosed with rheumatoid arthritis to illustrate these arguments.
The utility of different reality negotiation strategies among 57 persons who had traumatically acquired severe physical disabilities was examined. It was predicted that a sense of goal-directed determination ("agency"; Snyder, 1989) would predict lower depression and psychosocial impairment scores soon after injury. To meet the demands of rehabilitation and social integration, however, it was hypothesized that a sense of ability to find ways to meet goals ("pathways") would predict lower depression and psychosocial impairment among persons who had been disabled for a longer period. The expected interaction was significant in the prediction of psychosocial impairment but not of depression. The sense of pathways was predictive of impairment and depression regardless of the time since injury. Results suggest that in the reality negotiation process the different components of hope as defined by Snyder have salient effects on perceptions of ability to function in social capacities.