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PubMed1998

Negotiated care--fundamental to nursing practice.

This paper focuses on negotiation in nursing. It suggests that negotiation, in the form of negotiated care, is a key element of nursing practice in the many contexts in which it takes place. To support this statement the process of negotiated care is illustrated by three examples. These examples portray negotiated care as it occurs between nurse manager (or leader) and nurse clinicians, in an interdisciplinary context, and between nurses, other health practitioners and patients/relatives. These examples demonstrate that negotiation which is aimed at achieving quality patient care pervades nursing practice. Nevertheless, it is suggested that nurses often do not recognise the centrality of negotiation in their nursing practice, nor are its implications for long-held beliefs about the role of the nurse considered. This paper also suggests that the successful outcome of negotiation in the context of nursing is dependent on nurses' confidence in, and their ability to articulate their knowledge about, nursing practice. It also relies on their commitment to the therapeutic nature of nursing practice and nurses' awareness that their practice is an essential component to patient care. The specialist nature of negotiation in nursing care, and its fundamental role in the care process, suggests that negotiation in nursing is more accurately termed negotiated care.

Humans↗
PubMed2006

Negotiation of parental roles within family-centred care: a review of the research.

AIMS AND OBJECTIVES: To review research published in the past 15 years about how children's nurses' negotiate with parents in relation to family-centred care. BACKGROUND: Family-centred care is a basic tenet of children's nursing and requires a process of negotiation between health professionals and the family, which results in shared decision-making about what the child's care will be and who will provide this. The literature highlights inconsistencies in the degree to which nurses are willing to negotiate with parents and allow them to participate in decisions regarding care of their child. There is need to explore further the extent to which nurses communicate and negotiate shared care with children and their parents. CONCLUSIONS: Three themes emerged from this review of the literature relating to whether role negotiation occurred in practice, parental expectations of participation in their child's care and issues relating to power and control. Parents wanted to be involved in their child's care but found that nurses' lack of communication and limited negotiation meant that this did not always occur. Nurses appeared to have clear ideas about what nursing care parents could be involved with and did not routinely negotiate with parents in this context. RELEVANCE TO CLINICAL PRACTICE: For family-centred care to be a reality nurses need to negotiate and communicate with children and their families effectively. Parents need to be able to negotiate with health staff what this participation will involve and to negotiate new roles for themselves in sharing care of their sick child. Parents should be involved in the decision-making process. However, research suggests that a lack of effective communication, professional expectations and issues of power and control often inhibit open and mutual negotiation between families and nurses.

Attitude of Health Personnel↗
PubMedDate not supplied

Negotiating with third party payers: one community pharmacy's experience.

OBJECTIVES: To evaluate financial terms and legal wording in insurance contracts and negotiate their terms with companies to improve an independent pharmacy's financial position and to determine the time required to negotiate a contract and translate that time into a salary cost. SETTING: An independent pharmacy in a small town in Alabama with a population of approximately 6,000. PRACTICE DESCRIPTION: The prescription department accounts for two-thirds of the pharmacy's sales and dispenses approximately 70,000 prescriptions each year. Insurance companies paid for over 59% of these prescriptions in 2000. The pharmacy is open 7 days a week with one full-time pharmacist and a second pharmacist who works 2 days a month. PRACTICE INNOVATION: A contract negotiation form was developed that addressed factors that might affect a pharmacy's decision to accept or reject a contract; the form included an area for recording the time involved in negotiating each contract. INTERVENTIONS: Insurance companies selected by the pharmacy owner were faxed copies of an Insurer Demographics Collection Form. Upon collection of all data and finalization of proposed changes, a copy of the contract with the proposed changes marked, along with a letter explaining and justifying the changes, was sent to the insurance company. If no response was received from the company, the contact person was called and negotiations proceeded over the telephone. MAIN OUTCOME MEASURES: Primary end points were the percentage of companies that would negotiate and the average increase in reimbursement achieved. Secondary end points included the time involved in negotiations and the translation of that time into a salary cost. RESULTS: None of the nine participating companies accepted any of the changes proposed. The time to negotiate each contract ranged from 28 minutes to 74 minutes, taking an average of 48.4 minutes. Depending on the division of work between the pharmacist and the technician, the salary cost for the negotiations ranged from $14.68 to $18.73 per contract. CONCLUSION: This study provides a realistic description of attempts at contract negotiation between one pharmacy and nine third party payers. The difficulty of achieving successful results and the necessity of carefully considering the time and cost of contract negotiations underscore how important it is for independent pharmacists to concentrate their efforts on contracts and terms they have an opportunity to change.

Alabama↗
PubMedDate not supplied

Turning negotiation into a corporate capability.

Every company today exists in a complex web of relationships formed, one at a time, through negotiation. Purchasing and outsourcing contracts are negotiated with vendors. Marketing arrangements are negotiated with distributors. Product development agreements are negotiated with joint-venture partners. Taken together, the thousands of negotiations a typical company engages in have an enormous effect on both its strategy and its bottom line. But few companies think systematically about their negotiating activities as a whole. Instead they take a situational view, perceiving each negotiation to be a separate event with its own goals, tactics, and measures of success. Coordinating them all seems an overwhelming and impracticable job. In reality, the author argues, it is neither. A number of companies are successfully building coordinated negotiation capabilities by applying four broad changes in practice and perspective. First, they've established a company-wide negotiation infrastructure to apply the knowledge gained from forging past agreements to improve future ones. Second, they've broadened the measures they use to evaluate negotiators' performance beyond matters of cost and price. Third, they draw a clear distinction between the elements of an individual deal and the nature of the ongoing relationship between the parties. Fourth, they make their negotiators feel comfortable walking away from a deal when it's not in the company's best interests. These changes aren't radical steps. But taken together, they will let companies establish closer, more creative relationships with suppliers, customers, and other partners.

Commerce↗
PubMed2004

Getting past yes: negotiating as if implementation mattered.

Many deals that look good on paper never materialize into value-creating endeavors. Often, the problem begins at the negotiating table. In fact, the very person everyone thinks is pivotal to a deal's success--the negotiator--is often the one who undermines it. That's because most negotiators have a deal maker mind-set: They see the signed contract as the final destination rather than the start of a cooperative venture. What's worse, most companies reward negotiators on the basis of the number and size of the deals they're signing, giving them no incentive to change. The author asserts that organizations and negotiators must transition from a deal maker mentality--which involves squeezing your counterpart for everything you can get--to an implementation mind-set--which sets the stage for a healthy working relationship long after the ink has dried. Achieving an implementation mind-set demands five new approaches. First, start with the end in mind: Negotiation teams should carry out a "benefit of hindsight" exercise to imagine what sorts of problems they'll have encountered 12 months down the road. Second, help your counterpart prepare. Surprise confers advantage only because the other side has no time to think through all the implications of a proposal. If they agree to something they can't deliver, it will affect you both. Third, treat alignment as a shared responsibility. After all, if the other side's interests aren't aligned, it's your problem, too. Fourth, send one unified message. Negotiators should brief implementation teams on both sides together so everyone has the same information. And fifth, manage the negotiation like a business exercise: Combine disciplined negotiation preparation with post-negotiation reviews. Above all, companies must remember that the best deals don't end at the negotiating table--they begin there.

Commerce↗
PubMed1998

Non-linear Preference Functions and Negotiated Outcomes.

The study described in this paper explored the effects of non-linear preferences on negotiated settlements. The shape of negotiators' preferences (linear, increasing marginal utility, or decreasing marginal utility) was hypothesized to influence negotiated outcomes. Prior relationship between the negotiators (friends versus strangers) was hypothesized to moderate the effects of negotiators' preferences on negotiated outcomes by virtue of the influence of prior relationship on communication effectiveness within the negotiation dyad. Subjects participated in a buyer/seller negotiation role play. Results demonstrated a strong main effect for negotiators' preferences on negotiated outcomes. Results also supported a moderating role for prior relationship on these effects; this moderating role was not accounted for by communication effectiveness. Implications of these results for negotiation theory and practice are discussed. Copyright 1998 Academic Press.

Journal Article↗
PubMed2006

Continuous-time negotiation mechanism for software agents.

While there are several existing mechanisms and systems addressing the crucial and difficult issues of automated one-to-many negotiation, this paper develops a flexible one-to-many negotiation mechanism for software agents. Unlike the existing general one-to-many negotiation mechanism, in which an agent should wait until it has received proposals from all its trading partners before generating counterproposals, in the flexible one-to-many negotiation mechanism, an agent can make a proposal in a flexible way during negotiation, i.e., negotiation is conducted in continuous time. To decide when to make a proposal, two strategies based on fixed waiting time and a fixed waiting ratio are proposed. Results from a series of experiments suggest that, guided by the two strategies for deciding when to make a proposal, the flexible negotiation mechanism achieved more favorable trading outcomes as compared with the general one-to-many negotiation mechanism. To determine the amount of concession, negotiation agents are guided by four mathematical functions based on factors such as time, trading partners' strategies, negotiation situations of other threads, and competition. Experimental results show that agents guided by the four functions react to changing market situations by making prudent and appropriate rates of concession and achieve generally favorable negotiation outcomes.

Journal Article↗
PubMed1991

A method of teaching negotiating skill.

Can physicians and managers both enjoy successful contracts? Is it necessary for one party to win and the other party to lose? If both parties could win, or at at least have a perception that they won, perhaps the unpleasant nature of contracting and negotiation could be mitigated. Can inexperienced negotiators learn negotiating skills? The focus of this study is to attempt to answer formally the above questions. An experiment was conducted to investigate the effects of analytical information on the quality and efficiency of individual decisions during negotiations. The experiment required M.H.A. and medical students to agree in a medical services contract between a health maintenance organization and a group of physicians. A computer-based bargaining choice model was developed to elicit each subject's preferences and value trade-offs. Selected subjects used the analytical information when preparing for the contract negotiation. Significantly higher levels in quality of individual negotiator decisions and efficiency were observed when analytical information was used prior to negotiating. Also, significantly higher levels of joint quality and success in negotiation were observed in subjects using analytical information. The results provide strong support for developing models of individual negotiator choice behavior for use in actual health care negotiation and the education of health care administrators and physicians.

Contract Services↗
PubMed2002

Negotiating without a net. A conversation with the NYPD's Dominick J. Misino.

In some languages, the word for "business" is the same as the word for "negotiation." That's not really surprising: Every interaction--with customers, suppliers, and even partners and investors--entails negotiation. And some involve very high stakes: The breakdown in negotiations between Hewlett-Packard's management and its founding families, for instance, put the company's future in doubt. Dominick Misino is a man who knows about negotiating when the stakes are at their very highest. As a hostage negotiator for the New York Police Department, Misino successfully persuaded the hijacker of Lufthansa Flight 592 to lay down his gun and turn himself in. Misino spent the last six years of his career as a primary negotiator, handling more than 200 incidents and never losing a life. Since his retirement in 1995, he has taught negotiating skills to law enforcement officials, military personnel, and business executives. Anyone can become a crisis negotiator, Misino contends. It takes what he calls "applied common sense." Be polite. Listen. Acknowledge the other guy's point of view (no matter what it is). But it's clear that in dealing with hijackers, kidnappers, and child molesters, Misino is far from passive. Negotiation, he says, is really a series of small agreements, and he is adept at orchestrating those agreements from the start so that his adversary learns to trust him and come around to his point of view. In vivid and sometimes hair-raising detail, Misino demonstrates how he gets criminals to trust police officers enough to refrain from harming innocent parties and give themselves up. Many of the techniques he describes are surprisingly applicable to business negotiations, where the parties may seem equally intractable and failure is not an option.

Commerce↗
PubMed2000

The Impact of Conflict Issues on Fixed-Pie Perceptions, Problem Solving, and Integrative Outcomes in Negotiation.

It is argued that a negotiator's fixed-pie perception, cooperative motivation, problem-solving behavior, and integrative outcomes are influenced by the content of the negotiation-the conflict issue. Negotiation involves conflicting interests, conflicting ideas about intellective problems, or conflicting ideas about evaluative problems. Study 1 showed that individuals in a negotiation about interests have a stronger fixed-pie perception and have a lower cooperative motivation than individuals in an evaluative negotiation, with intellective negotiations taking an intermediate position. Study 2 showed that individuals in a negotiation about interests made more trade-offs and reached higher joint outcomes than individuals in an intellective or evaluative negotiation. Study 3 replicated this finding in a field study. The studies bridge insights from negotiation research and decision-making research and show that the conflict issue has important effects on the negotiation process. Copyright 2000 Academic Press.

Journal Article↗
PubMed2003

Is stair negotiation measured appropriately in functional assessment scales?

BACKGROUND: A decline in mobility may result in problems with the negotiation of stairs, which can potentially be hazardous. In practice, stair negotiation is an important aspect of daily living and therefore needs to be assessed carefully. METHODS: We conducted a systematic literature review to identify the way functional assessment scales assess stair negotiation. We evaluated whether stair negotiation could be assessed in a valid and reliable way with these scales. RESULTS: Forty-three of the 92 identified scales have an item on stair negotiation. In these scales, the definition of 'negotiation of stairs' varies, as does the definition of independence. Important aspects such as safety on stairs are missing from all scales. In contrast to older scales, newer scales consist of items that have been tested for validity and reliability. In none of the scales was the stair negotiation item tested separately for validity. Only two scales examined test-retest reliability and only one measured inter-observer agreement. DISCUSSION: In current functional assessment scales stair negotiation is measured with great heterogeneity and insufficient validity. In patients and in studies in which assessment of stair negotiation ability is a key part of functional assessment, an improved, well-validated scale is needed. This scale should include not only the subject's physical ability to negotiate stairs, but also safety and change in ability over time.

Accidental Falls↗