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PubMed1983

Negotiation: a fundamental process in family medicine.

Negotiation, a common term in American society, is a process that can be especially useful to family medicine as a specialty that interfaces with many other clinical areas. The basic concepts of the negotiation process, including Maslow's need theory, terminology, and the three phases of the process (ie, planning, implementation, and follow-up), are applied to family medicine. A case study of a successful curriculum negotiation between family medicine and pediatrics is presented, and the use of need theory in the planning phase and during the strategic approach is analyzed. The negotiation process is also applied to faculty contracts, practice management training for residents, clinical teaching, and interdisciplinary relationships as indications of its broad usefulness within family medicine.

Communication↗

PubMed1995

[Negotiations between a general practitioner and the patient after his visit to a private physician].

OBJECTIVE: To find what patients request from their general practitioner after they have seen a doctor privately and the type of negotiation which follows. DESIGN: A descriptive observation study of a crossover type. SETTING: Palma-Palmilla Health Centre (Málaga); within the primary care ambit. PATIENTS AND OTHER PARTICIPANTS: Everyone at the on-demand clinics of five general medical practices, who requested something concrete from their general practitioner after they had seen a doctor privately, in the period from june to october 1993. MEASUREMENTS AND MAIN RESULTS: There were 83 patients who attended a clinic after seeing a doctor privately, which was 0.63% of the total consultations during this period. 69 of these patients asked their general practitioner to give them the same prescriptions that they had been prescribed privately. In 77% of the cases there was negotiation with the patient, a mutual promise being the most common result. There was no negotiation with 19 patients (23%). In 74% of the cases the medication prescribed privately was considered necessary. The wishes of the patients were fulfilled in practice in 65% of cases. CONCLUSIONS: In most cases there was negotiation with patients. doctors agreed to a high degree with patients' requests, which doctors considered sufficient and necessary for the diagnosis and/or treatment of their condition.

Adolescent↗

PubMed2005

Auctions vs negotiations: a study of price differentials.

Recent contributions in auction and bargaining theory suggest that a procurer should place more faith in the power of competition among alternative suppliers than in his or her own negotiating skill. Based on data from 216 contracts between procurers and suppliers of medical and surgical articles, we test whether auctions and bargaining result in significantly different prices. The main results are that auctions give 'thicker' markets compared with negotiations, as expected, but that auctions do not result in significantly lower prices compared with negotiations.

Commerce↗

PubMed1995

Negotiating fees for medical specialists in The Netherlands.

This article presents an analysis of the negotiations on fees for medical specialists in the Netherlands since the introduction of the Law on Health Care Charges (WTG) in 1982. The peculiar position of the medical specialists and the institutional setting of the negotiations have produced a complex decision making process. Negotiations between the government and the health insurers on the one hand and the association of medical specialists on the other hand have been dominated by deep conflicts which were sometimes settled by temporary "peace contracts'. Attention is paid to the policy network, to the participants in the network and their principal goals, to the strategic use of the WTG by each participant and to the political effectiveness of the WTG. The article ends with a short overview of some recent developments and a sketch of three alternative scenarios on the future of the payment for specialist care.

Decision Making↗

PubMed2003

Intimate partner violence and safer sex negotiation: effects of a gender-specific intervention.

This study examined the effects of a gender-specific HIV/STD prevention intervention with two dosage levels (four-session, eight-session) among women reporting physical abuse by a current or recent (past year) intimate partner. From 360 women included in the full randomized trial, we conducted subgroup analyses among 152 women who experienced partner physical abuse within the past year. Unprotected vaginal and anal sex occasions and negotiation skills were examined as outcomes. We also assessed whether the intervention increased previously abused women's subsequent risk of physical abuse. Among abused women, those in the eight-session, but not the four-session, intervention decreased their unprotected sex occasions or maintained consistent safer sex at both 1-month (OR = 3.63, 95% CI = 1.50-8.80) and 1-year (OR = 2.88, 95% CI = 1.17-7.10) postintervention. In the short-term, abused women in both the four- and eight-session groups had a greater odds of using an alternative strategy (e.g., refusal, "outercourse," or mutual testing) and of having a safer sex discussion with their partners relative to their controls, and they scored higher on intention to negotiate safer sex. The intervention did not increase or decrease the incidence of subsequent abuse during the 1-year follow-up period. A gender-specific intervention that focuses on negotiation skills in the context of potentially abusive partners benefits, and does not appear to harm, recently abused women.

Adult↗

PubMed2004

Unilateral concessions from the other party: concession behavior, attributions, and negotiation judgments.

This article examines the effects of the other party's concession behavior on a negotiator's satisfaction and judgments. The timing of the concessions (immediate, gradual, delayed) and the justifications provided by the other party (negotiator skill vs. external constraints) were manipulated using a scenario method (Study 1) and a role-playing experiment (Study 2). Study 1 showed that concession timing influenced valuation of the object and satisfaction with the partner and the outcome. Justifications about why the concession was made interacted with concession timing to influence participants' attributions. Participants' attributions for why the concession was actually made, in turn, had a main effect on satisfaction and judgments of the negotiation. Study 2 replicated some, but not all, of these findings.

Female↗

PubMed2005

Choosing the path to bargaining power: an empirical comparison of BATNAs and contributions in negotiation.

Although the negotiations literature identifies a variety of approaches for improving one's power position, the relative benefits of these approaches remain largely unexplored. The empirical study presented in this article begins to address this issue by examining how the size of the bargaining zone affects the relative benefit of an advantage in one's BATNA (i.e., having a better alternative than one's counterpart) versus contribution (i.e., contributing more to the relationship than one's counterpart) for negotiator performance. Results indicate that whereas BATNAs exerted a stronger effect on resource allocations than contributions when the bargaining zone was small, an advantage in contributions exerted a stronger effect on resource allocations than BATNAs when the bargaining zone was large. These findings provide needed insight and supporting evidence for how to alter one's power relationship in negotiation.

Adult↗

PubMed2004

The interpersonal effects of anger and happiness in negotiations.

Three experiments investigated the interpersonal effects of anger and happiness in negotiations. In the course of a computer-mediated negotiation, participants received information about the emotional state (anger, happiness, or none) of their opponent. Consistent with a strategic-choice perspective, Experiment 1 showed that participants conceded more to an angry opponent than to a happy one. Experiment 2 showed that this effect was caused by tracking--participants used the emotion information to infer the other's limit, and they adjusted their demands accordingly. However, this effect was absent when the other made large concessions. Experiment 3 examined the interplay between experienced and communicated emotion and showed that angry communications (unlike happy ones) induced fear and thereby mitigated the effect of the opponent's experienced emotion. These results suggest that negotiators are especially influenced by their opponent's emotions when they are motivated and able to consider them.

Anger↗

PubMed2006

Supplication and appeasement in conflict and negotiation: The interpersonal effects of disappointment, worry, guilt, and regret.

This study examined the social effects of emotions related to supplication and appeasement in conflict and negotiation. In a computer-simulated negotiation, participants in Experiment 1 were confronted with a disappointed or worried opponent (supplication), with a guilty or regretful opponent (appeasement), or with a nonemotional opponent (control). Compared with controls, participants conceded more when the other experienced supplication emotions and conceded less when the other experienced appeasement emotions (especially guilt). Experiment 2 replicated the effects of disappointment and guilt and showed that they are moderated by the perceiver's dispositional trust: Negotiators high in trust conceded more to a disappointed counterpart than to a happy one, but those with low trust were unaffected. In Experiment 3, trust was manipulated through information about the other's personality (cooperative vs. competitive), and a similar moderation was obtained.

Anxiety↗

PubMed2006

When family enters the picture: the model of cultural negotiation and gendered experiences of Japanese academic sojourners in the United States.

A grounded-theory study aimed at reconceptualizing cultural adaptation processes from gender role and family/couple perspectives while critically drawing from acculturation and culture and self literatures. In-depth interviews with 34 Japanese academic sojourners (international students, scholars) and their spouses (a total of 50 interviews with select longitudinal interviews) were conducted. The author earlier developed the Model of Cultural Negotiation (2001; 2006) capturing uneven and cyclical processes of dealing with multiple cultural contexts. The current study further develops more tailored versions of this model, Family-Based (Couple-Based) Cultural Negotiation and Individual-Based Cultural Negotiation, highlighting the impacts of family/couple and gender roles, especially for female spouses. These conceptualizations afford a sophisticated understanding of the processes of culture.

Acculturation↗

PubMed2000

'Having a say': negotiation in fourth-generation evaluation.

In this paper, research guided by the principles of fourth-generation evaluation, which has negotiation as its centre, will be scrutinized. The role of stakeholders will be discussed with reference to negotiation issues. Throughout this discussion, observations will be based on the actual process of conducting three project evaluations in this tradition. Attention will be drawn to the consequences of negotiating at an uneven table.

Aged↗

PubMed2001

The negotiation of sexual relationships among school pupils in south-western Uganda.

The objective of the study was to explore how school-going adolescents in south-western Uganda negotiate sexual relationships. Qualitative data were obtained from 15 boys and 15 girls (14-18 years old), during a series of role plays, focus group discussions and one-to-one interviews. A questionnaire was administered to 80 pupils (12-20 years old) from the same school. Most of the pupils were sexually active. Sexual relationships between boys and girls were mediated by peers. Boys initiated relationships. Exchange played an important role in the negotiation of sexual relationships. Money or gifts were given and received in exchange for sexual favours and to strengthen the relationship. To maximize gains, some adolescents had sexual relationships with adults. Sexual relationships were characterized by ambiguity. Love is intertwined with sexual desire, money and prestige. Girls have to be explicit enough to get a good deal; if they are too explicit they will be stigmatized as 'loose' but if they are not interested in money they may be suspected of wanting to spread HIV. Boys try to persuade girls that they have money, but do not want to emphasize this too much. In sexual negotiations a boy must persuade a girl that although he is modern and sophisticated (i.e. experienced) he does not chase after every girl; the girl does not want to come over as an unsophisticated virgin, but does not want to give the impression that she is loose either. There is a tension between the traditional ideal of female chastity and submissiveness and the modern image of sexual freedom. Multiple partnerships were highly valued as a sign of sophistication. Condoms were not considered important. Interventions aimed at reducing the spread of HIV do not seem to be having an effect on the behaviour of this group of adolescents. On the contrary, risky attitudes and behaviour are part of an adolescent ideal of modernity and sophistication. New approaches are needed to persuade this group of the need for change. Shifting the source of interventions from adults to the adolescents themselves, encouraging girls to try other means of earning money and debunking the idea that having many partners is sophisticated may be productive alternatives.

Acquired Immunodeficiency Syndrome↗

PubMed2003

Going public: references to the news media in NHS contract negotiations.

This paper considers how middle-level managers in British Health Authorities and hospital Trusts orient to media reportage in the process of negotiating and monitoring contracts for clinical services. Although they sometimes produce media representations aimed at influencing the general public, local policy actors on both sides of the purchaser/provider split also use media messages as part of their negotiations with each other. We examine how they seek to manage negative publicity, and what happens when one side threatens to 'go public'. Managers must strike a balance between negotiating advantage and maintaining organisational relationships. Thus the powerful, but potentially double-edged, weapon of public disclosure was usually broached in indirect terms, and approached with some ambivalence. In rare cases, parties resorted to hostile press releases as relationships deteriorated. Arguably, these interactions reflect more general tensions that arise when managerial discourses, emphasising concepts such as adversarial contracting, markets and competition, are imported into professional organisations with a public service mission.

Attitude to Health↗

PubMed2003

Hospitals' negotiating leverage with health plans: how and why has it changed?

OBJECTIVE: To describe how hospitals' negotiating leverage with managed care plans changed from 1996 to 2001 and to identify factors that explain any changes. DATA SOURCES: Primary semistructured interviews, and secondary qualitative (e.g., newspaper articles) and quantitative (i.e., InterStudy, American Hospital Association) data. STUDY DESIGN: The Community Tracking Study site visits to a nationally representative sample of 12 communities with more than 200,000 people. These 12 markets have been studied since 1996 using a variety of primary and secondary data sources. DATA COLLECTION METHODS: Semistructured interviews were conducted with a purposive sample of individuals from hospitals, health plans, and knowledgeable market observers. Secondary quantitative data on the 12 markets was also obtained. PRINCIPAL FINDINGS: Our findings suggest that many hospitals' negotiating leverage significantly increased after years of decline. Today, many hospitals are viewed as having the greatest leverage in local markets. Changes in three areas--the policy and purchasing context, managed care plan market, and hospital market--appear to explain why hospitals' leverage increased, particularly over the last two years (2000-2001). CONCLUSIONS: Hospitals' increased negotiating leverage contributed to higher payment rates, which in turn are likely to increase managed care plan premiums. This trend raises challenging issues for policymakers, purchasers, plans, and consumers.

Contract Services↗

PubMed2002

Negotiation-centred versus client-centred: which approach should be used?

For nearly 20 years, Canadian occupational therapists have attached great importance to the client-centred approach within their practice. Professionals have agreed to define this approach through a philosophy built around the concepts of respect, power and partnership. But no reported work has really clarified what is meant by these three fundamental concepts. This article attempts to define the concepts of respect and power in the therapist-client relationship through a review of occupational therapy and related health and social sciences literature. It raises the question: "In the professional-client relationship, should the power reside with the client or is a more balanced approach needed?" This paper also proposes using the term negotiation instead of partnership, since negotiation seems to offer more applications for occupational therapy practice. The objective of the authors who advocate for greater negotiation between client and therapist is to stimulate analysis.

Canada↗

PubMed2002

The interpersonal contexts of negotiating care in home care nurse-patient interactions.

In this article, the author describes six interpersonal contexts within which care is negotiated between home care nurses and their patients, based on qualitative analysis of 31 videotaped visits. The interpersonal contexts were negotiation of (a) territoriality, (b) shared perceptions of the situation, (c) an amicable working relationship, (d) role synchronization, (e) knowledge, and (f) taboo topics. Analysis of moment-by-moment communication explored how social identity related to care activities is constructed, challenged, or threatened in the flow of events in the encounter. This approach does not problematize negotiation by assuming negative connotations of inequality of power; rather, it examines the therapeutic consequences of specific communication acts. It demonstrates how both nurse and patient are, paradoxically, both empowered and made vulnerable through everyday conversation.

Aged↗

PubMed2007

Negotiating sexual agency: postmenopausal women's meaning and experience of sexual desire.

The purpose of this feminist grounded theory study was to understand the meaning and experience of postmenopausal women's sexual desire. Data collection from 22 postmenopausal women who were ongoing participants of the TREMIN Research Program on Women's Health occurred via audiotaped, telephone-based, semistructured interviews. Women's descriptions of their sexual needs and desires led to the discovery of the core category, negotiating sexual agency, which refers to women's ability to act on behalf of their sexual needs, desires, and wishes. Women negotiated their sexual agency within three main domains (or axial codes): their own sexual self, their partners, and the medical system. An important finding was women's internalization of sociocultural assumptions that privilege their male partners' sexual needs over their own. The findings of this study, especially the contexts in which women negotiate their sexual agency, are important for women, women's health care providers, and women's life partners to understand.

Aged↗

PubMed1995

Negotiated and nonnegotiated nurse-patient interactions: enhancing perceptions of empowerment.

Ninety-eight students with upper respiratory symptoms participated in a study to determine differences in patient perceptions of two types of nurse-patient interactive styles. Subjects participated in either an actively negotiated process of decision making (n = 53) or a nonnegotiated approach (n = 45) with a nurse. Findings revealed that subjects in the negotiated group perceived significantly greater feelings of control and power in the nurse-patient relationship than did the nonnegotiated group. No significant correlations were found between motivation and patient perceptions of the interaction. Study results demonstrate that nurses can engage in an active negotiation process with patients and strongly influence feelings of control in decision making.

Adolescent↗