No one is happy with the resulting conflict: Orthopods fear losing their patients patients are anxious about getting lesser care PCPs worry that their relationships with specialists will erode and insurers and administrators find the resistance by all parties frustrating, time-consuming, and expensive.
Insurers want to control costs, of course, and they and others exert pressure to divert simple cases from high-cost specialists to less expensive physician’s assistants or other non-specialist care-givers. The PCPs value their relationships with the specialists in the network and focus on their gatekeeper role rather than stretching the scope of care they provide. Patients, meanwhile, want to be treated by an “M.D.” and often a board-certified specialist rather than their primary care physician (PCP). Doctors prize their clinical autonomy and their relationships with those they treat, and the fee-for-service model rewards them for taking care of patients themselves. Why?īoth physicians and patients have come to expect to interact with each other.
Such shifts in responsibility, however, are often resisted and the resulting conflict can be acrimonious. If outcome quality and patient satisfaction can be maintained and costs lowered, this should be an easy move to make. These can be adequately treated by a properly trained physician’s assistant (PA), and patients can typically be seen much more quickly by a PA than by a specialist. Most patients who arrive at an orthopedic office suffer from straightforward conditions such as a simple, non-displaced fracture or a sprain. Is this really best for the patient, the practice, and the larger system? Consider the situation in a traditional orthopedic practice where a physician sees every patient who comes through the door. For example, there is often pressure to change who does what when new technologies are deployed or initiatives are undertaken to lower costs. The same negotiation principles that can reduce nuclear stockpiles can be effectively applied even at the front lines in health care. This understanding enabled them to break the deadlock and move forward. During a break, the two lead negotiators went for a walk during which they unearthed their personal as well as each nation’s deeper, shared interests in peace and security. The delegations from the United States and the Soviet Union were at loggerheads. We call this process the Walk in the Woods after a play that dramatized a well-known negotiation over nuclear arms reduction. (See our book Renegotiating Health Care for more detail on the process.)
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We’ve taught people in as little as 30 minutes how to use this approach. The fourth step is to certify what has now become a larger set of agreements, or “ aligned interests.” Any outstanding disagreements are held to the side for future negotiations. The third step is to collaborate to develop solutions to the remaining disagreements, or “ enlightened interests.” This is the time for creative problem solving.
What does each need to get from this exchange? The second step is to look at where the overlap among these self-interests reveals agreement, what we call the “ enlarged interests.” In our experience, these agreements always outnumber the disagreements. We use and teach a simple four-step structured process that works in cases ranging from simple one-on-one interactions to extended multi-party discussions.Īfter assembling representatives of all stakeholders in a conflict, the first step is to have each stakeholder articulate their “ self-interests” so that they are heard by the others. We have worked on conflicts as mundane as work assignments and as complex as hospital mergers. We have been engaged in health care negotiation and conflict resolution for two decades. Yet the nuances of negotiation and conflict resolution are too rarely taught in medical or business schools. Conflict, however, is not new to the health care system it is a fragmented landscape with many players with sometimes conflicting interests and objectives. Conflict in health care has dominated the news in the United States lately with the political showdown over the Affordable Care Act followed by the shaky launch of the federal health insurance exchange.
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