Enhancing and using negotiation skills

Dermatology Nursing, April, 2008 by Keith Kriet

I have a reputation in my office of being able to "handle" any difficult situation. No matter how angry a patient is when he/she comes into the office, my staff has noticed that I can usually address the patient's issues in a way that has him/her walking out satisfied.

This is not an innate ability. These are skills that I've worked hard over the years to develop and hone. They did not come easily, nor did they come without trial and error. They are skills, however, that anyone can learn, and they involve techniques that you can train your staff to use. The first step is to develop and use the techniques yourself.

I recommend any or all of a number of books on negotiation:

* Getting to Yes by Roger Fisher and William Ury (1991)

* Getting Past No by William Ury (2007)

* Negotiate This! by Herb Cohen (2003)

* You Can Negotiate Anything by Herb Cohen (1980)

Even if you've read one of these books in the past, it is well worth the time to read it again. It always amazes me how even just 1 more year of experience in my life can draw out different understanding from things I've read before.

Dealing with Patients

The word "negotiate" comes from the Latin negotium, meaning "to transact business." Negotiate has a secondary meaning as well that implies, "an absence of leisure." To me, this means it takes work to achieve the mutually beneficial relationships that allow us to succeed in the long run.

Dealing with difficult patients can be the hardest thing we do on a daily basis. It's hard because many times what sets a patient off is not what is truly making that patient angry. Many come carting the baggage of frustrating and irritating medical conditions that they've struggled with for days, months, or even years.

I've found that many of the rough patches with patients stem from the nature of the doctor's visit itself. They don't want to be there in the first place. They are directed to fill out paperwork. They are made to wait. They are forced to share space in a waiting room with people they don't know. They don't know what to expect, and they are apprehensive. As a consequence, patients feel a fundamental lack of power. The difficult patients are the ones who share their discomfort in ways that make them feel as if they are regaining some control over their situation.

Interpersonal Skills

There are techniques that you can learn and use in dealing with frustrated patients. For example, the patient who reacts with overt frustration to a long wait in the reception area should be told why he or she is waiting longer than normal. Ideally, this should be done proactively by the front desk staff before that patient boils over. However, giving control back to the patient can be as simple as acknowledging her frustration and asking them if she would like to reschedule her appointment. Most times patients choose to wait longer, but by giving them a choice, you allow them to gain a measure of control over their situation.

Negotiation skills are, in essence, interpersonal skills. Learn how to negotiate. It is the one skill that will serve you well in every situation. Everything is negotiable and everyone (including vendors, patients, employees, and employers) negotiates. The manner in which you interact with the players in your practice will determine how successful you are as a manager.

References

Cohen, H. (2003). Negotiate this! By caring, but not T-H-A-T much. New York: Warner Books.

Cohen, H. (1980). You can negotiate anything. Secaucus, NJ: L. Smart.

Fisher, R., & Ury, W. (1991). Getting to yes: Negotiating agreement without giving in (2nd ed.). New York: Penguin Books.

Ury, W. (2007). Getting past no: Negotiating in difficult situations. New York: Bantam Books.

Keith Kriet is Business Manager, Debra R. Miller, MD, LLC, in New London, CT. He has recently been elected to the Board of Directors of the Association of Dermatology Administrators/Managers (ADA/M), and has been a member of ADA/M since 1999.

Note: This series is written by members of the Association of Dermatology Administrators/Managers (ADA/M). For more information, eontact ADA/M at 17 S. High Street, Suite 1000, Columbus, OH 43215; lisa.spoden@shcare.net; (866) 480-3573; fax (800) 671-3763; www.ada-m.org