Health care negotiations have a number of distinctive features. Most importantly, lives are often at stake. Health care negotiations cover interactions within health care-providing institutions and between those institutions and government regulators. They also extend to health policy decisions (both in the public and the private sectors). Williams Medical Center focuses on possible changes in drug prescription policies at a large metropolitan teaching hospital. Budget Cuts at Newtowne Hospital is a simulation that requires hospital administrators and employees to reach agreement on budget cuts to multiple departments. Health care is, after all, a business. Hopkins HMO involves a contract negotiation among representatives of an HMO and two pharmaceutical companies over a new drug. St. Francis Hospital and the Managed Care Model builds on the first three simulations and asks participants to negotiate budget priorities in the context of expanded application of the managed care model. The Hospital Committee is a smaller scale negotiation but asks the members of the Hospital Committee to decide on the rules for allocating scarce life-saving resources. The last two cases address community decision-making regarding health policy. In the Neighborhood Care, Inc. simulation a dispute has arisen between a church and its immediate neighbors regarding the use of church facilities to provide services to the mentally challenged. Blueville Health Foundation asks learners to imagine how a community might reach agreement on priorities and strategies for using philanthropic resources to improve community health.
Williams Medical Center by Eileen Babbitt and Lawrence Susskind, is a five-party, two-hour, negotiation among representatives of pharmacists, physicians, nurses, and administrators to develop recommended changes to the drug prescription policy of a large metropolitan teaching hospital. Major lessons of this simulation include BATNA evaluation, the link between internal and external negotiation, and contingent agreements.
Negotiating Budget Cuts at Newtowne Hospital, by Lawrence Susskind, is a six-person, three-hour negotiation among hospital administration and employee representatives to reach consensus on budget cuts in three departments. Dr. Van Hagen, a distinguished heart surgeon, will soon join the staff at Newtowne Hospital, a 750-bed teaching institution. Although some staff members are elated and perceive the arrival of the doctor as an indication of the hospital’s coming-of-age, other staff members are in shock. Newtowne is already facing financial difficulties, including the fact that the annual wage increase for staff has not kept up with the cost-of-living. Now that the hospital has promised financial support to Dr. Van Hagen and his special staff, and will also fund his new equipment, Newtowne is going to have to cut $3.5 million from the rest of its budget. John Demars, the Chief Operating Officer, has met privately with five people who will serve as a budget advisory committee. The five members: the Chief of the Medical staff, Vice-President of Nursing, Chief Financial officer, Head of the Nurses Union, and president of the Hospital Workers Association all were a bit angry and worried about suggested cuts in their departmental budgets. Demars has asked the Advisory Committee to try to reach a consensus on the budget cuts. If no agreement is reached, the Chief Financial Officer will submit his own recommendation to the hospital Board of Directors. Major lessons of this simulation include relationship concerns in negotiations, how to identify success, and separating interests from positions.
Hopkins HMO, by Janet Martinez, is a three-party, three-hour, multi-issue contract negotiation among representatives for an HMO and two pharmaceutical companies over the purchase of a new antidepressant drug. Major lessons of this simulation include how perceptions of power can affect an agreement, the process of creating and claiming value, and the effect of relationships on an agreement.
St. Francis Hospital and the Managed Medical Model, by Patricia Moore and Lawrence Susskind, is a five-party, four-hour, four-issue negotiation among representatives for a financially struggling hospital’s administrators, doctors, and nurses over budget priorities and expanded application of the managed medical model. Major lessons of this simulation include uncovering interests, issue linkages, and coalition building.
The Hospital Committee, by Irma Tyler-Wood and Bruce Patton, is a one-hour, multi-party negotiation among hospital committee members over the allocation of scarce life-saving resources. A hospital located in a small town has a serious dilemma: the facility only has two dialysis machines which are now in demand by seven community residents with kidney failure. Without treatment, each patient will die, but only three patients can use the available machines. The machines are extremely expensive, and money to buy a third, let alone a fourth, is simply unavailable at this time. The members of the Kidney Dialysis Committee are members of the community who have been asked to serve by the hospital administration. They have been given information about each patient, and have been asked to decide, confidentially, who will and who won’t receive treatment. Major lessons include psychological awareness of emotional reactions, power dynamics, and use of objective criteria.
Neighborhood Care, by Lawrence Susskind and Bruce Patton, is a two-party negotiation or mediation between church and neighborhood representatives over the possible use of church facilities for services for the mentally challenged. Neighborhood Care, Inc. is a non-profit mental health organization that provides counseling and recreational health services to mentally challenged adults and teenagers. Neighborhood Care would like to rent space in a local church, and the church is interested. Local residents oppose the idea and plan on staging a protest at the next zoning hearing, when the church will seek a permit to operate the Neighborhood Care facility. The situation is also complicated by the fact that the church is located in a neighborhood with residents of a different religious faith. Major lessons of this simulation include managing partisan perceptions, identifying success, and agreement Implementation.
Blueville Health Foundation, by Mieke van der Wansem, Lawrence Susskind, and Janet Martinez, is a five-party, three-hour, multi-issue negotiation among foundation, community, and medical board members of a new health foundation to set community health funding priorities and strategies for community engagement. The Blueville Health Foundation (BHF) has recently been created to fund health initiatives in the Blueville Area. The BHF is run by a 5-member Executive Committee. The Executive Committee of the Board has been charged to set priorities for funding health projects. Unfortunately, the members of the Executive Committee have struggled with how to identify community health issues that need funding, how to engage the community in this process, or even how best to interact among themselves to meet their Foundation responsibilities. Major lessons include managing conflict within an organization, negotiating budget priorities, and managing relationships in negotiation.
Douglas Stone, Bruce Patton, and Sheila Heen, Difficult Conversations: How to Discuss What Matters Most, Viking/Penguin, 1999.
Leonard J. Marcus with Barry C. Dorn, Phyllis B. Kritek, Velvet G. Miller, and Jamie B. Wyatt, Renegotiating Health Care: Resolving Conflict to Build Collaboration, Jossey-Bass, 1996.