In their bestselling book, Getting to Yes, authors Roger Fisher and William Ury share guidelines for “negotiating agreement without giving in.” The skills and techniques described are useful in any situation requiring give and take, but they are especially valuable when facing obstacles that often arise in accessing healthcare.
Described below are actual client scenarios in which we applied these guidelines.
Margaret and Her Mom, Beatrice
Margaret received a phone call from a hospital-based case manager, Kathy, and was told that Beatrice would be transferred to a skilled nursing facility the following day. Beatrice had been admitted for multiple medical conditions, including a urinary tract infection and congestive heart failure. Just the day before, the treating physician had relayed that Beatrice was quite ill.
Margaret was beside herself. She did not live locally, had not expected this, and reacted angrily toward the case manager. She didn’t know what to do and so she called us (we already had a relationship with the family due to a previous illness). We were able to guide her through the next steps.
Guideline #1: Separate the People from the Problem
The case manager’s role is to communicate a discharge plan and facilitate its execution. The physicians and nurses caring for Beatrice had input into the recommendation for discharge based on her clinical status, so it sounded as though she had improved from the day before. But, without being sure, we suggested Margaret do the following:
- Call Kathy back and acknowledge that she knew her role was to facilitate a safe discharge.
- State that out of fear, she was a bit angry when they spoke previously. She was rushing to catch a plane to Boston to see her mom and was confused. She felt she received conflicting information from what the physician told her the day before, and did not understand how today Beatrice was now well enough to be discharged.
- Ask that the discharge be delayed, allowing her time to get to Boston and work alongside the case manager to create the best discharge plan possible.
By separating the people from the problem, Margaret was able to realize that in any situation, both parties contribute feelings, opinions, and values.
Guideline #2: Focus on Interests, not Positions
The next morning, after arriving at the hospital and seeing her mom, Margaret met with Kathy. She remained “curious,” asked many questions, and received important information, such as:
- Beatrice’s clinical status
- The current treatment plan and what the treatment plan would be at the next facility
- Beatrice’s capabilities regarding getting out of bed, getting to the bathroom, feeding and dressing herself
- What a skilled nursing facility is and how one chooses one over another
- Why the team was making the recommendation that Beatrice go to a skilled nursing facility
Through this discussion, it was clear that Margaret and Kathy had mutual interests: Kathy wanted a safe discharge plan that would result in Beatrice not being readmitted to the hospital. Margaret also wanted a plan that would result in Beatrice’s health improving, so she could eventually return home safely and care for herself again.
They each understood what was motivating the other. Margaret needed some time to visit facilities and began that very afternoon. Kathy saw her moving quickly and in good faith, and took steps to delay the discharge two more days so everyone could feel comfortable that Beatrice was transferred to the best place to receive the care she needed.
Daniel, Angela, and Social Security
Those who newly enroll in Medicare must do so via Social Security. Most of the time, the personnel involved are both helpful and professional and the process goes smoothly. But not always…
We helped Daniel, his wife Angela, and their disabled, 35-year-old son, Paul, enroll. As is typical, within three weeks, we received confirmation that Angela and Paul’s enrollment was complete. However, Daniel’s was held up.
Over the next 60 days (the time they say it can take to achieve an enrollment), and after numerous calls that resulted in unacceptable answers and the news that Daniel’s application had been transferred to another department that did not accept calls, I was extremely frustrated and expressed this to the supervisor. She was equally exasperated with internal policies and the obstacles she had encountered when trying to assist me.
Guideline #3: Learn to Manage Emotions
I explained calmly that my only recourse at that point was to reach out to the office of Daniel’s congresswoman and ask for help. I clarified that I was not trying to cause problems, but that I had to keep my client’s interests in mind and there did not seem to be any alternative.
I contacted the congresswoman’s office and provided very detailed information about the actions we had taken on Daniel’s behalf. Fortunately, the situation was resolved positively — within one week — and Daniel received a phone call from the local Social Security office supervisor apologizing for the delays in his enrollment.
Guideline #4: Express Appreciation
Having interacted with the Social Security supervisor at least ten times over the 60-day period, I reached out one last time to thank her for her efforts. She said she was okay with me calling the congresswoman’s office because the incident resulted in an internal change of policy! She invited me to call in the future if I ran into any obstacles with clients.
I also reached out to my contact in the congresswoman’s office and thanked them, profusely, for intervening. Two years later, when I had to call another office for a similar situation, I began by relaying my previous positive experience and expressing appreciation.
John and His Prescription Medication
Our client John called one day, completely frustrated. When he went to the pharmacy to pick up a new prescription, the copay was $552. The pharmacist could not explain why it was so high, while John’s other two prescriptions cost just five dollars each per month. He refused the prescription and left.
Guideline #5: Put a Positive Spin on Your Message
I explained to John the complexities of the Medicare Part D Prescription Drug Program. His plan had a deductible of $505 and a co-pay of $47. Once he met that deductible, his medication would cost just $47. I further explained that the full retail cost of the drug was $650, which is why it cost so much this time. ($505 deductible + $47 co-pay = $552)
I explained that although the coverage was complicated, prior to 2006, Medicare recipients had no outpatient prescription drug coverage at all. I went on to describe some of the positive changes to the program that would be enacted in 2024–2026 due to the passage of the Inflation Reduction Act, which would help to lower future costs.
John was able to see some positives in what I said and agreed to pay the high amount for his much-needed medication.
Guideline #6: Escape the Cycle of Action and Reaction
Years ago, as a health care professional, I found myself defending the work I did and quite honestly, it sparked the idea to create Healthassist. My premise was — and still is — that much of the time, the only thing we have control over is ourselves. I wanted to help consumers change their reactions to frustrating health care situations.
As we coach clients to get what they need from the system, we encourage them to:
- Prepare for appointments by creating agendas they can share with their physicians
- Do their own research so they walk into appointments informed
- Approach health care professionals with curiosity, courtesy, and gratitude. View them as experts who can teach and inform.
Treating those within the system with anger and sarcasm, even if it’s the result of justifiable frustration, gets you nowhere and can even be self-sabotaging (John needed his new medication; refusing to pick up the prescription was not in his best interest).
Most health care professionals care deeply about their patients and are motivated to do good work, despite sometimes operating in settings that do not support them well.
In the scenarios described above, the “Six Guidelines for Getting to Yes” helped our clients identify shared interests and create options that led to mutual gains and positive outcomes.
It’s not always easy, and the results are not always precisely what we would like. However, by applying these principles, we can all do the best we can within our complicated health care system.