MHA 505 Week 5 Facilitation and Negotiation Strategy Example

Getting Three Organizations to Say Yes: A Facilitation and Negotiation Strategy for a Heart Failure Partnership Among a Hospital, a Nursing Facility and a Cardiology Group

[Student Name]

University of Phoenix

MHA/505: Systems Thinking in Health Care Environments

Week 5 Assignment

[Instructor Name]

[Date]

The hospital, its partners, positions and agreement are composites written for a model paper; research findings come from the sources listed.

The heart failure program proposed by the care transitions director at a composite 260-bed community hospital depended on two organizations she did not control. The partner skilled nursing facility, which received about a third of the hospital's heart failure patients needing post-acute care, would have to accept a phone handoff for every transfer and a shared care plan. An independent cardiology group would have to staff a weekend phone line for facility and home health nurses. Neither had agreed. This paper presents the director's facilitation and negotiation strategy and its outcome.

Why Negotiation, Not Direction

Leaders in health systems often need cooperation from people and organizations outside their authority. The director could not order the facility or the cardiologists to do anything; she could only create conditions in which agreement served their interests.

Mapping Positions

Each party arrived with a position. The facility administrator said the facility would accept no new requirements unless the hospital sent it more referrals. The cardiology group's managing partner said a weekend phone line was unpaid work the group could not absorb. The hospital's chief financial officer said the program could not add costs beyond the approved budget.

Finding Interests

Behind positions lie interests. Through one-on-one conversations, the director learned that the facility wanted a stable census and fewer difficult transfers late on Fridays; the cardiologists wanted fair pay for their time and fewer unnecessary emergency visits by their patients; and the chief financial officer wanted lower readmission penalties and predictable costs. Each interest could be met in more than one way.

Building a Shared Goal With Evidence

The director brought evidence that served everyone. A study of hospital and skilled nursing facility pairs found that when a greater share of a hospital's discharges went to a given facility, patients treated by that pair were less likely to be rehospitalized within 30 days, with a 10-percentage-point increase in referral share associated with a 1.2-percentage-point decline, driven largely by fewer returns in the first week (Rahman et al., 2013). Stronger linkages benefit patients, the facility and the hospital.

A Legal and Ethical Limit

Patients have the right to choose their post-acute provider, and hospitals must respect that choice and give patients information to support it. The director therefore framed the arrangement as a preferred clinical partnership with shared protocols and quality reporting, not a promise of referrals, and planned to share quality data on all nearby facilities with patients.

Anticipating Conflict

A review of conflict in health care found sources at the individual, interpersonal and organizational levels, with organizational sources including ambiguity in professional roles, scope of practice, reporting structures and workflows (Kim et al., 2017). The director expected conflict over who would decide weekend medication changes, whether facility nurses could call cardiologists directly and who owned the shared care plan.

Each Party's Alternatives

Each party had alternatives to agreement. The facility could continue as before, but faced a competing facility courting the hospital. The cardiologists could decline, but their patients' emergency visits would continue. The hospital could hire its own weekend cardiology coverage at higher cost. Knowing these alternatives helped the director judge what each party might accept.

Meeting One: Shared Understanding

The first facilitated meeting, led by a neutral facilitator from the hospital's quality department, set ground rules: speak from data and experience, focus on patients, no decisions in the first meeting. The group reviewed the system map, the Friday discharge data and the partnership research. By the end, all agreed on a shared goal: fewer patients returning in the first week.

Meeting Two: Options

The second meeting generated options for each concern: role definitions for weekend decisions, a phone protocol, a shared care plan template and several payment models for cardiology time.

The Difficult Conversation

Before the third meeting, the director met privately with the cardiology group's managing partner, who objected strongly that hospitals always ask physicians for unpaid work. Guidance on difficult conversations in health care emphasizes preparing for the emotional content, listening to understand the other person's perspective, acknowledging their concerns and focusing on shared goals rather than blame (Overton & Lowry, 2013). The director acknowledged the history, presented a stipend funded from the program's budget by reallocating part of a planned position and asked what would make the line workable. The partner asked for a limit on call volume and a review after six months. The objection was not to the work but to being taken for granted, and the answer began with saying so.

Meeting Three: Agreement

The third meeting produced a written agreement. The facility agreed to accept phone handoffs, use the shared care plan and report monthly readmissions; the hospital agreed to a quarterly quality review, direct access to the care transitions team and fair presentation of the facility's quality data to patients. The cardiology group agreed to staff the weekend line for a stipend, with a volume cap and six-month review. Roles for weekend medication decisions were written down.

What the Director Gave Up

Negotiation meant concessions. The director had wanted cardiologists to answer calls within 15 minutes; the group agreed to 30. She had hoped the facility would accept transfers until 7 p.m. on Fridays; it agreed to 5 p.m. unless a physician called ahead. She reallocated part of a planned analyst position to fund the stipend, delaying some reporting. Each concession was weighed against the shared goal, and none compromised patient safety.

Facilitation Choices

Several facilitation choices mattered. Meetings rotated among the three organizations' sites, signaling equal standing. A neutral facilitator kept the director free to represent the hospital's interests. Each meeting ended with written notes circulated within a day, so no party could later dispute what had been said. And frontline staff, a facility nurse and a cardiology nurse practitioner, attended the second meeting to describe the weekend problem in concrete terms, which moved the discussion from principle to practice.

When Negotiation Stalls

The director prepared a fallback in case the cardiology group declined: a smaller pilot using the hospital's own hospitalists for weekend facility calls. She did not raise it as a threat, but knowing it existed let her negotiate calmly. Knowing your own alternative is as important as knowing theirs.

Sustaining the Agreement

The parties meet monthly for the first six months to review measures: phone handoff completion, weekend calls, readmissions by facility and staff feedback. Problems go to the group, not around it, and any party may ask to reopen a term with a month's notice.

Conclusion

Three organizations with different positions reached agreement because the director mapped their interests, built a shared goal with evidence, respected patients' choice, anticipated conflict, used facilitated meetings and prepared for the hardest conversation. The written agreement gives each party something it needed and gives patients a better connected trip from hospital to facility to home.

References

Kim, S., Bochatay, N., Relyea-Chew, A., Buttrick, E., Amdahl, C., Kim, L., Frans, E., Mossanen, M., Khandekar, A., Fehr, R., & Lee, Y.-M. (2017). Individual, interpersonal, and organisational factors of healthcare conflict: A scoping review. Journal of Interprofessional Care, 31(3), 282-290. https://doi.org/10.1080/13561820.2016.1272558

Overton, A. R., & Lowry, A. C. (2013). Conflict management: Difficult conversations with difficult people. Clinics in Colon and Rectal Surgery, 26(4), 259-264. https://doi.org/10.1055/s-0033-1356728

Rahman, M., Foster, A. D., Grabowski, D. C., Zinn, J. S., & Mor, V. (2013). Effect of hospital-SNF referral linkages on rehospitalization. Health Services Research, 48(6 Pt 1), 1898-1919. https://doi.org/10.1111/1475-6773.12112