It’s fascinating how often you have to negotiate in life. The reality is that negotiation is a critical part of clinical practice.

I recently read “Never Split the Difference” by expert FBI negotiator Chris Voss because. It was an extremely interesting book to read. By the end I realised that his concepts in negotiating with terrorists and business owners would be invaluable for clinicians and clinic owners when working with staff and patients alike. 

Negotiations permeate through every facet of our lives. Even though the person you are talking to is not a terrorist, the thinking process in achieving a desired result is the same.

Below are some useful techniques Voss laid out in his book. I also cover WHY they work. Anyone can use these techniques during any negotiation.

Two key things before we address strategies

First, what is a negotiation?

Negotiation as a situation where you and another party need to get something done, but the terms of that “something” have not been defined. That’s where the negotiation comes in.

Why do we negotiate?

In clinical practice, actions need to be taken and progress needs to be made to reach an outcome your patient wants. People have different views, beliefs and motives, and of course, different incentives on how they want to do things. 

There are times when you might have an idea on how things should be done to get clinical improvement, but your patient might have other ideas. 

Effective negotiation allows both parties to achieve goals whilst maintaining the ability to make decisions freely.

Emotions Drive Decisions

Almost all of us make decisions based off of emotion. Often we are convincing ourselves that we are making a “rational” choice to cover the fact that we don’t think rationally.

As Nobel Prize winning psychologist Daniel Kahneman quips in his book “Thinking Fast and Slow”: 

“We are blind to our own blindness.”

So what’s the point here?

You can’t win a negotiation by trying to appeal with reason. By doing this, you immediately put yourself at a disadvantage.

How often do clinicians try to reason with their patients? I certainly did! And I can tell you from experience that my reasoning rarely made long term changes to behaviour in chronic care management.

As Voss says, “Most of us enter verbal combat unlikely to persuade anyone of anything because we only know and care about our own goals and perspective.”

How do you find out about another’s goals and perspective? UNDERSTAND THE OTHER PERSON FIRST. 

Here’s Voss:

“Work to understand the other side’s “religion.” Digging into world-views inherently implies moving beyond the negotiating table and into the life, emotional and otherwise, of your counterpart.”

To create the right frame for anything to get done, you have to first understand the emotions of the other person, and appeal to those emotions. 

Here are a few strategies he lays out to get started creating empathy and understanding. None of these use logic.

Strategy 1: Mirroring

Mirroring is a simple technique where you mirror the person you are talking to by repeating the last 3 words. Or you repeat the most critical pieces of information, that they just said.

For example, if someone says, “I’m having a really bad day. The pain just hasn’t let up.”  A simple mirror looks like, “hmm, the pain hasn’t let up?” 

By ending the mirroring with an upward inflection in your tone, you make it a question. This allows the patient to give you more information.

You can choose to mirror using a downward inflection in your tone. This will make the mirror a statement and could be followed by “Tell me more”.

Mirroring builds rapport with your patient by showing that you are listening and have heard what they had to say. Everyone wants to feel listened to. They are more likely to continue with their thoughts for you to better understand their situation.

Strategy 2: Labelling

Labelling refers to calling out the emotion of the other person/patient. It lays the emotion out on the table in order to discuss and move the conversation along productively. While it seems combative on the surface, Voss describes the usefulness of labelling:

“We employed our tactical empathy by recognising and then verbalising the predictable emotions of the situation. We didn’t just put ourselves in the fugitives’ shoes. We spotted their feelings, turned them into words, and then very calmly and respectfully repeated their emotions back to them. In a negotiation, that’s called labelling.”

Putting a label on an emotion gives your patient a chance to better explain themselves. Furthermore it helps you better understand their perspective. 

Instead of trying to get commitment when you sense resistance, try using some counterintuitive labels such as these:

• “It seems like you are really frustrated.”
• “It looks like you have given up”
• “It seems like you have a reason for hesitating.”
• “It feels like there’s an obstacle here…”
• “It seems like something is holding you back.”
• “It feels like there’s something I’m not seeing.”
• “It feels like I’ve missed something important.”
• “It seems like you’re not happy about something in this plan.”

To label emotions, lead with “It seems like…”, “It sounds like…” or “It feels like…”

The challenge for you is to make the labelling statement and nothing else. No more sentences. No leading questions. Just wait for the response. Sounds easy but not so. Believe me, it takes practice to zip your mouth and wait for the response.

Have the confidence that the information you get in the response will direct your next question or statement.

Strategy 3: Ask Questions

One of the main goals, if not the most important objective of any negotiation revolves around information extraction. Here’s Voss:

“Your goal at the outset is to extract and observe as much information as possible. Which, by the way, is one of the reasons that really smart people often have trouble being negotiators — they’re so smart they think they don’t have anything to discover.”

Often you have no idea what really motivates your patient. They may have an agenda you know nothing about. The only way to learn is to simply ask questions.

Asking open questions allows your patient to feel in control, when in fact you sit in the driver’s seat. In particular, Voss hypes up the “how” question saying that,

“‘how’ engages because ‘how’ asks for help.”

Asking ‘calibrated’ questions will give you an understanding of the thinking process of the patient. You may uncover limiting beliefs that will impact on the success of your management. They also help your patient work out for themselves what it’s going to take to reach the goal they want.

Here area some examples:

• “How are you going to fit these exercises into your day?”
• “What needs to happen for you to commit to this plan?”
• “I see you know quite a bit about this — how can I add value to what you already know?” This question is especially useful for those who regularly visit Dr. Goggle!
• “How can I do help you achieve your goal if you can only get treatment sporadically?”
• “How are you able to help me in this situation?”

The answers to these questions will help you understand your patient’s thinking, evoke feelings of control, and use that discovery to your advantage.

Summary

I could go on about all of the other specific strategies Voss laid out. Many are very useful. But to me, the strategies of mirroring, labelling and asking open questions, permeated all of the other strategies. They account for 80% of the work needed to start learning how to become a better negotiator.

If your aim is to increase compliancy through collaboration then start working on these three strategies. For true collaboration, negotiation is a critical part of clinical practice.

Remember, negotiation is a learned skill and will require commitment and practice to master.

I can thoroughly recommend Chris Voss’s book. It is very entertaining and you will learn so much about managing yourself and others.

To learn more about motivational tools through effective communication download my eBook:

“Improving Patient Motivation In Physiotherapy”

I wrote this eBook in response to the most common question I get asked and that is “How do I motivate my patients?”

If you would like to fine-tune your communication skills when working with resistant patients, you might consider working with a coach or mentor.

Or perhaps your staff would benefit from training in this area.

Contact us, and find out more about what we can offer you.

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