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ANNOUNCER:
Welcome to ASA’s Central Line, the official podcast of the American Society of Anesthesiologists, edited by Dr. Adam Striker.
DR. CRYSTAL WRIGHT (HOST):
Welcome to another special episode of Central Line. It's Leadership Month, and I'm your host for these episodes, Dr. Crystal Wright. This month we're talking to Dr. Tiffany Cheng about the Monitor article she's co-authored with Drs. Sam Wald, Sara Strowd and Solmaz Nabipour. Welcome to the show, Dr. Cheng.
DR. TIFFANY CHENG:
Thank you for having me. I'm excited to be a part of the show.
DR. WRIGHT:
Great. Thank you. Your article is entitled Negotiating for Success. I think when some people hear the word negotiation, they tense up and get nervous. But it's really an everyday skill that we all utilize all the time. Can you talk a bit more about how common negotiation is and why that matters for health care professionals who are trying to integrate better negotiation skills into their leadership practices?
DR. CHENG:
I think you make a great point, Dr. Wright. The word negotiation, I think, often carries a very negative association with it. But like you aptly pointed it out, it's actually a skill that everybody uses every day, whether that be negotiating at bedtime with your toddler, or what to have for dinner with your significant other. Professionally, of course, we all negotiate as well. Specifically to anesthesiologists, we negotiate with our surgeons, our nurses, and other operating room staff every day about how to medically optimize and time the appropriate type of anesthetic for the best possible patient care. I think many of us may not think of these scenarios as explicitly negotiating, but they really are. You're learning about what is important to the other party as well as yourself, developing a plan to achieve a common goal, which is a negotiation. For health care professionals, negotiation, like any other skill, should be honed with practice to help develop leadership skills. Again, I go back to talking about the operating room because I am an anesthesiologist. But both the operating room and the health care system is just a giant system made of many people working together in both micro and macro level teams. Well-developed negotiation skills creates leaders in each of these teams that makes the whole system run much more smoothly. And at the end of the day, this is what we all want, the best possible patient results and care.
DR. WRIGHT:
So sort of the crux of what negotiation skills entail are that it really is about improving our communication skills when we’re quote unquote negotiating.
DR. CHENG:
Absolutely. I think a lot of negotiation is understanding how to communicate more effectively and understanding what the other person wants, needs and values in a situation.
DR. WRIGHT:
And you bring up a very interesting point when we talk about that in relationship to patient safety, because a lot of what we do when we are making appropriate treatment plans for patients comes through in terms of ensuring that we are communicating effectively with our patients and with, with other physicians.
Why don't you talk to me a little bit about the adversarial side of negotiating. Is it helpful or problematic? And if the latter, how do we move past adversary to being more of a collaborator?
DR. CHENG:
So, again, kind of, I think part of the negative associations people have with negotiating stems from probably past poor experiences due to thinking of other party as your, your enemy and that you have to fight for something that they really want when they go into a negotiation. But really, I think the mindset that we frame a negotiation in isn't about really fighting anybody at all. It's about approaching the negotiation as if it were some sort of a collaborative problem that you have to solve together with this other person or group of people. And that's the adversary is just the problem, it's not the other person. You're not negotiating against each other for each person to get the biggest slice of pie possible. And when you open up the negotiation table to involve everybody and really understand each other, you end up creating a much bigger piece of pie for everybody, so to speak. Rather than, you know, grabbing whatever you can for yourself. And using the strategy of collaboration, you really take the time to learn those different values that need to be solved per party that's involved and also therefore how to solve that problem best. And by creating this long term kind of relationship with each party that's involved in the negotiation, you can basically revisit this group and this strategy of this party to kind of achieve what needs to be solved throughout x number of months, years, however long you guys will be working together to work together to create and solve this problem.
DR. WRIGHT:
I think it's very interesting how you bring up the idea about not taking things personal during the negotiation process, because it's more than when you can separate people from the problem that needs to be negotiated, then it tends to allow one, I believe, to work through the problem once emotion is removed. And I think a lot of that comes from psychological safety in the workplace. I know there was a recent book, The Fearless Organization from Dr. Amy Edmondson talks about psychological safety in the workplace. And I agree with you. Once you create that space, then people are able to less likely feel as though the, the negotiation is personal, that it's more about everyone is trying to work together to get to a solution in the problem.
In your article, you suggest people employ mirroring in their negotiations. Can you tell us about that?
DR. CHENG:
Sure, mirroring is a technique that was described by Chris Voss, who is a master FBI negotiator. He teaches a master class and I'm sure everybody has heard of his books already and his podcast. But mirroring is one of his many techniques that he talks about to help the other party or your colleague that you're negotiating with know that you're negotiating in good faith. You're trying to reach across the aisle and genuinely trying to understand what it is that matters to them, and therefore help you understand better what they want or need to help you solve this problem together. Mirroring invites the counterpart to share their view and their rationale with you, and it's actually really simple to do. You invite the other parties to talk and they simply repeat the last three words of their statement with an inquisitive and open tone, inviting them to elaborate on what it is that they want. These effective negotiation techniques fundamentally are about understanding what the other person is saying and kind of drawing out of them fully what they really want out of a situation. Adding clarity to a negotiation talk between both parties again helps people problem solve and find win-win solutions at the end of the day.
He also describes a few other techniques, such as labeling, which helps diffuse negative emotions, kind of referring back to what you were talking about earlier by removing emotions from a situation, and then using dynamic silences to kind of really listen to each other as we're talking about values for each person at the table, and then together, cooperatively, that kind of creates an environment where people can really work together to solve something rather than feel like they are facing off against one another.
DR. WRIGHT:
Mm hmm. That’s interesting. And, you know, speaking to the importance of clarity, then, once both parties are clear as to the direction or the goal or what the intended outcome is supposed to be, then you can easily move to the problem solving part of the dynamic which the two, two or three parties are in.
So let's talk a little bit about the demographics of negotiation, some studies show that women, I think for example, are often punished for negotiating, which leads women to fear negotiating, and sometimes they end up settling for less than their male counterparts. So what, what advice do you have for women and men about how to move past this dynamic?
DR. CHENG:
I think this is a great point that you bring up, Dr. Wright, and I think in recent years it's been quite a bit of interest in understanding how men and women approached negotiation differently. And studies have been done that show women are less likely to attempt negotiation, or women who do attempt to negotiate such things, such as their terms of employment, are often disliked or viewed as disagreeable. And this is in part because we have gender norms in society that are seen as being violated when this happens.
I think there was a recent statistic that was really interesting. When you looked at women who tend to just plain out except their first job offer without any attempts to negotiate, that occurs about ninety three percent of the time. When we look at men in the similar situation, they only accept their offers about forty three percent of the time. And you might think, what's the big deal? The big deal is that this unwillingness to negotiate actually has long term consequences, because when women and men start at different points at the beginning of their career, there are differences in compensation and resources that will continue to propagate throughout the course of their career. And this might be things like talking about compensation, resources for any research or projects and or promotions just because they start at a different starting point.
So jumping ahead to your question about advice, I think starting with the advice I have for men, men need to take some ownership in leading and bringing both genders to work together at the table. And by normalizing women at the negotiation table, men can proactively help eliminate gender bias with regards to women being able to negotiate for something. And it's really important for negotiations to be normalized, I think, at the start of a relationship, because when somebody joins a new group or practice the way that relationship starts and grows and what you develop that basic understanding for and value in terms of bringing that person in to negotiate with what they value to an, an organization, really kind of grows over the term of that relationship as a person is a part of that organization.
For women and underrepresented minorities, I think there's a couple of key points that have been also studied a bit. Learning to simply ask for it as a woman is something that's really important. Not accepting anything that's offered without negotiating, and if you don't know what your value is relative to an organization that you're joining, asking for benchmarks or talking to colleagues in the area that you might be looking for a job, for example, to get an idea of the compensation, your value, is a good starting point.
And I think it's easy to think, oh, the other people in the room might not look like me, might not be like me. I feel uncomfortable or awkward already. I think it's important to kind of reframe that when you go to the negotiation table, knowing that you have to understand why you're there, what you're negotiating for, and be prepared to justify it and therefore negotiating from a place of strength rather than thinking this isn't quite who I am or I don't feel comfortable here. You have to be your own advocate.
Lastly, for women, I think framing a negotiation has been shown to be most effective if you are able to create a situation for yourself where you're asking on behalf of a larger group or organization, and I think that has been critically important. So instead of asking for a raise for yourself in a group, you can say, hey, this is what my raise will do for my group as a whole, has been much more effective in, you know, bringing yourself up as well as, you know, other people around you and the organizations tend to receive this much, much better.
DR. WRIGHT:
Yeah, and I think that the importance of mentorship and sponsorship come in, because I think that those people that are mentees and people that are sponsoring other individuals, that's where that relationship and helping you to realize your value and realize, you know, the importance of, of what your worth is in terms of negotiating.
So finally, I am going to ask you the same question I'm asking all of our guests in this leadership series. Can you name a misconception that many anesthesiologists have about leadership and tell us here, why they're wrong?
DR. CHENG:
That’s a very interesting question, Dr. Wright. I think, I myself am a junior faculty member, and I think a common misconception amongst anesthesiologists is that their colleagues and leadership may not necessarily share the interests of the average day-to-day practitioner in the operating rooms. And I think part of that is because leadership personnel is viewed as being more administrative and therefore their goals may not necessarily be aligned with the average practitioner in any given group. I think this is just simply not true at all. I think, again, talking to people about negotiation and how to understand that all, everything is kind of a, a series of cogs working together to create optimal patient care.
Leadership really has to look at both the micro kind of day to day activities, as well as the macro looking at different groups interacting with one another. I'm not just talking about surgeons, nurses and anesthesiologists or patients, but really kind of the whole system based approach and how to make that the best possible way to make it all functional so that that patient gets to, you know, schedule their surgery safely. People are going to take care of the patients safely, the patient gets to stay safe and then have adequate post-operative care. And I think all these things have really come to light, especially with the pandemic that has been going on, because we've had to change so much of our system practices to kind of accommodate things that have happened globally and affected how we do care on a day to day basis. So I think leadership has really stepped up to show us how important that is, and especially if you don't have it, how critically important it was before, to kind of fill that vacuum.
DR. WRIGHT:
And, you know, I think the pandemic definitely highlighted the importance of, of leadership in terms of, and anesthesiologists as well, both within the hospital setting and outside. And again, as you mentioned, just the importance of highlighting that during our training for our residents rather than waiting for that to be a part of something that they're looking to develop in practice, because it's something that I agree with you that can be taught sooner rather than, than later.
Well, Dr. Cheng, thank you so much for your time today. I truly appreciate your insight. To read Dr. Cheng's article and others in ASA’s Monitor’s issue on Mentoring, Coaching and Negotiation: Connecting with Purpose, visit asamonitor.org and join us again soon for more Central Line.
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