St. Francis Hospital and the Managed Medical Model

SCENARIO:

A hospital in a large urban center is struggling to improve patient care, meet financial obligations, and resolve inter-professional differences. A new Medical Management Model, under which physicians assume responsibility and accountability for the operation of all medical services, has been developed by the Chief of Medicine. The CEO and Chief Financial Officer have both supported the model, as well as the new Management Information System on which it rests. Other members of the hospital community–most notably the Vice President for Nursing and the most senior Attending Physician–are either opposed to its adoption or determined to obtain some compensating benefits if they go along with it. The CEO has called a meeting of these five major players to see if they can reach agreement on four issues facing the Executive and the Board of Directors. If the CEO cannot obtain agreement on a package, the Board will make decisions on these issues; none of the managers would be happy with that outcome.

 

MECHANICS:

Time Requirements:

This five-party exercise requires approximately 3 1/2 hours to play and debrief; additional preparation time is useful. Negotiations require a minimum of 90 minutes. General instructions are distributed at some point prior to the start of the exercise. At least 20 minutes should be given for reading the general instructions, 20 minutes for the confidential instructions and 20 minutes for same-role group discussion — giving players time for preparation and strategy. Allow 90-105 minutes for negotiating and 45-60 minutes for debriefing.

 

Facility needs:

Room with seating and writing materials for 5. At least one private breakout room is highly recommended.

 

MAJOR LESSONS:

• Interests vs. positions – Many difficult negotiations start with parties offering their positions. It is important to identify the underlying interest behind these positions. Focusing on interests encourages the parties to listen carefully to each other so as to discover what each considers important. This encourages joint problem-solving rather than adversarial posturing.

• Different values and priorities facilitate agreement building: When parties value issues differently, the possibility of reaching an agreement is high if the parties are able to identify these differences during the negotiation. Awareness of different preferences and values can enable negotiators to work together and structure agreements which create maximum value for all parties.

• Trading across options to create a package: Packaging involves putting together a proposal that provides solutions to a set of problems. In many negotiations, no agreement can be made by dealing with each issue separately. However, agreement can be reached by parties trading across all the issues.

• Coalitions: The building of coalitions is an important consideration in multi-party negotiation. It is important for parties to ask themselves, "who might share my interest? If we unite as a coalition, might be able to block agreements that do not meet our interests? How stable is our coalition and who are my preferred coalition partners?" Coalitions are likely to be fragile and unstable. Members of coalitions should for ways to strengthen the coalition. This will frequently involve paying close attention to coalition members' interests and priorities.

• The Mediator or Manager: Managers frequently function as mediators. The skillful use of mediation techniques can benefit not only the manager personally, but also the participants as a whole, in terms of maximizing value.

 

TEACHING MATERIALS:

For all parties:

• General Instructions

• Fact Sheet from Executive Summary prepared by hospital consultants

 

Role specifics:

Confidential Instructions for

• Dr. M. Mason, M.D., Chief of Medicine

• C. Marshall, Chief Financial Officer

• N. MacNamara, Senior Vice President of Nursing

• G. Bennett, CEO

• Dr. A. Parker, M.D., Senior Attending Physician

 

Teacher's Package (58 pages):

• All of the above

• Teaching Note

 

KEYWORDS:

Health care negotiations; multi-party negotiations; managed conflict inside the organization

 

SIMILAR SIMULATIONS:

Williams Medical Center

 

St. Francis Hospital and the Managed Medical Model Attributes

Time required:	3-5 hours
Number of participants:	5
Teams involved:	No
Agent present:	None
Neutral third party present:	Mediator
Scoreable:	Yes
Teaching notes available:	Yes