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Renegotiating Health Care: Resolving Conflict to Build Collaboration (Book Review)

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By Leonard J. Marcus et. al

Jossey-Bass, 1995 San Francisco

272 Pages

ISBN 0-7879-0151-02

Written more than five years ago by a group based in the United States, this book is essential reading for all who want to make positive improvements to the Canadian health care system.

Starting from the premise that “health care work bursts with incongruity” the authors point out that “high volume, brief though intense meetings of great consequence typify the culture of health care negotiation”.

In case you are not feeling sufficiently daunted by the task ahead they also point out that “little control with full responsibility is a precarious and conflict ridden mix”. Finally, somebody who understands our predicament!!

Renegotiating Health Care is really three books in one. The major portion deals with the topics of interest-based negotiation (IBN), mediation, and conflict resolution as they apply to health care.

The second involves four essays that reflect the experience and practice of four individuals who have applied ADR theory and practice in their specific areas of expertise : public health and policy, management, nursing, and medicine.

The third “book” is an intriguing series of stories that intermingle with all chapters and that serve to illustrate some current problems and potential solutions in health care.

The field of ADR (Alternative, or as some prefer, Appropriate Dispute Resolution) is still relatively young in Canada. Significant experience and understanding has developed over the past 30 years in the USA. The authors do not try to provide an overview of the field but rather to apply some of the more pertinent lessons to health care.

Such a marriage of ADR with health care negotiation and change seems like a “natural” – the systems approach that is central to IBN reflects the interdependence that is central to all aspects of health care today. As well, the focus on discovering the range of interests of the parties to a negotiation is key to building integrative solutions to problems. As the authors note “if power is the only currency of negotiation then the options and actions are severely limited”.

Drawing on their extensive experience the authors provide many useful insights and concrete propositions to move the negotiation process in a positive direction. There are many practical suggestions that will help anyone involved in health care change.

One of the major themes of IBN, namely “expanding the pie” ( creating new or additional value in the negotiation process), is applied to health care systems. The process of creating (through brainstorming exercises) and subsequent refining of options is a tool that is not applied systematically in day to day activities involving the care of patients, whether at the micro or macro level.

A particularly striking and visionary contribution in the second “book” is provided by Velvet Miller, presently the CEO of a large HMO in New Jersey. Many of her observations can be easily “Canadianized” , as in her comment “we will have missed the opportunity if we assume that health care change is accomplished merely by way of insurance reform [ read: merely by way of a more equitable federal/provincial sharing of funds]”.

The parallels seem even more striking when Ms. Miller comments “stacking the discussion with the same cast of characters that brought us the current system would be an exercise in futility”. This raises one of the key points in all negotiations – recognizing who should be at the table and including all relevant parties.

This book is a human and gentle “call to arms” for all who want to address the problems in our health care system, particularly by using ADR to reduce the incongruity that exists between our purpose and the process of how we have been trying to accomplish it. The authors launch the challenge we must face when they ask “is it possible for people to negotiate based on their common purpose rather than merely based on their comparative level of power”?


Rob Robson

Dr. Robert Robson is Director of Patient Safety at the Winnipeg Regional Health Authority and is responsible for coordinating patient safety programs and initiatives throughout the region. He has recently been named to the Board of the Manitoba Institute for Patient Safety and served on the Minister of Health’s Emergency… MORE >

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