The Daily Dose • Thursday, June 3, 2021

Negotiating, Mediating and Facilitating in the Work Place: How to Develop and Employ Your Skills

Allison M. Janda, MD

This excellent campfire session, “Facilitate, Mediate or Negotiate: Do You Have the Skills to Successfully Engage in the Conversation?,” on May 15 at the IARS 2021 Annual Meeting, discussed effective facilitation, mediation and negotiation skills and how to manage teams through change, address issues and resolve conflict using these techniques.

Laureen Hill, MD, MBA, Senior Vice President & Chief Operating Officer for New York-Presbyterian and Columbia University Irving Medical Center, and Elizabeth Duggan, MD, Associate Professor and Director of the Professional Development, Culture, Wellness and Inclusion Collaborative in the Department of Anesthesiology and Perioperative Medicine at University of Alabama Birmingham, moderated this session.

Dr. Hill opened by presenting a few scenarios that demonstrate the role of effective facilitation, mediation and negotiation to address a situation and introduced the first panelist to first discuss facilitation.

Dr. Duggan focused on facilitation during her talk, defining facilitation as “a communication process in which a guide (facilitator) leads a group of people through an open discussion as a means to understand their common objectives, put forth mutual goals, and inclusively design a plan to actualize an outcome.” She emphasized that an effective facilitator must be a neutral party without a position or interest in the outcome to facilitate trust and reconcile the group’s interests, not their own. An effective facilitator must also actively listen, diffuse disruptions, perceive and manage emotions and uphold expectations and accountability of the group. Promoting team emotional intelligence has positive effects on team trust and was positively associated with building a positive culture. A skilled facilitator should also ask questions and avoid multitasking or overplaying their own expertise.

Dr. Duggan explained that it’s about the process, not the content, and it is important to concentrate on the person, not your own words while serving as a facilitator. Facilitation techniques work best when the climate is supportive of change, the resources exist to address this change, the participants are receptive and organizational values align. She outlined guiding principles for facilitation which include establishing a common purpose and cultural mindfulness, promoting equal participation and mutual understanding, focusing on building or developing the conversation instead of asking pointed questions, and developing a team mentality, motivation and ownership of resolving the issue. She elaborated that converting formal power to shared power can help change individual interest to group engagement. Dr. Duggan also encouraged facilitators to create a team mentality by fostering trust and coaching team members to develop open communication and promote conflict resolution.

Facilitation works because it is neutral and allows all voices to be heard and promotes a transparent decision-making process. This procedural justice is positively correlated with improved work attitudes, job satisfaction, organizational benevolence, supervisor legitimacy, outcome favorability and perception that the voices of individuals are heard and included. Dr. Duggan emphasized that facilitation is a key professional skill and that the role of a facilitator must be chosen carefully and taken seriously to promote effective facilitation.

Caitlin Sutton, MD, Assistant Professor and Division Chief of Maternal-Fetal Anesthesia at Texas Children’s Hospital at Baylor College of Medicine, presented on mediation to help move groups from conflict mode to problem-solving mode. She defined mediation as “a process for resolving disputes during which an intermediary helps conflicting parties have a conversation to jointly resolve their concerns.” Mediation is specifically intended to resolve conflict and should be considered if people are capable of participating constructively, desire resolution and if all stakeholders are represented. Dr. Sutton also suggested picking a different technique or format if parties are not willing to engage, not empowered to make decisions, have a wide power differential, serious concerns are involved, or if public attention, investigation or disclosure are needed.

The goal of mediation is to focus on future instead of past behavior and creates emotional relief to find a pragmatic approach to moving forward and working together. Skilled mediators help manage the three emotional components of cognitive, physiological and behavioral factors. They watch for signs of tensions within these domains and use techniques such as listening without questions, finding commonalities, redirecting, reframing, caucuses and helping parties save face. A good mediator is an individual who has no stake in the conflict or outcome, can build rapport, is patient and creative, and having some background in the field or topic of interest is typically beneficial. The process of mediation is also very important. Dr. Sutton explained that after an introduction by the mediator, unencumbered opening remarks occur during which each party takes a turn speaking. Then, the mediator leads an exchange during which an open discussion takes place and questions are asked, followed by a topic and synthesis by the mediator to help parties talk through possible options and find a workable solution. The final step of a mediation is to review the decisions made during the session, iron out the details and assess whether the solution is workable. Best practice includes setting a supportive tone, effective and fully present listening without bias, providing impartial empathy, attempting to mirror their responses or emotions without taking sides, reframing to focus on shared goals, and avoiding persuading the parties of anything or giving advice. Dr. Sutton closed by emphasizing the importance of selecting an effective mediator, key benefits of mediation and best scenarios for applying mediation techniques.

Kathy Rogers, JD, from Emory University School of Law, is a trained mediator and arbitrator and spoke specifically about negotiation. She emphasized that anyone can negotiate and that we’ve all been negotiating since early childhood. She explained that negotiation should be used when the relationship warrants an informal approach, when little or no emotional catharsis is needed, when time does not allow for a formal process, or within a formal structure such as mediation. Situations where negotiation is not effective include those for which the potential benefit isn’t big enough; you do not trust the other party to honor a deal; the act of negotiating hurts your representation or long-term goals with that party; or the act of negotiating confers legitimacy of your counterpart and you do not want to legitimize their position. There are two approaches to negotiation: distributive bargaining and integrative bargaining. The distributive bargaining approach is fixed and binary, resulting in a zero sum result. The integrative bargaining approach creates joint value and an enlarged bargaining zone or deal where one may not exist otherwise.

There are many considerations before negotiating, the most important are: best alternative to a negotiated agreement (BATNAs), reservation points and relationships. Ms. Rogers then presented a negotiation preparation chart which includes goals and points raised by each side to help increase the understanding of the opposite party and therefore increase the chances of a successful deal or result. She emphasized that it is important to include internal and external preparation to better understand your counterpart’s views, goals, and wants to maximize your potential for a successful negotiation. BATNAs are important to examine prior to the negotiation and to prepare, you should list all of the alternatives to your desired agreement so you can choose the next best option if the deal at hand falls through.

The reservation point is the most a party will pay (in some form) to obtain a value item through negotiation or the least they will accept to give up a valuable item. In most scenarios, different sides typically have different reservation points since they are set by intangible components such as emotion and personal significance. Dealing with emotions during negotiations can be challenging but one primary tool is the addition of sincere, meaningful apologies. Other considerations include implicit bias and power differentials and it is important to identify these biases and differentials ahead of time to best address them and treat everyone with respect. However, Ms. Rogers did add that if a person’s biases result in them underestimating you, feel free to use that to your advantage during the negotiation. She also emphasized the importance of preparing prior to any negotiations to maximize the likelihood of success. She closed her talk by summarizing the various types of communication of facilitation, mediation, and negotiation and how they differ by the content that is discussed, the degree of neutrality, and how emotions are handled.

The three excellent talks were followed by a content-rich question and answer session with the panelists. They dove into topics including bluffing, the role of gender in bargaining and conflict resolution, dealing with parties who may be unwilling to participate in facilitation, mediation and negotiation, maintaining trust through these techniques amongst parties, and managing bias. The panelists encouraged reaching out via email with any further questions.

Encourage, stimulate, and fund ongoing anesthesia-related research projects that will enhance and advance the specialty, and to disseminate current, state-of-the-art, basic and clinical research data in all areas of clinical anesthesia, including perioperative medicine, critical care, and pain management. The IARS is focused solely on the advancement and support of education and scientific research related to anesthesiology.

A&A
OpenAnesthesia
A&A Case Reports
SmartTots

IMRA Awards

This award is intended to support investigations that will further the understanding of clinical practice in anesthesiology and related sciences. Up to four research projects are selected annually, with a maximum award of $175,000 each, payable over two years.

International Anesthesia Research Society
90 New Montgomery Street, Suite 412
San Francisco, CA 94105