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What's the most important skill you didn't learn in dental school?

Feb. 1, 2003
Getting what you want means helping other people get what they want.

by David Verity, DDS, MBA

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It happens every day. It's costing you thousands of dollars, and hours of grief and frustration if you're not doing it well. It happens when you're talking to Mrs. Silva about getting that bridge she needs but keeps postponing. It happens when the hygienist and the front-office assistant come to you — at odds with one another — and each expects you to tell the other one that she is wrong. It happens when you go to hire a new chairside assistant, talk to the lab about the bill for Mr. Salazar's ill-fitting crown, buy that new piece of equipment, sell your practice; it even happens when you set a time with your friends to hit the links. Whether you realize it or not, whether you like it or not, you are negotiating. We all spend a lot of time negotiating. If you think about it, everything you want is either owned or controlled by someone else. The question is how much will you pay or give up to get it. The answer lies in your ability to negotiate.

Important distinctions

Most people would say that successful negotiating means getting what you want, but that is only partly true. Winning negotiators understand that both parties need to believe they walked away from the table with some of the things they wanted. For example, the guy who sticks a gun in your ribs and demands your money gets what he wants — your wallet — but I doubt you would feel very good about the exchange.

As dentists, we are trained not to negotiate. Think about it. Can you negotiate with a disease, a surgical site that is not healing, or an ill-fitting crown? Of course not. Our training taught us how to deal with and solve clinical problems. But, how much training did you get on dealing with and solving people problems? You cannot negotiate with disease or unexpected outcomes, but you can negotiate with the patient who has the disease, prolonged discomfort, or is frustrated because a crown will have to be remade. Almost anytime you deal with people, you are negotiating.

The good news is that you can improve your negotiating skills by understanding the principles of negotiating and practicing them. You can be better equipped to discuss the topic of a raise the next time an assistant demands one, or when Mrs. Johnson insists she can't get her veneers because "they cost too much."

Rules for effective negotiating

The most important concept of negotiating is that you can get anything you want if you help other people get what they want. With that in mind, let's look at three critical elements for effective negotiating.

First rule: Establish criteria. Find out what the other person wants even if you are pretty sure you aren't going to like what you hear. Then, state what you want. Not long ago, I was called in to talk to a client's patient who was threatening legal action and had written a scathing letter to the Board of Dental Examiners. The patient was irate, because during a procedure the doctor discovered that the tooth being worked on needed a root canal rather than just a filling. The patient agreed to have the procedure done since she was already numb and had the rubber dam in place.

After the procedure, she was informed that she needed a crown and that it would cost several hundred dollars more than her insurance would cover. She also was told that she would have to pay for the treatment before the crown was seated. In hindsight, the dentist realized that things could have been handled better. He was concerned that the patient not only was going to sue him, but also would tell other patients and potential patients about it as well.

When I met with the patient, I started off by asking her what she thought should be done. I was pretty sure she had been asked that several times before, but I have found it valuable to hear it first-hand. She was very upset and talked around the question for about 15 minutes, but she eventually told me. To my surprise, all she wanted was to pay for the extra treatment over a six-month period so she didn't have to borrow the money! Apparently, no one in the office had asked her what she thought would be fair. We worked out a payment plan and scheduled her for treatment. The doctor sings my praises as a fantastic negotiator, but I simply followed the first rule of negotiating — find out what they want.

Second rule: Get as much information as you can. This is where most negotiations fail. Get to know the people involved. Find out what is important to them and what other issues exist — there is always more at stake than is initially discussed or apparent.

Good negotiators have learned to get as much information as possible. They want to know about the people involved, not just the cold facts of the situation. What is important to them? What are their core values? By asking questions, you can find out information that will be invaluable later on. Poor negotiators want to jump to the bottom line too quickly and "drive a hard bargain." They want to appear to be in control; to have all the facts. This is not the time to assume anything. Don't jump to conclusions or it will cost you!

Ask the other party to tell you about their point of view. Allowing them to talk about themselves shows that you are interested in their concerns. People are then more willing to listen to your position if they feel that you have taken the time to listen carefully to them and made an attempt to get to know them.

In his book, Seven Habits of Highly Effective People, Stephen Covey puts it this way: "Seek first to understand, then to be understood." It is always beneficial to create a little positive energy by getting to know the person(s) with whom you're negotiating. Even if you already know them well, take the time to dig deeper. Remember that you are really trying to uncover issues and information that will be valuable when trying to reach an agreement. Find out what is important to them — their concerns that are you willing to concede in the final agreement.

Seek out other issues, problems, or concerns to be solved. At first glance, it may seem counterintuitive to be looking for more problems rather than solving the "key" issue. It is essential that you never narrow the negotiation to one issue — like price — because if you do, you have set up a situation where one of you has to lose. The more issues to be resolved, the better your chances of getting what you want.

Getting to know the people with whom you are negotiating allows you to determine their personality types, read their body language, and gather other personal clues. Personal insights, information about what is important to them, and discovering any hidden agenda give you a powerful advantage in the home stretch of your negotiations. Time spent gathering this information is time well-spent.

Third rule: Structure the agreement. Crafting a successful agreement is a lot like playing chess. Good players learn a number of strategies called "gambits." The real game is learning to use these gambits to win. There are many gambits in negotiating. Although there isn't enough space here to explore all of them in detail, we'll look at a few to get you started.

Higher authority

You have probably used this tactic many times. A friend telephones and asks you to come to a social gathering on Friday evening. You don't really know if you want to go, so you say something like, "That sounds fun. It would be great to get together, but let me talk to my wife to be sure we are available that evening."

You've seen higher authority used by patients when you are presenting a treatment plan. Everything is going swimmingly until you ask Mrs. Jones when she would like to schedule an appointment to begin treatment. She replies, "It sounds good, but it's a lot of money. I will need to talk to my husband about it and get back to you." It may just be a matter of time before she calls to schedule her appointment for those six veneers and two all-porcelain crowns; but, more likely, she won't call at all. So how do you deal with the resort to higher authority? Remove the option at the outset by making sure the decision-makers are present.

When scheduling the consultation appointment, you might ask, "If this proposal meets all of your needs, will you be able to make a decision today or will you want to discuss your treatment decision with someone (husband, wife, girlfriend, brother)?" It is a lot better to deal with this at the outset than to think everything is on track only to be derailed at the very end. Make sure you have the decision-makers present before you begin, or they will delay the decision using higher authority.

This tactic is so prevalent that even when you have taken measures to ensure that the decision-makers are present, they still may come up with a higher authority like "Uncle Bill," whom they may ask for money, or their elderly, but wise, parents who live out of state. All is not lost. Try these two questions as countermeasures:

1. "They usually follow your recommendations, don't they?" For some personality types, this is very effective and all that is needed.

2. "You will be sure to tell them the reasons this is important to you, won't you?" Getting them to commit that they will positively recommend your plan is a big psychological advantage. The key is in how they present it. For example, they could tell their higher authority, "This is a really good plan and I think we should do it. Let me tell you about it." On the other hand, the response could be far less favorable if they say, "What do you think about spending seven thousand dollars on my teeth?"

To this point, we have only discussed how higher authority can be used against you. Because it is so effective as a negotiating gambit, you will want to learn the many ways it can be used to your advantage. The key to remember about higher authority is to always maintain your own, but remove the ability of others to resort to it.

The set-aside technique

This is especially effective in getting beyond what seems to be an impassable barrier. Suppose you have a staff member approach you at the end of the day who says that she has been thinking about how much you pay her and that it is not enough. She has talked to her friends and has decided she won't work for anything less than X dollars an hour. Assuming she is worth keeping — but that you are not prepared to pay her as much as she is asking — you could use the set-aside technique. It would sound like this: "I understand your desire to earn more per hour, but let's set that aside for the moment while we discuss the other areas of your compensation package." You would talk about the other things that are important to her such as childcare or time off. You would show her that by increasing her contribution to her 401(k), she would pay less in taxes. You could agree to pay for a special training course she has wanted to attend. You get the idea. By resolving the little issues first, you can establish some momentum. Psychologists in Canada showed that we are more likely to agree on bigger issues after we have agreed on smaller ones.

Feel, felt, found

Whatever you do, don't argue. Arguments force people to defend their position. Agreeing with them diffuses the tension and makes them more willing to consider your point of view. Here is an example of how you might use the feel, felt, found technique.

Let's say an adult patient doesn't want fluoride after getting a prophy. He may say, "I've been told that fluoride is for kids. My teeth are fully grown and wouldn't benefit from fluoride." He might even add, "You're just trying to pad the bill."

Although your first inclination would be to defend your position, it is better not to argue with patients. Many of us will launch into an argument without even realizing it. Instead of arguing, you could say:

"I understand exactly how you feel about fluoride. In fact, I felt the same way and used to tell my patients the same thing you have been told in the past. However, we have found that adult patients who receive fluoride don't get sensitivity to cold, hot, or sweets as they age. We also have found that they don't get cervical or root decay, which is the most common form of decay in adults." Using this technique, you make patients want to listen to you without embarrassing or demeaning them by proving them wrong or arguing with them. If they are defensive, they are not listening to you; instead, they are thinking about how to respond to your "argument." As my father used to say, "A man convinced against his will is of the same opinion still."

Getting results

The key to successful negotiations is not to dominate the other party, but to achieve a win for them also. You can get what you want from people by determining what they want and giving it to them, not by overpowering them.

Winning negotiators evaluate their success by these five standards:

• Both parties come away feeling like a winner.

• Both believe they each cared about the objectives of the other.

• Both feel that each side was fair in the negotiations.

• Both feel that they would enjoy dealing with the other in the future.

• Both believe the other party will uphold their side of the agreement.

Realize that every person acts in his own self-interest, and must, therefore, be motivated from that base. In order to reach a workable solution, the winning negotiator respects the needs and values of his opponent and works actively to satisfy those needs as well as his own.

Practice these skills often in everyday situations. Before long, you'll realize you've acquired a surprising amount of control in dealing with other people. Remember, you can get anything you want if you help enough other people get what they want.

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