Negotiating with the NHS

August 2019 — #Fatima Ahmed

Negotiating with the NHS

This year, the Startup Leadership Program collaborated with the NHS Clinical Entrepreneur Program delivering 3 workshops for the Clinical Entrepreneurs. I was class CEO for one of those workshops, and reflect on the experience

 

Negotiation. Look it up in the dictionary and you’ll see it means the process of discussing something with someone in order to reach an agreement. In business it’s when two or more parties, each with their own set of objectives and needs, bargain to reach a common ground, in order to arrive at an agreement, resolve a conflict or settle an issue. Whether it’s negotiating bedtime with our young, or politicians trying to negotiate the best Brexit deal, or whether it’s a startup founder trying to negotiate how much of their company to give away to a VC in return for a much needed injection of cash and opportunity, the reality is, negotiation is woven into the fabric of our everyday lives. Done well, it can enrich our existence. Done poorly, it can lead to resentment and discontent.

I’ve always felt that my negotiation skills lacked, well, skill. In the past, when I was faced with an issue that required some element of negotiation I’d either avoid the issue altogether or accommodate the other party’s needs above mine. Not out of generosity or altruism, but because it was easier than pushing to get what I wanted. I recognised that the way I dealt with these situations in the past wasn’t particularly great, you might even argue, unhealthy. Being class CEO for the SLP’s workshop on negotiation was therefore a welcome opportunity, and one that I’d almost missed (I’d hesitated and volunteered late for the role). 

In preparation for the class I contacted two previous class CEOs for some advice; Max Desiatov and Marco Filippi. Both were incredibly helpful and offered interesting insights into preparing for and running the workshop. They also demonstrated the positive and collaborative nature that underpins the SLP’s ethos. They both willingly gave their time to help someone they did not know. It wasn’t until I spoke to, and later met with Steven Hess that I connected the dots, appreciating where their refreshing attitude came from. From the top down, the organisation has a passion for helping budding entrepreneurs succeed, something I quickly realised in my brief work with the SLP.

I was given a long reading list by both entrepreneurs. Two books that stood out were ‘Never split the difference’ by Chris Voss, who was an FBI hostage negotiator and ‘Getting to Yes’ by Roger Fisher and William Ury. I didn’t have time to read both so pressed Marco to recommend one. He suggested the former. I cannot recommend the book enough if you’re serious about the fine art of negotiation. The author goes beyond the science and examines human behaviour and how we make decisions. He argues that emotion, and not logic, can ultimately determine the decisions we make. I won’t give more away. Just read the damn book. I even tested some of his theories out during my preparation and to my surprise they actually worked.

I did a bit more reading around the subject to understand some key negotiation concepts such as BATNA and enlarging the pie and supplemented the material with some useful YouTube videos.

To get a gist for what the Clinical Entrepreneurs knew about negotiation, and what they expected to gain, I sent out a questionnaire for them to complete. The results were really interesting. Everyone wanted advice on how to approach investor/VC negotiations. What was also quite interesting was that the results revealed an underlying insecurity among the clinical entrepreneurs and that they perhaps did not fully appreciate the value they bought to the table. They wanted to learn “tactics” to get the best deal whilst protecting themselves from the same “tactics” that might be used against them. This suggested that they viewed negotiation as a battle, and one in which they did not have the upper hand. I made a mental note of this common sentiment, and decided I needed to make sure it was addressed.

I decided to invite negotiation experts to add value and enrich the session for the entrepreneurs. Dr. Sarvi Banisadr, a surgeon, founder, blockchain expert advisor to Parliament, and consultant for healthtech startups, discussed the power of empathy in negotiating. As someone with 15 years experience as a surgeon under her belt, she was the natural choice to come and speak to the clinicians wanting to pursue entrepreneurship alongside their clinical backgrounds. Sarvi’s session was incredible, and highly relatable. In addition, she candidly spoke of her past failures, and provided her very unique insights in how to conduct successful business negotiations. The kind of stuff you can only pick up through real world experience, which Sarvi has a wealth of. Dr. Mike Drayton, a clinical psychologist, organisational consultant with expertise in negotiation and conflict management spoke about the psychological nature of negotiation and how our perceptions, assumptions and unconscious biases influence the deals we negotiate, for better or worse. To demonstrate the biases that influence our behaviour he delivered an excellent practical negotiation exercise. We were required to split into pairs where one of us represented a theatre needing to hire an opera singer for an upcoming show and the other played the role of the agent representing the opera singer. We were required to negotiate a deal that was mutually agreeable to both parties.

The negotiation experts complemented each other, and indirectly addressed the issues I’d extrapolated from the entrepreneurs’ responses to my questionnaire. And that’s that negotiation shouldn’t be viewed as a battle where the goal is to win. That compromise isn’t actually the best solution. That you need to fully understand your value before entering into a negotiation, and, to feel empowered enough to walk away when your bottom line is crossed.

I’d planned to round off the session with another practical negotiation exercise that would allow us to implement the things we’d learnt from our experts. Unfortunately one of the experts inadvertently revealed the details of the game so I could no longer use it. Instead, I decided we’d do a group session to discuss what we’d learnt and answer questions. Steven and I addressed some of the revealing responses from my questionnaire, namely that a startup business is not just about the team’s relationship with a VC/investor. More importantly it’s about the customer or end user. They are the key stakeholder and they must be the priority if a startup company wishes to succeed. Addressing the needs of the customer, and negotiating great deals with them strengthens a startup’s position and will inform how deals go during funding rounds. We acknowledged that raising funds from VCs can be stressful and all consuming, but iterated that it’s only one aspect of the business.

Using healthcare as an example, the end user could be the patient. If a healthcare related startup fully researches what the patient needs and values, addresses those, and offers innovative solutions the rest will take care of itself. I’m reminded of an innovative and simple piece of software I’d come across whilst working on labour ward. A pregnant diabetic woman came in to triage with a medical complaint. When I asked about her blood sugar control she pulled out her phone and opened up this app that had detailed data in graph format that was easy to understand and interpret. What’s more, it alerted her partner of when her blood sugars were dangerously low, a phenomenon that could render her unconscious and critically ill. More importantly, the app empowered her to independently manage her chronic condition. My greatest surprise came when I learned she was willing to pay for the service. Even more interestingly, I learned that patient groups were pressuring government to subsidise this service, and make it free for all users. This company got it so right that it’s something I can see happening in future.

Key take home - focus on your customer, and the rest will follow.

Top 10 things I learnt as class CEO

  1. Negotiation is a dance, not a fight. Both parties can win. That doesn’t meant it’s synonymous with compromise. Compromise can lead to both parties feeling like they’ve been short changed, so neither has actually won anything.
  2. Shut up and listen. Do not have assumptions about the other party. Listen more than you talk so you can learn more about your counterpart and therefore negotiate the deal that you want.
  3. Know. Your. Worth.
  4. Once you know your worth, you can have a bottom line. Be prepared to walk away when it’s not met.
  5. Slow. It. Down
  6. Learn to say no, without actually saying no.
  7. Make the other side work for you and you can get them to bid against themselves. For more on this, read the Chris Voss book.
  8. That everyone needs to read Chris Voss’ book
  9. Deadlines are a figment of yours and your counterpart’s imagination. Don’t take them too seriously. The important thing is to not rush your negotiation process just to fit someone else’s deadline. On the flip side, you can use deadlines to your advantage, to get people to complete tasks for you by creating a sense of urgency. They can also help you focus and organise yourself. Key message - don’t let a deadline thwart your negotiation process. Go back to lesson 5, and slow it down.
  10. The only way you can learn is through practicing. You will make mistakes, and that’s okay. Dr. Sarvi’s account of her past failures was powerful and honest. It was also proof that you don’t learn as much through blind success.

Final reflections

So, am I negotiation expert now that I’ve completed the class? Far from it. I’ve got a long way to go. The class has armed me with the understanding of which specific skills I lack and why. Moving forward, I’ll continue to try and develop these skills I now know I lack with each future interaction that involves any element of negotiation.

But, perhaps the most important take home for me, was the entrepreneurial learning the process demanded. Negotiation as a specific skill aside, I appreciated what it takes to become a good entrepreneur as secondary outcome to organising and delivering the class. It’s learning through practise. Learning on the job. Doing the thing. Accepting that you’ll fail many times before you eventually succeed. That you’ll make lot’s of mistakes. I made plenty organising the class, ranging from not giving myself enough time to prepare, to logistical and organisational ones. And that’s okay. Being an entrepreneur doesn’t come through pouring over theory or obtaining a degree from prestigious universities like Oxford, although those things undoubtedly help. There comes a time where you have to put the books away and just do it. My background in clinical medicine meant I struggled to come to terms with this concept. A clinician scientist at heart I can’t help but try to study everything before taking my first step. I’ve slowly come to realise that this perfectionism, and fear of making a mistake, is obstructive to entrepreneurial learning. Unlike medicine, nobody will die if I make an error. This is what’s so great about the peer led Startup Leadership Program. You’re encouraged to work it out for yourself. You’re given the permission to make mistakes, to learn from them, to pivot, to make the absolute most of the resources you’ve got, however little they may be in order to eventually succeed. 

I’d like to give special thanks to Steven Hess, for being my Yoda, as I navigated uncharted waters. A mentor in the truest sense. And to Sarvi Banisadr, a breathtaking example of what great leadership looks like.