With the increased emphasis on collaboration rather than competition in the NHS, Tamara Hodgson offers practical advice on how to achieve win-win results for all parties
The concept of collaboration, and specifically collaborative commissioning, is not necessarily a new one in the world of specialised commissioning; but when I speak to professionals who work in this area today, they tell me that it’s turned into something of a buzz word or ‘hot topic’. It seems that there is a growing awareness that in some negotiation scenarios, being more collaborative makes good sense, without it necessarily being clear why or how.
What is collaborative negotiation?
Within my world of negotiation, collaboration has a very specific definition and meaning. Collaborative negotiation refers to the potential for all parties’ interests to be combined in ways that create joint value—or to put it another way, enlarge the pie. When you put it like that, the ‘why’ starts to become clearer.
With lots published information available on collaborative commissioning, let’s take a closer look at what it means and how we can decide between a collaborative or competitive strategy for negotiation planning, preparation, and execution. The Gap Partnership works with organisations across the globe to support them with their negotiation strategy. One of the key tools that we use is a six-stage strategic process. In this model, the emphasis is very much that the starting point in the process is understanding the endpoint. In the words of Canadian sociologist Laurence J Peter, ‘If you don’t know where you are going, you will probably end up somewhere else.’
At this point, it is worth defining what we mean by a collaborative negotiation strategy: ‘a conscious decision to pursue a joint agenda, focusing on a win-win approach or value creation.’ Equally, we need to define what we mean by a competitive negotiation strategy. A competitive negotiation strategy is ‘a conscious decision to pursue a self-interest agenda, focusing on a win-lose approach or value distribution.’
With these definitions in mind, commissioners can ask themselves some questions as to what is really meant when talking about collaboration in negotiation terms. These might include:
- do we really want to collaborate across all parties, or just with our commissioning colleagues?
- is it in our interest for the provider to be profitable, or are we just trying to drive the best possible price?
- do we have joint responsibility for outcomes, and is there an interdependency between the provider and commissioner?
As negotiators, we have the ability to choose either a competitive or a collaborative negotiation strategy, and carry out either of these through to completion with a set of appropriate tactical behaviours and actions. It is important if a commissioning team is issuing an invitation to tender (ITT) for them to consciously think about which negotiation strategy they are intending to use, and what behaviours to adopt to implement that strategy.
When is collaborative negotiation appropriate?
The objectives of specialised commissioning are to promote excellence and advance specialised healthcare for the whole population. One of the ways these objectives can be achieved is to have joint and/or integrated commissioning. The NHS Commissioning Board first published its draft collaborative commissioning framework for clinical commissioning groups in 2012, which examines in‑depth collaborative commissioning models to improve services and outcomes.1 Since then, there have been further additions and frameworks to act as guides in collaborative working across commissioning groups, the principles of which can also be applied to specialised commissioning. Choosing a negotiation strategy means evaluating the size of the pie. If the pie is only so big and it’s simply a case of how it gets distributed, then a competitive strategy and value-distributive approach would be chosen. If the size of the pie can be grown by parties coming together, then a collaborative strategy and value‑creation approach would be ideal.
Within the collaborative commissioning framework, a competitive negotiation strategy may be an option even when healthcare services are being commissioned collaboratively. Commissioners need to decide on either a competitive or collaborative strategy for their negotiation prior to embarking on the ITT process.
Every negotiation, regardless of collaborative or competitive strategy approach, can be divided into a series of interconnected steps. Systematically following these steps will dramatically increase the chances of success, and clarify the objectives before starting the planning (see Figure 1).
If the size of the pie can be grown by parties coming together, then a collaborative strategy … would be ideal
In its 2014 Model collaborative commissioning agreement: multiple contract option document, NHS England strongly encourages its commissioners to collaborate closely when negotiating and agreeing contracts with providers.2 It is important to differentiate between the collaboration of a group of commissioners to commission services and the strategy that is applied in negotiation to maximise the outcomes and total value. When choosing a collaborative negotiation strategy, an evaluation has taken place to ensure that there is opportunity for the creation of incremental value for all parties, a degree of common purpose, higher dependency, or even interdependency between providers and commissioners.
By starting with implementation at the planning stage, commissioners can start to map the deal and decide if the negotiation has a self-interest agenda or a joint agenda with a view to creating value for both parties. True collaborative negotiation will mean sharing with your counterparty what’s important to you, and by applying reciprocity, they should share with you what is important to them. This reciprocity in collaborative negotiation requires a true mindset shift from the negotiators, and makes it essential that trust is built within the provider– commissioner relationship.
In negotiation, there is no good or bad, right or wrong,3 just our ability to define the reference point for the negotiation and decide the appropriateness of either a competitive or a collaborative approach depending on the results that need to be achieved.
Figure 1: The six-stage strategic process
Less competition, more collaboration
The King’s Fund has looked at how commissioning has reorganised and evolved over the years and, in its blog,4 has explored the developments from the first NHS 5‑year forward view, which was published in 2014.5 This found a broad thrust of English health policy shifting from commissioners and competition to providers and collaboration. Using Jeremy Hunt’s words, moving from the purchaser– provider split to integrated provider models means fewer resources are used in complex contract negotiations.6 However, the consideration would be that collaborative negotiation is often more complex, taking more time and effort at every stage. There needs to be considerable trust‑building through the trading of information: the act of reciprocation starts to build trust and encourages collaboration from all parties. The phases of proposing, repackaging, moulding, and taking time to shape tangible and intangible variables demonstrates flexibility, helping to create joint value and collaboration.
… collaborative negotiation is often more complex, taking more time and effort at every stage.
Because of the specific complexities around specialised commissioning, ensuring high‑quality patient‑centric care and understanding the dynamics of the situation from inside the other party’s head(s)3 are necessary elements that will support collaborative relationships to become mutually beneficial and encourage long-standing partnerships. Competitive egos and concentrating on our own pressures and needs are often the biggest obstacles to achieving true creative collaborative outcomes in negotiation.
… the act of reciprocation starts to build trust and encourages collaboration from all parties.
Understanding creative conditional trading is essential. High‑value, low‑cost variables are key elements to successful cost and service efficiencies in negotiation. The planning and preparation of all trading concessions, mapping out the deal, and valuing these from the other parties’ perspectives will allow you the ability to create movement, proposals, and ultimately successful agreements.
- NHS Commissioning Board. A framework for collaborative commissioning between clinical commissioning groups, draft. NHS Constitution, 2012. Available at: www.england.nhs.uk/wp-content/uploads/2012/03/collab-commiss-frame.pdf
- NHS Standard Contract Team. Model collaborative commissioning agreement: multiple contract option. NHS England, 2014. Available at: www.england.nhs.uk/publication/model-collaborative-commissioning-agreement-multiple-contract-option/
- Gates S. The negotiation book: your definitive guide to successful negotiating. Chicester: Wiley, 2015.
- The King’s Fund. Commissioning is dead, long live commissioning. www.kingsfund.org.uk/blog/2019/03/commissioning-dead-long-live-commissioning (accessed 10 July 2019).
- NHS England. Five year forward view. NHS, 2014. Available at: www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
- National Health Executive. A balancing act: commissioning in the new world of accountable care. www.nationalhealthexecutive.com/comment/a-balancing-act-commissioning-in-the-new-world-of-accountable-care (accessed 10 July 2019).