Trained to Operate, Not to Negotiate · ACOS 2026
Five Moves for Monday
You don't have to remember any of it. Pick one move. Use it this week on something small.
Before any negotiation, three questions
What outcome do I need?
What relationship do I need when it's over?
What does this mean for the long game?
Every move below serves all three, or it's the wrong move.
The five moves
Find the location of the constraint.
Before you push on a wall, find out what it's made of. Legal requirement? Policy? This budget cycle? Departmental practice? Precedent? Someone's preference? The short form is two words: fixed by what? Until you know where the constraint lives, you don't know what you're negotiating.
Build your alternative before you need it.
One locums quote. One conversation with the system across town. One honest hour with the question: what would I actually do if the answer is no? An alternative is not an exit. It's knowing where your work and your energy go next. You almost never say it out loud, and it still changes how you sit in the chair.
Open with their problem.
Before any ask, write one sentence describing the problem the other person already has that your ask would solve. If you can't write that sentence, you're not ready to have the conversation.
Acknowledge before you counter.
One accurate sentence about their constraint, in their language, without conceding your position. Then reframe the question. The order isn't optional: a reframe before acknowledgment reads as a maneuver. One question does most of the work: what has to stay protected here, no matter what?
Never accept a number without a mechanism.
If today's answer is half, the counter isn't a bigger number. It's a review date, with criteria agreed now, in writing. Temporary money that nobody revisits becomes the permanent number.
The diagnostic: fixed by what?
| Legal requirement | Rare, and specific. Ask which rule, and what it actually requires. |
|---|---|
| Institutional policy | Written by people. People can revisit it. |
| Budget cycle | A timing constraint, not a permanent one. Ask about the next cycle, with criteria. |
| Departmental practice | How it has been done. Not how it must be done. |
| Precedent | Someone's earlier decision, still running. Ask who made it and why. |
| Preference | The most common wall, and the most negotiable. Usually unstated. |
Don't negotiate against a wall until you've found out whether it's actually a wall.
The HEAR approach
Built on a relational mindset: in healthcare, the person across the table is someone you'll need again.
Three rooms: the operating room (practice of medicine), the exam room (delivery of care), the boardroom (business of health). Same institution, three languages. Modern healthcare leaders have to become trilingual.
Continue the conversation
Stacey B. Lee, JDJohns Hopkins Carey Business School · Bloomberg School of Public Health
Tell me which move you tried, and how it went.
For educational purposes only; not legal advice.
© Stacey B. Lee, JD · Praxis Pacisci