Interest-Based Problem Solving
for Collaborative Team
Leadership
John Gilvar
President, Gilvar Consulting Services
Barbara Conanan
SRO/Homeless Program Director, St. Vincent’s Hospital-Manhattan
National Health Care for the Homeless Conference
June 2009
A Team Leadership Approach to Change
• Much of HCH leadership time is devoted to
either creating change or adapting to it
• Managing the status quo is rarely helpful or
even possible
• The best teams
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See the whole playing field
Brainstorm creative innovations
Orient toward finding win-win solutions
Consider the practical consequences for all team members
Rarely arise spontaneously of their own accord
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HCH Directors and other HCH leaders are
by definition team leaders
• Effective HCH clinical models of care are team-driven
• Partnering with other agencies to form teams is
critical to long-term HCH leadership success
• Care
• Advocacy and Resource Development
• HCH leaders work to strengthen relationships within
and among multiple stakeholder groups
Staff
Consumers
Community Leaders
Funders
Executive Leaders
Partnering agencies
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Essential Dynamics for Effective Teams
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Sense of Urgency
Common Vision
Players feel heard, acknowledged, valued
Sense of shared mission that can trump anxiety
about hierarchy and power plays
• Collaboration ascends as a key value proposition
• Competition among competing stakeholder agendas
descends as a preoccupation
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Interest-Based Problem Solving
• Uses methods and tools developed in the
arena of mediation and dispute resolution to
help facilitators resolve and avoid conflict
among stakeholders
• Keeps brainstorming oriented toward win-win
solutions and creativity
• Provides a constructive framework with which
team leaders can facilitate collaboration in
making difficult decisions or solving problems
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Defining “Interest”
• Interests are fundamental needs that underlie
and drive the “positions” that stakeholders
take
• Interests are the goals that drive us to do the
work we do, to come to work in the morning,
ready to make a difference
• Interests are not the personal or
organizational agendas we bring to the table,
but the reasons we create those agendas
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Interests versus Positions
• Position: “Hospitals must be stopped from discharging to the
streets homeless patients who lack a place to recuperate and
are at risk of decompensating.”
• Some corresponding interests:
– The well-being of vulnerable members of our community
– The short-term and long-term costs to hospitals, taxpayers, and
the community as a whole associated with re-admissions, more
expensive treatments, and longer inpatient stays.
– Retaining HCH physicians, nurses, social workers and other staff
who experience intense professional frustration at seeing the
clients they care for needlessly develop complications and
become sicker
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Some Typical Interests for
HCH Executives
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Sustainability of the organization and its operations
Board and community confidence and enthusiasm
Staff satisfaction and retention
Growth and development among the people and
teams that make things go
• Increased harmony and consensus
• Satisfaction derived from making a difference
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Step-by-Step Meeting Process
1. Communicate about the Issues
Take the risk to open things up and invite opinions
2. Identify Interests
Tease out and record the interests of all stakeholders
Define the problem (decision) in terms of the interests of all
Be sure to articulate and record the interests of the organization as a whole
3. Generate Options
Don’t censor or edit at this point
Try to stay open to “crazy ideas”
4. Evaluate Options
How well do the suggested options address identified interests?
Focus on overlapping interests
Ensure organizational interests get their due
5. Develop a Plan for Moving Forward
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Why focus on Interests?
• The executive’s job entails one negotiation
after another
– Interests are much more likely to overlap than
positions are (find the common ground)
– Discussing overlapping interests paves the way for
identifying opportunities for mutual benefit (winwin solutions)
– Less time devoted to coping with conflict = more
time devoted to innovating, growing, learning
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The (Often) Missing Link
• Without a structure for identifying the interests of all
of the stakeholders and deliberately highlighting the
areas of overlap, processes for soliciting stakeholder
input often devolve into competitions between
preconceived agendas
– The energy of stakeholders gets spent on organizing to see
their position prevail rather than on creatively
brainstorming win-win solutions
– The interests of the whole organization get lost in the heat
of battle
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Collaboration Facilitator and
Captain of the Ship
• HCH leaders can wear both hats
simultaneously
– As the facilitator, she or he:
• leads the process of identifying overlapping interests
– As the captain, she or he:
• Articulates the interests of the entire organization
• Focuses the energy of teams on the areas where team
member (stakeholder) interests overlap with the
organization’s interests
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Interests as a Framing Tool
• Leaders who can frame the reasons for their
decisions in terms of the interests of the
organization as a whole can better avoid “We
versus Them” tugs of war
• More often than not the interests of the
organization as a whole significantly overlap
with the interests of stakeholder camps
– E.g., providers, nurses, board members, consumer
advocates
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Hierarchy is Not a 4-letter Word
• Without hierarchy, who will keep the
organization focused on the big picture and
ensure results?
• Mission
• Accountability
• Sustainability
• But well-defined hierarchy does not obviate
the need for team member buy-in
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Interest-based Labor-Management
Negotiations
• The Interest-based Problem Solving Approach:
– Establishes problem-solving as the first mode of
engagement before there is a need for grievance or
disciplinary action
– Decreases recurrent grievances, incidents, issues and/or
disciplinary problems
– Helps identify and implement projects that improve
patient care and the working environment for both Labor
and Management.
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Interests versus Positions in LaborManagement Negotiations
Positions
• Specific demands you make
to resolve a problem
• Do not explain why
• Do not help the other party
understand why you want
what you want
• Are often reactivate and
override your values
• A singular response to
satisfy your needs and
desires
Interests
• The reasons you want what
you want
• Explain why
• Help the other party see
things from your point of
view
• Responsive, based on values
you want to uphold
• Your needs and desires.
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Other HCH Decision Making Applications
• Locating a new service site and service model
• Clinical productivity issues/conflicts
• Negotiating with hospitals, mental health
providers, or other health care systems
• Resolving chronic or acute staff conflicts
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Summary
• Interest-Based Problem-Solving Advantages
• Preserves and enhances relationships
• Facilitates listening
• Provides a safe space for considering a problem or conflict
from all sides
• Produces a greater number of and more creative options
for solving challenging problems
• Better buy-in to decisions made
• Increased stakeholder confidence in leadership
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Additional Resources
• Getting Past No by William Ury
– Published by Bantam, 1991
• Harvard Program on Negotiation
– http://www.pon.harvard.edu/
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Contact Information
 John Gilvar, Gilvar Consulting Services
 john@gilvarconsulting.com
 360-349-9719
 www.gilvarconsulting.com
 Barbara Conanan, St Vincent’s Hospital
 bconanan@SVCMC.org
 212-604-2705
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