Next post reserved for posting discussions out of the negotiating rooms.
Should be fun. I'm not posting confidential instructions here so that lurkers can have fun figuring out who's after what as well.
Sides:
Bennett, CEO -- Myki
Marshall, CFO -- Vnosikov,
MacNamara, Vice president for Nursing -- Gavagai
Mason, Chief of Medicine -- AdrienIer
Parker, representative senior attending physician -- Rho21
On the table:
ISSUE I. SHOULD THE MMM BE EXPANDED TO ALL INPATIENT SERVICES IN THIS BUDGET YEAR? SUCH A CHANGE WILL REQUIRE MAJOR ORGANIZATIONAL RESTRUCTURING, AS WELL AS BUDGETARY CHANGES. THESE ARE OUR OPTIONS:
Option A. Expand the MMM in its current design to all inpatient services in this budget year.
Option B. Create a fully collaborative physician-nurse management model instead of the MMM. This will take at least a year and could create significant conflict in many areas of the hospital.
Option C. Increase the nurses' role in an amended MMM and then expand to all inpatient services a year from now. Use the year to reinforce the nurses' increased administrative and medical role, through cross-disciplinary planning and training.
Option D. Do not expand the MMM; continue it just as a demonstration.
ISSUE II. IF THE MMM IS EXPANDED, EITHER NOW OR IN ONE YEAR, WHO WILL HAVE THE FINAL DECISION ON PRACTICE NORMS?
Option A. Administrative Model. Physician practices must meet national DRG and cost-efficient norms; a minimum of outlier cases will be tolerated. Decisions will focus on potential fiscal impacts and cost savings, with heavy emphasis on better use of medical staff. Final decisions on practice norms will be determined by the chief of medical staff, the CEO, and the CFO.
Option B. MMM Model. All physicians on the medical staff (including the attending physicians) will establish and apply the norms. Case records will be reviewed by the medical chief of each department, and broad categories of accepted performance for outliers will be allowed.
Option C. Potential MMM Model, with increased role for nurses. Hospital norms of practice will be determined by a multi-disciplinary team of physicians, senior nurses, and ancillary service representatives, and will be approved by the CEO. Nurses will have input into treatment and discharge decisions, and will be accountable for bedside decisions if a physician is not available. Case records in each department will be reviewed weekly by a departmental multidisciplinary team.
ISSUE III. IF ST. FRANCIS ADOPTS SOME FORM OF THE MMM, WHO SHOULD TAKE THE LEAD IN TRAINING OTHER MEDICAL SERVICES IN THE HOSPITAL-WIDE IMPLEMENTATION OF THE MODEL?
Option A. This is a quality-of-care issue for patients and staff alike. It is a perfect role for nurse managers to show their professional leadership and skills in working with other medical professionals.
Option B. This is a financial management issue. The CFO and the MIS staff should train medical staff -- physicians, nurses, and ancillary services staff -- in how to initiate and maintain appropriate records.
Option C. Chief of the medical staff and the chief of medicine should plan and manage this important transition. Physicians are responsible for medicine, and they should be the leaders in explaining any new medical management processes throughout the hospital.
Option D. The CEO is responsible for integrating financial and quality-ofcare issues at St. Francis. It's up to the CEO to decide on the appropriate process.
ISSUE IV. IF AN EXPANDED MMM IS ADOPTED -- EITHER IMMEDIATELY OR IN ANOTHER YEAR -- SIGNIFICANT ADDITIONAL BUDGETARY RESOURCES WILL BE NEEDED OVER THE NEXT FEW YEARS. THIS MEANS THAT TOUGH DECISIONS HAVE TO BE MADE ABOUT NEW BUDGETARY PRIORITIES, BECAUSE THERE WILL NOT BE ENOUGH MONEY TO DO EVERYTHING. THESE PACKAGES OF PRIORITIES ARE APPROXIMATELY EQUIVALENT, ALTHOUGH MOST PROPOSALS TEND TO REFLECT THE DIFFERING INTERESTS OF DIFFERENT HOSPITAL CONSTITUENCIES. THE BOARD EXPECTS BENNETT, AS CEO, TO RECOMMEND PRIORITIES REGARDING NEW EXPENDITURES. BENNETT, IN TURN, NEEDS TO GET AGREEMENT FROM THE PARTICIPANTS AT THIS MEETING. THE OPTIONS THAT HAVE BEEN PROPOSED ARE AS FOLLOWS:
Package 1 MIS coordinator and technicians * Physician administrator for the MMM * New equipment for the operating room * Nurse discharge coordinator
Package 2 Dollars for nurses’ salaries and staff upgrades * Nurse co-administrator for the MMM * Nurse discharge coordinator * MIS technicians, but under nursing supervision
Package 3 Physician administrator for MMM * New operating room * MIS coordinator and technicians
Package 4 CEO flexible fund and final budget decision making * Physician administrator for MMM * Nursing salaries and staff upgrades * MIS technicians
Bennett, CEO -- Myki
Marshall, CFO -- Vnosikov,
MacNamara, Vice president for Nursing -- Gavagai
Mason, Chief of Medicine -- AdrienIer
Parker, representative senior attending physician -- Rho21
Parker-Marshall
Parker: Afternoon, how are you today?
Marshall: I am fine, thanks. How are you? I’d like to begin with a clear question. Is there any chance, you are going to support MMM?
Parker: I'm well, thank you. I see you're aware of my distaste for the MMM. While I would rather we proceeded no further with it, I might be persuaded to support it with appropriate amendments. An expansion of the current MMM is simply not acceptable to me.
Marshall: What do you have in mind?
Parker: My preference would be to leave the MMM as a demonstration for now. Mason is welcome to have it apply to his department, but I think there are significant flaws and wouldn't want it to apply to all physicians. If it must be expanded, I would favour adding a minor role for nurses, but I won't be agreeing to even that without significant concessions elsewhere.
Marshall: Well, I can’t agree to this. MMM should be expanded. Can we reach some agreement given this? I am ready to amendments on other issues. I know you need an operation room. We can start here
Marshall: So, could you imagine a scenario where you could agree on immediate MMM expansion (Issue-1, option A)?
Parker: To put it simply, while a new OR is very much needed, I shall be looking elsewhere for employment if St Francis ends up expanding the MMM in its current form. I could be persuaded of an amended MMM (Option C), but I'd want your support on other issues, particularly about doctors making the decisions on practice norms.
Marshall: I see. Would you for example agree on CBDC?
Parker: Almost. I'd prefer that we agree on the issue of training in this meeting, rather than just handing the decision to Bennett to make later. I'd be willing to agree on CBCC or CBAC. Would either of these options be acceptable to you?
Marshall: CBCC is barely acceptable for me. It's definitely not that I'd prefer but I could live with it. It is reassuring to know that we have some common ground. But to be clear, at this moment I am not making any exact proposal, I am just trying to find out , what are your thoughts on the subject.
So just to be clear III-D is not an option for you? It looks like a reasonable compromise from my point of view.
Parker: III-D is very unpalatable. I'm not sure I'd consider it even if it were the only way to reach an agreement. Anyway, I'm pleased we've had such a productive discussion. I was afraid your priorities might leave us little room for compromise. I should go and talk with Mason now. If the three of us can agree on a plan, perhaps we can convince Bennett or MacNamara to follow along as well.
Marshall: Yes, thanks for a productive meeting. Bye.
Marshall: I’ll cut, paste and send our discussion when you vacate the room
Parker: OK, leaving now.
Mason - Parker
Parker: Hello Mason, are you in here?
Mason : Yes I just arrived
Should we just get to business ?
Parker: Yes. While I don't like all aspects of the MMM, I'm sure as fellow physicians we can agree wholeheartedly on many of the issues. A largely united front should significantly strengthen our position.
Mason : Absolutely
Especially when there are issues like the new OR which we both wholeheartedly want.
Did you discuss that with Marshall ?
Also, there's the third issue where I think we'll both agree that physicians should be in charge of training people into the program.
Parker: Yes, I'm in favour of physician-led training. I assume, as author of the MMM, you are in favour of the status quo on the second issue, as well. That is to say, physicians having the final say on practice norms. It’s unthinkable that such an important medical process could be assigned to financiers!
Mason : That would be fine yes. I hope said financiers won't demand to have the final say. My general position is that we need 4 out of 5 people to agree. While The nurses do a fine job, and MacNamara most of all, we can easily find an agreement with Marshall and Bennett.
You haven’t mentioned whether you’d be ok with a simple generalized MMM (aka option A of issue I)
Parker: To briefly go back to your earlier question, I did talk to Marshall about the possibility of a new operating room, yes. He didn't seem as reluctant as I was expecting from someone with such a reputation as a cost-cutter. Perhaps his priorities lie elsewhere.
Parker: Also, I'd be a little wary of cutting MacNamara out of the deal entirely. The hospital is renowned for its nursing, and we wouldn't want all our excellent nurses to go elsewhere. Perhaps some minor concessions can be made to nursing to bring her in on our side.
Mason : MacNamara won’t be happy about package 3 for issue IV. But the other 4 will probably want that. Same with issue III if we go with option C.
Parker: Yes, I can see the possibility of an agreement. Perhaps it will work out that way.
Parker: So, to issue 1. I'd been avoiding it, honestly, as I feel it's likely to be the one place we disagree, and I was hoping we could see how agreed we are other issues before tackling it. I know it's your baby, but I feel strongly that there is room for improvement. I expect you've seen the full SHY report, so you can see why I'm concerned. I am very worried that chasing targets will lead to pressure on physicians to make choices that are not in the best interests of their patients.
Mason : The problem is that if the finances don't get any better Marshall will get a free pass to deciding everything. Including on the stuff we both agree on, like issues 2, 3 and 4. This is our chance of making the financials happy while keeping control over most of the medical stuff.
We can’t do our job if the hospital closes
Parker: I'm afraid that I'm totally opposed to the MMM being expanded in its current form. Honestly, I'd rather see it remain a demonstration indefinitely unless my concerns can be addressed, but I could be convinced of an amended MMM, perhaps with a minor role for the nurses. This is one reason I'm interested in MacNamara as a potential ally, as I'm sure she could join us in this option. What are your thoughts on this relatively minor amendment to the existing plan?
Mason : I don't like it much. Nurses aren't physicians, and while I could agree to give them some responsibilities option c goes too far.
So you’re opposed to an A-B-C-3 option pack ?
Parker: Yes, I’m afraid so. C-B-C-3 would suit me much better. Not that I’m a great fan of C for the first issue, but I can’t imagine we could find any common ground on my preferred option of D.
Mason : What if Bennett or Marshall ask for something else ?
II B and III C might not suit them. We could be forced into II A (III is more complicated because Bennet and Marshall will be divided on it)
Parker: I think, based on my initial conversation with Marshall, we might be able to agree C-B-C-3 with him as well.
Mason : Ok we need to talk to Bennett, I want to do it but if you really want to talk to him I could pass the time by talking with Marshall.
Parker: I’m sure we’ll both have the opportunity to talk to both of them in time. I’m happy for you to talk to Bennett next.
Mason : Good. I’ll erase the page now, ok ?
Parker: Yes, go for it. Bye.
Mason : Bye
Mason - Marshall
Mason : Hello Mr Bennett
Or rather hello Mr Marshall then.
Marshall: Hello. How was your talk with Dr Parker?
Mason : It was useful, and it made us craft a draft for a possible solution. Since he had talked with you already you may not be opposed to it (at least that’s what Parker implied) but Bennett might be more difficult.
But I’m not 100% certain that I can trust his words on your positions. He explicitly said that you would agree to C-B-C-3
Marshall: I am afraid he is too optimistic about my intentions. True, we discussed possible outcomes in a search for a possible common ground. It does not mean I am going to support any plan that started with I-C at least when other options are still on the table. I believe you are more interested in this outcome too. Also why do you think, Bennet will oppose that agreement?
Mason : II B III C IV 3 is very pro-physicians. I can’t be sure that Bennett will want that. Actually, unlike with the other 4 I’m not sure what Bennett’s ultimate goals are.
Marshall: That’s true. It is a shame I had no chance to talk with him
Marshall: I can agree with II B III C IV 3 if I is A. As far as I understand that’s unacceptable to Parker. But what do you think about I-A?
Mason : I-A is what I’d like too, but I have to be realistic. Parker said that A was out of the question, even with the rest of the things he probably wants (B-C-3). In my mind there are now two options : either some kind of C-(A or B)-C-3 that cuts off MacNamara or something else that starts with A (without Parker). But how could we get MacNamara to agree with A ? I don’t want the nurses meddling with purely medical concerns.
Marshall: You can be sure in my full I-A support. Maybe we can build the coalition without Parker. Also if we make I-C I think we can get MacNamara on board, so maybe we will not need Parker in this case. Could you also tell me about your other preferences?
Mason : If we need to get MacNamara on board we could give her IV 1 instead of IV 3. Maybe we could use II-A to get Bennett on board if he proves to be difficult. I’m sure you’ll agree with that.
Marshall: So we are talking about something like AACA? Sorry didn’t see my notes, so I could miss
Marshall: Or ACDA. Or ABDA
Mason : I’ll insist on C in issue III.
Marshall: That’s fine by me
Mason : AAC1 would be fine yes. I don’t expect MacNamara to agree but we could try.
Marshall: Would you consider II-C to make on offer better for MacNamara? Of course it depends on Bennett priorities, which we still unfortunately don’t know
Mason : Not unless I get IV-3, which MacNamara won’t like either.
(sorry getting confused with the numbers)
AAC1 or ACC3 is the best I can do. I hope you realize that, while I want option A going ACC1 is going too far
Marshall: Sorry I am a little confused too.
Marshall: Do I get it right, that issue I is third-important for you? Or is it second?
Mason : Issue I is important, but I think we both agree that we want A >> C, and that the rest is mostly unacceptable. Hence why I didn’t discuss it much after you said you wanted A.
Mason : Is it your most important ?
Marshall: You evade my question and expect that I will answer
Marshall: I am just contemplating, how large are chances that you go I-C if everything else will look good to you
Marshall: Sorry my bad I wanted to write I-C
Mason : Not very subtle of me wink
Mason : I’ll take I-C as a last resort.
Marshall: That’s my position too
Marshall: I think if MacNamara and Parker are smart they’ll try to stay on I-C whatever the pressure on them will be
Mason : you mean I-C
Marshall: Of course. I miswrote again
Mason : Probably. That’s why I’m hoping for either A if MacNamara isn’t too stubborn on C or going C-A-C-3 which might even be acceptable for everyone. I assume that issue IV is not very important to you, and it might be important for MacNamara so we might be forced into 1
Marshall: Option IV is quite important for me
Marshall: Let’s assume we are forced to I-C. What other agreements would you prefer?
Mason : CAC3 would work, or maybe CAC1 if MacNamara insists.
Marshall: I also will insist on the CAC1
Marshall: Option III for you is out of compromise, isn’t it?
Mason : Do you mean issue III ? Because I want issue III to be C.
Marshall: Yeah I meant issue III. Would you consider III-D?
Mason : I’d consider B if I get some compensation. Like I A or IV 3.
Marshall: I see. It looks to me that if we go I-C we can have better outcomes that Parker proposed
Marshall: But of course I still prefer I-A
Marshall: Something like AAC1
Mason : AAC1 would be great, even though Parker will 100% never agree to that. I want to talk to MacNamara to see what can be done.
Marshall: Great. Looks we are on the same page here. I become unavailable soon, but try to speak some hours later with Bennett or somebody else
Mason : Ok let’s close this for now. Bye (I’ll do it)
Mason - MacNamara
Mason : Hello
McNamara: Hi!
Mason : I’ve had long talks with Parker and Marshall already. I’m already confused with the option numbers. I hope I won’t be making mistakes when naming them.
So why don’t we start discussing the things we could agree on. Issue IV for example. Do you think going with option 1 is possible ?
McNamara: Option 1 is something I can agree on but not happy about as it really provides very little of much needed funding for my department. So, I will vote for it only in the condition that needs of my department are satisfied by alternative means.
Mason : Something like going I-C instead of I-A ? Or is that not enough ?
McNamara: I-C by itself is not enough. In conjunction with other concessions it is a possible option.
Mason : That may be problematic. Parker and I would want IV-3 but I think he could be brought to IV-1. On the other hand we can’t make compromises on all issues. For example Marshall likes II-A, so if we were to give the administrators II-A and to accept going IV-1 we’ll want III-C which leaves you with nothing. That’s the dead end we seem to be going towards.
McNamara: I see your point. I-C is possible as a part of a more complex deal which would bring other parties to the table. Let me think a little bit…
Mason : Sure take your time.
McNamara: Did you reach any agreement with Parker about Issue I? What is his position on it?
Mason : he seemed rather opposed to option A, but I am not sure whether he is 100% against it or if he’d just rather have option C.
McNamara: I can say that if Parker would agree on Option C, from my perspective it would be a strong argument in favor of it.
Mason : Marshall and I would rather have A (we’re still waiting on Bennett’s input), so in fact just from having option C we’ll want some kind of compensation. Hence why II A and III C were proposed.
McNamara: I understand. If you agree to support I-C, I can support you with II-A and IV-1. III C is problematic, however.
Mason : So you’d be ok with CAC1 ?
No sorry you’d prefer CAA1
McNamara: CAA1 seems acceptable. Of course, I will need to talk to other parties first but at this stage I would like this deal. Of course, it is provided that other parties would agree to it.
Mason : to be perfectly honest I’m not sure I’d accept this. And I’m not sure Parker would. There’s just not enough in there for the physicians.
McNamara: I see. I suggest we get back to this after I talk to other parties. Under some conditions I may be able to compromise on III.
Mason : before you leave, is there some option starting with I-A that you would accept ? Maybe ACA1 ? Or AAA2 ?
McNamara: I do not think that Option I-A is negotiable.
Mason : Very well, Parker/Rho is waiting for you in room 1 and you will probably have more in common.
McNamara: Later. Will you sent e-mail to gamemaster?
Mason : Bye. Sure
Parker - MacNamara
Parker: Ah, good evening MacNamara.
McNamara: Hello!
Parker: I'm very hopeful we can have a productive discussion.
McNamara: I hope so. Let’s start with Issue I. I suppose that Option I-C is a kind of middle road between our positions. We may agree to compromise on it in exchange for harder concessions on other issues. What do you think of that?
Parker: I agree. My preference would certainly be for keeping the demonstration indefinitely, but I don't think I'm going to find much traction for that amongst the other staff. A compromise may have to be made, and 1-C is definitely the best of the other options. What are your thoughts on the third issue?
McNamara: My preferences is III-A, of course. I think this may be also acceptable for you, though not ideal. In exchange, I may vote your favor on some other issues where we may have more in common. I mean, II and IV. Basically, your alternative on Issue III is to collaborate with nurses or management and I do not think you want to collaborate with management here.
Parker: You're right, of course. I could be persuaded to vote for nurses in training roles (III-A) in exchange for your assistance keeping physicians in charge of the clinical decisions (II-B). If you can reach an agreement with the others on that, you can count on my support.
McNamara: Would you vote IV-D in such arrangement?
Parker: My discussions with Mason suggest no problems with those plans for the first two issues. We didn't discuss his position on the idea of nurses leading the training. As to issue IV... I'd sooner go with the first package, the compromise solution with a little for everyone.
McNamara: I may accept IV-1. It seems we have some kind of agreement on all issues. Now we only need to convince 2 more people to agree with this plan.
Parker: I should warn you that Dr Mason was mentioning the possibility of cutting you out of the deal entirely, expecting it to be difficult to form a bargain that would work with you. I warned him that this might not be the best result for the hospital: our nurses are an integral part of the team and the hospital wouldn't function without them.
McNamara: Without me Dr Mason will need to find a way to placate both you and two management guys. Good luck with that. I think I’ll go for now, it surely was productive.
Parker: One moment.
Parker: I didn't get a particularly clear view of Marshall's plans. He seemed willing to agree to most of my suggestions, perhaps hopeful that I will stay with the hospital and not kick up too much of a fuss about keeping the MMM. If you could get a clearer view of what he will agree to, it would be very useful. I hope your negotiations go well.
McNamara: Noted. I will talk to him.
MacNamara - Mason
McNamara: Just a quick question: what do you think about option D in the third Issue? Can it be acceptable for you together with I-C?
Mason : I’m not a fan of III D but I could live with it if I get something else. C(A or B)D3 for example.
McNamara: CAD1?
Mason : CAD1 would be preferable to no agreement. I’d want to explore other options before. You do realize that there’s nothing for the physicians there (or at least none of the options favor physicians)
McNamara: I understand and I’m not thrilled with this either. I do not get anything except a compromise on I. But this is a package to which Bennet and Marshall could both agree.
Mason : We’ll see when Bennett arrives. But let’s say that it would be an acceptable fallback option.
McNamara: Yep. I agree that a lot of depends on Bennett and his attitude. That’s all for now. Will you sent it to gamemaster?
Mason : Sure. Note that with both II-A and III-D I’d be really surprised if Bennett disagreed.
McNamara: We’ll see.
Bennett - Marshall
MYKI: Good evening, good evening, sorry for the delay
Marshall: Good evening. How are you?
MYKI: Not too bad. So how may I help you?
Marshall I think we are the natural allies here as we both want to get things done here. So I hope it is possible to share some of our plans and priorities. I'd like to ask you first, I understand this agreement is very important for you. Being a president you also have to think about balancing interests of everyone involved. So will it be fine for you, if an agreement made by four makes the fifth one so unhappy that he or she resigns
MYKI: Obviously this is an outcome that would sadden me deeply. But progress must be made. No one man (or woman) is more important than St Francis.
Marshall: I see. Could you also say how do you see the ideal agreement?
MYKI: Well firstly I assume we are in agreement regarding the importance of rolling MMM out across the entire hospital as soon as possible.
Marshall: I definitely agree
MYKI: As I see it, then, the challenge is to make this palatable to the nursing staff and the traditionalists within our ranks.
Marshall: I-A is a no-way for Dr. Parker. Unfortunately I didn’t have a chance to talk with Mrs. MacNamara still. What are your thoughts about I-A and I-C? Do I agree correctly that you certainly prefer I-A?
MYKI: I most certainly do prefer I-A, but I guess if we need to hold the whole thing together I-C is a distant second.
Marshall: I fully support I-A. So does Dr. Mason. Could you tell me about your other priorities?
MYKI: I bet Mason prefers I-A… so the question is how we get McNamara to join us. Are there any bones we can throw him from elsewhere, do you think? Hard to know without us talking to him.
MYKI: I’m reasonably open to suggestions regarding II and III, but I really do think that the flexibility offered by IV-4 is crucial to the financial wellbeing of our hospital.
Marshall: Mason will fight you on this. II-C looks like an offer to MacNamara. Mason is fine with it
MYKI: II-C works for me - I just hope it’s enough
Marshall: How do you look on IV-A or IV-C? ‘A’ could be an offer to nurses too. Mason will be very happy with C
MYKI: IV-D also involves increasing nurses’ salaries. And Mason is getting everything he can reasonably ask for with I-A.
Marshall: I am afraid his priorities are different. He told me that he can live with AAC1 or ACC3. He will not go ACC1 even though he likes I-A.
Marshall: He considers going I-C if other things will be fine by him
Marshall: What do you think about going I-C?
MYKI: (which one is ACC1?)
Marshall: What do you mean?
MYKI: *thanks moderator*
MYKI: you young people and your shorthand
MYKI: interesting from Mason. AAC or ACC are fine with me, but I just don’t think he should have it all his own way.
MYKI what are your priorities? Do you have a preference for II or III?
Marshall: Do you mean issues II and III. I have but they are not too important.
MYKI: yeah I suspect they’ll matter a bit more to the Parkers and Macnamaras…
Marshall: The thing is I-A is possible only if we get MacNamara on board. And also we have somehow to amend all our disagreements on other questions. If we go I-C it will be possible to create a coalition from any 4 players.
Marshall: I really really don’t like to go I-C, but I believe if we do not find a way to agree between our four this is what will happen
MYKI: You have a good point. I-C is not ideal, but given that even Mason seems to find it okay it would be something I’d consider.
MYKI: But I’m worried I’m going to come to blows with him over issue IV
Mason: I will not be happy with IV-D too. Especially if I goes C.
MYKI: hmm. IV-D is something of a dealbreaker, between you and me. And we’re sure I-A is a dealbreaker for Parker?
Marshall: He explicitly said to me and also to Dr. Mason that he will resign if I-A
MYKI: That’s some punchy negotiation
Marshall: Could you tell me what is barely acceptable for you in issue IV?
MYKI: I don’t see that there are any acceptable options that are not D. If I could rely on your understanding regarding this matter I will happily push hard for I-A and whatever else you’re into.
Marshall: If we agree on I-A I’ll be fine with IV-D
MYKI: Works for me. Is III-B something you care about or does it just look like it is?
Marshall: I care about it but not too much. Just don’t make me agree on III-A and we will be fine
Marshall: You have no preferences about II and III, haven’t you?
MYKI: Nothing I’d got to the wall for, but I certainly agree that III-A sucks
Marshall: That’s something
MYKI: Indeed
Marshall: So it is something like ACC4. II-C to try to accommodate MacNamara, III-C is important for Mason. And IV-4 is important to you
MYKI: I would be fine with that outcome. How do you think it will be with Parker?
Marshall: I-A = NO PARKER
MYKI I meant Mason (sorry)
Marshall: I do not know honestly. The thing is this outcome is not most wonderful to me but I am realistic. I hope when he sees that there is no other chance to get I-A and III-C he agrees
MYKI: Let’s hope so - I imagine that a Mason option is better for you than a Parker option?
Marshall: I can pay a lot for getting I-A
MYKI: Understood
Marshall: Would we also discuss now a fallback plan? If I goes C?
MYKI: I’d still be fighting hard for IV-D, but would support you in your first choices for II and III if that would make a difference.
Marshall: I am afraid in this case we could create a coalition without you
Marshall: We have a draft already
MYKI: Interesting
Marshall: Something like CBC3
MYKI: Yeah no can do with that.
Marshall: I will be much happier with ACC4. But if I goes C I think I’ll fight for IV and what else leaves for me
Marshall: So my point is: It’s better for us both to stick to I-A
MYKI: You present a strong case.
MYKI: Let’s hope for I-A.
Marshall: Indeed
Bennett (MYKI) - MacNamara (Gavagai)
MYKI: Good morning, thanks for dropping by.
MYKI: Just a quick one - are there any circumstances under which I-A and IV-4 would be acceptable to you?
MYKI: I think we’ve got a coalition of four firming up around that offer, and there’s some flexibility around issues II and III
MYKI: The downside obviously is that Parker is having none of it - i think if we are to sort this out either Parker or Mason is going to need to be let go because they’re both pretty hardline
Gavagai: IV-4 is acceptable, I-A is absolutely not. However I am willing to agree on I-C AND vote III-D in exchange. I can also support you in II-A. Is there anyone who adamantly refuses to vote I-C? I have not spoken to Marshall yet but others seem to be OK with this compromise.
MYKI: I’m less worried about II and III, or even I really, but both Mason and the FCO are reluctant to go to I-C without significant concessions.
Gavagai: I see. What do you think of I-D? We can bring Parker on board with it.
MYKI: I think you’ll meet significant obstruction from Mason and Marshall. It’s pretty bad for me, too, but it would reluctantly be on the table if it meant the difference between IV-4 and anything else.
MYKI: is there nothing that could make I-A acceptable?
Gavagai: Nothing. I’m thinking what we can offer Mason or Marshall to accept I-C or I-D. I think I-C is actually more viable.
MYKI: I-C is probably viable, while I-D I’m pretty sure is not.
Gavagai: Yep, I-C should be the only option which is not unacceptable for anyone. PArker is ready to agree on it and he is a person from whom the strongest resistance should be expected.
MYKI: I imagine I-C suits him very well. Not quite as well as I-B, but it’s still pretty nurse-heavy.
MYKI: I wouldn’t want to give in to too many more demands from him if we’re giving him that.
Gavagai: I agree with that.
MYKI: So the question then becomes what we can do to win the other two over. IV-4, as I said, means a lot to me, but apart from that I am happy to go with most things from II and III without too much of a fight.
Gavagai: Do you think it will be possible to convince anyone to go III-A? With this I can suck it up and vote II-B which should be good enough for both Mason and Parker. I think III-A should be acceptable for both doctors.
MYKI: III-A is something I’d suck up, and even II-B. You’re right, it would be good to be able to actively offer Mason something like that.
MYKI: But it is a significant concession on my part.
Gavagai: On my part also. So, the deal can look like this: CBA4 Correct?
MYKI: that would be acceptable. I’m just slightly worried about how happy Marshall will be with that.
Gavagai: If Mason and Parker are happy, we may not worry about Marshall.
MYKI: You raise a good point,
MYKI: And you’re pretty sure Parker is on board with this?
Gavagai: I am not. I have not really discuss III-A with anyone before, so no idea how people feel. I suggest that we discuss it with Parker and Mason we say that the other one has already agreed to it to create additional pressure. I think it should be non-unacceptable for them both.
MYKI: Cunning, cunning. Although I have yet to talk to either of them and so may not be able to land that line of attack. Unless I say you told me that Parker was cool with it.
Gavagai: I think that it would be better if I talk to Parker and you talk to Mason. I have establish very good rapport with Parker already, with Mason - less much so.
MYKI: Excellent.
MYKI: I imagine Mason is going to be tricky.
Gavagai: This situation is tricky anyway. So, to restate, the proposed deal is CBA4. I think, we done here. Will you sent it to gamemaster?
MYKI: Agree that we’re done here for now. I shall send this to gamemaster. Good luck with Parker.
Gavagai: Good luck for you too. Put me in copy, please.
MYKI. Thank you. Will do.
Marshall - Mason
Marshall <Letter to Mason MD>: Good morning, Dr. Mason. Yesterday you had a chance to talk with Mrs. MacNamara and I spoke a lot with Mr. Bennet. These people are critical to get an agreement, and I hope we can share some information.
First of all, Mr. Bennet is really interested in IV-4. I mean it’s so important for him, that he doesn’t care about II and III at all.
So if we want to get I-A we really need Bennett and MacNamara at board. Bennett will not move if we propose anything but Package 4. I do not know what Mrs. MacNamara has in mind and I hope you tell me.
The solution that looks possible to me between us four is ACC4. I know it is unpalatable, I do not really like it too, but I don’t see the other one.
If you think this agreement can’t be done, I think we should forget about I-A and fallback to I-C. In this case there are five possible coalitions, and a chance for everyone to be excluded, so the outcome becomes less predictable.
Please tell me your thoughts on all this and also what did you find out from your talk with Mrs. MacNamara. I really hope for a fruitful dialogue.
Mason : Are you sure Bennett wouldn’t agree to AAD1 ? MacNamara proposed CAD1 as a compromise, which I’d rather not have but would take if it’s the best we can do. She didn’t seem amenable to option I-A. I’m afraid that I-C is the best we can do. CAD1 would be a possibility if Bennett doesn’t put his foot down on IV-4
Marshall: I thought a lot about building a coalition if I-C is chosen. How I see it, if we agree at I-C the battle follows to issues IV. Bennett and MacNamara want package 4, I want package 1 and Parker wnats package 3. We can exclude Bennett and I will back Package 3, but then I decide that being fucked on two most important issues is enough and ask for III-B. Would you okay with it? And of course MacNamara should be placated too. Or we can exclude Parker but that’s looks silly given we already went I-C and in this case I will not back Bennett on IV-D. Or you can exclude me, but then good luck for finding a common ground between Bennett and Parker
Mason : I could live with IV-4, but not with II-C
Marshall: If ACC4 is not an option be should forget about I-A. Or push Bennett to reconsider but I highly doubt it is possible.
You mentioned CAD1. I am moderately good with it. Will Parker or Bennett agree on this?
Mason : I need to talk to Bennett. Parker won’t be happy with II-A and probably with III-D. I haven’t talked about IV-1 with him at all so I don’t know about that one.
Marshall: Could you tell me more about MacNamara’s position. From your word I get that she still didn’t come to an understanding, that you can’t get all whant you want.
Mason : I think that her problem is probably issue IV. She would want IV-2 but can’t get it. I thought she would compromise on IV-1 but she seemed to want a lot of compensation for that.
Marshall: IV-2 is out of question, I will never agree on that. How do you think, how important are issues I and II for her. If Bennett compromises on IV, will she plays ACC3 or something along these lines?
Mason : I don’t think issue I is as important to her as it is to us. But she needs to get something out of the deal, and doesn’t seem to like IV-1 as much as I’d hoped. I don’t know how she’d react to ACC3. I assume that this would exclude Bennett.
From my perspective, we shouldn’t try to exclude each other. We agree on I-A >> I-C, I want II-A and would agree to IV-1. That leaves either leaving out MacNamara with a CBC4 that Parker might accept, leaving out Parker with some kind of CAD1, or leaving out Bennett with a C?C1 or C?C3.
Marshall: Look, let me explain my position on issue I. If it is A I can compromise on almost everything. If we go C I will fight for everything what leaves. CBC4 is absolutely unacceptable for me. CAD1 will work.
Marshall: If we go I-C I will ask for IV-A or if it is impossible for IV-C AND III-B. I already thought about it a lot. Going I-C does not mean it will be easier to build a coalition
Marshall: What are your views on issues III. Do you consider anything but C?
Mason : How about AAA4 ? Bennett might agree because of IV-4 and MacNamara might agree because of III-A.
I really need to talk to Bennett.
Marshall: III-A is possible, but I thought you will never agree to it.
Marshall: yep, I will be unavailable for some hours now too
Mason : I would accept III-A only if there is I-A AND II-A
Marshall: I now checked by notes AAA4 is worse for me than most of I-C combinations so I don’t think I will support it
Mason : so CAD1 ?
Marshall: I like it. If we can’t get I-A that’s what I find the best one. But we need Bennett’s or Parker’s support here.
Marshall: Anyway, thanks for talk. I am becoming unavailable now.
Marshall: I think maybe today we should try to invite more people in a room and try to find a common ground?
Mason : If you’re around when I talk to Bennett I’ll invite you I think. MacNamara was ok with CAD1 so if we convince him to go with it it’ll be great.
Marshall: It’s very important to know Parker’s position on issue IV too. I’ll try to speak with him when I come back.
Mason : Ok Bye
Marshall: Bye. Would you copypaste and send everything?
Mason : Yep
Marshall - Parker
Parker: Good evening, Marshall.
Marshall: Good evening. I am happy to finally chat with somebody
Marshall: I have a good news for you and a bad news. Good news are that I-C looks more and more probable. Bad news are that even this way is still difficult to forge a coalition.
Marshall: The struggles go around issue IV. You need Package 3, Bennett wants Package 4 *a lot*, MacNamara wants Package 2, which is absolutely unrealistically to expect. I want Package-1 but can go Package-3 if I get III-B or III-D
Marshall: How strong are your preferences to IV-3?
Parker: One moment, let me find my notes.
Parker: If I could be sure of a good outcome on the first three issues, I could be persuaded to give some ground on the matter of funding. I agree that Package 2 is unrealistic, but I got the impression that MacNamara understood that and would be willing to compromise.
Marshall: Her compromise will be Package1 most probably. Or Package4 but that would be unacceptable for me.
Marshall: That’s a shame but I still had no chance to talk to her. So I’m mostly speculating based on what Dr. Mason told me about her intentions
Marshall: What does it means good outcome on first three issues for you?
Marshall: Honestly at this moment I believe if everybody involved in an agreement can get just one issue his way it will be a wonderful achievement
Marshall: I for example think that most probable I get only one issue really my way, which is third-important.
Marshall: As I have told you it’s difficult to build any coalition here
Parker: For the first three issues, CBC would be acceptable. CBA at a push if we need to offer something to MacNamara for an agreement on funding.
Marshall: That’s sounds good to
me. But will Mason be happy with it?
Parker: I’m sure Mason will be OK with CB for the first two issues. C for the third is ideal for him as well. I don’t have a good sense of whether A is also acceptable for him on the third issue. I’m sure everyone will agree on IV-A as a compromise that gives something to everyone.
Marshall: I wish I was so sure
Marshall: Regardless I agree to it. If we can get Mason and MacNamara behind CBDA, I will support it. Or CBCA.
Parker: Hang on, where did III-D come from? I’m OK with III-C or III-A if needed.
Marshall: My bad.
Marshall: III-C is unpalatable but I could live with it. III-A unfortunately in unacceptable
Parker: OK, I think you’ll have trouble getting MacNamara to agree to CBCA as there’s not much in it for her. Dr Mason will probably be on board though, at a guess.
Marshall: I think we must start in terms in possible coalitions. For example MacNamara declines. What other agreement can she realistically get? If she goes with us she can at least get I-C and IV-A. that’s something.
Marshall: If she declines our offer, she can try to reach Bennett. That means IV-D for her and loose hands on everything else. So for example it is CCA4 she wants. Whom she can persuade to join her?
Marshall: I do not like it too
Marshall: Maybe she tries give to Mason and you II-B and III-C, or only one things from it. Mason is particularly interested in III-C. Is it feasible at all? CBCD? Would you agree on this?
Marshall: I am not actually sure if IV-D is worse for her then IV-A. There are some bonuses for nurses in both
Parker: From what she said to me, she’d prefer IV-D to IV-A but would probably accept IV-A if it came with III-C or something like that.
Parker: As to CBCD, I could live with that if it were the only way to get an agreement. I could see MacNamara agreeing to that set too.
Marshall: That’s really bad agreement for me, though I can live with it too. The problem is that maybe you don’t need me for it.
Marshall: I am playing against my best interests. Quite a lousy CFO
Parker: So what are your most pressing concerns with that? You’d like to see IV-A and what else?
Marshall: That will be enough. Or IV-C AND III-B
Parker: III-B is out of the question for me, I’m afraid. IV-A is fine though, if you can get people to agree to it. Better than CBCD, in fact.
Marshall: CBCD looks like the worst acceptable option for me.
Marshall: And MacNamara just went to sleep. Again I lost my opportunity to talk to her
Marshall: CADD? I am thinking about possible solution that will exclude MacNamara
Parker: That wouldn’t work for me, I’m afraid.
Parker: It seems clear to me that we’re definitely choosing I-C. It’s the best compromise, while not really ideal for anyone, as far as I can tell. Still, we’ll have a number of people simply refusing if we try for any other option.
Parker: As for issue II, I’m adamant that the final decision for patient care must rest with the physicians.
Marshall: CBDD? You feel better now?
Marshall: Anyway, I think Dr. Mason will not agree to it.
Marshall: Though the more I think about it, the less I am sure
Marshall: So what do we have?
Marshall: CBCA - if we can get MacNamara without Bennett
Marshall: CBDD - with Bennett without MacNamara, if you are fine with it
Parker: Maybe without Mason too. He did seem very hot on III-C, and I’m largely in agreement with him there.
Marshall: I think you still do not see, that it is really difficult to get a lot what you want here
Marshall: This decision is hard for me. It’s just there are not many other options.
Marshall: Yes we can hope for CBCA, but most probably MacNamara refuses
Marshall: So I am trying to prepare for a fallback
Parker: So IV-A is absolutely unacceptable to Bennett? It seems like the compromise that should suit everyone.
Marshall: He told to me that he wants IV-D and there is no other option for him there. Of course maybe he bluffed. I tried to persuade him to go IV-A or IV-C, he was adamant
Parker: So who would be unhappy with IV-D? Mason, perhaps?
Marshall: Me too
Parker: Ah, hence trying to cut Bennett out of the deal. I think our best option then is to convince MacNamara of CBCA. Perhaps that will work.
Marshall: Looks like this
Parker: Failing that, CBCD is only barely acceptable for you, but might get everyone on board. CBDD is just about barely acceptable for me, I suppose, but I’m not sure if Mason will tolerate it.
Parker: You said III-A was totally out for you, I believe. Makes it trickier to bring MacNamara on board.
Marshall: Yeah
Marshall: Well I think that’s all for today. I am gonna try to reserve a meeting with her. She is very evading.
Parker: I’ve yet to see anything of Bennett, I’ll be looking out for an opportunity to talk to him.
Parker: Thanks for the chat, I think we can see a way forward if we can get enough people on board.
Marshall: Bye. I am copying the text to send
Bennett - Mason
MYKI: Greetings, Mason.
MYKI: I just wanted to run a nascent plan past you - it was proposed by Gavagai and seems to make some sense.
Mason : Hello, bennett
MYKI: CBA4
MYKI: Good morning
Mason : Hmmm, I wanted to ask you about IV-4. Marshall said you would not accept any other choice for issue IV, is that true ?
MYKI: It is, I’m afraid - it’s the only issue I really care about
MYKI: it seems to offer flexibility, gives something to everyone
Mason : Because, before we had a chance to talk to you we had thought of a possibility that we thought you might agree on : CAD1. You get II-A and III-D in exchange for giving us IV-1.
MYKI: Actually II-A isn’t great for me and I don’t care about III at all - I am prepared to sign up for pretty much anything so long as it involves IV-4.
Mason : Let’s say I accept making the concession of IV-4. From earlier talks it seems like I-A is not going to happen. So on this issue I get my second choice of C. Is there a reason to go II-B ?
MYKI: As I told my CFO, I was prepared to fight for I-A for you guys but it seems that both Parker and MacNamara are vetoing. I wonder whether this is a bluff from MacNamara, though.
MYKI: II-B sucks, but I’d support it on your behalf if it meant I got IV-4.
Mason : I’m not CFO I’m head of cardiology. I’m only asking about II-B because I’m sure Marshall will prefer A, and I know I prefer A. So unless you plan to pass this proposal through Parker I’d rather do CAA4.
Mason: BTW this plan supposed to pass with Marshall/Mason/MacNamara/Bennett right ?
MYKI: (I know your not the CFO - I was talking to him yesterday)
MYKI: I would be happy to support you for CAA
MYKI: The challenge is MacNamara - if we can get him signed up to II-A instead of II-B then we’ll be fine.
MYKI: Parker seems to be quite an awkward character, and I don’t need a unanimous outcome.
Mason : Good, I was afraid of that.
MYKI: MacNamara did tell me that II-A was something he would be prepared to cede.
Mason : Yes, MacNamara was the one who proposed CAD1 in the first place
MYKI: Interesting. I hope the IV-4 doesn’t matter too much to him.
Mason : I hope so as well. Let’s end this, I’ll want to talk to MacNamara later to make sure it’s alright.
MYKI: Cool - I’ll check with Marshall whether CAA4 would work for him.
MYKI: Shall I email this to the gamemaster?
Mason : If you want, but can you copy it to me ? So I can review it whenever ?
MYKI: Good idea. What’s your email address?
Mason : I’ve been using forum PMs instead of emails whenever I sent the text to Bacchus. Could you do that ?
MYKI. Clever. I’ll do that.
Bennett - Marshall
MYKI: Just been chatting to Mason. How does CAA4 work for you? It’s palatable to him, and he thinks he can get it past MacNamara. And I get my IV-4.
Marshall: I can’t live with III-A. Other things in this agreement look very bad to me albeit possible.
Marshall: I will be unavailable for about an hour now.
MYKI: Dammit. I feel we’re closing in on something, though.
MYKI: Do you reckon MacNamara really can’t do I-A, or is she just being difficult?
Marshall: I still had not a chance to talk to her. So I do not know.
Marshall: I think she realized that it is virtually impossible to build a coalition without her, so she is trying to sell expensive
Marshall: Did you ask her about ACC4?
MYKI: Agreed
MYKI: There was no mention of II-C or III-C in our conversation, although she said that I-A was not possible
Marshall: That’s interesting. I believe the only way to build a coalition without MacNamara will be C**4. So she definitely gets I-C and IV-4 no matter what. No wonder she wants more. The problem is it will be difficult to everybody to find a solution if she stays so stubborn
Marshall: I mean you said anything but IV-4 is not an option for you. And for Parker I-A is impossible. So the coalition with you two will be C**4
MYKI: Good point. I haven’t spoken to Parker yet - have you?
Marshall: Oh yeah I did. I agreed to an agreement he posted. But I believe MacNamara will be against it too.
MYKI: Are II-B and III-C okay for you, then?
Marshall: II-B is fine. III-C is bad. I am not sure I will support CBC4
MYKI: What would be more acceptable for III?
Marshall: Of course I want III-B there. III-D will be also better
Marshall: Once again we are talking about C**4. If it will be A*** or C**1 or C**3 I will be more lenient on issues III.
Marshall: I meant C**3
MYKI: I do wonder whether we’d be able to get an A*** past MacNamara…
…
Marshall: I wonder if we can get anything past MacNamara :-)
MYKI: haha
MYKI: Well I guess I’ll talk to Parker next.
MYKI: see if I can sell him a C*B4 or something. Long shot.
Marshall: Give me a sec, maybe I already discussed it with him
MYKI: that would be useful.
Marshall: we discussed CBC4 and CBD4. Both are barely acceptable for us both. I mean they are very bad. CBD4 is marginally better for me and CBC4 for him
MYKI: II-B sucks for me, although the package in general is something I would probably sign. My preference would be III-D over III-C, but neither is ideal by a long shot.
Marshall: The question is, will MacNamara agree on it. And if not, will Mason agree on CBD4 because most probably I will decline CBC4.
Marshall: Tell me, previously you told me you care only about IV-D and everything else is whatever we want
Marshall: Now you say, you have some other preferences
Marshall: Is there a chance your position on IV can be changed?
MYKI: Sadly not, and the way things are going I would probably sign anything that went ***4. I was just saying that if there was a choice between CBC4 and CBD4 I would chose CBD4. Obviously I have preferences for every field, but realistically these will be irrelevant given my need for ***4. This is all I care about.
Marshall: I see
MYKI: basically I’ll sign something that’s bad for me for I, II and III because I appreciate that IV-4 is a sacrifice for some people.
Marshall: At this point I think I’ll be happy to sign anything where at least one issue goes my way :-) but more probably I will not even get this
MYKI yes it’s looking pretty bleak
MYKI: so what are our next steps?
Marshall: I hope to talk with MacNamara, because she is a critical player here. I also never had a chance to talk to her
MYKI: yes. And I’ll have a word with Parker to see if there’s a C**4 option that would be okay for you and Mason.
MYKI: is there anything else we need to discuss?
Marshall: Issue II is important for Parker. Obviously he wants B and will not accept A. Could you ask him if he will be fine with II-C? I don’t care about this issue, but maybe II-C is what greedy MacNamara wants
MYKI: haha I’ll ask
Marshall: See you. Bye
MYKI: Bye (assuming you’re sending to gamemaster)
Marshall: I will.
Bennett - Parker
MYKI: Good afternoon. I’ve just been chatting with Marshall, who provided some background to your proposed agreement.
MYKI: There is one problem from my point of view - I need ***4, and in exchange for that don’t really mind about anything else.
MYKI: I was hoping issue IV would be low enough on everyone else’s agendas for this to not be too much of a problem.
MYKI: Are there any C**4 options you think we’d be able to build a coalition around?
Parker: I could work with CBC4 if it would bring you on board (and not lose everyone else, of course).
Parker: I think MacNamara might agree to that one, but Marshall would be trickier. He seems not to like the idea of package 4 at all.
Parker: I’ve not asked Mason about the fourth issue much at all, so I don’t know his thoughts. I suspect he would join us though. So it’s probably mostly a question of whether MacNamara will accept that deal.
Parker: Not that I’m all that pleased about package 4, of course, but I can live with it. With you having financial discretion, I’m sure something can be worked out to ensure the hospital gets the operating room it so desperately needs.
MYKI: Exactly.
MYKI: Basically as long as there is a IV-4 I’m happy with pretty much anything.
MYKI: You’re right, Marshall isn’t keen on IV-4, but it’s not a deal-breaker for him.
MYKI: but yes, I would sign CBC4. Marshall would be keener on CBD4, but he’d still be reluctant.
Parker: Interesting. Marshall gave me the impression that IV-4 was not something he’d ever consider. Perhaps he’s trying to avoid being cut out of the deal.
Parker: Anyway, this has been an interesting discussion. I must get back to my rounds now.
MYKI: Good luck saving all those lives. For my part, I’ll get back to my Important CEO Things.
MYKI: I’ll send this to the gamemaster and copy you in.
Marshall - MacNamara
Marshall: Hello there, Mrs. McNamara. How are you? It is a shame we didn't talk before. Would you excuse me if I go straight to the issue? I think you are the critical player here, as the only way to exclude you is to build C**4 coalition (Parker withdraws if not I-C, Bennett withdraws if not IV-4) in which case you also get I-C and IV-4, so that coalition would be a stupid endeavor. I understand that without your collaboration no agreement is possible, so I am very open to your needs.
As far as I understand it's fruitless to hope for I-A support from you, given that you can expect C**4 as a worse possible outcome. Am I wrong? So we are talking about I-C.
Tell me, do I understand right that IV-4 is better for you than IV-1? Obviously IV-2 is what you desire but it will never happen as it is not an option neither for me nor for Bennett, so it will be impossible for you to build such a coalition. IV-4 on the other side is what Bennett desires, I can also live with it (though barely), doctors too. If IV-A is worse for you than IV-D, obviously IV-D is the only possible outcome as moving to IV-A makes Bennett withdraw too.
So I think C**4 is the only way to forge any agreement (maybe I should write it on a forum board, so that everyone understands it, but I’d like to talk first with you). Do you agree? I think what we should discuss are issues II and III.
McNamara: First I need to point out that you are not entirely correct that IV-2 is out of the question. In fact, I was able to persuade Bennet to agree to it on the condition that I would vote for II-A. A possible deal which we were discussing and with which both doctors are tentativly on board looks like CAC2. However, I really do not like this deal because of C in the third issue and here is where I need your help. My offer would be CAD4. Would you be willing to accept it?
Marshall: That’s interesting to hear. I suspected that Bennett lied to me. Still CAC2 will be hard for you to get because Parker doesn’t support II-A quite fiercely and I can’t live with IV-2. CAD4 though looks tolerable for me. I doubt however that Mason and Parker will be ok with it.
Maybe we can get CCD4? I am not sure if Parker agrees to II-C
McNamara: I suspect I may be able to persuade him - that is why I also wanted to talk to him today. From our conversation I got an impression that it is in the realm of possibility. CCD4 will hardly be acceptable for me, I most definitely want to try CAD4 first. If you are OK with it, this is very good to hear.
Marshall: I am surprised to hear that you prefer an administrative model to MMM with increased role of nurses. Do you distrust doctors so much?
McNamara: Wait, I think I’m mixing up numbers. Let me check everything.
McNamara: Yes, I was mixing up numbers. CCD4 is OK for me. Who is actually is the most likely opposition to this deal? Mason, I think?
Marshall: Yes he wants III-C also maybe Parker, I am not sure he will be fine with II-C.
Marshall: I will prefer CCB4, but CCD4 is barely tolerable as well
McNamara: But am I correct that CAD4 is also a possible deal? As a fallback option?
Marshall: As for me it’s even better than CCD4
Marshall: But what about you? What are you trying to achieve besides C**4?
McNamara: Most importantly - not C or B in the third issue.
Marshall: III-A is impossible for me. So it leaves III-D as a compromise
Marshall: Also CAD4 is bullshit. Let me explain. Bennett is already happy with IV-4, so it is a question of me and doctors. Doctors, especially Parker will hate II-A. So we are buying nothing with II-A. Yes, I’ll be marginally happier with it, but that’s what is not really important
Marshall: Could you live with CCB4?
McNamara: No, B in the third issue is too much a sacrifice, I would want my first choice in Issue 1 for this and no one would give me that.
Marshall: May I ask, what is worse for you III-B or III-C?
McNamara III-B As for CAD4 option, what I want to do with this deal is to terrorize our doctors. I will say both of them that the other one had agreed to it, hoping to force them into CCD4
Marshall: Always masterminding
Marshall: CBD4 is ok for you? Just going through all the possibilities
McNamara: No, it’s not OK. I will not surrender that much power to doctors.
Marshall: So what do you want is basically C[not B][not B, not C]4
McNamara: Pretty much
Marshall: You have Bennett’s support, as he will be fine with it and you are looking for a support ⅔ of us.
Marshall: I am fine with CAD4. But CCD4 - I am not sure I will support it
McNamara: One moment… OK, one possible configuration I discussed with Bennett is CBA4. What would you say about it?
Marshall: No way to III-A.
McNamara: I suspected it. That leaves us with CAD4 with CCD4 as a fallback option.
Marshall: What do you like more CCD4 or CBA4?
McNamara: CCD4 is better but marginally.
McNamara: Are we done here? Need to talk to others about CCD4 and CAD4.
Marshall: I am contemplating, if it is better to write these things publically.
Marshall: I mean the rationale behind C**4 and some preferences in IInd and IIId issues.
McNamara: I do not believe it is reasonable. You assume that this problem can be solved by just sharing info about preferences and summarizing them but it is clearly not. What we need to do is to terrorize someone into accepting what is not really acceptable to him. And for this we need the state of indeterminancy
Marshall: You say we, I hear McNamara
Marshall: I think you are going to play Parker, Mason and me too, so giving to them a hint is actually a good thing for me. Right now I am terrorized already into quite bad agreements.
McNamara: If I wanted to play you, I will not be telling you this, will I? How I see that is that we are at endgame stage here. You, Bennet and me are on board, all what is left to do is to get one of the doctors.
Marshall: I am not 100% on board CAD4 is fine, but I doubt it will pass. So will CCB4, but you oppose it, don’t you? You go CCD4 and you probably lose me.
McNamara: You said that CCD4 is tolerable and it is the best one can get here. I bet it is better than CAC2 which is a fallback option if I can not count on your support.
Marshall: Parker will be against CAC2
McNamara: III-C is pretty important for him. Anyway, if not CCD4 what is your alternative?
Marshall: CAD4
McNamara: And this is what I’m going to try to get. If at least one of the doctors is on board, we have a deal.
Marshall: (Do you know how many times I heard, now we only have to convince McNamara?)
McNamara: Whoever told you this, he sucks at convincing.
Marshall: I also think it is your position. I mean it looks to me it’s virtually impossible to build a coalition without you.
McNamara: Good to hear. I suggest that we both try to convince doctors into CAD4 then. At least one of them would be good enough.
Marshall: Ok, we can try. I´ll go for Mason
McNamara: Reasonable, I seem to have much better rapport with Parker than with Mason. My discussion with Mason went pretty bad.
McNamara: Put me in copy, OK?
Marshall: what’s your mail?
McNamara: gavagay.real@gmail.com. You should have it, we communicated through it earlier.
Parker - MacNamara
McNamara: Hi! Wanted to ask, how your negotiations are going. From my perspective, it looks like that there is a growing consensus on I-C and IV-4. Issues II and III, however, are tricky.
If you agree about I-C and IV-4, can you tell me:
1) What options in Issues II and III you will not accept under any circumstances
2) What options you will accept together with I-C and IV-4
3) What options you will accept provided some additional compensation is given
Parker: Afternoon. I agree that I-C looks like a done deal now. Bennett is pushing hard for IV-4, while Marshall dislikes that and wants IV-1. Personally I can live with either, I think it will depend who is in the final deal as to which is selected.
Parker: To answer your questions, I doubt I would be party to any deal that didn’t include II-B. It seems obvious that physicians must have the final say in any medical practice decisions, much as we will welcome the input of others, especially the nurses.
Parker: For issue III, I’d be happy with either A or C. C is preferable of course, but I think the nurses could do an excellent job of training everyone in the implementation of the MMM, so I would be very willing to make this concession.
Parker: I don’t think I really have an answer for your third question. CBA or CBC are acceptable with any package except 2. The financial package isn’t particularly important to me though, so there’s nothing there I could be offered to sweeten a change to one of the other issues.
Parker: How about you? I assume you’re pretty happy with I-C and IV-4.
McNamara: I-C and IV-4 are in the range of acceptable. However, we really need to discuss Issue II. Would you accept something like DCC3?
Parker: It hadn’t occurred to me that I-D might even be on the table. Mason would never agree to that, and I doubt Marshall would be too happy with it either.
McNamara: I am asking to understand the strength of your commitment to II-B. You are hardly going to get. I just talked to Marshall - he does not want it, I do not want it either. Is II-C acceptable? Or II-A?
Parker: I am strongly committed to II-B. I was hoping we might be able to reach an agreement on III-A, a much better compromise from my perspective.
McNamara: II-B and III-A is a possible combination, though barely acceptable on my part. However, Mason does not want it.
Parker: Presumably Mason is happy with II-B, but doesn’t think highly of III-A. Hmm, that does make a deal more tricky.
Parker: From what I know of Bennett, he’ll be happy with anything that includes IV-4, so that’s one easy vote.
McNamara: Marshall is also against III-A as I just looked up.
Parker: Yes, I was wondering about a deal that didn’t include Marshall. I was quite hopeful about CBA4, but if Mason won’t accept that, it’s back to the drawing board. CBC4 would bring Mason on board, but not be great for you, I assume.
McNamara: I think that the only way to proceed is to get Mason on board - I have a sense that he is more amendable than Marshall. I think I’ll talk to him.
Parker: Let me know if you reach a deal. I’m hoping to talk to Mason later too.
McNamara: OK. Later, then.
Mason - Marshall
Mason : Hi Marshall. What’s your opinion on CAA4 ?
Marshall: Hi Mason, New ideas every day. I will oppose it. Tell me, McNamara told me you had a rough discussion. What happened between you two?
Mason : That’s… Not true ???
Marshall: What is not true?
Mason : We didn’t have a rough discussion. We had two discussions, the first one where I tried to explain my position and where we arrived at some kind of arrangement, and a second one where she proposed a CAD1. Which I could accept.
Marshall: Interesting. She proposed CAD1. I thought it was your proposal. Now she wants CAD4. Would you be fine with it?
Mason : Meh. I only get my second most important issue, and have to compromise heavily on the other 3.
Marshall: It looks even worse for me. From the upside this agreement can be done right now.
Marshall: I think I screwed things with McNamara
Marshall: The problem is that is virtually impossible to build a coalition without her. To get both Bennett and Parker on board we needed C**4 that’s actually what she wants, so it’s a quest in futility. I am afraid she didn’t realize it before I told it to her
Mason : Bennett seems to be mostly ok with anything as long as it ends with 4. Maybe MacNamara would agree to CAB4 ? You’d want that, I’d accept that and Bennet would probably accept that too.
Marshall: She will fight it. She is ok with III-A or III-D, but I’m not ok with III-A.
Marshall: What about you?
Mason : III-A is my least preferable option, so unless I get II-A and IV-1 or 3 I’m not going to accept it I think.
Mason : So we’re back to CAD4. I don’t like it and probably won’t accept signing it.
Marshall: The thing is ,it looks to me we are locked into C**4 now no matter what.
Mason : I’m starting to think about a new possibility, excluding Bennett. CA*1 maybe ?
Marshall: I thought about it. It could work earlier, but now MacNamara will most probably stick to IV-4
Mason : She prefers 4 to 1 ?
Marshall: Doesn’t she?
Mason : I didn’t ask her, she only said she prefered 1 to 3.
Marshall: She didn’t answer it directly, but the context was quite clear that she prefers IV-4 to IV-1, if only she doesn’t scheme something very complex. Common sense also said salaries and upgrades are better than just a discharge coordinator position.
So I am 90% sure she wants IV-4 more than IV-1
Marshall: I really do not see now a way to go back to IV-1. Looks that’s my fault, but still I thought she found out herself that without her support C**4 is what we get, so she can be staunch in her IV-4 position. Maybe she didn’t find it herself, and we could push her to IV-1 but that’s too late at this moment
Mason : So I think the two options are CBC4 with Parker or CAD4 with MacNamara
Marshall”: What do you prefer from this two?
Mason :Hard to say, it exchange my first choice for second most important (II-A) + 3rd choice for 3rd most important (III-D) for second choice for second most important (II-B) + first choice for 3rd most important. Do you have a preference ?
Marshall: I prefer CAD4 and I’ll try to persuade you to go this way. First if we go CBC4 excluding MacNamara she anyways wins a lot by virtue of I-C and IV-4 so we just threw things away, given that it doesn’t improve your position and worses mine.
Also I believe that it’s better to get first choice on second most important issue and third on third most important issue then get second choice for second most important if if it get first choice on third most important.
So from your description I suppose that CAD4 is better for you too.
Also I would say that I get only one first choice for fourth-important issue :-( And a lot of compromises too. I just do not see any other opportunity to get things done.
Mason : Ok do you want to check with MacNamara if she’ll accept or should I ? The other can talk with Bennett.
Marshall: I just spoke to her before our meeting. She is quite keen to get CAD4. Bennett assured me earlier that he will be happy to get C[anything][anything]4 too
Marshall: So it looks like we have a deal.
Mason : Ok let’s post it in the thread.
Mason : I’ll copy paste this to Bacchus
MacNamara - Mason
McNamara: Hi! I assume that Marshall was trying to convince you into accepting CAD4. How it went?
Mason : Yeah I’ll go with CAD4, I think we’re good to go.
McNamara: Then it appears to be done Marshall and Bennett are on board with it too.I suggest we post it officially in the main thread.
Mason : I just did. Vnosikov did it too.
McNamara: Did it. Sending this little exchange to the gamemaster, leaving the room.
As experience shows, negotiations tend to fall strongly on the ends of the "participatory" spectrum -- either people stay mostly around the table, normally with someone taking the role of facilitator, and discuss issues openly, with only rare head-to-heads to break through loggerheads, or negotiation quickly breaks off into numerous bilaterals and people only come back to the table towards the end, with coalitions pre-formed on the basis of secret talks.
Here we clearly have the second model, and it's noteworthy how susceptible the direction of the negotiation is to the "first movers". It's enough for the first people to speak up to open with "Parker, let's go for a talk" to totally set the tone. By contrast, someone could have started with discussing the process, laying down some ground rules, thinking together about how best to use the time, maybe even start with introducing your position in public, instead of going through the process four times in four separate bilateral chats.
Posted titles, may post longer summaries later today. They are pretty straightforward, Parker is an "old school" physician who dislikes bureaucrats and financiers, the rest are all in line with their titles. Mason is practically the inventor of MMM.
Quote:McNamara: I do not believe it is reasonable. You assume that this problem can be solved by just sharing info about preferences and summarizing them but it is clearly not. What we need to do is to terrorize someone into accepting what is not really acceptable to him. And for this we need the state of indeterminancy
