Dictionary guide to negotiating with polymorphous DHBs
Article by Ian Powell, Executive Director - The Specialist, Issue 87, June 2011
The ASMS’s negotiations with the 20 DHBs is now at a critical stage. Since negotiations commenced over a year ago in the main they have proceeded in a constructive manner with the highpoint being the achieving of the joint ASMS-DHBs developed and supported document - Securing a Sustainable Senior Medical and Dental Workforce in New Zealand: the Business Case.
This document provides a blueprint for the health system including the practical application of the Time for Quality agreement between the ASMS and the DHBs and In Good Hands, the government’s policy statement on clinical leadership in DHBs. It offers the framework for the government to achieve its objectives, including cost effectiveness and reducing financial wastage and duplication.
Negotiations have reached a precarious state, however, just at the point when the ASMS and DHBs were edging close to a recommended settlement with some hope that this might be achieved by the end of April. The last week of April was not a good week as things went to the proverbial ‘custard’ with the DHBs endeavouring to worm their way out of the Business Case. Hopefully by the time this article is read it is a better week!
One of my daily enjoyments is to receive an email from ‘Dictionary.com’ advising of their ‘word of the day’. Sometimes I even manage to remember some of them! While focussing on reaching a ‘better week’, this has provided an insightful tool for improving my understanding of DHB decision-making in a journey from polymorphous to effloresce via osmose.
A bit of poly and a bit of morphous
The adjective polymorphous comes from the combining of the Greek roots poly- (many) and morphous (shape) and means assuming, or passing through, many or various forms, stages, or the like.
Never, in my view, has a word so well described DHBs. At a governance level boards are quiet different ranging from the disruptive effect of toxic elements of some individuals to well performing and functional (even where there are different views among board members – a plus rather than a minus).
But it is at the operational level that polymorphous has greater impact. At one supra level it is cultural including different managerial, medical (and dental) and nursing cultures. Within senior management it is surprisingly polymorphous. At times, when talking to chief executives, chief operating officers, chief finance officers, human resources and employment relations, multilingualism is required. And this is without mentioning payroll and IT!
Consequently it is not surprising that in dealing with DHBs on a range of issues we are confronted with many different and changing shapes. For much of our MECA negotiations to date the DHBs had been constructive and collaborative, even when dealing with some thorny matters. But in the last week of April the DHBs were publicly sharply critical of the ASMS following our reporting back to members of the Business Case. This was despite the DHBs being forewarned and accepting, that the report back was positive, and that there was no criticism of the DHBs. As recently as early April the DHBs were still talking positively about the Business Case but by the end of that month, through polymorphous, they were trying to worm and squirm their way out of it.
Oppugn versus irenic
Here the verb oppugn comes into play. Born from the combination of the Latin op- (to oppose, attack) and pugnare (to fight; similar to pugilism), it means to assail by criticism, argument, or action; or to call in question or dispute. The DHBs response to the ASMS reporting back the Business Case to members, especially being so upfront supportive of it, was to oppugn us, including misleadingly claiming it was unaffordable (as if they had never read the Business Case), feigning surprise at the release to members, and demeaning it as merely a discussion paper when over a fortnight earlier they had accepted it was not.
In contrast the ASMS was trying to be irenic, an adjective with biblical origins from the Greek eirenikos and meaning to tend to promote peace and be conciliatory. Clearly irenic did not work!
Getting DHBs to effloresce
There are some options for the DHBs to pursue next in our negotiations. They might resort to the adjective splenetic from the Late Latin spleneticus. It includes being irritable, peevish and spiteful as well as morose, bad tempered and melancholy. There have been suggestions of this in recent correspondence from the 20 DHBs.
They could also try the adjective of plangent which derives from the present participle of Latin plangere, to beat, to strike noisily, especially to strike the breast or head as a sign of grief. It means beating with a loud or deep sound (the ‘plangent wave’) or expressing sadness and plaintiveness. There is a little bit of this around as well in DHB land.
If we are to move forward and resolve these negotiations then what we need from DHB leaders is for them to osmose, a verb which comes from the biological term osmosis and means to gradually or unconsciously assimilate some principle or object (in this case the principles and tenor of the Business Case).
Through osmose they might get to effloresce, a verb with origins in chemistry and combines the Latin roots ex- (out of) and florescere (to blossom) and meaning to burst into bloom and blossom. At this point our DHB leaders, especially the chief executives, will realise the enormous quality and cost effectiveness potential offered by the blueprint that is the Business Case.
Ian Powell
EXECUTIVE DIRECTOR
