Negotiation and the New Graduates

It is commencement season once again. Here at Harvard the gowns will be donned on May 24. It is always a celebratory event as hopeful graduates take their first steps into the next chapter of their lives. For those of us who teach it is also a time for introspection: have we prepared them for the challenges they will face?

It would be hard to imagine a more unsettled time to be starting a career:

– The global economy remains in turmoil and job prospects questionable even for intelligent, skilled, motivated graduates;

– The fate of the Affordable Care Act may be determined next month when the U.S.  Supreme Court renders its verdict. If the Act stands, we’ll have one set of complex events unfolding. If it falls, there will be equally complex yet likely more complicated activities as the parts of the Act that have begun implementation must be unwound. In either case, tempers will flare and contention will fill the air;

– After years of always finding ways to do more, there will be pressure to do less. The recent advisory on routine PSA screening tests for men is an example: a common prevention measure is now being called unnecessary  — a finding disputed by many. This follows on similar, and equally divisive, advice around mammograms. Some of this is driven by new evidence on efficacy or side effects. Some of it is based on cost/benefit analysis. In any event, such reversals of course cause confusion for patients and clinicians alike;

– The drive to improve outcomes while reducing costs will cause shifts — and rifts — in the system. It is not hard to imagine that many careers will not unfold in the way imagined by this year’s graduates.

Granted we are biased, but it is more satisfying than ever to give a congratulatory handshake to the students who have participated in Leadership and Negotiation courses at the Harvard School of Public Health. We don’t mean this in a self-congratulatory sense. Rather it is because it is clear that negotiation is going to be a critical skill for doctors, nurses, public health professionals, and many others who pursue health care as a career. The ability to negotiate productively with a wide range of stakeholders is something they will draw upon daily.

And, given the state of the health care system, we are going to need leaders among clinicians, insurers, administrators, and policy makers. We are going to need people who can craft unity of effort despite the disruptions and lack of clarity that will mark their professions in the years ahead. We will need people who can rise above the parochial interests of their specialty or organization to help navigate a way forward toward a health system that meets the needs of the population, provides satisfaction for those who work in it, and that is financially sustainable.

Our hats are off to you, Class of 2012. It is now your turn to negotiate the future. There will be tense conflict — we trust that you will resolve it. There will be intimidating obstacles — we are confident you will overcome them. And there will be great opportunities — we believe you will seize them. Lead on!


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