The Power of Simplicity

My father taught us, “If you want to be happy, simplify, simplify, simplify.” He loved the quote from the movie, Amadeus, in which the Austrian emperor told Mozart that his music had “too many notes.” My father did not agree with the criticism of Mozart’s music, but felt the quote was great for describing anything from cluttered architecture and art to overly complex solutions to problems. His house that he built from steel is pictured with this article. It is an expression of his design and artistic philosophy: clean, smooth, uncluttered, simple lines.

Albert Einstein said, “The definition of genius is taking the complex and making it simple.” Steve Jobs surely met this definition as he brought us the power and complexity of computing through as simple a user interface as possible. He took the complex and made it simple.

We often find that we cannot complete all of the tasks that are already on our “to do” lists let alone other tasks and goals we should be adding. We can choose what is most important to us and drop some good things from our list that are standing in the way of our accomplishing better. Advice I received from the book, Scrum: The Art of Doing Twice the Work in Half the Time by Jeff Sutherland and JJ Sutherland, helped a lot. Give yourself a short deadline. I needed to write an application to the Texas Medical Board to start a hospitalist fellowship. It seemed to me like this should take several weeks to complete which I did not have so I kept pushing it down on my to do list. I gave one of my hospitalists and me two hours to complete the application. We were done, and the application was accepted. My inner OCD wanted to overly complicate the task. I needed to simplify. Read Full Article.

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Rural Health's Specialty Lies in the Special Care

It was my first time back to a rural hospital. Though I had practically grown-up in rural health – both with frequent visits as a volunteer and as a support services employee – I had not been within the walls of a rural hospital in many years. And never had I been in one as a healthcare executive.

I arrived early, intending to look around and meet a few staff to better prepare me for a meeting with the Critical Access Hospital’s Board of Directors.

One of my first interactions was with a nurse coming out of a patient room. She was clearly emotional. Practically crying. I had seen the impact of caring for patients over the years. But this was not that. No, it was not simply a nurse and patient, but something much more. Even with my many years of experience, I didn’t yet know what I didn’t know – or regrettably, perhaps had forgotten. (Read Full Article)

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What learning to fly taught me about handling adversity

""When everything seems to be going against you, remember the airplane takes off against the wind, not with it", Henry Ford.

Ask any pilot if they remember the first time they flew the airplane alone. And you’ll get a resounding yes! The solo flight is a milestone in each pilot’s life, it’s the time when preparation and opportunity all come together. You are alone in the airplane, no instructor by your side correcting mistakes, keeping you safe, it’s all up to you.

Although my solo was over 20 years ago, I remember it as though it were yesterday. The weather, the sounds of the engine and the wheels rolling down the runway. But what I remember the most about that day is looking over to my right and seeing that empty seat next to me, knowing I was completely responsible for returning this aircraft safely to the ground, intact.

Whether your piloting an aircraft, an organization or a team, how you face and ultimately handle adversity will largely determine your success or failure. What my instructor taught me long ago was a simple lesson, the goal for each flight is for takeoffs to equal landings, what happens in between is up to you and will determines your success in achieving this goal. Read Full Article

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How to ‘Stop the Insanity’ and Pave the Way to Real Achievements

I am sure you have heard the old adage “the definition of insanity is to keep doing the same thing over and over again expecting a different result.” I would like to expand to that definition “and doing something without appropriate planning and expecting a better outcome.” Have you ever witnessed an unexpected result or outcome followed by a flurry of activity which is expected to positively impact the outcome? The danger of this reactionary activity is the false sense that the problem is being solved. Reactionary activity may address the fringe of the problem, but the root cause remains festering and aggravating the organization. To help with the risk of confusing activity with root cause problem solving, I suggest the Four Steps to Achievement, or what I like to call P8. Read the Full Article

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Systemizing Healthcare: The Integrator Role

This is Part 2 of a Four-part Leadership Transformation Series (LTS). (Read Part 1 Here)

Transformation in healthcare is personal: it requires the transformation of health system leaders. This LTS begins to speak to key differences in some of the fundamentals of transformational vs traditional leadership in healthcare.

This article focuses on the changing role delineation of leaders.

The leadership need for ‘the Integrator’ is re-shaping traditional CEO and COO roles.

A few decades ago, the role of ‘the Integrator’ in healthcare leadership did not exist – at least not in the form needed today. Unlike roles with new names – CTO, CMIO, CPHMO, etc. - the same titles of CEO or COO may be used for a healthcare system, yet the shapes of these roles bear little resemblance to those with the same titles used in a hospital or other ‘vertical.’

While a hospital administrator/CEO is expected to stay close to the pulse of acute care operations, the system CEO is expected to transcend operations to assure an aerial view/perspective, i.e., to become more visionary and system-focused. The transition from hospital to system requires a view that is less entrenched with how we have run hospitals and more focused on the population served. Despite use of the same title for both roles, it is the difference between being ‘tied down’ and ‘freed up.’ (REAd Full Article)

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When is achieving all your goals not good enough?

We’ve closed the books on another year, and it’s time to review your performance. Maybe you’ve completed all your goals -- congratulations you’ve failed. Failed? How could that be, I’ve completed all my goals? And therein lies the problem, you didn’t set your goals (or the bar) high enough for your own performance. Goals by definition are aspirations and should be set high enough to stretch the organization and yourself in new directions. If you are constantly beating your goals, you’re not stretching enough.

But why don’t we set our goals high enough? Well, it’s complicated. It has a lot to do with you, and with equal parts of your companies’ culture and goal setting process.

Take this simple test: Read Full Article

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Patient Care Experience Beyond the Medicine

INTEGRATING SUPPORT SERVICES AND FAMILIES FOR PSYCHOSOCIAL CARE.

He is that family member we all know, regrettably often looked upon as bothersome, annoying or cantankerous. Throughout my career in home health, skilled nursing and acute care, these family members are at every level – anywhere that involves caring for vulnerable patients.

One doesn’t even have to be in patient care – simply working in healthcare means each of us will likely deal with these troublesome family members at one time or another.

I was still a teenager when I first encountered “the husband” as we came to know him. Little did I know that those few days with him would have an impact upon my entire future, and that of my very role as a healthcare leader.

Interacting with patients’ families while working both in dietary as a dishwasher/server and facilities as housekeeping/maintenance taught me the importance of both support services and family members within the patient care experience – beyond the medicine. Read Full Article

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A visionary leader is proactive

Reactive vs Proactive Leadership

I do a lot of reading on leadership. About 2 years ago, I read a book in which the author briefly contrasted reactive and proactive leaders. The author said that reactive leader does not seem to anticipate problems and does not see them coming until they are blowing up in his face. The reactive leader is constantly putting out fires. The proactive leader on the other hand sees problems just as they are starting to grow, or even before they begin, and calmly takes quiet and gentle steps to correct and avert so that the conflicts and disruptions are minimized or even completely prevented.

A reactive leader may be confronted with ugly contentions for any combination of the following reasons:

  1. Does not see the problem or consider that it might develop.
  2. Sees the potential problem, but does not want to be bothered over something that “might” happen.
  3. Sees the problem, but is afraid to act.
  4. Created the problem by misguided attempts to solve other problems.
  5. Enjoys contention and creates problems in part to create sparring opportunities or opportunities to assert dominance that are ego driven rather than leadership required.

The proactive leader does as Walter Gretzsky did and skates “to where the puck is going, not where it has been.” He has an eye to future disruptions. He sees the problems and is ready, willing and unafraid to act. He does not shy away from healthy conflict resolution, but prevents or minimizes unhealthy contention within his organization. He may disrupt his organization to move it where it needs to be to survive and thrive, but he will not allow his organization to be disrupted to no purpose.

I recently read an online article that presented reactive and proactive leaders as two equally valid leadership styles.i The reactive leader is presented in this article as strong in the surprise conflict, but weak in anticipatory leadership and the proactive leader as strong in long-range planning, but weak when called upon to “shoot from the hip.” I could not disagree more. A reactive leader is responding to whatever hits him and cannot have a firm hand on the tiller of the organization. For the proactive leader, the ability to extrapolate likely future scenarios and to predict human nature and act with vision and foresight does not make one unable to act upon the present urgencies and emergencies. Indeed, a proactive leader who has an eye to the future will be able to craft acute conflict resolution that is long lasting and strengthening to the organization.

Now, here is the part that stuns me, yet I have seen time and time to be true. This unknown author says that the reactive leader is often seen as the stronger leader, because he is often seen with guns blazing at a terrible dragon he is slaying for the organization, even if he is the one who fed and nurtured that dragon. The proactive leader is too often seen as weak or irrelevant. Why is he even needed? The organization seems to run itself. He often addresses problems discretely allowing key stakeholders to save face in front of the rest of the organization while bringing them effectively back on track. So much of what he does is unseen so it is assumed that it is not happening.

iPROACTIVE OR REACTIVE LEADERSHIP, WHICH IS MOST EFFECTIVE IN THE WORKPLACE? VICKY BAILEY, 2016-12-02

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The Fourth Discipline: Transition Management

Leadership Transformation Series

This is Part 1 of a Four-Part Leadership Transformation Series (LTS).

2012 Womens Olympic Triathlon finish in London - After two hours of racing with the best in the world, what would one or two seconds in transition time have meant for the top three athletes?

Transformation in healthcare is personal: it requires the transformation of health system leaders. This LTS begins to speak to key differences in some of the fundamentals of transformational vs traditional leadership in healthcare.

This article focuses on how the nature of our work is changing.

Many compare the healthcare transformation journey to one of our oldest Olympic sports: “It’s a marathon!” Although this might reflect the persistence, resilience and endurance sentiment, I offer an analogy upgrade from one of our newest Olympic sports: “It’s a triathlon!”

Why?

First, transformation requires mastery of multiple disciplines. We – and our organizations - may have competency in one or two disciplines, but adaptive learning is required to develop and integrate the different and stronger skills needed for next level or breakthrough performance. We cannot count on simply doing more of the same ‘one foot in front of the other’ plodding and grinding to advance our mission – our people are burning out. Unlike in the run or bike, the first triathlon discipline – the swim - does not ask as much of the legs. While the upper body provides most of the forward propulsion, for swim speed it is more important to reduce drag. Drag is not a material factor in running, but it is in running our organizations – and barnacles, barriers and anchors come in many, mostly self-inflicted, forms.( Read Full Article)

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Want to build your culture -- start by sweeping the floor!

Over the years, I’ve heard many stories, inspirational stories on leadership, one of my favorites involves President John F. Kennedy and his first visit to NASA in 1962. As the story goes, the President was touring the facility when he came across a janitor carrying a broom down the same hallway as the touring President. Kennedy, a great lover of people stopped him and asked him what he did for NASA, not missing a beat he replied, “I’m helping to put a man on the moon”.

As I reflect on this, I’m struck by the absolute simplicity of this statement, but also the way it speaks volumes. This individual clearly understood that he was an integral part of the team, no matter what the role. If he did his job well, he contributed to the overall success of the team, engineer, scientist, astronauts etc. His job, although different in almost every way imaginable from his colleagues, still contributed to achieving the overall goal, that of putting a man on the moon. Read Full Article

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Focus on Culture for Patient and Family Care: Beyond the Medicine

As healthcare (including acute care, nursing homes, home health and all downstream providers) moves towards a greater focus on patient/family satisfaction, the model of healthcare must also evolve, for both the government and patients/families will be closely reviewing these in determining healthcare provider(s) of choice. A satisfied patient is a more compliant patient, making for a more engaged patient. Providers at every level must now move beyond the patient centered approach, into an understanding of the patient/family perspective and be willing and able to convert input to action and measurable goals, benefiting staff, patients and families. Read Full Article

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Miracle-Gro® or Roundup® - Which One Are You Using on Your Network?

Why is it that some people thrive and others survive in business? Much of it comes back to their network. A network is like a garden. You have to water it on a consistent basis for it to grow. However, most of us put our heads down and focus on daily tasks. We say that we are too busy to network. We end up neglecting our networking garden and focus mainly on what others can do for us. Unfortunately, this self-referenced behavior is the equivalent of spraying Roundup® on your lush networking garden that you worked so hard to create. So what’s the cure?

Reciprocation is the Miracle-Gro® of networking. Without it, your network will shrivel up and look like you won a pallet of Roundup®. Here are three ways to rethink how you network, which can start to produce some Miracle-Gro®:

  1. When you talk to an executive recruiter next time, see what you can do to help them find a new client (not only a referral to a candidate). Go out of your way to introduce them to someone you know that might take their call. This can do wonders for your relationship with the recruiter.
  2. Instead of thinking of suppliers or vendors as another salesperson, invest time in getting to know them personally and see if you can introduce them to someone that might make a difference in their business. Remember that vendors may visit hundreds of organizations each year and their network could be very large.
  3. Focus on informational networking rather than looking at how you can find a new position. Invest in the relationship, find out about their journey and see what you can do to add value to the conversation. You might decide to follow up with writing an article that is relevant to the other person.

By investing in relationships over the long-term, thinking of others first and finding ways to reciprocate, you will develop a beautiful networking garden for many years to come.

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Take your team to first place -- by putting yourself last

Many high performing companies have discovered the value of servant leadership, which simply defined is serving others first. When leaders make this simple, but fundamental mind shift, the culture and the organization will follow as will bottom line results. Employees working under leaders who put their needs first, build self-confidence, make decisions more autonomously, have greater job satisfaction and engagement, and are more likely to practice this same style with their direct reports.

How does servant leadership build organizational and team performance? Read Full Article

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Healthcare Integration: Ship-to-Shore Work and the Ultimate Weapon

Veterans Day reminds me of my father. In WWII, he landed on Omaha Beach on D-Day.

As Steven Ambrose details in his book “D-Day,” the Allies planned the Normandy invasion for three years, but as soon as our troops hit the beaches, the plans went out the window. To the ‘man on the ground,’ NOTHING was as planned. And on the beaches, formal leaders were dead or not available. Survival and progress to save the free world depended on rapid learning and action, i.e., adaptive leadership. Our troops felt empowered to act, German forces felt compelled to wait for Hitler’s direction. The rest of this leadership story, as they say, is history.

Despite asserting to my Dad, in my youth, the growing impact of technology, e.g., pilotless planes, long-range capabilities, etc., he remained convicted of the mantra “the ultimate weapon is the man on the ground.”* My Dad and his colleagues, some of whom made it past D-Day, are heroes. I have since learned that there were others “on the ground” back in the U.S. who heroically enabled these heroes. During the planning for the largest invasion in modern history, a significant challenge was figuring out how to get our troops from ‘ship-to-shore.’ The U.S. federal government knew how make large ships to get our troops across the English Channel, but they could not get our troops to the shore. Enter Andrew Jackson Higgins, who was described by Dwight D. Eisenhower in 1964 as “the man who won the war for us.” (Read Full Article)

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Changing Landscape and Designation Within Rural Healthcare

The landscape within rural communities was very different in 1977 than it was 20 years later when Congress created the Critical Access Hospital (CAH) designation through the Balanced Budget Act of 1997. The intent was to reduce the financial vulnerability of rural hospitals and improve access to healthcare by keeping essential services in rural communities. In the 20+ years since, healthcare and the settings in which it is provided (and subsequent regulations) has continued to evolve.

Recently, there was H.R. 2957, Save Rural Hospitals Act. Creating a Community Outpatient Hospital (COH) designation. The focus would maintain the vital economic contribution the health system makes to the community, expand funding opportunities, along with telehealth and transportation for accessibility and improved quality of care. Read Full Article

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Is it 'Mission Impossible' for healthcare? Why mission-driven leadership is still the answer.

Healthcare has been in a tremendous period of change, mergers, acquisitions, leadership restructures, and new and improved strategic plans and priorities fill the time of most leaders. During this time of change, many leaders may wonder privately, does the mission of this organization still matter? Or is it only about the bottom line?.

When looking at high performing companies outside of healthcare, they all share some things in common, first, they have a clear and well spelled out purpose/mission. This is important so everyone, front line staff to executives can understand the why we are here, and how we will define success. This is not just a feel-good statement, and properly developed and executed this has the potential to pull people forward, especially during uncertain or difficult times. Read Full Article

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Does your new hire have the right stuff? How their personality has a long-term impact on your organization’s bottom line.

In healthcare, how often have you heard this, he/she is a great clinician, but has no personality. Or, take me to hospital A, but if I’m really sick take me to hospital B, this assumes hospital A is the “Nice” hospital but Hospital B is where all the best clinicians work. So, the obvious question is, can’t you have both? Yes, if you select the right people.

In Jim Collins book, “From Good to Great”, he writes, “People are your most important asset,” or rather the right people are. In today’s healthcare market many organizations are making the move from Volume to Value, with Quality being a primary focus, but how do our patients define quality? Sure, having the best possible outcome is right up there, with no medical mistakes or errors please. However, most patients come to our organizations assuming great quality, and value the interaction with their caregivers as high if not higher than any other part of the patient/caregiver interaction. Read Full Article

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Are you holding your team back? Why task-oriented leaders should build their relationship skills to accomplish goals

Task oriented leaders, those using just workplans, measurements, goals, dashboards, etc.… sometimes may be left scratching their heads when their teams do not accomplish their goals, or performance begins to decline without any clear reason as to why.

To motivate your teams, and accomplish your goals, perhaps you would be better served to examine your leadership relationship competencies.

WHAT IS RELATIONSHIP LEADING?

WHAT IS TASK-ORIENTED LEADING?

When determining what leadership style works best for your team, consider the make-up of the team, today’s workforce is motivated much more by team achievement but still values individual recognition. Workers today want to achieve the goal, but want much more flexibility than past generations when it comes to how to achieve that goal. Read Full Article

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New Year’s Resolution: Become A Better Leader!

In all the hustle and bustle of the holiday season, it’s easy to forget that in just a few weeks most of us will be looking at the New Year and a list of resolutions or promises that we have made to ourselves that we hope to accomplish. Some of our old favorites are bound to make the list, lose some weight, exercise, give more to charity, get back in touch with family or old friends.

But what about including in this year’s list the commitment to be a better leader next year?

Research tells us that when we write our goals down, we are far more likely to achieve them, so begin the year by taking a good hard look at what is means to be a leader, remember, you may have the title but being the leader of people requires these fundamental building blocks, can you complete these? Read Full Article

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Congrats you got the job! Read before you sign.

A physician who I greatly admire and respect once took a job as a hospitalist in a small town. She was told that she would have a guaranteed salary. But she did not read the fine print in her employment contract. The guarantee was actually an advance against future production, or collections. She was required to meet a certain level of collections to support her salary. If she did not meet that level of collections, she had to pay back the deficit. There was a hospitalist outside of and competing with her group. One of the emergency department physicians really liked this hospitalist. If he determined that the patient had good insurance, he called the outside hospitalist to do the admission. If he determined that the patient did not have good insurance, he called my friend’s hospitalist group. They were providing a tremendous amount of care to the patients in the hospital. They were just not getting paid. The longer she worked there, the deeper in debt she was getting. One of her partners did the math and simply left. My friend stayed out of a sense of integrity and fairness to give them time to find her replacement. She was not repaid in kind. And who was going to come and take over for such a terrible deal? She ended up in court and had to pay everything that the hospital was demanding of her. The judge said that it was a terrible contract, but a legally binding one and that she was a big girl and should have read the contract. Her partner who left early made the right decision in that she paid much less to the hospital.

When I was in medical school, we had a medical legal course which consisted of about 10 hours of lectures. One of the things that we were told was to read very carefully anything that we put our signature to. We were particularly cautioned to read employment contracts. I have followed this advice, and it has served me very well. I know of some stories where physicians were badly injured for not having read their employment contracts.

The first question is, “Will I be paid as an employee or as a contractor?” If an employee, then the employer pays half of the Social Security and Medicare taxes. If a contractor, then you pay all of the Social Security and Medicare taxes. If paid a salary, you will get a set amount of money, usually every two weeks or every month. Most people who are paid a salary are expected to work significantly more than 40 hours per week, because there is no additional cost to the employer for extra hours that you work. Many job offers will sound like salaried positions, but close examination of the contract will reveal that all or a significant portion of the payment offered is contingent upon one or more performance metrics. These metrics may include collections, relative value units (RVU’s), quality & efficiency. These may be based on individual performance, group performance or some combination of both. Collections is how much was actually paid for the care you delivered. Usually, a percentage of your collections is paid to the group or hospital for overhead. RVU payment is based not on collections, but on billing. This system is often used by organizations that serve the underserved as it encourages physicians to deliver care regardless of an individual’s ability to pay. Increasingly large portions of physicians’ compensation packages are only paid if the individual and/or group meet certain quality and efficiency metrics. Whether you are actually in control of a metric, the manner in which the metric is tracked & calculated and the thresholds to qualify for the metric all can have significant impact on your actual compensation. Benefit packages can also have significant impact.

In such a short article, I cannot tell you everything to look for. I would advise you to look closely at the exit clauses. When you go to work for a new employer, you have great hopes and even expectations that things are going to go very well. But they may not. I heard of a physician who, within two months of joining a new group, learned that his partners were engaged in and engaging him in activity of questionable legality. The exit clauses in his contract were onerous, and it was very costly for him to leave so early. Issues that may hit you with early separation can include repayment of sign-on bonuses, repayment of moving stipends and noncompete clauses. I was once invited to sign a contract that said I could not work for two years in any hospital anywhere in the United States owned by any company or organization that had a contract with this large physician staffing company (which had hospital contracts in many states).

So how do you go about reading an employment contract? Of course, you are not going to receive a copy of the contract until after you have been given an offer of employment. The contract is usually sent as a PDF. You can either print it out and use a highlighter and an ink pen or, if you can get it into an editable format on your computer, you can go through the document using track changes. You are now going to sit down and read every single word of the document: slowly, carefully and thoughtfully. You will go online and look up the definitions of any legal terms that you do not understand. You can write those definitions in the margins. You can make notes about things that you understand and want addressed and about things that you do not understand. After fully digesting the document, you will either decide to walk away from this job or you will think that this might be doable if the potential employer is agreeable to reasonable changes.

If you wish to go forward, you will now hire an experienced physician employment attorney and will send him or her a copy of your highlighted document with all its notations. You will discuss your concerns. Your attorney will review your document and schedule a follow-up discussion. Your attorney may advise you simply to walk away. Or he may give you a list of items that need clarification or correction. Some issues you identify and some of your attorney’s recommendations will be deal breakers meaning either these changes are made, or you refuse the offer of employment. Others may be that it would be nice if you could get them, but are not that important. With the help of your attorney and your spouse or significant other, if there is one, you will formulate a plan for seeking necessary and desired changes in your employment contract that are reasonable and fair to both parties. Your attorney will help you express your concerns in a language that resonates with the attorney working for your potential employer who will have to give the final approval on any changes to the employment contract.

I will walk you through how I approach these negotiations. I schedule a phone meeting with the individual designated by the potential employer to be their face for the negotiations. My tone is very pleasant and reasonable. I start by saying that my wife and I have carefully read the contract. I have sought the advice of a very competent attorney experienced in physician employment contracts. From these discussions, the following concerns have arisen. If the concern is coming from me, I do not hesitate to say so, but I consider it a good strategy to point out when the concern is coming from my wife or from the advice of my attorney. This is called an appeal to higher authority. It may seem like weakness, but it is a very powerful tool. Used properly, it can tremendously strengthen your position as nothing they say to persuade me will have any impact on how my wife feels about it, especially when it is an issue that is recognized as a reasonable concern for the employee’s wife. When appropriate, I ask for clarification of language in the contract rather than outright changes. Everything that I am asking for needs to be laid out in this first meeting. If you keep coming back with new demands, they may tire very quickly and look for another candidate.

You likely will not get everything you ask for. Just make sure that you get everything you need.

You likely will not get everything you ask for. Just make sure that you get everything you need.

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