AACN News—December 2007—Opinions

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Vol. 24, No. 12, DECEMBER 2007

President’s Note

Dave Hanson,

How to Say No and Still Get to Yes
It is easy to say ‘no!’ when a deeper ‘yes!’ is burning inside.
— Stephen R. Covey

Last month we considered the paradox where saying Yes can mean No, but saying No can mean Yes. In his new book, “The Power of a Positive No,” Harvard negotiation expert William Ury proposes transforming No into a positive word. This paradigm shift comes from a mindset that desires success instead of one that even subconsciously aims at failure.

The Yes Reflex
We often say Yes almost instinctively because it seems so benign at the very moment we utter the word. Then the aftershock hits and we find ourselves in a real pickle as our rational inner voice poses the million-dollar question: “What on earth was I thinking?” We may not have inquired deeply enough or we misinterpreted the request and its ramifications. Perhaps we said Yes fearing retaliation for breaching perceived or real authority gradients, even though we were trying to voice our concerns about a critical issue such as safety. Or we said Yes to preserve a fragile relationship—with an overbearing or incompetent co-worker, for example—instead of honoring our core values of patients and families, safety and reliability.

Ury explains how a Positive No represents a marriage of the two most fundamental words in our language: Yes and No. Yes is the key word of community. No is the key word of individuality. Yes without No destroys our own satisfaction, whereas No without Yes destroys our relationship with the other person. Think of Yes as the key word of connection and No as the key word of protection.
What would a Positive No look like? It has three basic parts. First, we affirm the underlying Yes. Next, we spell out the No in a matter-of-fact statement of reality. Then we lead to a constructive Yes, which is an invitation that furthers the relationship and enables everyone to continue working together collaboratively.

What If
Let’s say we all worked in a large regional health system that imposed electronic charting technology on all of its hospitals. The technology has been implemented and it’s a disaster. What choices might we have? We could say Yes and use it even though we have evidence of its negative impact on patient safety and our own reliability. We could throw our hands up in frustration and whine to one another. We could also dig in our heels and refuse to use it outright. Or we could consider a Positive No.

Communicating with the appropriate decision makers, we would put forward our first Yes. “Safe and reliable care for patients and their families is our primary concern.” We would spell out our No in an objective matter-of-fact manner. “Since the charting technology was instituted over a year ago, we have data showing patient care errors have been directly linked to use of the new system, the process of charting has become too time intensive —on average it is taking more than 2.5 hours to accurately admit one patient—and we’re now losing revenue because we cannot bill accurately.” After the No, we would immediately propose an engaging and constructive Yes. “We know this issue isn’t unique to just our organization and commit to helping find and implement best practices for turning around the problem so we balance the high-tech goal of complying with regulatory requirements with the high-touch goal of providing quality service and care.” (For those already thinking about attending NTI 2008 May 3 through 8 in Chicago, consider attending one of the preconference workshops on precisely this issue.)

In a different situation, perhaps one involving abusive behavior, we can say Yes to ensuring safe and reliable care for patients and families and No to unacceptable behavior such as abusive language. Then Yes to developing true collaboration in order to improve our professional relationships so we can learn how to disagree without being disagreeable.

A Visual Image
Ury uses the visual image of a tree to illustrate his message. The roots from which the trunk emerges represent the first Yes. They are the deeper interests that sustain us. The trunk is the No. But just as the trunk is only the middle of a tree, our No is only the middle of a Positive No. The branches and foliage growing out of the trunk are the second Yes--a Yes reaching out toward a possible agreement or relationship. The fruit, of course, represents the positive outcome we seek.
Using a Positive No may seem awkward and even difficult at first. I encourage you to keep trying again and again, appreciating the comfort as this new skill takes hold. Remember we’re simply using the clarity, specificity and power of No to communicate a Yes to what truly matters. If using a Positive No is already a familiar and comfortable skill for you, please share your successes with me. If you’re like me and find yourself intrigued enough to try it, let me know how it works for you. Either way, you can write to me at priorities@aacn.org. I look forward to celebrating the successes that await us as we continue reclaiming our priorities, learning to say No while getting to Yes.
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