HLTH 8465 Week 10 Partnership Counterargument Brief Example

Counterargument Brief: The Larger Hospital System's Case Against the Shared Crisis Center

Student Name

Walden University

HLTH 8465: Strategic Planning: Collaboration, Cooperation, and Coordination

Instructor Name

Month Day, Year

Counterargument Brief: The Larger Hospital System's Case Against the Shared Crisis Center

Introduction

The strongest objection to the composite county's shared crisis receiving center belongs to the larger hospital system. This brief writes that objection at full strength, in the voice of the system's executive team, before answering any of it. The objection and the response are given roughly equal space. The aim is to find out what in the shared plan survives a serious challenge, not to win the argument.

The Objection

From the larger system's executive team: We support better crisis care, and we will build it. We object to building it jointly, for three reasons.

First, speed. A crisis unit owned by our system could open within a year, because only our board must approve it, our capital program can fund the renovation and our clinicians are already employed. The shared center has already slipped six months, and every decision needs four boards. Adults in crisis are waiting in emergency departments now, including ours.

Second, the backbone. The partnership's planners propose a coordinating organization modeled on collective impact, whose five tenets, as Flood and colleagues summarize them, include an agenda the parties share, common measures, activities that reinforce each other, ongoing communication and a central support infrastructure, usually called the backbone (Flood et al., 2015). A backbone needs its own staff and budget. Within a few years it will be arguing for its own survival, adding a fifth party with its own agenda to a partnership that already struggles to agree.

Third, transaction costs. Negotiating, monitoring and renegotiating with three partners, one of them our direct competitor, will absorb much of the benefit. Every staffing level, data request and admission rule becomes a negotiation. The costs of governing a partnership are real costs, and they fall heavily on the party that supplies the clinicians (Williamson, 1981).

Response to the First Point: Speed

The objection is right about speed. A system-owned unit would almost certainly open sooner. The shared plan cannot match a single board's decision time, and the six-month delay is evidence of that.

What speed does not answer is who the unit would serve. A system-owned unit would serve the system's own emergency departments and its insured patients first, and it would have no reason to accept people deputies bring from across the county, or uninsured adults the authority funds. It would relieve the larger system's emergency department and leave the independent hospital's, and the jail, as they are. The shared center's slower path is the price of a county-wide front door. The partners should acknowledge that price openly, and consider whether the larger system's own unit and the shared center could coexist, with the shared center accepting all referrals and the system's unit taking its own transfers.

Response to the Second Point: The Backbone

The objection is partly right about the backbone. Collective impact's call for a separate backbone organization assumes a large, multi-sector effort with many participants; it fits less well a four-partner, single-site project. Provan and Kenis's comparison of governance forms supports the point: a separate administrative organization suits larger networks needing specialized competencies, while small networks can often be governed by a lead organization (Provan & Kenis, 2008).

The response is to drop the backbone and use the lighter coordinating role already recommended in the governance memo: the authority as lead organization, bounded by reserved matters that need a supermajority or unanimity. That arrangement adds no fifth party. It concedes the objection's core while keeping coordination.

Response to the Third Point: Transaction Costs

The objection is right that governing a partnership with a competitor is costly. The answer is to reduce what must be negotiated, not to abandon the partnership. Three steps would do that. First, the larger system's role could be limited to a fixed clinical staffing contract with the authority, priced per shift, with no shared data on referrals beyond what the contract requires. Second, the center's admission criteria could be set once, by the operating committee, and revisited annually rather than case by case. Third, disputes about staffing and payment could go to the contract's own terms rather than to the partner council. Transaction cost reasoning itself suggests that a well-specified contract reduces the costs of governing a relationship where it can be written, and leaves relational governance for what cannot (Williamson, 1981).

Why the Larger System Might Still Join

The objection assumes the larger system's best alternative is to build alone. Fisher, Ury and Patton advise every party to a negotiation to test its best alternative to a negotiated agreement honestly, because parties often overestimate it (Fisher et al., 2011). The system's alternative is strong but not costless. A system-owned unit would carry the full operating loss of a service that mainly treats uninsured and Medicaid patients, with no authority funding behind it. It would still receive people brought by deputies from across the county, since deputies take people to the nearest open door, so it might become the county's crisis front door anyway, at its own expense. And it would leave the system's clinicians competing for the same small pool of psychiatric staff as a shared center the other partners might build without it.

Under a narrowed staffing contract, by contrast, the system would be paid for each clinician shift, would gain relief for its own emergency departments and would keep the freedom to build its own unit later. Seen against its real alternative, joining on these terms may be the better deal for the system itself. The partners should put that comparison to the system's executive team directly, rather than appealing to the shared goal.

What Survives

The plan survives, but changed. It concedes that a system-owned unit would be faster, and accepts that the two could coexist. It drops the backbone organization in favor of the lead organization model. And it narrows the larger system's role to a staffing contract, reducing the transaction costs the system would bear. The partnership the objection leaves standing is smaller and more specific than the one first proposed, and more likely to hold.

References

Fisher, R., Ury, W., & Patton, B. (2011). Getting to yes: Negotiating agreement without giving in (3rd ed.). Penguin Books.

Flood, J., Minkler, M., Hennessey Lavery, S., Estrada, J., & Falbe, J. (2015). The collective impact model and its potential for health promotion: Overview and case study of a healthy retail initiative in San Francisco. Health Education & Behavior, 42(5), 654-668. https://doi.org/10.1177/1090198115577372

Provan, K. G., & Kenis, P. (2008). Modes of network governance: Structure, management, and effectiveness. Journal of Public Administration Research and Theory, 18(2), 229-252. https://doi.org/10.1093/jopart/mum015

Williamson, O. E. (1981). The economics of organization: The transaction cost approach. American Journal of Sociology, 87(3), 548-577. https://doi.org/10.1086/227496