You probably know the line even if you’ve never seen the movie.
In the film Glengarry Glen Ross written by David Mamet based on his play of the same name, the Alec Baldwin character, Blake, in a conference room he’s not supposed to be in, humiliates a sales team that thought they were having a normal Tuesday. “A-B-C. A-Always, B-Be, C-Closing. Always be closing.” It’s become shorthand for a certain kind of relentlessness, and for anyone actually managing a hospital relationship, it’s also exactly backwards.
Closing implies an ending: a signature, a handshake, a document that goes in a drawer until the renewal date shows up on someone’s calendar. But that’s not how it works between a hospital-based physician group and the hospital, and if you’re treating your contract that way, you’re already behind.
The better rule is “always be contracting”. The truth is that there is no interval between negotiations. There’s only negotiation, conducted through whatever instrument happens to be lying around at the moment.
If you want to see that principle in its most exaggerated, most public form, look at what happened earlier this year outside Eugene, Oregon.
The Negotiation That Never Looked Like One
In February, PeaceHealth told its emergency department group of 35 years, Eugene Emergency Physicians or “EEP”, that it was done, and handed the contract via an RFP to an Atlanta-based company operating through a freshly formed local shell.
Everything that followed for the next four months looked, on the surface, like anything but a negotiation.
There was a no-confidence vote, with 93 percent of the medical staff against hospital leadership. There was legislative testimony, with EEP’s leaders in front of an Oregon Senate committee describing the risk to the region’s emergency care. There was a rally of 150 people outside the hospital and a petition with more than 6,800 signatures. And, there was a federal trial, in which the judge concluded that the incoming group’s own witnesses had been dishonest with the court about who actually controlled the arrangement.
None of that was a departure from negotiating. It was negotiating, just conducted in rooms without “negotiating tables” in them.
By the time PeaceHealth and EEP announced, on May 6, that they were resetting course, the terms had already been substantially set: the region’s chief hospital executive was gone within the week, the once incoming replacement group no longer had a role, and on May 21 the parties signed a new three-year contract.
What happened from rejection to replacement to reinstatement was one continuous negotiation that happened to pass through a courtroom on its way to a signature page.
Your Version Is Quieter, But It’s the Same Negotiation
Your relationship with your hospital is unlikely to produce a no-confidence vote or a federal trial, and you should hope it never does. But the underlying mechanism is identical, just conducted at a lower volume.
The patient satisfaction scores the hospital cites at a QI meeting. The casual question from the CMO about extending coverage an extra two hours. The medical staff committee seat your group didn’t volunteer to fill. Every one of those is a move in a negotiation that will eventually produce, or fail to produce, your next contract. Treating any of it as separate from “contract negotiation” is the institutional-scale version of a physician who thinks a hallway conversation with a hospital administrator doesn’t count.
Groups lean on tenure the way EEP could have: 35 years should count for something, so the relationship itself is treated as protection, no need to formalize what good conduct and cooperation are worth. That’s a bet that certain channels, informal conversation, committee participation, simply showing up, don’t count as negotiating positions. It’s exactly the bet EEP’s history should have warned against: tenure didn’t stop PeaceHealth from renegotiating the entire relationship through an RFP. A hospital under financial or political pressure will make that same move against you, because it never treated those channels as anything other than part of the negotiation.
Some Timely Takeaways for You
1. There is no off-the-record conversation with your hospital’s administration. If it happened, it’s part of the negotiation, whether or not anyone called it that at the time.
2. Watch for the hospital’s opening moves long before a term sheet appears. An RFP, a leadership change, a new interest in a metric nobody cared about last year, these are opening positions, not neutral administrative housekeeping.
3. Build your leverage, and your documentation, between renewal cycles, not just before them. The record you’ll need someday is being created right now, whether or not you’re keeping it.
4. When a relationship goes public, a vote, a rally, testimony, that’s not a breakdown of the negotiation. It’s the negotiation changing rooms. Don’t mistake the new venue for a loss of control.
5. If the hospital dismisses your group’s advocacy as “outside the official process,” recognize the line for what it is: a negotiating position, not a fact. The official process is whatever actually determines the outcome, and lately that hasn’t been limited to a boardroom.
If you’d like to talk through what’s actually being negotiated in your hospital relationship right now, whether anyone’s calling it that or not, let me know.
