When someone asks you for something, I don’t care if you’re dealing with a child or a CEO, you can’t just say "No," or "What are you, nuts?" That is not a real response to a query made in earnest. To avoid that, I approach every conversation?whether it is with my direct report or the chairman of the board?as a conversation between peers. Even if I’m not sure we ought to do what someone is asking us to do or I’m vehemently opposed to doing it, it is still someone asking me an earnest question. And chances are he’s trying to fix a real problem. He may have come up with a less than optimal solution, but you’ve still got to start a dialogue and address the underlying problem.

More often than not, that conversation can be as simple as suggesting further analysis of the situation: "Let’s bring a consultant in," or "Let’s ask Sally and Herb to take a look at this." No matter what the words are, what you’re saying is, "Let’s explore this a little further before we make a decision." Chances are the people you’re dealing with will be responsive to this approach.

In one case, one of the senior members of our medical staff thought the IS department should lead the charge in reducing medical errors. I knew this was something that the medical leaders needed to address. It wasn’t appropriate for the IS guy to go in there and say, "Hey you guys are making too many mistakes, and we’re going to fix that." This was a very senior member of the executive team with enormous influence and power, but I knew he was just frustrated. The organization wasn’t moving fast enough, and he thought IS could speed things up. While there are some cases where IT should be the mover, I knew that given the issue and the way our business community works, our medical department should lead this effort, and I told him that by saying, "Now will I help you with this? Damn straight. But let’s talk about how we move this along together."

I don’t want to be Pollyannaish. There are situations in which a person holds to her beliefs and the collegial approach won’t work. At the very least you should invoke what I call the "arbitration rule" and get the opinion of two other folks on the situation.

Every now and then, you will get stuck with a person who is going to say, "We’re going to do this no matter what." But that ought to occur in the low single-digit percentages. I remember more than a decade ago, when we were trying to get out of an outsourcing agreement, my boss wanted to bring in attorneys, play hardball, and yell and scream about it. I wanted to take more of a high road. I went over his head to explain why [to his superior as well as to him] and told him that if I was wrong we’d go back to his plan, which we eventually did. And I think that the months of keeping to the high road made it easier to play hardball when the time came to do so.