Monthly Archives: August 2026

Small Talk Is Not Wasted Time. It Is the Only Rehearsal for Big Trust.

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Most executives treat small talk as the tax you pay before the real conversation starts. Research on negotiation and workplace behaviour suggests it’s closer to the opposite: the low-stakes rehearsal that determines whether the real conversation goes anywhere at all.

 

What the Research Actually Shows

A frequently repeated claim holds that people who make small talk before negotiating are four times more likely to reach agreement. That number doesn’t survive a check against the study it’s supposedly drawn from. The actual 2002 research behind it, published in Group Dynamics, found something more modest but still real: negotiators who “schmoozed” beforehand reported significantly higher rapport than those who didn’t, and reached an impasse less often, 40.6% of the time versus 60.7%, though that gap was only marginally significant. The finding itself is that small talk measurably raises rapport and modestly improves outcomes. It is not some four-times multiplier, and repeating the inflated number would undercut exactly the kind of precision this argument needs to be taken seriously.

 

The Mechanism, Confirmed More Recently

A 2021 study in the Academy of Management Journal tracked 100 employees across 978 daily workplace observations over three weeks and found small talk works through a specific, two-sided mechanism: it “enhanced employees’ daily positive social emotions at work,” which increased helpful, cooperative behaviour toward colleagues, while simultaneously disrupting people’s ability to concentrate on their actual tasks in the moment. Both things are true at once. Small talk builds the social capital that makes cooperation possible later, and it costs a small amount of focus right now. A 2024 qualitative study of 35 B2B professionals found the same rapport-building mechanism operating specifically in negotiation contexts, identifying genuine curiosity, active listening, and respect for boundaries as the actual ingredients, not just friendly chatter for its own sake.

 

The Counterargument Worth Taking Seriously

Not everyone in this field agrees, and the disagreement is worth taking seriously rather than editing out. Kim Scott, whose Radical Candor framework has shaped how a generation of executives think about direct feedback, has argued the opposite case directly: real trust with employees comes from substantive one-on-ones and working relationships, not casual chat, and treating small talk as the relationship-building mechanism risks substituting a comfortable habit for the harder work of actually knowing someone. That critique lands hardest in ongoing management relationships. The negotiation and cross-cultural research above is mostly about a different situation: the first few minutes with someone you don’t yet have a working relationship with, where there’s no substantive history to draw on yet, and small talk is the only tool available to establish enough trust for the real conversation to start at all.

 

Why This Matters More in Some Rooms Than Others

Research on Arab business negotiators found relationship-building carries even more weight in that context, with negotiators leaning on personal networks and trust-building as central to how deals actually get made, rather than an optional warm-up. The mechanism isn’t unique to any one culture. It’s just more visibly load-bearing in markets where trust is built through recurring personal contact rather than through contracts alone.

 

What This Means in Practice

Skipping small talk to “get to the point faster” isn’t efficient. It’s removing the only low-stakes moment where two people calibrate whether they trust each other, before the stakes get high enough that a miscalibration actually costs something. The application is genuine curiosity about the person in front of you, delivered before you need anything from them, rather than performed friendliness, so that when you do need something, the trust required to ask for it is already there.

Pre-Mortem: The Liability Chain Medicare’s AI Prior Auth Model Has Not Drawn

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On 1 January 2026, the Centers for Medicare and Medicaid Services in USA launched the WISeR model in six states, introducing prior authorisation to procedures that traditional Medicare had always provided without it. Contracted companies now assess medical necessity using AI. Human clinicians are required to sign off on any denial. The Senate voted 46-50 in July 2026 to keep the programme running. One question has not been answered.

This is the twelfth piece in the Pre-Mortem series. Five questions, applied to the public record, before a programme has had the chance to succeed or fail.

 

The Bet

CMS is wagering that AI-assisted prior authorisation reduces unnecessary Medicare spend without producing the patient-safety incident that forces a political reversal. If WISeR delivers measurable waste reduction without a documented causal chain from AI denial to patient harm, it becomes the template for prior authorisation across Medicare nationally. If it produces that chain, a documented line from AI recommendation to denial to patient harm, it does not just end WISeR. It becomes the reference point that makes AI prior auth politically untouchable in federal health programmes for a generation.

 

The Assumption

CMS has answered every operational question about WISeR except this one:

When an AI recommendation leads a contracted clinician to deny care and a patient is harmed as a result, where does liability sit?

The model design places a human clinician between the AI output and the denial decision. That establishes a paper trail. It does not establish a liability framework. Contractors earn between 10 and 20 per cent of the savings generated by denials and lose that payment when a denial is overturned on appeal. That is a commercial penalty, not a clinical one. The Federal Tort Claims Act does not cover contracted entities. No federal court has tested whether a contracted clinician reviewing AI recommendations at volume carries the same duty of care as a treating physician making an independent clinical judgement.

The assumption doing all the work in this model is that the human review layer is accountability enough. That assumption has not been tested.

 

The Sequence

1 July 2025. CMS published the WISeR notice in the Federal Register and did not submit it to Congress under the Congressional Review Act. That omission would matter later.

1 January 2026. WISeR launched in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington.

17 March 2026. The Washington Post published an exclusive: Medicare’s new AI gatekeeper was delaying care for seniors. The University of Washington’s medical system had nearly 100 patients waiting for epidural injections. In Arizona, Phoenix pain specialist Dr Matthew Crooks told Medscape that every epidural injection submitted in the first three months had been denied and described the system as completely nonfunctional and unsustainable. In Texas, initial AI approval rates ran at 62 per cent, against a 92 per cent national approval rate across Medicare Advantage.

25 March 2026. The Electronic Frontier Foundation filed a FOIA lawsuit against CMS in federal court in California, seeking records on WISeR’s AI algorithms, training data, bias safeguards, and the financial incentives paid to contractors. The suit confirmed that CMS had not made its AI methodology or vendor compensation structure publicly available seven weeks after launch.

6 April 2026. CMS published a Federal Register notice delaying prior authorisation implementation for certain services within the model to allow additional time for operational readiness. CMS also issued a corrective action order against one of its AI contractors. Both confirmed that the model’s operational design had not performed as intended in the first quarter.

12 May 2026. The Government Accountability Office issued its determination: WISeR met the Administrative Procedure Act definition of a rule and was subject to the Congressional Review Act. CMS had not made the required submission to Congress before the model took effect.

20 May 2026. Senator Ron Wyden and Representatives Suzan DelBene and Greg Landsman introduced resolutions of disapproval in both chambers, seeking to repeal WISeR under the CRA.

6 July 2026. Gold carding launched in Washington state. Providers achieving a 90 per cent affirmation rate across a minimum of ten prior authorisation requests become exempt from further review for covered services. Quarterly rollout to the remaining five states is planned.

16 July 2026. The Senate voted 46-50 against advancing the disapproval resolution. Party line. WISeR survived. The liability question the GAO had exposed survived with it.

The Pager

Dr Mehmet Oz, Administrator of the Centers for Medicare and Medicaid Services.

The message: WISeR’s accountability chain has not been drawn. The model places a contracted clinician between an AI denial recommendation and a Medicare beneficiary, but no published document establishes where negligence sits when a patient is harmed following an AI-assisted denial. The Federal Tort Claims Act does not cover contractors. Contractors point to the human clinician. Clinicians are reviewing AI output under volume pressure with no published duty-of-care standard for that specific context. When the first federal lawsuit tests this configuration, and one will, CMS will need a published framework, not a contract clause. That framework is easier to write before litigation than after.

 

The Proof

Gold carding is the model’s self-correction mechanism. If quarterly rollout reaches all six states and the 90 per cent affirmation threshold functions as a genuine quality signal, the AI layer contracts over time as trust is established. Proven providers exit prior auth. New entrants face the review. The model becomes calibrated rather than blanket.

If gold carding stalls or rollout criteria are applied inconsistently across jurisdictions, the AI layer expands without a release valve. Prior auth burden accumulates regardless of provider track record. The model becomes a cost-reduction instrument with no exit for providers who have earned one.

The proof of the bet is not the aggregate savings figure. It is whether WISeR, by the end of 2026, has published a liability framework and delivered gold carding in all six states. Without both, the model is running on the same untested assumption it started with.

 

Verdict

If CMS publishes a liability framework for AI-assisted denials before a federal case forces the question, and gold carding delivers consistent rollout across all six states, WISeR will be the strongest government evidence yet that AI-assisted utilisation review can reduce Medicare waste without a patient-safety crisis. The accountability design would become the reference for every federal health programme that follows.

Without the liability framework, WISeR accumulates its risk quietly. Not through a single dramatic incident, but through the gap between AI recommendation volume and human review capacity, compounded by an accountability vacuum no published document has yet closed. That gap does not stay open indefinitely.