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Learning to Coordinate: A Relational Model of Organizational Change
Jody Hoffer Gittell, Brandeis UniversityAmy Edmondson, Harvard Business School
Edgar Schein, MIT Sloan School of Management
2011 Academy of ManagementSan Antonio, TX
Learning to coordinate
Coordination is a key organizational competence that drives performanceBut how do organizations learn to coordinate?If coordination is relational, people need to learn new patterns of interrelatingHow does this happen in an intentional way?What is the sequencing or interplay between changing relationships, and changing the structures that reinforce them?
In this paper we will…
Explore relational models of • Coordination • Learning and change
Propose a relational model of learning to coordinateDescribe three cases of learning to coordinate
• Canadian obstetrics units• Texas primary care clinics• Maine health and human services
Relationships shape the communication through which coordination occurs
Shared goals
Shared knowledge
Mutual respect
Frequent communication
Timely communication
Accurate communication
Problem-solving communication
This process is called
“A mutually reinforcing process of communicating and relating for the
purpose of task integration” (Gittell 2011)
How do organizations learn new ways to coordinate?
Because relational coordination is a mutually reinforcing process, it is difficult to change
Relational dynamics tend to become deeply embedded in the form of assumptions and self-concepts
What do we know about organizational learning and change that might be helpful?
Organizational learning (Edmondson 2002)
Organizational learning is interpersonal and relational, and often involves learning to coordinate work in a new way
Psychological safety – the perception that it is safe to express disagreement and be fallible – is a necessary condition for this kind of interpersonal, relational learning to occur
Psychological safety enables participants to identify and question current assumptions
Changing structures is not enough Change cannot occur only through changing
formal structures – new structures will not be embraced or sustained unless the assumptions that underlie them are identified and questioned (Fletcher, Bailyn, Blake-Beard 2009)
Need ‘discursive’ or ‘relational’ space for identifying and questioning the current organizational assumptions (Fletcher, Bailyn, Blake-Beard 2009; Kellogg 2009)
How to start the learning process (Schein 2010)
Individuals or groups can participate in a ‘cultural island’ that enables examination of past practices, cultural norms and constraints to learning
Goal is to identify and commit to shared goals based on a new compact with the organization and with each other
This can improve relational coordination
Off-site agenda: Learning and unlearning (Schein 2010)
Step 1: Self-assessment of present state Step 2: Identification of learning barriers Step 3: Identification of cultural constraints and aides Step 4: Commitment process to shared goals and compact Step 5: Identification of desired new behaviors
Timely and relevant communication Role-mapping and identification of interdependence Role negotiation to build relationship Mutual sharing of knowledge Mutual agreement on how to measure progress
Step 6: Ensure that rewards and incentive systems and other organizational structures are consistent with the new ways of working
Learning to coordinate: A relational model of organizational change
Relational coordination
Shared goalsShared knowledge
Mutual respect
Frequent communicationTimely communication
Accurate communicationProblem-solving comm
Relational interventionCultural island
Psychological safetyRelationship mapping
Role modeling
Organizational structures Performance
Case studies of learning to coordinate
Case 1: Canadian obstetrics Case 2: Texas primary care Case 3: Maine health and human services
Canadian obstetrics
Canadian obstetrician and obstetrics nurse discovered through their own work experience that relational approaches between providers and with patients seemed to result in fewer errors, better quality outcomes, less waste, fewer liability claims
With support from a Canadian insurance association, they formed a consulting practice to teach their methods to obstetrics units throughout the country
Canadian obstetrics (continued)
Intervention works with frontline providers to improve work processes and relational dynamics, then seeks leadership support for new structures to support the new relational dynamics
“We didn’t know what to call what we were doing, but after reading organizational theory in the late 1990s, I realized we were doing relational coordination” (Ken Milne, CEO, Salus Global Consulting)
Canadian obstetrics (continued)
Have worked with over 100 Canadian hospitals and about 30 U.S. hospitals, often achieving reductions in liability claims, and increases in satisfaction and other quality outcomes
Now rolling out the model to other hospital units (surgery, ER, ICU), that have been requesting the same type of intervention
Texas primary care
Research team from UT Health Science Center in San Antonio enrolled 40 rural primary care clinics in an effort to improve chronic care for their patients
Intervention team led by a physician/researcher helped clinics to measure their outcomes, their structures for chronic care delivery, as well as relational coordination and reciprocal learning
Texas primary care (continued)
Through coaching visits every 2-3 weeks over a one year period, the intervention team facilitated meetings, process improvement efforts and relational improvements among clinical and non-clinical members
“We shared the data with them and let them decide what they wanted to do about it. We gave advice, like meeting with each other, doing regular huddles to coordinate care – but we were there to help them do what they wanted to do” (Raquel Romero, MD, Intervention Team Leader)
Texas primary care (continued)
Base-line cross-sectional data suggests that relational coordination and reciprocal learning among members predict greater adoption of chronic care structures
Still analyzing longitudinal data to assess changes over time
Maine Dept. of HHS
Leaders in Maine’s Office of Lean Management have been implementing lean principles in government for 6 years
They respond to requests for training and for assistance with process changes
Maine Dept. of HHS (continued) “It is a blame/shame environment. During the
training we started to see the goal alignment, the shared knowledge and the respect they were developing for each other. We saw it but didn’t know what it was” (Walter Lowell, Director, Office of Lean Management)
“We realized that when the lean training works, it’s because they are changing their relationships in really important ways” (ibid)
Maine Dept. of HHS (continued) “We designed a coaching intervention to
foster relational coordination, and we call it the soft side of lean” (Kelly Grenier, Consultant, Office of Lean Management)
“But people can get really discouraged when they go back to work – some say it was great training but within a couple of months they are back in their old boxes. Nothing has changed to support their new ways of working together” (ibid)
Learning from casesIn cases 1 and 2, relational interventions were
followed by changes in organizational structures Our model predicts these structures will reinforce and
sustain the new relational patternsIn case 3, relational interventions were not
followed by changes in organizational structures Our model predicts failure to sustain new relational
patternsIn all three cases, relational interventions occurred
along with process improvement interventions We revised our model to reflect this combined
intervention
Learning to coordinate: A relational model of organizational change
Relational coordination
Shared goalsShared knowledge
Mutual respect
Frequent communicationTimely communication
Accurate communicationProblem-solving comm
Relational interventionCultural island
Psychological safetyRelationship mapping
Role modeling
Organizational structures Performance
Process improvement intervention
Data gathering/analysisProcess mapping
Structured problem solving
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