Relational Coordination: Transforming Relationships for High Performance Relational Coordination Conference November 13, 2014 Jody Hoffer Gittell, Ph.D

Relational Coordination:Transforming Relationships for High Performance

Relational Coordination ConferenceNovember 13, 2014

Jody Hoffer Gittell, Ph.D.Professor, Brandeis University

Executive Director, Relational Coordination Research CollaborativeChief Scientific Officer, Relational Coordination Analytics

What is relational coordination? How does relational coordination impact

performance in airlines, healthcare and elder care? What is the newest research?

How can organizations support relational coordination?

Getting from here to there - stories of organizational change

Today

Relational coordination was discovered while studying flight

departures in the airline industry…

Operations Agents

Pilots

Flight Attendants

Mechanics

CaterersCabin

Cleaners

Gate Agents

Ticket Agents

Ramp Agents

Baggage Agents

FuelersFreight Agents

Flight departure process: A coordination challenge

Passengers

Relationships shape the communication through which

coordination occurs ...

Findings

For better...

Shared goals

Shared knowledge

Mutual respect

Frequent

Timely

Accurate

Problem-solving communication

… or worse

Functional goals

Specialized knowledge

Lack of respect

Infrequent

Delayed

Inaccurate

“Finger-pointing” communication

This process is called

“Communicating and relatingfor the purpose of task integration”

Does relational coordination matter for performance?

Investigated performance effects of relational coordination

Nine site study of flight departures over 12 months of operation at Southwest, American, Continental and United

Measured relational coordination among pilots, flight attendants, gate agents, ticket agents, baggage agents, ramp agents, freight agents, mechanics, cabin cleaners, fuelers, caterers and operations agents

Measured quality and efficiency performance, adjusting for product differences

Relational coordination drivesflight departure performance

Efficiency QualityGate time/ flight

Staff time/ passenger

Customer complaints

Lost bags

Late arrivals

Relational coordination

-.21*** -.42*** -.64*** -.31* -.50**

Flights/day -.19**** -.37*** -.30*** .13 -.22+

Flight length, passengers, cargo

.79*** .45*** .13 .12 -.54**

Passenger connections

.12** .19** .09 .13 .00

R squared .94 .81 .69 .19 .20

Observations are months (n=12) in airport locations (n=9). Standardized coefficients are shown.

Relational coordination drives flight departure performance


Quality/efficiency performance

index

AMR2

AMR1

UNI2

UNI1

CON1 UNI3

CON2

SWA2

SWA1

Case Managers

NursesAttending Physicians

Physical TherapistsNursing

Assistants

Social Workers Technicians

Referring Physicians

Administrators

Patient care:A coordination challenge

Patients

Institute of Medicine report

“The current system shows too little cooperation and teamwork. Instead, each discipline and type of organization tends to defend its authority at the expense of the total system’s function.” (2003)

Physicians recognize the problem

“The communication line just wasn’t there. We thought it was, but it wasn’t. We talk to nurses every day but we aren’t really communicating.”

Nurses observe the same problem

“Miscommunication between the physician and the nurse is common because so many things are happening so quickly. But because patients are in and out so quickly, it’s even more important to communicate well.”

Same study conducted in hospital setting Nine hospital study of 893 surgical patients Measured relational coordination among

doctors, nurses, physical therapists, social workers and case managers

Measured quality and efficiency performance -- and job satisfaction, adjusting for patient differences

Relational coordination drives surgical performance

Length of stay

Patient satisfaction

Freedom from pain

Mobility


-.33*** .26*** .08* .06+

Patient age .02 .00 .01 .04

Comorbidities .09* .07 .01 .04

Pre-op status .03 .01 .20*** .28***

Surgical volume

.11** .10* .06+ .03

R Squared .82 .63 .50 .22

Observations are patients (n=878) in hospitals (n=9). Model also included gender, marital status, psychological well-being and race. Standardized coefficients are shown.

Relational coordination drives surgical performance


Quality/efficiency performance index

Hosp2

Hosp1

Hosp7

Hosp3Hosp9

Hosp5

Hosp6

Hosp8

Hosp4

Nursing Aides

NursesActivities

Staff

TherapistsDietary Staff

Housekeeping Staff Case Managers

Referring Physicians

Attending Physicians

Elder care:A coordination challenge

Resident and family

Coordination is lacking

“The problem is that doctors in acute care don’t understand what happens in long-term care or rehab. …In post-acute there’s a knowledge gap about what is going on in acute care. There often aren’t very good processes in place, so patient transitions can be very ad hoc…”

Families recognize the problem

“I’m in Arizona, my mother is in Florida, and I’m working long distance to orchestrate home care. There were all sorts of scheduling mix-ups and miscommunication. The doctor’s office sent in the referral for home care, and then closed for the day. It ended up taking 36 hours to get home care. Meanwhile my mother—who is very high risk for a frightening and expensive hospitalization—was kept waiting.”

Staff see the same problem

“The problem here is that people don’t talk – and it’s the residents who lose. The nursing aide knows when a resident is having trouble eating or mobilizing or is feeling down. But who is listening? She can’t talk to dietary or activities or physical therapy. Here everything has to go through the chain of command.”

Study conducted in nursing homes

Fifteen nursing home study of 105 residents Measured relational coordination between

234 nursing aides, nurses, dietary staff and housekeeping staff

Measured resident quality of life, adverse events, and staff job satisfaction, adjusting for resident and staff characteristics

Relational coordination drives elder care performance

Observations are residents (n=93) and staff (n=234) in long term care facilities (n=15). Model also included facility size and ownership. Standardized coefficients are shown.

Resident quality of life

Adverse outcomes(weight loss, sores,

functional loss, UTIs)

Staff job satisfaction

Relational coordination .39** -.40*** .30***

Resident age -.13 .04 .04

Resident gender .19+ -.06 -.01

Resident tenure .16 -.08 -.04

Resident severity .61 -1.90+ --

Staff language .23 -.27*** -.07

R squared (between) .24 .21 .31

Relational coordination drives elder care performance

Performance index


LTC11

LTC2LTC15

LTC4

LTC9

LTC5

LTC12

LTC8

LTC13

LTC10 LTC6

LTC3

LTC7

LTC1

LYC14

Relational coordination and performance – the evidence across

industries

RC has been studied in many industries

• Airlines• Manufacturing• Banking• Pharmacies• Accounting• Early childhood

education• Higher education

• Surgery• Med/surg• Emergency care• Intensive care• Maternity• Peri-operative• Primary care• Chronic care• Elder care

And in 15 countries…• Ecuador• Japan• Korea• Pakistan• Israel• Australia

• United States• Denmark• Norway• Austria• Switzerland• Netherlands• Belgium• Scotland• Ireland

Quality and safety outcomes Reduced customer complaints Increased on-time performance Reduced baggage handling errors Increased patient satisfaction with care Increased patient psychological well-being Increased patient intent to recommend Improved postoperative pain/ functioning Improved quality of chronic illness care Increased quality of life for elderly Reduced family complaints Reduced medication errors Reduced hospital acquired infections Reduced patient fall-related injuries

Efficiency and financial outcomes Reduced turnaround time Reduced product development costs Increased employee productivity Reduced length of hospital stay Reduced total cost of hospital care Reduced inpatient hospitalizations Reduced total costs of chronic care Increased profit growth Increased growth of deposits Improved operational excellence

Worker engagement Increased job satisfaction Increased career satisfaction Increased professional efficacy Increase competence at work Reduced burnout Increased work engagement Increased involvement at work Increased proactive work behaviors Increased motivation at work Increased psychological safety Increased learning from failures Increased reciprocal learning Increased equity of team member contribution Increased collaborative knowledge creation

Client engagement Increased trust and confidence in care team

Increased self-management Increased evaluation, enrollment and

retention of drug-exposed infants Increased community linkages Increased family readiness for caregiving Increased family engagement with teachers Reduced parenting stress Increased ability to care for autistic child Increased ability to cope with needs of child

For a review of 67 studies from 15 countries, see

Gittell and Logan (2014). “The Importance of Relational Coordination for Performance and How Organizations Shape Its Development.”

Working Paper, Brandeis University.

Relational coordination pushes out the quality/efficiency frontier, creating greater value

Quality

Efficiency


Relationships of shared goals, shared knowledge and mutual respect provide an organizational culture that

supports process improvement

Why does RC improve performance?

Relationships of shared goals, shared knowledge and mutual respect help

workers to connect around the customer

Why does RC improve performance?

Relational coordination enables workers to achieve better quality outcomes with less wasted effort and less stress

Why does RC improve worker outcomes?

For theory and evidence about how this works, see

Barbara Frederickson (2004) “The Broaden-and-Build Theory of Positive Emotions,” Philosophical

Transactions of the Royal Society of Biological Sciences.

How do organizations support relational

coordination – or not?

Invest in frontline leadership

Resolve conflicts proactively

Reward team performance

Select for teamwork

Measure team performance

Make job boundaries flexible

Create boundary spanners

Develop shared protocols

Develop shared info systems

Partner with suppliers

Relational Coordination

Shared goalsShared knowledge

Mutual respect

FrequentTimely

AccurateProblem-solvingCommunication

Quality & Safety Performance

Efficiency & Financial

Performance

Broaden participation in team meetings

Organizational structures that support relational coordination

Worker & Client Engagement

“Here technical expertise exceeds teamwork ability as a criterion; doctors expect teamwork of others simply by virtue of the fact that they are doctors, after all.”

Select for teamwork

“You’ve got to be a nice person to work here…We pick it up through their references. The doctors here are also sure to know someone who knows that doctor.. . . . Nurses like it here because physicians respect their input.”

Select for teamwork

“The quality assurance (QA) committee is strictly departmental and it’s strictly reactive. Everybody is giving reports to QA but nobody is listening or learning. The QA committee satisfies hospital-wide reporting requirements. But it’s not effective. We have board members on that committee, but we still can’t get it to work. People have a bad attitude when they go. It’s a lengthy, cumbersome meeting.”


“Quality assurance used to be completely reactive here, with incident reports. There would be a review to determine injury or no injury. QA is more real-time now, not so reactive.”

“But we don’t have a full system in place. It’s evolving… It’s not cross-functional yet. Usually I take the nurses and the chief of the service takes the physicians. There is finger-pointing.”


“We have a Bone Team which includes the service line director, the case management supervisor, the head of rehab, the VP for nursing, the nurse manager, the clinical specialist, three social workers and three case managers. We generally look at system problems.”


“I would say that for any non-physician to challenge a physician has the whole episode laced with pitfalls. For a nurse, a therapist, a pharmacist, a social worker, a nutritionist, an occupational therapist to challenge a physician is up there with losing a job or getting a divorce—very stressful. And I can say personally as a nurse that in my more formative years that was something that you would try to avoid at all costs.”

Use conflicts to build relationships

“The kinds of conflicts we often have are disagreements about the patient’s treatment plan: what it should be. It can go across all of the groups. The other big thing is getting a physician to come up to the unit, to be available. . . . We have a formal grievance process if you’re fired, but not for conflicts among clinicians. . . . There are no particular processes. We just hope people use common sense and talk to each other.”

-


“We implemented training classes for all employees that teach employees how to deal with conflict resolution, including adopting appropriate behaviors. There is a Pledge to My Peers, which is a structured format for resolving conflicts in a peer-to-peer fashion. Aggrieved employees are encouraged to approach the coworker or supervisor or whoever and say, ‘I would like to speak with you regarding the pledge.’”


“There are customs – like the fact that a physical therapist will never deal with bedpans and such – that go above and beyond licensing. These customs have a negative effect, like when a physical therapist will go get a nurse just to deal with the bedpan, making things difficult.”


“[Here] physical therapists definitely do the bedpans. You see, length of stay is so compressed and time is so valuable. You’ll only delay yourself if you try to hunt down the nurse’s aide.”


“The case manager does the discharge planning, utilization review and social work all rolled into one. The case manager discusses the patient with physical therapy and nursing and with the physician. He or she keeps everyone on track. The case manager has a key pivotal role – he or she coordinates the whole case.”


”Case managers have to be very very very good communicators and negotiators and very assertive but also have a good sense of timing …. Willing to be a patient advocate but also be able to balance the financial parameters and think ‘out of the box’ and have a system perspective.”


”I have about 30 patients – with that number I pretty much just go down the list and see who is ready for discharge.”


“It’s often the person who is closest to the patient who knows where the patient and the family are at. In our huddles doctors are learning to listen and not feel like they have to know everything. Everybody has a different piece of the puzzle to contribute.”

Broaden participation in meetings and huddles

“I can spend half of my day tracking down patients. I will hear somebody mention somewhere in the hallway about a patient with this condition, and they’re not on my printout, so I’ve got to walk on every floor and say, ‘Do you have this patient?’ And they go: ‘Oh that patient’s on the vascular service, but yeah, I think Dr. So and So already operated on him.’ It’s ridiculous.”

Develop shared information systems

“You can’t track down all of the physicians here because some of the physicians have their own system. That’s a problem – they don’t talk. Independent physicians have their own independent systems, and they only talk to themselves. I mean, so there’s a big problem. Some of them are on the email system, and some of them aren’t.”


”Information systems are important for coordination, I think, but right now they are more a hope than a reality. Our chief information officer is building a clinical and administration information system allowing patients to receive care anywhere across the continuum…For automation to work, it’s important to get a format that’s understood across specialists.”


Invest in frontline leadership

Resolve conflicts proactively

Reward team performance

Select for teamwork




Develop shared protocols

Develop shared info systems

Partner with suppliers


Shared goalsShared knowledge

Mutual respect

FrequentTimely

AccurateProblem-solvingCommunication

Quality & Safety Performance

Efficiency & Financial

Performance

Broaden participation in team meetings

Organizational structures that support relational coordination

Worker & Client Engagement

Leaders have a role in designing and implementing ALL of these structures

Structures can be designed to WEAKEN relational coordination or to SUPPORT

relational coordination

Bottom line

Getting from here to there

How do organizations learn new ways to coordinate?

Many organizations are still traditional bureaucracies with workers in their silos

Relationship patterns are deeply engrained in organizational cultures and professional identities

Changing structures is not enough

Change rarely occurs simply by changing organizational structures

Need to identify and question current assumptions

Need ‘relational’ space for doing this

Three kinds of interventions needed for change to “work”

Relational interventions Technical interventions Structural interventions


Shared GoalsShared Knowledge

Mutual Respect

Frequent Timely

Accurate Problem Solving Communication

Relational InterventionsPsychological Safety Relational Diagnosis

Coaching & Humble Inquiry

Structural InterventionsShared Costs & Rewards

Shared AccountabilitySelect & Train for Teamwork

Conflict ResolutionMeetings & HuddlesBoundary Spanners

Shared ProtocolsShared Information Systems

Spatial Design

Performance Outcomes

QualityEfficiency

Worker EngagementClient Engagement

Innovation

Technical InterventionsGoal and Role Clarification

Process MappingStructured Problem Solving

Relational model of organizational change

Three stories of change

Dartmouth-Hitchcock Varde Municipality in Denmark Billings Clinic

Dartmouth-Hitchcock

Dartmouth-Hitchcock

Well-known medical center in New England with long history of clinical excellence and organizational innovation

At the cutting edge of payment reform, process improvement, microsystems, and shared decision-making with patients

Building a regional Accountable Care Organization, led by CEO James Weinstein

Dartmouth-Hitchcock

“Imagine a health system that focuses on health, not just health care. Our solution to the current health care model is to eliminate fee-for-service and provide service that is rewarded for quality and results, rather than volume.”

- CEO James Weinstein

Dartmouth-Hitchcock

These new goals created pressure to reduce costs and increase quality throughout system

In 2013 Rich Freeman, Chair of Surgery, launched a transformation effort

From traditional silos of expertise toward team-based model of care

Some urgency due to payment reform, as well as quality and morale issues

Dartmouth-Hitchcock

“There were a few wrong site surgeries and near misses [which] happened despite compliance with the checklist and timeout. The issue was rote completion of the checklist, and there wasn’t any communication and feedback.”

-Giri Venkatramen, Associate Quality Officer

Dartmouth-Hitchcock

"I think morale across the organization is troubled. And I think within surgery, some of the sections are particularly troubled because for the first time ever they're having trouble making budgets. Normally surgeons are the ones who bring in the bulk of the money for institutions - sort of prized and highly valued and right now we're just expensive."

- Dale Collins Vidal, surgeon and unit chief

Dartmouth-Hitchcock Change effort in 12 surgical units launched by

Freeman, and fellow surgeon Jack Cronenwett Margie Godfrey and Tina Foster (co-directors of

Microsystem Academy) played a lead role in training frontline leaders to become coaches

Leadership coaching provided by outside consultant Eddie Erlandson to enable leaders to “become vulnerable and hear from others how they can do better”

Twelve participating surgical units

Vascular Urology Transplantation Plastic surgery Pediatric surgery Otolaryngology

Ophthalmology Neurology Neurosurgery General surgery Dermatology Cardiothoracic surgery

Dartmouth-Hitchcock

Measured RC across all workgroups on each unit Response rates very high - 75%, 85%, 86%, 90%, 92%,

92%, 93%, 94%, 97%, 100%, 100% Scores varied across units, with high and low outliers,

and some common themes across the units regarding the seven dimensions

Goal was to feedback survey results almost immediately to each unit, with facilitated time to discuss and determine improvement steps

Dartmouth-Hitchcock

”We held two sessions with the coaches and champions to prepare them for sharing the RC scores with their sections. This included rehearsals of what they will say and do with their group. Since some of the coaches are surgeons who have a mindset of diagnosis and being prescriptive, having them practice how they will coach the group was very important."

-Margie Godfrey, Coach

Dartmouth-Hitchcock

“People are starting to feel comfortable talking about these things and I guess the numbers didn't look as bad as we thought. I also give credit to the leadership retreat we did with the section chiefs in December. The section chiefs are starting to feel like a team and that was never true before. It is a huge change for us here."

-Dale Collins Vidal, Surgeon and Unit Chief

Feeding back the data



Creating change at the frontline

“The surgeons were surprised by the RC results! Their ratings of others were pretty high, but the ratings of them were not as high. It was an eye opener for them. I also did one-on-ones with all the surgeons to show them what we need from them with the After Visit Summaries. Everybody's AVS’s have improved.”

-Annette Tietz, Coach for Otolaryngology Section

Creating change at the frontline

"We did group exercises with the RC data. Not just with the improvement team but with everyone in the section. I developed some scenarios based on what I hear people talking about in the halls, outside my office. The scenarios were between-group, like between physicians and other groups. Some of them were simulations like 'here's your RC data and here's your budgetary data. What would you do?' The scenarios involved everyone, including the practice manager, our section chief, and our nurse manager."

-Annette Tietz, Coach for Otolaryngology Section

Top leader initiatives

“We tell people what their specific goals should be. We tell them in what time period. And we expect that this is motivating when 100 years ago, we already knew that it was not. Nor is it efficient because we are not building cars. Care is complex, and we need systems thinking.”

- Stephanie Goode, Director of Organizational Learning


“A lot of our leadership development currently focuses around individual behaviors and on how people get along. Relationships do matter, but it's not just about do I get along with you. It’s do I understand your role, do you understand mine, and is this understanding built into our roles?”

-Stephanie Goode, Director of Organizational Learning

Billings Clinic

Billings Clinic

Innovative community owned healthcare system in Montana, Wyoming, North and South Dakota

Organized as a multi-specialty physician group practice with hospitals, clinics and long term care

Responding to payment reform – want to become an accountable care organization with bundled payments and patient-centered medical homes

Billings Clinic

CEO Nick Wolter decided to meet these challenges by fostering teamwork throughout Billings Clinic

Billings had been working for years with complexity science and positive deviance

Positive deviance is an improvement methodology based on identifying high performance - then learning from those strengths

Billings Clinic

”We started our change efforts in the Intensive Care Unit because the leaders there were highly respected. Introducing relational coordination was easy – they grabbed onto it very quickly. The ICU docs and the whole team have been using it to improve their work.”

-Curt Lindberg, Internal Consultant

Billings Clinic ICU Connections team meets monthly to reflect on

RC survey results, find new ways to work together Led by Bob Merchant, ICU Director and Chief

Medical Officer, and Dania Block, ICU Coordinator One initiative is ICU Bingo “We encourage ICU healthcare team members to

submit cards for examples of behaviors we want to encourage in the ICU – shared goals, shared knowledge, mutual respect, communication that’s timely, frequent, accurate and focused on problem-solving.” - ICU Connections Newsletter

Billings Clinic

Jen Potts, Occupational Therapist, recognized Ted, ICU Nurse, for Shared Goals, Mutual Respect, Problem Solving Communication

Dr. Davis recognized Andy and Troy from Radiology for Mutual Respect, Shared Goals and Timely Communication

Jamie Humphrey, ICU Nurse, recognized Reina, Respiratory Therapist, for Shared Goals and Problem Solving Communication

-

Billings Clinic

Amber Hellekson, ICU Nurse, recognized Dr. Randall, Cardiovascular Specialist, for Shared Knowledge

Jen Potts, Occupational Therapist, recognized Kristi Nelson, Dietician, for Timely and Accurate Communication

Dr. Davis recognized Chaplain Doug Johnson for Shared Goals, Mutual Respect and Timely Communication

Billings Clinic

For each submission, a story is shared:“When Dr. Yandell (cardiovascular specialist) overheard nursing staff discussing a procedure a patient had, he took the time to find an anatomical picture and explain, in depth, what took place. Amber Hellekson (nurse) wrote – ‘This was not even his patient or his service… he just took the time to offer his knowledge.’”

Billings Clinic

Story from Jen:“In making discharge recommendations, Jen (occupational therapist) needs as much information as possible about any changes in routines the patient will experience and new knowledge the patient must take in. Kristi (dietician) discussed the new knowledge the patient had to acquire as well as changes in diet and how that would alter the patient’s daily routine. Kristi sharing her expertise helped Jen make a safe discharge recommendation.”

Billings Clinic

Story from Dr. Davis:“When a patient is in a code situation, doctors, nurses, pharmacists and other team members are focused on working with the patient. Fortunately we have Pastoral Care to provide comfort and support to family members. Despite heroic efforts the patient died. Chaplain Doug was present and supportive to the family. Moreover he offered his compassionate support to the ICU staff, nurses and MDs.”

Shared rewards– Accountable care – shared costs/rewards with payers– Positive recognition through RC Bingo

Shared meeting structures– Family centered rounds– ICU connections monthly meeting

Shared protocols for behavior– New Years Resolution

Shared information systems– ICU Connections newletter– Redesigned electronic health record with Cerner

Training for teamwork – Quarterly leadership course with RC focus– Include RC in internal medicine residency program

Structural interventions

Varde Municipality

Varde Municipality

Danish municipalities are responsible for elder care, care for children and youth, home care, drug abuse, homeless, handicapped, workforce development, cultural activities and infrastructure

Consolidated from about 300 municipalities to 98 in 2007 to handle their responsibilities

Now accountable for 20% of healthcare costs if citizen is hospitalized or visits a doctor

Varde Municipality

“Some cities are setting up a body within the municipality to coordinate across professionals or bringing together professional groups to address the needs of a particular population – the elderly or troubled kids, or troubled families. Healthy Cities will require everyone working together in a new way.”

- Carsten Hornstrup, Organizational Consultant

Varde Municipality

Current efforts:Wellness visits to all citizens 78 and older Outreach and support for citizens with

depression, joblessness, handicaps, drug abuse

“It doesn’t work to say do it because I am the nurse and I said so. It has to connect to something the citizen cares about.”

– Margit Thomsen, Director of Health Promotion

Varde Municipality

“Say you had a stroke - we know it’s better to have exercise. That is part of this change - that you take responsibility for your own health. You cannot just go to the doctor and say, 'Cure me.' Instead it's 'take responsibility for your own life.’”

- Kirsten Myrup, Head of Health and Rehabilitation

Varde Municipality

“We also do rehabilitation for those who are out of work. If you lose your work, you lose your connections with work. Within six months it is very tough to get you back into work. It’s our job to get them healthy and get them back to work again. This takes a lot of collaboration between different people.”

- Erling Pedersen, CEO

Varde Municipality

“Now we have the challenge of working across sectors and we don’t know how to do it yet. These people have to get along and work together. Sometimes it works – especially at the beginning of the week [much laughter around the table]. They need to have a good relationship between each other and a good dialogue - they need to know what is going on in the other silos. Otherwise nothing works.”

- Erling Pedersen, CEO

Varde Municipality

“We also need to coordinate with the GPs and the hospitals. It is a real challenge for us. We each have our own budgets and our own goals – we are not clear about our shared goals and we don’t have enough knowledge of what each other does.”

- Kirsten Myrup, Head of Health Board

Relational map created by frontline leadersLow under 2,5Medium 2,5 – 3,4High 3,5 – 5

Physio-therapist

AssistantNurse 1

Admin

Hospitalnurses

AssistantNurse 1

ConsultantDementia

GP

Community Nurses

Results of relational coordination surveyLow under 2,5Medium 2,5 – 3,4High 3,5 – 5

Physical Therapist

Assistant Nurse 2

Visitation

Hospital Nurses

Assistant Nurse 1

Consultant for Dementia

GPs

Community Nurses

1,96

2,36

3,11

2,00

2,83

2,61

2,81

2,65

2,00

2,91

2,29

2,14

2,00

2,52

3,51

2,91

3,41

1,35

1,98

2,78

2,05

2,51

3,47

1,941,98

2,34 2,502,262,41

1,38

2,422,42

3,54

3,61

3,54

3,502,85

2,73

2,59

2,86

CEO’s perspective

"This map and the red ties we see here just reflect the way we told our employees to work. We tell them you have to go and work and do your job. We think we tell them to work together – but that’s not what they are hearing from us.”

Erling Pedersen, CEO

Frontline leader initiatives

"We discussed the map with the frontline leaders and simply brainstormed possible initiatives that could handle this thing. Now we’re talking about two different things - role clarification, and building spaces for cross professional collaboration. Those are the two main things they identified to work on.”

- Carsten Hornstrup, Consultant


Top leaders are looking for ways to support these changes, combining budgets and developing new agreements with the hospitals and GPs.



Mutual Respect

Frequent Timely








Spatial Design


QualityEfficiency


Innovation




Relational Coordination, Coproduction & Leadership


Mutual Respect

Frequent Timely








Spatial Design


QualityEfficiency


Innovation



Frontline Leaders

Middle and Top Management


How do we measure RC to assess current patterns and

provide feedback for learning?

Measure RC to assess and diagnose

Validated tool to measure relational coordination oWithin workgroupso Across workgroupso Across highly distributed networkso Can include citizen, family, communityo Can be measured at any level of leadership and

across levels of leadership

Dimensions of relational coordinationRC dimensions Survey questions

1. Frequent communication

How frequently do people in each of these groups communicate with you about [focal work process]?

2. Timely communication

How timely is their communication with you about [focal work process]?

3. Accurate communication

How accurate is their communication with you about [focal work process]?

4. Problem solving communication

When there is a problem in [focal work process], do people in these groups blame others or try to solve the problem?

5. Shared goals Do people in these groups share your goals for [focal work process]?

6. Shared knowledge

Do people in these groups know about the work you do with [focal work process]?

7. Mutual respect Do people in these groups respect the work you do with [focal work process]?

Also a diagnostic tool

Measures can be shared with participants for the purpose of organizational change

“Looking into the mirror” “Putting the elephant on the table” A starting point for conversations A starting point for innovation and change

Documents

Relational Coordination: Transforming Relationships for High Performance Relational Coordination Conference November 13, 2014 Jody Hoffer Gittell, Ph.D