2016 Roundtable Presentations:  Research and Practice

Abstracts and Artifacts from Presentations

Callie Watkins LiuInvestigating RC Dynamics in a Social Movement Organization

Callie Watkins Liu (Brandeis University)

Country: USA

Abstract: Structural inequality in the United States systematically disadvantages vulnerable populations (e.g. low-income racial and ethnic minorities) while accruing benefits to privileged populations (e.g. upper-income whites) (Blauner, 1972; Bonilla-Silva, 2010; Chesler, Lewis, & Crowfoot, 2005; Crenshaw, 1995; Oliver & Shapiro, 1995; Shapiro, 2005). Policy and legislation have been used to challenge inequity, but formal mechanisms tend to be in the hands of those who are more powerful in society and who may benefit from the inequality. As a result, the solutions that come out of these mechanisms are likely to be shaped such that powerful actors will receive minimal burdens, while vulnerable populations receive minimal benefits (Birkland, 2005; Schneider & Ingram, 1997). Informal processes like social movements can hold a particular social value as powerful means of social change that prioritize and empower those who are more vulnerable in society (Andrews, 2001; Barreira, 2011; McAdam, 1999; Ondetti, 2008; Robnett, 1997; Staples, 2004; Tarrow, 2011; Tilly, 1978). This study uses Critical Race Theory, Intersectionality, relational coordination and the congruence model to analyze the internal dynamics of the social movement organization, Right to the City. Through a year of fieldwork that included participant observation, surveys and interviews I collected detailed data about organizational dynamics, social identity, roles and impact. This study hold theoretical, methodological and practical implications including; the role of social identity in organizational operations; how organizational methodologies were customized to fit into this context; and essential drivers of or obstacles to success for this organizational case.

brenda and erin

Heart Failure Practice Transformation at a Medical Center in the Pacific Northwest Using TeamSTEPPS and Relational Coordination

Erin Blakeney, Danielle Levallee and Brenda Zierler (University of Washington Heart Center)

Country: USA


Click to view artifact from presentation

Context: The need to accelerate integration of interprofessional collaborative practice (IPCP) approaches into clinical settings is increasingly recognized as essential to improving healthcare delivery and patient outcomes. An initiative is underway to strengthen IPCP within the Regional Heart Center of a medical center in the western part of the United States. This work is guided and supported by experts in the field of IPCP, patient engagement, patient safety and professional education. In our shift and share we will describe how we have utilized Change Management strategies, TeamSTEPPS skills training, Relational Coordination (RC) Principles, and Liberating Structures to collaboratively identify and implement practice transformation goals.

Methodology: Since 2014 we have worked with key representatives (“Change Team”) of an inpatient heart failure (HF) care team at the Medical Center. The HF Change Team members represent each profession or role within their unit (e.g., nursing, medicine, pharmacy, social work, physician’s assistant). After several leadership workshops that included relational coordination, liberating structures, and conflict resolution, the HF Change Team identified “structured interprofessional bedside rounding” (SIBR) as a care process that they wanted to implement to improve communication and team functioning. Baseline RC surveys and observations of rounds were carried out over spring and summer of 2015 prior to the development and implementation of SIBR. From fall 2015 to spring 2016, the Change Team met twice per month and attended additional leadership workshops quarterly to develop a standard rounding process and associated scripts and tools for all team members. Five, 4-hour purposeful team training (TeamSTEPPS skills) and rounding practices were scheduled in early March 2016 for all team members (n = 136) and SIBR was officially launched in mid-March 2016. A one-year follow-up RC survey (May/June 2016) and observations of rounding were carried out March through June of 2016. Follow-up trainings, observations, a 3rd year of RC follow up, as well as analysis to determine whether there have been changes in patient outcomes (e.g. satisfaction, readmissions) will occur in 2016-2017.

Findings or Expected Findings: Since SIBR went live in March 2016 RN participation in rounds has increased from approximately 2% to 85%. Testimonials from patients, providers, and nurses have been overwhelmingly positive. To further advance this work, complementary tools for patients and family members are in development to support their involvement in SIBR with support from our patient and consumer advisory team. Analysis of the one year follow up RC survey and further development of the patient database is currently underway.

SorenandKarenRelational Coordination as a Tool to Increase Employment Effort in a Danish Municipality

Soren Bjerregaard Kjaer, Eva Thoft and Karen Albertsen (Team Working Life)

Country: Denmark

Within the last years a change has taken place in the legislation as well as the approach toward people outside the Danish labor marked. Previously, there was an employment system targeting unemployed people and a social care system targeting people on other temporary income support and working as separate silos and based on different legislation and economical budgets. Now, these two systems are supposed to work together in a shared effort to increase employment for all citizens outside the labor market, but still under different legislations and separate budgets. These changes pose huge demands on collaboration between previously totally separated functions in the municipality. Thus the job-center, the social center, the handicap center and the family center are supposed to coordinate their efforts with the common purpose of helping the citizen closer to getting a job.

A municipality wanted to increase the collaboration across these centers and as part of this to measure the relational coordination. They were on their way introducing a new kind of cross-professional meeting structure with coordination meetings including participation of the citizen and representatives from all relevant centers. They wanted before- and after-measures of RC.

RC among the four centers was measured before implementation of the new meeting structure with two different wordings of the central work process. In the first survey, the wording of the central work process was long and difficult to interpret. In the second the wording was simplified. For the time being, the new meeting structure is under implementation, and three meetings have been held. After full implementation, the RC measurement will be repeated.

The first measurement showed extremely low levels of RC between all groups. From these results it became obvious for the overall management that they had a huge task in front of them in order to create shared understanding and supporting structures around the work. Some of the managers suggested that the low RC had to do with the difficult wording of the central work process. However, the results from the second RC-measurement with a simpler wording showed same low levels of RC. Qualitative reports from the implementation of the new meeting structure suggested high satisfaction among the participating citizens, but low experience of meaning among the employees combined with difficulties in alignment of purpose and statements at the meetings.

In a situation where a new praxis is implemented, and employees have hardly had any collaboration previously, it can be a very difficult process to agree on a shared formulation of the central work process.  What is in fact the shared task? Furthermore, in complex worksites such as a municipality, there may be difficulties identifying which roles are actually supposed to collaborate, and who should accordingly be included in the RC survey.  Furthermore, it can in itself be a rather comprehensive task to inform employees why they are supposed to answer the RC questions, and to convince them to do it.

jon erik

Using Relational Coordination to Improve Cost Estimating Process in Global Purchasing Department in Manufacturing Industry

Jon Erik Borreson (Alaric)

Country: Sweden

A department in Purchasing at a manufacturing company (4 groups, 45 employees) were experiencing great challenges winter 2013. The work engagement was very low measuring 37% out of 100 %. There was high conflict between and in teams and 50% of the managers were questioned about their management abilities.  Many of the cost estimating processes were not effective, resulting in unfortunate delays in projects. Relational coordination was poor with low degree of shared goals and mutual respect. There was some knowledge sharing, but this was not sufficient. Communication was based on blaming and was seldom frequent or on time.

A series of interventions were performed all with relational coordination in focus. Interviews with a majority of the employees were performed where results and feedback was presented in a dialog form between facilitator and Vice President Purchasing where the whole organization was present. The groups listened actively to the conversation and were engaged in reflective dialogs in groups. Techniques as conference model, open forum, dialog interviews and after actions reviews where performed.

This workshop resulted furthermore in a two day work conference, called «work-out» spring 2014. All four groups attained the conference working cross sectional and multi professional. They were working and training relational coordination all with concrete processes in focus.

Now two years later, spring 2016, the engagement index has increased to 87%. The group managers have a strong focus on shared goals across the teams where they are all working together to improve their processes. The communication is timely, frequent and problem solving, and as they frankly put it: this is actually working, but it has been quite challenging, and as we can see it is paying off!

Darren and MartinImproving Relationships and Outcomes Through Relational Coordination at Gold Coast Health: A Proof of Concept Program

Martin Connor and Darren McLean (Gold Coast Health)

Country: Australia

Gold Coast Health (GCH) is implementing Relational Coordination (RC) across four multi-professional clinical teams involving the following focal work processes:

• the discharge process in General Medicine
• the time from referral to first treatment in Cancer Care
• the management of the woman and baby during pregnancy, birth and postnatal care in Women’s Health
• the care processes for consumers within the Acute Young Adults Mental Health in-patient unit.

This is the first time in Australia that RC has been used as part of a systematic approach to improve culture and quality.  To date:

• 7 initial surveys have been deployed
• 370 surveys have been completed with an overall response rate of 56%
• 313 staff discussed the survey data during 53 feedback sessions
• Intervention plans have been developed in all teams
• Measures of improvement have been identified for all focal work processes.

GCH serves a population of approximately 550,000 and delivers a broad range of primary, secondary and tertiary health services across two hospitals and a number of health precincts.  A novel 18 step-by-step process has been developed and used to guide the implementation of the RC program over the following 5 stages: initiation, scoping, engagement and improvement, evaluation and dissemination.

The program is led by an RC Project team who apply an ‘Emergent Design’ approach to inform how the next step in the process will be delivered; accepting that this will only be fully determined by reflecting on the outcomes of the previous step(s). The team endeavours to ‘be the change’ using the RC process as a conduit to model relating and communicating behaviours that foster quality relationships. They use reflective practice as a tool for learning and enhancing how future activities are undertaken.

We are interested in sharing and discussing the following:

• how we achieved corporate, board level, commitment to RC
• how we engaged the management structure and grew capacity
• how we used the step-by-step process to secure and sustain engagement with teams.

RC Survey (T1) results indicated broad opportunities for RC improvement. For example, the between group scores (all group means) showed that typically ‘shared knowledge’, ‘timely communication’ and ‘accurate communication’ rated as weak dimensions while ‘frequent communication’ typically rated as being a moderate or strong dimension.

Staff feedback during the post survey briefings suggested that the survey data reflected the staff experience. Several strong themes emerged which were then used to develop responsive interventions to improve RC. For example, interventions to improve the understanding of each other’s role and improve the way communication systems are used. We are optimistic that this process will lead to sustainable and quantifiable improvements in both outcomes for patients and the work experience for staff.

Using picRelational Coordination and Process Improvement for Organ Transplantation: Collaborative Improvement and Innovation Network (COIIN)

Michael Curry (United Network for Organ Services)

Country: USA

The United Network for Organ Sharing (UNOS) manages the organ allocation system for the entire United States in part by coordinating the efforts between the organizations that procure deceased donors (OPOs) and transplant hospitals. Furthermore, UNOS is charged with monitoring hospitals for patient safety outcomes. If programs fall below an expected threshold of either patient or graft survival, programs come under review to help improve outcomes. The current monitoring system only focuses on patient and graft survival outcomes at one year. UNOS created the Collaborative Improvement and Innovation Network (COIIN) project to pilot a new monitoring system for kidney transplant programs to create a more holistic approach to monitoring hospital performance with a sub-goal of increasing transplantation. Particularly, it is important to increase the utilization of moderate to high risk donor kidneys because these kidneys have a disproportionally high discard rate. Some of the new monitoring changes that will be piloted are: understanding the relationship within transplant centers and between transplant center and OPOs to help improve acceptance practices, waitlist management, and care management.

UNOS will incorporate the Relational Coordination (RC) survey to help understand the relationship dynamics within hospital and between hospital and OPO. Currently, 10 workgroups have been identified (nine in the transplant hospital and one in the OPO) as serving an essential role in waitlist management, donor acceptance, and care management. Initially UNOS identified 11 practice model hospitals to determine best practices that can be spread to other transplant hospitals. These 11 hospitals will be given the RC survey once to determine if their best practices are associated with a higher RC score. Additionally, a total of 30-40 pilot hospitals will be selected to enter COIIN to try to improve waitlist management, donor acceptance, and/or care management. The RC survey will be administered twice to the pilot hospitals, six months apart to determine if improving aspects of RC improves work processes.

It is expected that the practice model hospitals will have high RC scores with internal transplant teams as well as with the OPO on each of the work processes. It is expected that the pilot hospitals who have worse than expected outcomes would also have lower RC scores. Furthermore, if a transplant hospital and OPO improved their relationship it would also improve waitlist management, donor acceptance, and/or care management.


Relational Coordination and Child Care Quality Improvement

Anne Douglass (University of Massachusetts, Boston)

Country:  USA

In 2015, the federal government awarded $500 million in new grants to enhance child care quality by developing partnerships between Early Head Start programs and local child care centers serving low income children and families. A small body of research offers guidance about what it might take to build and sustain effective ECE partnerships to promote improved quality across settings. However, a relational coordination lens has not been applied yet in the research to examine these child care Early Head Start partnerships. This study will examine the development of one of these funded collaborative partnerships, focusing on the partnership’s development, characteristics, relational, organizational and contextual factors, and the influence of these factors on quality improvement and family engagement across settings. This study is using the Relational Coordination Survey to assess relational dynamics at both the cross-agency partnership level as well as within each partnering child care center. The study will examine the use of the RC survey in the child care context.

Prior research suggests that high quality communication and relationships characterized by shared goals, shared knowledge, and mutual respect are essential ingredients of effective collaborative partnerships and systems in which learning and improvement can take place. The study will take a relational systems approach. Relational networks and leadership at each level of the system will be examined: within partner organizations, between the lead agency and each partner, and among all members of the partnership. In addition, to implement and sustain effective collaborative partnerships, organizational and systems structures must be established to support and promote communication and high quality relationships. This study will therefore also examine how formal structures are implemented and used to support effective collaborative relationships among partners and within participating partners’ organizations. In addition, the study will explore how relational coordination within the cross-agency partnership influences relational coordination within the individual partner organizations.


Perceived Prevalence of Relational Barriers to Improvement: Canada vs. the United States

Malcolm Eade and Neil Baker (Salus Global)

Countries: Canada and USA

Context: Despite extensive knowledge about the technical methods of improving quality and safety in healthcare, success rates have been quite variable. Relational issues, as suggested in multiple studies, may be the cause of such variation but their prevalence is not well-defined.

The purpose of this study was to determine perceptions of Canadian healthcare leaders and staff about how often relational barriers get in the way of improvement and compare the results to published data from the United States. Also, the study explored perceptions about how often problematic behavior is productively addressed in participants’ organizations.

All participants (N = 99 from Canada) and (N = 420 from the United States) completed a written survey at 1 ½ hour workshops on transformational leadership they attended in the last three years.  “Relational issues” was defined to include problems with communication, conflict, motivation, resistance, teamwork, collaboration, meeting structures and processes, and the way leadership is expressed.

The same Canadian participants and a different group of 284 participants from the United States were also asked to estimate the frequency with which the following occur within their organizations: (1) “With conflict people take care to hear and explore each point of view as opposed to talking over each other or engaging in win-lose debates.” (2) “When people communicate or behave in ways which impair collaboration they receive feedback and are expected to make changes.”

Nearly the same percentage of participants, 87.5% from Canada and 88.0% from the United States, indicated that when problems occur with improvement initiatives, relational issues are the predominant cause the majority of the time. Also, 92% of both groups indicated that they were currently facing an important relational problem having a significant impact on work life, about 60% of which had been going on 6 months or longer.

In the Canadian group, only 3.1% perceived that conflict is very frequently addressed when it occurs by avoiding debates and hearing and exploring all points of view. Only 18.4% indicated that conflict is addressed in this way more than half the time that it occurs. For the United States sample more participants, 6.3% and 31.3% respectively, gave these estimates.

With non-collaborative communication and behavior, no Canadian participants indicated that it is very frequently addressed when it occurs with feedback and expectations that there will be change. Only 7.4% indicated non-collaboration is addressed in this way more than half the time it occurs. For the United States sample, 5.6% and 27.5% of participants gave these respective estimates. Almost 80% of both the Canadian and United States participants indicated their organizations have written values or norms for communication and behavior.

In summary, nearly 90% of participants in both Canada and the United States perceive that relational issues are the predominant cause of problems with improvement initiatives the majority of the time. Also, 92% of both groups reported a current, important relational issue. The data suggests one intervention could be to increase the use of conflict and feedback skills at necessary times.

Amanda and SteveUsing Relational Coordination to Assess and Promote Team Cohesion at Blue Shield of California

Steve Freund and Amanda Flaum (Blue Shield of California)

Country: USA

In 2013, several disparate teams within Blue Shield of California with little previous interaction came together under a single leader. In 2015, the new leader sought to transform this group of loosely associated teams into one truly unified, connected, high performing team under the banner Medical Care Solutions (MCS). To be successful, the leader posited, that staff at all levels and in all groups would need to connect and develop relationships built on shared goals, shared knowledge, mutual respect as well as communicate in a frequent, timely, accurate, and focused way.

The team used a relational coordination survey to assess current state of the organization. The leaders viewed scores below 3.25 as weak, those between 3.25 – 3.75 as moderate, and those above 3.75 as strong. The average score in MCS was 3.21, which was toward the upper end of the weak range. To ensure that leaders focused on building stronger relationships between the teams, all managers and directors had relational coordination targets added to their annual performance goals. The targets were specific to individual teams whose relational coordination was deemed important to meeting shared business goals and objectives.

Interventions took place at all levels. At the staff level, the “MCS Connections” work group was developed by a small cadre of staff members who wanted to promote relational coordination. The group organized a series of summits and invited all MCS staff to attend. The stated mission was to “foster a respectful environment where we can establish positive, purposeful relationships to improve communication, productivity, and the ability to achieve our common goals.” The forum provided a channel for staff to voice concerns, identify barriers, and promote solutions. One of the solutions that emerged was a learning fair where hundreds of staff members, most notably the Blue Shield of California CEO, learned more about their shared goals and responsibilities. There was also considerable work done at the team level. Managers throughout MCS used tools and techniques known as liberating structures to further promote relational coordination.

After a year of work, overall relational coordination rose significantly. The average score across MCS rose from 3.21 to 3.45 (7.5%). The team transitioned from the upper range of weakly coordinated to well within the range of moderate coordination (3.25 – 3.75).

Each team had at least one identified relationship that it committed to strengthen. On average, there was a 0.41 increase in coordination on these targeted relationships. This represented almost a full degree of coordination. Most teams transitioned from weak to moderate coordination. One team in particular, the Training and Support team, saw its relationships with two of its client teams completely transformed. It shattered its 0.3 goal with increases averaging 1.16.

Linking relational coordination scores to the performance appraisal process increased program focus and engagement, but it may have produced some unintended outcomes. A number of leaders who supported the program at inception began to question their commitment as targets were missed. The program team plans to assess program perceptions to gain insight into the effects of linking relational coordination scores to performance assessment.


A Quantitative and Qualitative Examination of the Association of Team Participation, Solidarity, Innovation and Leadership Facilitation with Relational Coordination

Thomas Huber (UC Berkeley)

Country: USA

Under the Affordable Care Act, Accountable Care Organizations (ACO) are being reimbursed for quality and cost of care for an entire patient population, and are increasingly utilizing team based care and coordination of work among front line providers to achieve improved care delivery results. Therefore, it is important to enhance our understanding of the relationships and associations between teamwork factors and relational coordination(RC).


Click to view artifact from presentation

In our study we examine the association of relational coordination with team factors like participation, leadership, solidarity and innovation. Of particular interest for qualitative methods is to describe in more detail how relational coordination which measures a kind of teamwork task interdependence, relates to the other types of teamwork constructs like participation, solidarity, leadership and innovation. We use hierarchical linear modeling to examine the association between relational coordination and team participation measures developed by (Alexander et al., 2005), leadership (Helfrich et al., 2009, 2001; Hagedorn et al., 2010), and team culture by (Kralewski et al., 1996).

This research project is part of a larger (PCORI) Patient-Centered Outcomes Research Institute grant that is examining patient activation and engagement, patient outcomes, and teamwork characteristics in two Accountable Care Organizations (ACO’s). A mixed methods approach will be used with a total of 52 interview respondents from 16 primary care practices, and the quantitative study has 411 survey respondents from these two organizations. Atlas ti will be used to analyze the interviews, and the cross sectional survey design results in a two-level hierarchical structure analysis with team members nested in practices.

Team members in this study showed higher levels of relational coordination when they report higher levels of team participation as well as leadership practices. Surprisingly, the solidarity measure does not appear to be significant. One explanation could be that participation is a closer measure of task coordination, while solidarity approximates and centers more on feeling cohesive at the team level. It was less surprising that innovation was not statistically associated with relational coordination since the measure encompasses more of a future orientation rather than current team interaction. From the initial qualitative investigation several key nuances are emerging. For example, respondents participating in highly innovative teams often commented on how their team had shared goals, or joint problem solving in order to be innovative. Leadership was also described in terms of how directors and the larger organization support the team in improving patient care, creating a positive environment, soliciting feedback, and support changes in the practice patterns.


Enhancing the Interprofessional Learning Environment through a Collaborative Care Model to Improve Patient Care: A Pilot Study

Kanapa Kornsawad, Meghan Crabtree, Temple Ratcliffe, Christopher Moreland, Erika Bowen and Luci Leykum (UT Health Science Center at San Antonio; Southern Texas Veterans Health Care System, University Health System)

Country:  USA

Despite efforts to improve the care of hospitalized patients, adverse events remain common. Care is siloed across disparate providers and patients are not engaged in their own care plans. In a collaborative care model, patients, families and providers partner to integrate high-quality care across disciplines to best meet patients’ needs. While support for delivering inter-professional, patient-centered care is growing, limited research exists examining the impact of delivering a collaborative care model, particularly with regard to learners’ experiences. 

Our objective is to evaluate the impact of delivering a collaborative care model on rounding patterns and student and resident learning experiences during an inpatient teaching service at a single academic medical center.  We implemented a collaborative care model on a single inpatient team. The team included nurses/physicians/(attending, residents)/medical students/pharmacists/social worker/physical therapist. Each discipline’s workflow was adjusted to allow frequent interactions and bedside-rounding. Additionally, the team met daily for a 30 minute reflective session. Rounds were patient-centered and focused on patients’ stories and values surrounding care. Plans were scribed on a communication board and verbally summarized afterwards. A standardized safety checklist was utilized during every patient discussion.  Our mixed-methods approach to assessing the model’s impact included direct observation; provider and patient interviews; and administrative data analysis. Conventional inpatient teams served as comparators.

We engaged stakeholders to identify key elements for successful collaborative care implementation. Elements included workflow/observation/practice-simulation/geographic localization/daily goals of care/reflection/safety checklists/and patient/family engagement. Once implemented, mean time per patient discussion for traditional vs collaborative rounds was 16:57 vs 17:20 mins. Mean % of time spent with the patient during traditional vs collaborative rounds was 28% vs 99%. Patients/families contributed to discussions 2% of the time in the traditional care model vs 17% in the collaborative model. We interviewed 22 housestaff &16 medical students who worked on the collaborative team and coded interviews to identify themes related to learner’s interprofessional and educational experiences. Respondents generally saw the benefits of the collaborative model, citing improved provider communication and more patient-centered care delivery. Concerns and negative responses were also identified, of which 40% related to perceived workload and “time required” for collaborative rounds. Other concerns related to less explicit teaching time and expressing uncertainty over care plans in front of patients and other providers.

Implementing a collaborative care model on a medicine teaching service was feasible and did not substantially increase rounding time per patient. Improved patient and interprofessional communication was tempered with concerns over learners’ educational experiences. These concerns could be addressed through improved orientation and targeted curricular objectives and content. We will continue to assess this model’s impact on patients, learners, and providers to optimize its implementation in a teaching environment.

hun whee

Multisource Feedback, Relational Coordination, and Firm Performance: Evidence from South Korea

Hun Whee Lee (Michigan State University)

Country: South Korea

Multisource feedback, also known as 360-degree feedback, is feedback provided by multiple sources such as subordinates, peers, supervisors, and customers. As an important step in revealing the underlying processes and moderators for the effects of multisource feedback, relational coordination is proposed as an intervening process at the firm level through which multisource feedback affects firm performance. Furthermore, we highlight the moderating roles of two informational sources in organizations, particularly education diversity and long-tenured workers in organizations, as critical contingencies that moderate the effect of multisource feedback on relational coordination. Lastly, relational coordination is proposed to enhance both objective financial performance and subjective performance ratings. We test our theoretical arguments using data from 344 Korean firms in the manufacturing, service, and finance sectors. The present findings offer novel practical and theoretical insights into the effect of multisource feedback on firm performance.


Research and Practice as Bedfellows: Analyzing Cases of Organizational Change from the Relational Coordination Research Collaboration Interventions Registry

Kathy McDonald (Stanford Health Policy) and Joanne Beswick (Brandeis University)

Country: USA


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Previous research has established a positive correlation between relational coordination and organizational performance. With this backdrop, researchers and organizational consultants are attempting to use relational coordination interventions within organizations to ameliorate performance problems and gaps. To support a learning community on this topic, the relational coordination research collaboration developed a registry for voluntary reporting about organizational change efforts (i.e., complex interventions) aimed at improving relational coordination and determining effects on organizational performance. This study has two main aims: 1) describe in a structured format all intervention projects in the registry to date, 2) based on those projects that collected pre- and post-intervention measurements of relational coordination and reported on effects (qualitative or quantitative), conduct a case analysis to test hypotheses associated with the Relational Model of Organizational Change (Gittell, Edmondson, Schein, 2014; Gittell, 2016).

The registry includes 25 cases spread across four countries, and 10 meet the criteria for case analysis with another 4 potentially completing data reporting for eligibility soon. Descriptively, we observe variation in the ways that baseline measurements were used as inputs to the change process, variation in the extent to which three key components of the Relational Model of Organizational Change – relational, work process and structural interventions – were incorporated into the change process, and variation in the extent to which performance outcomes were measured and achieved.  In terms of case analysis, we find some relational model hypotheses supported, others with mixed findings, and the remainder untested by this set of cases. The study concludes with lessons learned to date on implementation and use of a prospective case registry for organizational change research.

Effectiveness of Policies for Innovation at a Local Level: A Comparative Study of Social Networks

Paola Menapace (Graduate School in History and Sociology, University of Bielefeld)

Countries:  Netherlands and Germany

Innovation projects are characterized by cooperation between partners from different types of organisations. A specific challenge for innovation projects is how these partners develop a network that enables a functioning communication to increase the project‘s performance.


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The present study aims to investigate the effect of Donati’s social reflexivity on team performance in the context of four innovation projects in which different public-private stakeholders entered a network to together develop a new product or a new technology. Previous studies used the concept of “team reflexivity”, which is characterized by certain actions like planning, questioning, reviewing past events with self-awareness, learning at a meta level, etc. In my study I aimed at the concept of “social reflexivity”, which considers an innovation team’s capacity of being reflexive about the relationships within the team and of using this reflexivity to perform better. Two main hypotheses are considered: (1) The higher the degree of social reflexivity within the team the better the performance of the team at the end of the project. (2) Different innovation policy systems will result in different degrees of social reflexivity and thus, in turn, in different performances.

The project involved data collection from two projects in the Eastern Netherlands and two projects in the region of North Rhine Westphalia, Germany. All projects were financed by the European Regional Development Fund (ERDF) in the past programming period 2007-2013 and were in their final stage. They are all in the field of biotechnology/bio-medicine. The 22 Partners who participated in the interview were asked to draw their own network map and to explain the perceptions about their own network referring to the last six months of the project. Then, during the interview, I used a second methodology in which I showed the respondents some images of networks that helped them to reconstruct changes in the structure of their own network map.

For the analysis of the network data, the Krackhardt methodology of the cognitive social structures is used to measure how similar each individual perceived network is to the general perceived network of the group. Of special interest are the positions of some relevant actors in the network and the perceived changes during the development of the network’s structure. The analysis of the network maps is integrated using a content analysis of the interviews in which the partners explained their individual perceptions on the networks and their considerations about the final results of the project. The resulting perceived network distances served as an indicator of how much the social reflexivity is developed in the four innovation projects.

It is discussed how the data can be explained and interpreted within the framework of Donati’s Theory of the Relational Society. The results should reveal whether the relational steering is the dominant coordination mechanism that assures the most performative project or whether it is rather perceived as a barrier to innovation.

Improving the Service Culture of Dental Practices with Relational Coordination

Ed MillsEd Mills (American Dental Partners, Inc.)

Country: USA

Dental practices are busy places with tight schedules where unexpected challenges such as emergency patients occur on a daily basis.  It is critical for all operational and clinical roles in the dental practice to work seamlessly together.  American Dental Partners has made a commitment to measuring and improving relational coordination in all of its group dental practices. ADPI leaders believe that the delivery of quality patient care and an outstanding patient experience relies heavily on a high level of relational coordination in the practice team – shared goals, shared knowledge and mutual respect, as well as frequent, timely, accurate and problem solving communication.


Click to view artifact from presentation

To evolve the service culture and drive team performance, ADPI has launched a development program called the American Dental Partners Service Academy.  This is a program for high potential Service Leaders from both the clinical and operational sides of our practices.  In the Service Academy, participants learn about relational coordination, the benefits of it, and how it can be measured for purposes of feedback and improvement.  Service Academy participants also learn emotional and social intelligence competencies in areas such as emotional self-awareness, conflict management, influencing and empathy.   With support from Relational Coordination Analytics, ADPI is engaging with each dental practice to interpret its baseline relational coordination data and to develop action plans to improve relational coordination.  These dental practices will resurvey in the future to assess improvements in relational coordination and performance outcomes.

laura montvilleRelational Coordination from Top Leadership to the Frontline at Mid Maine Health Care

Laura Montville (Montville Associates)

Country: USA

In Fall 2014, Natalie Smith had been the new CEO at Mid Maine Health Care for about 8 months. She had already experienced the
turnover of the CFO and the VP for Patient Care Services, and the VP for Human Resources had announced his retirement. The remainder of the senior team members had been on the team for approximately 18 months and the hospitals was facing a project $4million shortfall in the coming fiscal year. Discussions began at the senior team level about what work could be done to move this team from infancy to high performing in a short period of time, to adequately meet the demands of the hospital and community.


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The physician leaders on the team, having been familiar with facilitator Linda Edwards through her work with them in the PELI physician leadership course, suggested we reach out to Linda. We had all read Transforming Healthcare, and were intrigued when she suggested we use RC as a way to get to the high performance level that was needed. We engaged Linda for the project and the work began.

As a small rural hospital and group of physician practices, resources were scarce to devote to the project. The senior leadership team had to be committed and give large blocks of time away from work to engage with Linda and each other, over about a year period, to do the initial RC survey, complete the subsequent team building and communication building activities and complete the post survey. I have to say that the results were frankly astonishing to me. Having been a CEO for many years, I was a skeptic at first. By about six months into the process, my senior team was functioning at a level that I would have thought they had worked together for five years. This was not only noticed among the team, but by other leaders and employees throughout the organization.

The added benefit to the higher function of the team was that the hard work and dedication on all of our parts got us pulling the organization in the right direction. We turned the projected financial loss to an operating margin by year end, the quality indicators, patient satisfaction, employee satisfaction and culture of safety were all going in a positive direction.

During the year that Linda was working on RC with the senior management team, a crisis arose in our Obstetrics Department. Physician and nursing relations were deteriorating, patient safety was viewed as being at risk and the Board was considering having to close the program. We again asked Linda if she could help the OB department. She agreed. This was different from the senior management project in that we had large groups of different professionals, such as providers, RN’s, CRNA’s, housekeeping, foodservices etc. The worked kicked off with all staff taking the RC survey, and then an OB council was formed with representatives from each group to do the work of identifying obstacles to high performance, removing them, and communicating back to their peers. The OB council met multiple times over several months and employed many of the same tools that the senior team had. The council met and engaged with the Sr. Team in a Wise Council format. The end result was that the RC survey showed great improvement in relations and much improved team work between providers and nurses. Another successful project in a small hospital!

Note:  Names have been changed to protect confidentiality.

Irene Moore

Effective Team Function: A Study Exploring Relational Coordination in Small Animal Veterinary Practice

Irene Moore and Jason Coe (University of Guelph)

Country: Canada

There is now a considerable body of knowledge supporting use of relational coordination to improve work processes in a wide variety of industries in a number of countries. To date, relational coordination in veterinary clinics has not been investigated. However, given that veterinary teams also require communication that is timely, frequent, and accurate, as well as problem-solving, it is anticipated higher levels of relational coordination would have improved outcomes. Improved relationships, through mutual respect, shared goals, and knowledge of each other’s work, are also anticipated to improve work performance in veterinary clinics. In addition, veterinary clinic environments are characterized by time constraints, task and input uncertainty, and reciprocal independence, thus are likely to be enhanced by stronger relational ties.

This study, part of a larger observational study exploring effective team communication, examined the relational coordination of seven functional groups in the veterinary healthcare team, including veterinarian owners, associate veterinarians, managers, veterinary technicians, veterinary assistants, receptionists and kennel attendants. Study participants were drawn from small animal clinics in southwestern Ontario, Canada. In addition to the relational coordination survey, participants also completed the Maslach Burnout Inventory (MBI-GS), and single item measures to assess job satisfaction and intent to stay at the clinic.

The study descriptively examined relational coordination at the individual participant and clinic level. Since relational coordination had not been explored in veterinary clinics, the validity and reliability of the scale was assessed in this context. Outcomes assessed included the three dimensions of burnout (exhaustion, cynicism, and professional efficacy), job satisfaction, and intent to leave. Linear regression models were built to identify significant factors associated with the outcomes at the clinic level.

A total of 274 participants from 48 clinics completed the online surveys. At the individual level, relational coordination did not differ significantly by age, gender, tenure, or employee group. However, it did vary when looking at interactions with some functional groups. Relational coordination scores also varied significantly by clinic.

In the linear regression models, relational coordination was significant in a number of the final models. For exhaustion at the clinic level, relational coordination explained 18.4% of the model (adjusted R2=0.184; p=0.004). Relational coordination explained 24.6% of cynicism (adjusted R2=0.246; p=0.001). No significant variables were retained in the professional efficacy model. For job satisfaction, relational coordination explained 22% of the model (adjusted R2=0.220); p=0.001), while for intent to stay, it explained 12.3% of the model (adjusted R2=0.123; p=0.02).

The findings from this study indicate relational coordination is significantly associated with a number of important outcomes in veterinary clinics. They are also consistent with findings in the human healthcare field as well as many other industries, thus supporting the use of interventions to improve relational coordination in veterinary clinics.


Creating Value For Stakeholders In the Global Agricultural Supply Chain

Erik Nicholson (United Farm Workers)

Country: USA

Agricultural production remains a highly segmented and in many ways an oblique industry. Many farm workers often do not know what becomes of the products they harvest. Some, working through farm labor contractors, don’t even know the name of the farm or farm operation where they’re employed.  The silos continue within a farm; pickers, supervisors, pesticide applicators, irrigators, truck drivers and growers all carry out their duties largely unaware of the impact of their actions on one another.  Many growers sell their product to marketing companies or brokers and lose track of where and how their products reach the consumer. Retailers and food service providers have no visibility back up the supply chain; not knowing which farms they are sourcing from, much less who the women and men involved in supplying them with produce are.

One of the UFW’s goals is to professionalize farm work; to make the provision of fresh fruits and vegetables to US consumers a dignified and meaningful job that one’s children would be proud of their parents for doing. To accomplish this objective, traditional labor/management collaborations are inadequate as they fail to capture the needed value in the supply chain.

The UFW is engaged in several global supply chain engagements. Our work is multi-tiered; simultaneously working at the farm level and within the global supply chain. Our goal is clear; to create a culture of mutual understanding and respect that creates real value for all. For example, we facilitate Costco produce buyers and farmworkers employed on farms that sell them produce to have direct conversations.  For example, many farmworkers are quite aware of the food safety threats they experience regularly in their work. Yet the current structure of their work impedes their taking measures to address these threats. We have brought this knowledge to the table and are now partnering with both willing growers and retailers to redesign how work is performed as well as how workers and growers are rewarded economically and otherwise by the market for these efforts.

While we’re encouraged by our initial success which has resulted in documented improvements for farmworkers, growers and the companies that sell their products, we still have a long way to go. There are many barriers, physical and psychological. Food production is spread out across the Americas; race, nationality and legal status are issues in many locations. There are significant differences in access to information and technology. But rather than seeing these as obstacles, they are opportunities to continue to innovate new solutions to build a strong agricultural supply chain while holding up the vital role farmworkers play.

We have invited representatives of both Costco and one of the participating EFI growers to join us to discuss our work together.


Building the Ties that Bind: Hub Firms and Relational Capacity in Cross-Organizational Networks

Anna Perlmutter (Case Western Reserve University)

Country: USA

Central “hub” firm organizations play an integral role in building relational capacity in cross-organizational systems towards collective outcomes (Ostrom, 1999; Bardach, 2001; Hocevar et al., 2006). Using the context of management support organizations (MSOs), I explore the emergence of this relational capacity by reimagining the act of giving and receiving organizational support as an important coordinating relationship, driven by hubs orchestrating new connections, channels of communication, knowledge creation, and shared resources for network members. Guided by new Institutional theory, Stakeholder theory, and Relational Coordination theory approaches, the hub firm is presented here as a unique boundary-spanning entity whose mission drives these coordinating relationships characterized by shared goals, shared values, and mutual respect across multiple levels of analysis (Gittell & Weiss, 2004; Bond & Gittell, 2010). Through this lens, cross-organizational coordination, characterized by the relational capacity of participants, is defined as a new institutional form, ready for further exploration.

Relational capacity, or Collaborative Capacity as it is examined here, is treated as both an outcome (Ahuja, 2000; Weber, Lovrich, & Gaffney, 2007) as well as a driving force (Hocevar et al. 2006; Weinberg et. al., 2011) of positive coordinating relationships. Within this model, the hub support firm serves a bridging and bonding purpose for network participants (Burt, 1997), depending on the level of Collaborative Capacity and Relational Coordination present. The theoretical discussion is accompanied by propositions that capture the process by which cross-organizational coordination improves and is improved by greater relational and Collaborative Capacity, facilitated by a central coordinating firm within the network. Within this theoretical framework, the increased social capital brokered by the organizational hub deepens trust-based network relationships resulting in stronger partnerships, positive organizational outcomes, and greater organizational wellbeing across the network (Mulroy & Shay, 1998; Foster-Fishman et al., 2001).

A research study was designed using qualitative and quantitative methods to explore these concepts, addressing coordination at multiple levels of analysis as well as the role of emerging organizational-level orchestrators in coordinating network-based support systems. The Relational Coordination survey in conjunction with qualitative methods help to develop a narrative around the process by which hub-affiliate coordinating relationships are formed and produce positive outcomes within an organizational network. Results of this study are forthcoming and will be presented alongside implications for future research.

AnneandKenA Systems Approach to Building a Better United States Marine Corps Psychological Health System: The Potential for Applying Relational Coordination Principles

Anne Quaadgras and Ken Kaplan (MIT Sociotechnical Systems Research Center)

Country: USA

As a result of rapidly increasing demand for behavioral health services arising from combat during the wars in Iraq and Afghanistan, we have been working with the Marine Corps to help them improve their behavioral health system. This practitioner-oriented action research has used systems engineering and management design perspectives, with a focus on the roles of organizational and inter-organizational relationships, operations and processes, and information technology.

The Marine Corps system consists of myriad services provided by disconnected medical and nonmedical (community-based) organizations. A 2013 Memorandum of Understanding (MOU) between these organizations has become the impetus for systemic improvements. In early 2015 we were asked to analyze the effects of MOU implementation and develop actionable, evidence-based recommendations for further improving the Marine Corps behavioral health system.

We interviewed 45 behavioral health and Marine Corps leaders and providers at three installations, and analyzed relevant policy documents and quantitative information to develop a systems description case study and build actionable recommendations. We framed our research using coordination models derived from recent medical, public health and organizational literature, with special focus on behavioral health, as our umbrella systems concept. Coordination requires taking a systemic perspective, and is both complex and nuanced when used in this context. Our analyses included taking a relational coordination perspective. This framing and analysis enabled us to highlight systemic impacts of local variations in MOU implementation, and to communicate the systemic potential of installation-level innovations, many of which were aligned with RC principles.

When viewed through the lens of recent coordination models, our analysis suggested that the Marine Corps needs a more comprehensive behavioral health system that better links its many services and programs. The MOU is a partial blueprint towards a more comprehensive system, and Marine Corps installation-level innovations were consistent with the types of coordination innovations and experiments occurring in civilian medical/community-based systems. While clear progress was being made, challenges remained, in particular around system-level measurement. Our recommendations focused on ways to meet these challenges through a combination of top-down and bottom-up system design and measurement efforts, governance, and policy-based actions that, among other impacts, are expected to measurably improve relational coordination effectiveness.

As of spring 2016, the Marine Corps was in the process of implementing our recommendations, and we expect there will be an opportunity to measure the implementation impact and show both an improvement in relational coordination and in system outcomes. Although this research is still developing in terms of measurable system and clinical outcomes, we believe that the concepts of coordination as observed in the Marine Corps system offer valuable insights and learnings to the relational coordination community.

Virginia Garcia Memorial Health Center Team Optimization Project

Sally Retecki and Chris Hill (CareOregon and Virginia Garcia Memorial Health Center)

Country: USA

Click to view artifact from presentation

Click to view artifact from presentation

Virginia Garcia Memorial Health Center (VGMHC) is a federally qualified healthcare center near Portland, Oregon, operating in both urban and rural areas. VGMHC provides healthcare services to more than 42,000 patients at five primary care clinics, five dental clinics, and six school-based health centers. VGMHC’s mission statement is “to provide high-quality, comprehensive, and culturally appropriate primary health care to rural communities with a special emphasis on migrant and seasonal farmworkers and others with barriers to receiving healthcare.” VGMHC serves a population that is 70% Medicaid/Medicare, 15% Commercial, and 15% uninsured. There are 57 different languages spoken across the population served.

VGMHC rolled out a new “medical home” care model at the end of 2007: a customer-driven, relationship-based team care with each team accountable for continuity of high quality care for a specified patient population. Teams engage in pro-active panel management, offer barrier-free access, and integrate behavioral health services into the flow of care. The care teams are composed of 2 PCPs, 3 MA’s, 1 RN, a Panel Care Coordinator, and a Team assistant. Teams share other resources including Behaviorists, Community Health Workers, Resilience Workers, Clinical Pharmacists, Front Desk and more. Teams are 100% co-located. Two of the primary care clinic sites have 5 teams, one has 4 teams, one has 3 teams and one has 1 team. The vision of team practice is “We are a team; we share knowledge and goals, communicate effectively, use a systematic problem solving approach, and are committed to building trusting relationships that improve the health and happiness of our patients and ourselves.” In the eight years of delivering care with this model, VGMHC recognized the growing need to standardize and optimize the team practice to dramatically improve patient access, sustain high quality care, invest in a team culture of trust, transparency, and accountability to assure the ability to attract and retain the highest quality staff.

The Team Optimization Project was launched in 2016.

  • Project Aim : Meaningful engagement of all patients on team panels by March 31, 2017.
  • Scope: Five major value streams of team practice
  • Goals and Measurements:

– All patients established in care have a touch by licensed staff member within the last 18 months

– 85% of assigned patients are established

– Quality: Each team meets VG’s target quality goals

– Patient satisfaction: measured at the team level

> “I’m included in decision making about my care”

> Access/wait times

– Staff satisfaction:

> “Our organization cares what I think.”

> “The people I work with cooperate and work as a team.”

Methodology Process Owners: Front line staff leads the work

  • Each clinic has a Continuous Improvement Team (CIT) that leads QI work for that clinic; membership is across all care teams and roles.
  • A Project “Super Team” that is cross clinic, cross role, with members from each CIT, creates each preliminary VSM, which is then handed off to a CIT. The Super Team acts as a clearinghouse for assuring integration across all value stream design and implementation.
  • When a CIT receives a value stream, they refine the design, conduct PDSA cycles, and spread when ready to that clinic’s care teams. Then they finalize and document expected outcomes and minimum design requirements to guide spread across clinics.
  • The VGMHC Exec Steering Committee sponsors and owns the project and meets weekly to assure project work across all projects stays on track and is aligned with whole system priorities and outcomes; a subset of this committee provides the framework, guidance, and resource escalation for the design and implementation work, and oversees project spread.

To optimize team practices, the project will use both process improvement and RC methodologies together:

  • Improvement methodologies


– PDSA cycles

  • Relational interventions

– Supervisory Coaching training (as part of long-term VG training strategy)

– “Relational Coordination ©” Tools (RC) to focus the work on improving the key relationships and interactions on the team for each VSM. There are 60 frontline team 60 staff members and clinic leaders to survey. The survey plan is to survey baseline and at project end; use a single survey question, with results aggregated at clinic level. Issues: (1) timing, given there is a major organizational restructuring in the works (2) resources for prep and engagement work with staff to assure readiness for survey , and (3) use of results: at which level of the design and implementation work will the RC survey results be meaningful, and build the capacity to imbed the use of RC framework in ongoing change management work.

– RC concepts would be introduced, discussed and addressed where relevant during: Super team initial VSM design, site level sustainability team work on the VSM, spread and refinement of the new workflows across teams within a site, and across sites.

We expect that the highest leverage improvements in critical value streams of team practice are likely to be those that will emerge from exposing and improving relational coordination dynamics on the teams. Use of RC will become part of VGMHC’s approach to change management, and contribute significantly to the larger VGMHC agenda to enable clinic leaders and front line staff to deepen and sustain a culture of trust, transparency and collaboration in delivering patient focused care.

The Relatidylan-ross-headshot-3onal Model of Organizational Change: Organizational Insights from a System Wide Implementation of Alcohol SBIRT in Adult Primary Care within an Integrated Healthcare Delivery System

Dylan Ross (Kaiser Permanente Colorado)

Country: USA

There are more deaths, illnesses and disabilities from substance misuse, abuse and addiction than from any other preventable health condition. When it comes to alcohol use, over 38 million adults exceed the recommended safe drinking limits. Despite the numbers, not all of those who exceed the recommended limits meet criteria for an alcohol use disorder. While at-risk drinking is common, only 1 in 6 adults report having discussed their alcohol consumption with their doctor, nurse or health care professional. The US Preventative Services Task Force has ranked alcohol screening and counseling as the fourth most effective and cost-effective preventative service, ranking it above screening for high blood pressure, cholesterol, and a number of cancers.


Click to view artifact from presentation

Over the past 12-months Kaiser Permanente, Colorado has implemented universal alcohol screening for adults in primary care across 30 medical offices. As a part of the Alcohol as a Vital Sign initiative, hundreds of primary care providers and care teams were trained in the evidence based Screening, Brief Intervention, Referral to Treatment (SBIRT) model. To embed the practice into standard care delivery and to ensure routine and consistent screening Kaiser Permanente, Colorado developed an implementation strategy which leveraged relational, work process and structural interventions. As of today, over 90% of all eligible members have received alcohol screening during primary care visits.

This case presentation will review, through the lens of the Relational Model of Organizational Change, the region-wide implementation strategy of primary care based universal alcohol screening, brief intervention and referral to treatment (SBIRT) in an integrated health care delivery system. Discussion will focus on the practice based successes and challenges using the Relational Model of Organizational Change as a guide.


The Digital Workplace: A Relational Approach to Workplace Transformation for High Performance

Ina Sebastian (MIT Center for Information Systems Research)

Country: USA

As organizations across industries respond to intense, rising competitive pressures and digital disruption, they increasingly focus on innovation, agility and holistic customer solutions. In order to achieve these objectives, many organizations recognize that workplace transformation with focus on creating outstanding employee experiences and promoting collaboration is essential. Well-designed digital workplaces are becoming important relational approaches to performance pressures. We define the digital workplace as the technological advances and related physical and cultural practices that simplify working life in complex, dynamic and often unstructured business environments.

How do organizations design workplaces that promote high quality relationships and communication patterns, as defined by Relational Coordination, within and across organizational siloes? The digital workplace research is an ongoing, multi-year research project of the MIT Sloan Center for Information Systems Research, in collaboration with Erasmus@Work at the Rotterdam School of Management. We study how organizations design digital workplaces that simplify work in complex environments and promote collaboration, and how these design choices contribute to organizational performance.

To answer these questions, we utilize a mixed methods research design. Based on a series of exploratory semi-structured interviews with 63 executives at 27 large global organizations (to date) with digital workplace initiatives, we developed a research model that outlines the design elements of a digital workplace. We subsequently tested the importance of the design elements for organizational performance with quantitative data from an online survey that was developed in a separate study (between 2011 and 2014 with senior managers at 318 European organizations with digital workplace experience). The findings informed the design of an online survey, which we will field in July 2016, to test relationships among digital workplace design, collaboration, workplace complexity and organizational performance. In addition, we are conducting a series of case studies on organizations that have gone through a significant workplace transformation.

Our qualitative research shows that transformations of traditional workplaces, with slow moving hierarchies, to collaborative, dynamic workplaces require a fundamentally different way of working. Effective design for such workplaces goes far beyond isolated changes to physical workspace or information technology. Instead, it comprises four design levers – physical and virtual space, technology systems, enterprise social networks, and the symbols that communicate the strategic importance of workplace design. These design levers are applied in the context of sustaining leadership and iterative learning with continuous adaptation based on feedback from employees and data (increasingly including sensor data). Digital workplace leadership teams work closely with employees in a co-creative capacity to design and resource workplace transformation, and continue to iterate to keep improving the employee experience.

The quantitative results support our findings and provide us with evidence that higher performing firms (self reported over five performance criteria) against industry averages) have higher levels of effectiveness across all six elements of workplace design.

I will introduce our research results, elaborate on case studies that capture the most effective approaches to workplace design, and apply this research framework to my previous study on relational coordination in multi-disciplinary clinician teams in EHR-supported workplaces.


Creating Aligned Partnership Processes in Public Schools: A Relational Coordination Approach

Sana Shaikh  (Brandeis University)

Country: USA

The Office of School and Community Partnerships at Boston Public Schools has faced organizational challenges over the past several years. Though there are over 700 partners in and over 2500 partnerships at BPS, the district still struggles to have shared definitions, clear goals, and well-articulated metrics for school-community partnerships. As a doctoral policy summer fellow, my objective is to create a shared definition of the terms partner and partnership so that community partners and schools are following a relational coordination approach. Throughout the summer, I am interviewing 12 different stakeholders, ranging from BPS community partners to district employees. The goal of these interviews is to understand how partners and partnerships can best be characterized and classified for BPS. Furthermore, these interviews will assess important partnership initiatives moving forward. I have conducted 3 interviews and each respondent has discussed the merits of a relational coordination approach (re: shared goals, knowledge, mutual respect). The challenge comes in determining how to best incorporate differing data points (interview responses) into a coherent action plan for BPS’s Office of School and Community Partnerships.

A Relational Approach to Elicit Organizational Change in Agencies Focused on Minimizing Gang and Youth Violence

Stephanie Smith (Suffolk University)

Country: USA

The Comprehensive Gang Model (CGM) is nationally recognized as a promising strategy to reduce gang and youth violence. Barriers to goal achievement have most often been attributed to problems with collaboration, leadership, and data. This study provides a Massachusetts-based intervention on the organizational change elements of the CGM to better understand whether targeted guidance around organizational change affects the CGM goals of increased community capacity to address gang and youth violence and decreasing gang and youth violence. A quasi-experimental design, with two non-equivalent control groups, is employed whereby two intervention sites engage in relational coordination and organizational change strategies to elicit greater communication, collaboration and coordination among participating agencies. We examine whether relational coordination and organizational change supports increased community capacity to address gang and youth violence as well as decreased gang and youth violence. This presentation will offer preliminary findings and insights into baseline relational coordination data and assess how relational coordination tools can support efforts toward scaling up youth violence reduction initiatives.

jpstephensDeveloping Relational Coordination in Temporary Organizations: The Role of Relationships in Construction Project Management

John Paul Stephens and Amanda Varley (Case Western Reserve University)

Country: USA

The construction of complex buildings involves interdependent work with high levels of uncertainty in tight time-frames. For a project to be successful, construction managers must adhere to a given construction schedule that depends on contractors reliably reporting when their scope of work will be completed. Any deviations from the overall schedule can cost both the project owner and contractors’ additional time and money. To add another layer of complexity, most buildings are built by a temporary multi-team structure composed of individuals formally employed by other organizations, who may not have worked together before. Because of scheduling constraints, this means that individuals must learn to swiftly coordinate in the absence of established working relationships. This leads us to ask how multiple groups, working together in a large, complex, temporary project, act as a unit in the face of uncertainty, competing interests, and complexity?

Our study looks at the practices and mechanisms employed by a large Midwestern healthcare system (MidHealth; a pseudonym) as it organizes temporary teams to undertake large-scale construction projects. MidHealth has developed a new project management delivery system that challenges traditional norms in the construction industry. Individuals are asked to set aside the self-interest of their independent organization and act as a team in the collective interest of the overall project. Participants must do this as part of a temporary organization, with limited history and continuity.

We have been conducting interviews and observations on the site of one of MidHealth’s new medical facilities to understand the role relationships play in coordinating work on site. As part of our observations, we have captured portions of the on-boarding practices as new trades join the job. These practices include participation in quarterly Summit meetings with participants across hierarchical levels in the project. In these Summits, MidHealth introduces new trades to the principles of OCTPD and solicits feedback on improving the project. Next, we will survey participants using the relational coordination survey along with several other relevant measures such as trust and psychological safety. We will measure these constructs at three different time points to see how they develop over time, and link these results to overall deviations from budget and schedule.

From this study, we expect to gain greater insights into how relational coordination may differ when it is generated within a temporary organization. This would be among the limited, if not the only, longitudinal study of how relational coordination develops over time. We anticipate learning how levels of relational coordination at earlier time points will affect levels of coordination at later time points and how this may affect levels of trust on the job, and deviations from budget and schedule. Since working in a relational fashion is new to some of the participants, we anticipate being able to show some of the “start-up costs,” and enabling factors that help individuals learn to engage in of relational coordination.


The Role of Trust in Relational Coordination

Anna Sward, Daniel Massie and Ragnhild Kvalshaugen (Norwegian Business School)

Country: Norway
Relational coordination (RC) theory operationalizes RC through the seven conventional RC-items (shared goals, shared knowledge, mutual respect as well as frequent, timely, accurate and problem-solving communication) (Gittel, 2002). In this paper, we argue that an underexplored area of RC is the role of trust. Trust is defined as “the willingness of a party to be vulnerable to the actions of another party based on the expectations that the other will perform a particular action important to the trustor, irrespective of the ability to monitor or control the other party” (Mayer et.al. 1995, p.712). When deciding whether to trust, the trustee will make an assessment of the other party’s ability, benevolence, and


Click to view artifact from Shift and Share presentation

integrity (Mayer et al., 1995). Benevolence refers to the trustee’s expectations regarding the other party’s positive intentions. Integrity concerns the trustee’s evaluation of whether the other party’s actions and intentions are in line with accepted principles (Mayer et al., 1995). Information regarding ability can be obtained from reputation, for instance, while benevolence and integrity must be experienced during interaction. Trusting is not only a mental but also a social process. This means that in the process of coordinating trust is likely to form when the seven items of RC are successfully established. For instance, in the process of building mutual respect and shared goals it is likely that the partners constantly make assessments of ability, benevolence, and integrity and as such trust will develop in the process. However, we also know that trust may be beneficial for building shared goals and mutual understanding as well as open communication. For instance, trust-based relations facilitate openness and the exchange of sensitive information that may be important for successful coordination (Kale et al., 2000; Uzzi, 1997). Furthermore, when trust and the quality of cooperation is high, partners will be less inclined to suspect hidden agendas, which will create greater willingness to invest in the relationship and find solutions to coordination challenges (Gerwin, 2004; Gulati, Wohlgezogen, and Whelyazkov, 2012; Larson, 1992). Researchers have furthermore argued that cooperation and coordination are two concepts that cannot be easily separated (Gulati et al., 2012).

In this paper, we argue that relational coordination theory may benefit from gaining a deeper understanding of the role of trust, as well as how it is associated with the relational dimensions of RC. We take a process perspective on trust, as we are interested in how trust develops and changes over time in relation to RC. The paper draws upon qualitative data from 10 case projects in the construction industry where we use interviews, participant-reporting, observations, and archival data. The preliminary findings indicates that the dimensions of RC relates to the process of trusting as the process of augmenting the RC dimensions contribute to 1) signaling ability and integrity; 2) demonstrating benevolence; and 3) establishing emotional connections. Furthermore, this is a positive reinforcing spiral as high levels of trust makes it easier to establish the RC dimensions.

How to Lead and Facilitate Relational Coordination in Temporary Workgroups: A Mixed-Method Case Analysis of Collaboration in the Norwegian Construction Industry

Runa Thrap-Meyer and Taran Hellenes (Norwegian Business School)

Country:  Norway

This research project is a master thesis study at BI Norwegian Business School, which will be conducted during the fall of 2016/spring of 2017. The study focuses on expanding the concept of Relational Coordination (RC) by applying the framework and testing it in temporary work groups within the Norwegian construction industry. Furthermore, the study will explore how leaders can influence and facilitate RC within temporary work groups. Consequently, we hope to contribute to resolve the concurrent challenging situation within the construction industry in regards to poor performance and a lack of collaboration.


Click to view artifact from presentation

A post-doc study at BI Norwegian Business School uncovered that relations within the Norwegian construction industry suffer from mistrust and a lack of collaboration, which leads to conflict, poor performance and a lack of productivity. Based on these findings, a research project seeking to increase collaboration through process-leadership training for project managers within The Norwegian Public Roads Administration (NPRA) has been initiated at BI. A review of the literature shows that the same key factors examined through the Relational Coordination framework are relevant towards collaborative working in the construction industry. In light of this, we propose that RC can be a useful tool and framework for overcoming these collaborative challenges.

Our literature review has identified two research gaps that we wish to address. First, we have not been able to find any research connecting RC to temporary work groups. The projects within the construction industry are mostly based on temporary, inter-organizational work groups, which give us an opportunity to study RC within this context. With this study, we therefore wish to respond to the call for advancing RC-research by applying it to new contexts, both inter-organizational and in temporary, project based work groups.

Second, there is little research on the leader’s role in facilitating relational coordination. Gittell and Logan (2015) propose that relationally designed leadership and supervisory roles support participants in understanding and bridging across differences, and thus supporting the development of RC. In the context of the construction research project, leaders are defined as the project managers leading the construction projects. The process-leadership program at BI thus provide us with a unique chance to empirically explore this proposition and study the project managers and their effect on the projects and the people they manage (i.e. the work groups) after they have received the RC-related training.

The research design is an exploratory mixed-method case study analysis. The qualitative data will be gathered through in-depth interviews with the project managers (before, during and after the training program) and a sample of participants from the temporary workgroups, in addition to diaries and archival data. Quantitative data will be gathered with the use of the Relational Coordination Survey. The survey will be used to map the quality of the collaboration in construction projects when the project starts (T1) and after the interventions to improve coordination (i.e. the process-leadership training) is conducted (T2), to measure the effectiveness of the interventions.

As this is an exploratory study, our hypotheses will be generated as the data emerge and are being analyzed. We plan to gather the first sets of data during August and September, and will therefore be able to present some of the results of our preliminary analysis at the Roundtable.

54d049d09857eccf26958c50_lglImproving the Interdisciplinary Team Work in the Operating Room: Using Relational Coordination as a Framework and Model for Organizational Change

Birgitte Torring  (University College Denmark, Aalborg University)

Country: Denmark

In surgical teams, where health professionals are highly interdependent and work under time pressure, it is of particular importance that the team work is well-functioning to secure treatment quality and patient safety. Using the theory of relational coordination (RC) may be the key to unlocking the black box of teamwork in search for relational elements critical to successful collaboration and communication. Few single studies exists which explore how RC could be observed and improved in this context. The present study examines surgical teams in selected operating rooms (OR) focusing on RC with the purpose of identifying different ways of communicating and managing relationship in contexts of variable complexity and to develop an intervention program.

An ethnographic field study where data are collected through participant observations (35 teams) and semi-structured interviews (15), over a 10-months period in 2014 in two orthopedic surgical wards in a university hospital. A directed content analysis on the basis of theory of RC is used to transform the data to show different typologies of interdisciplinary team work. RC was subsequently measured using the RC Survey.

Data describe very complex conditions for team work in the OR. Four typologies of interdisciplinary team work are identified. The teams have a varying degree of relationship and coordination based on shared goals and different characteristics of communication are identified. Based on these findings and the results from the measurement of RC an intervention program was developed.

Implications are that implementation of the intervention program may facilitate improvement of positive and efficient relationship in the surgical teams in the OR, thereby enhancing treatment quality and patient safety.

nancyandkenFamilies, Caregivers and Hospital Leaders Working Together to Transform Healthcare Culture

Nancy Whitelaw and Ken Milne  (Salus Global)

Country:  Canada

The aim of this project is to strengthen and enhance a resilient team, that includes patients and families, who experience a culture of values strongly rooted in mutual respect, compassion, and understanding to ensure safe care and best quality outcomes.

The project took place within the Neonatal Program of a large urban tertiary academic hospital. The executive leadership, based on a number of internal assessments, had identified a need to build a just culture within the organization. The work began with the engagement of multiple stakeholders to develop a new policy that described the desired culture, and a comprehensive communication of expectations throughout the organization. It was then determined that a concerted effort beyond establishing the policy would be required to effect transformation of the existing culture to the desired future. The Neonatal Program, comprised of three distinct groups – the NICU, the Intermediate Care Nursery, and the ambulatory Neonatal

Click to view artifact from presentation

Click to view artifact from presentation

Follow-up Program – was chosen to work with external facilitators to engage in the cultural transformation project.

A series of meetings was held with the senior executive sponsors, program leaders and the project team, which is comprised of interdisciplinary members of the frontline staff from each of the three areas of the program, and a family advocate. These meetings resulted in the establishment of a shared Aim, Expected Outcomes and Measures of Success for the project, aligned from senior executive to the frontline caregivers and family representative. A project structure was put in place to describe the mandate, roles, responsibilities, and channels of communication among the stakeholders.

Narrative story-telling was used within the Project Team to elicit themes related to both the current state and the desired future state of the culture within the Neonatal Program. This was followed by the Relational Coordination (RC) Survey, which included all frontline caregivers, two levels of leadership, and a number of families whose children were currently receiving or had recently received care in the program.

The initial RC Survey results were shared with the Project Team, the Leadership Support Team, and the Executive Sponsors. Through discussion to discern meaning of the results, and noting the congruence between the narrative themes and the survey results, the Project Team established three specific projects to begin the work of transforming their culture. They have established goals, strategies and concrete action plans, with lead responsibilities and timelines assigned for each project, to be implemented concurrently in the three areas of the program.  As the project moves into the “experimenting” phase of testing, tweaking and adopting, and/or developing new strategies, the external facilitators work directly with the Project Team, in tandem with the Leadership Support Team, to ensure ongoing alignment, commitment, dialogue and support for the work.

The results of the initial RC Survey correlated well with the cultural themes described by the Project Team. The expected outcomes and measures of success established at the beginning of the project will be assessed, and the RC Survey will be repeated in one year, to determine whether the Aim of the project has been achieved, and if the transformative change is reflected in the second RC Survey results.