2013 Roundtable Host Committee

The 2013 Roundtable Host Committee. From left: Barbara Belk, Jody Hoffer Gittell, Stephen Shortell, Edgar Schein, Terry Hill, Kathryn McDonald, and Thomas Huber.

Dear all–

We just spent a rewarding two days sharing our experiences with advancing the practice of relational coordination to achieve high performance. It was the third annual RCRC Roundtable, held at the University of California Berkeley. At the end one person asked, “What is it about this concept that brings such an engaged and varied group of people together?” Another observed, “I’ve never seen people at a conference listening so intently to each other!” The sense of connection was palpable – which was remarkable given that many were meeting for the first time. For the Roundtable booklet with its summary of activities and participants, see here.

Steve Shortell of UC Berkeley started us off by sharing recent data regarding the multiple levels – micro, meso and macro – at which relational coordination is needed to achieve the  goals of accountable care. We realized through sharing that while people often see the need for it at their own level, they often see people at the other levels as obstacles to their work rather than as partners.  Top management often sees the front line as failing to understand its need to build relational coordination at the macro system level while the front line sees top management as being unreceptive to the need to build and support relational coordination at the micro system level. Could the concepts of RC – shared goals, shared knowledge, mutual respect supporting frequent, timely, accurate, problem-solving communication – help us to connect conversations across these levels to build systems thinking?

We also explored:

  • the challenge of unfreezing deeply entrenched professional roles and identities to build new ways of working together and how RC concepts can help to jump start the necessary conversations
  • the challenge of including the patient, family and community on the team to co-produce desired outcomes including health and wellness – and new ways to assess and strengthen their inclusion
  • combining relational coordination with lean methods – this lively group figured out how to layer RC metrics onto work process maps to gain greater insight and avoid purely mechanistic approaches to lean
  • building RC metrics into our dashboards to gain ongoing visibility into the powerful dynamics of RC to inform our decisions and improvement efforts – this group also considered how the design of EHRs can foster or undermine the development of relational coordination across boundaries
  • and identifying methods for developing leaders who are able to support relational coordination through systems thinking and humble inquiry

We discussed the formation of a RCRC Learning Network with several leading health systems – a conversation that will continue in the aftermath of the Roundtable.

Edgar Schein, MIT Sloan School, concluded the Roundtable with a reflection on the importance of doing interventions that are attentive to the needs of the participants, not allowing the ethic of “pure research” to override the ethic of helping. He also provided us with a deep dive into theories of organizational change, showing how these theories of change are needed to inform the practice of relational coordination.

I was gratified to hear Ed articulate this final point so well, knowing that the book we are writing, called Learning to Coordinate: A Relational Model of Organizational Change, is striving to do exactly that!

I want to express deep gratitude to all the participants who made this Roundtable one of the best moments I have experienced in the journey we are on.  And I send my gratitude to the host committee – Thomas Huber of Quantros, Kathy McDonald of Stanford, Terry Hill of Hill Physicians Group, Dominick Frosch of the Moore Foundation, Barbara Belk of Kaiser Permanente – whose energy and ideas and leadership made this possible.  I also thank the RCRC team who worked and strategized since the spring to support the host committee  – Debbie DeWolfe, Anna Perlmutter and Joanne Beswick. Their efforts were tireless and good spirited with much creative problem solving. A true example of relational coordination at work.

We are all grateful to UC Berkeley for hosting us on its lovely campus on a lovely Fall weekend – see below for a stand of redwoods I discovered literally in the middle of campus – and to the Gordon and Betty Moore Foundation for its financial support.

I will conclude by reflecting back and thanking the visionaries who originally saw the potential for RC to become more than a research tool and more than an academic theory. They recognized RC as a way to foster behavior change and system change and they  encouraged me to form the Relational Coordination Research Collaborative. They are Dale Collins Vidal from Dartmouth, Thomas Huber from Quantros, Ken Milne from Salus Global, Nancy Whitelaw from Salus Global, Stan Wallack from Brandeis, Kathy McDonald from Stanford, Gene Beyt from Brandeis, and Tony Suchman from McArdle Ramerman Center. They have been visionary leaders building a network that seems to grow each day.

And I especially want to thank the partners of the RCRC – our organizational partners, our research center partners, our professional partners, and our student and faculty partners. You are the RCRC and you have made it into a community.   We look forward to the continued journey and we welcome others to join!