Relational Coordination in Healthcare - Suchman

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Co-Creating Healthy, Innovative and Humane Organizations, Networks and Eco Systems: A Global Discovery Roundtable

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Relational Coordination in Healthcare - Suchman

  1. 1. Relational Coordination in Healthcare Anthony Suchman, MD, MA Co-Creating Healthy, Innovative and Humane Organizations, Networks and Eco Systems: A Global Discovery Roundtable October 3, 2013 McArdle Ramerman Center
  2. 2. Flight departure process: A coordination challenge Operations Agents Ramp Agents Baggage Agents Gate Agents Ticket Agents Cabin Cleaners Caterers Passengers Freight Agents Fuelers Flight Attendants 2 Mechanics Pilots © 2012 Relational Coordination Research Collaborative and McArdle Ramerman Center
  3. 3. Relational Coordination Frequent communication Shared goals Timely communication Shared knowledge Accurate communication Mutual respect Problem-solving communication c 2012 Jody Hoffer Gittell
  4. 4. Relational coordination and flight departure performance Efficiency Quality Gate time/ flight Staff time/ passenger Customer complaints Lost bags Late arrivals Relational coordination -.21*** -.42*** -.64*** -.31* -.50** Flights/day -.19**** -.37*** -.30*** .13 -.22+ Flight length, passengers, cargo .79*** .45*** .13 .12 -.54** Passenger connections .12** .19** .09 .13 .00 .94 .81 .69 .19 .20 R squared c 2012 Jody Hoffer Gittell
  5. 5. Quality/efficiency performance index Relational coordination and flight departure performance SWA1 CON2 SWA2 CON1 UNI1 AMR1 AMR2 UNI2 Relational coordination c 2012 Jody Hoffer Gittell UNI3
  6. 6. Patient care: A coordination challenge Case Managers Nurses Nursing Assistants Attending Physicians Physical Therapists Patients Social Workers Technicians Referring Physicians 6 Administrators © 2012 Relational Coordination Research Collaborative and McArdle Ramerman Center
  7. 7. Relational coordination and surgical performance Length of stay Patient satisfaction Freedom from pain Mobility -.33*** .26*** .08* .06+ Patient age .02 .00 .01 .04 Comorbidities .09* .07 .01 .04 Pre-op status .03 .01 .20*** .28*** .11** .10* .06+ .03 .82 .63 .50 .22 Relational coordination Surgical volume R Squared Observations are patients (n=878) in hospitals (n=9). Model also included gender, marital status, psychological well-being and race. Standardized coefficients are shown. c 2012 Jody Hoffer Gittell
  8. 8. Quality/efficiency performance index Relational coordination and surgical performance Hosp6 Hosp4 Hosp8 Hosp9 Hosp3 Hosp7 Hosp1 Hosp2 Relational coordination c 2012 Jody Hoffer Gittell Hosp5
  9. 9. Relational coordination also improves worker outcomes Reduces emotional exhaustion and burnout Increases professional efficacy Increases job satisfaction Increases career satisfaction Increases capacity to learn from failure c 2012 Jody Hoffer Gittell
  10. 10. Applications of Relational Coordination Fostering group reflection to improve organizational, workgroup and individual performance Proactive team-building c 2012 Jody Hoffer Gittell
  11. 11. Results of First Relational Coordination Survey Dimension of Relational Coordination Average for All Work Groups Average for Physicians Individual Low Score Individual High Score Frequent Communication 4.47 4.31 3.74 4.72 Timely Communication 3.81 3.72 3.22 4.00 Accurate Communication 3.97 3.94 3.69 4.14 Problem-Solving Communication 3.63 3.40 2.76 3.89 Shared Goals 3.85 3.62 3.36 3.77 Shared Knowledge 3.53 3.52 3.31 3.62 Mutual Respect 3.60 3.32 2.97 3.65 Overall Relational Coordination 3.88 3.74 3.44 3.98 c 2012 Jody Hoffer Gittell and Anthony Suchman
  12. 12. Pre- and post-intervention survey scores Avg for all groups Phys avg Phys 1 Phys 2 Phys 3 Phys 4 Phys 5 T1 3.88 3.73 3.58 3.98 3.84 3.44 3.87 T2 4.08 4.10 4.19* 4.23 4.02 3.84 4.07 c 2012 Jody Hoffer Gittell and Anthony Suchman
  13. 13. Improving relational coordination Mutual respect Communication skills Team-building Relational meeting practices Process reflection Leadership development Shared goals Assessing convergence Collaborative planning Dialog Shared knowledge “Conversations of interdependence” c 2012 Relational Coordination Research Collaborative and McArdle Ramerman Center
  14. 14. Bibliography Gittell JH. High Performance Healthcare. New York: McGraw Hill; 2009 Relational Coordination Research Collaborative http://rcrc.brandeis.edu Summary of research on the association of RC with various dimensions of organizational performance available at: http://MakeWorkingBetter.com/RC Suchman A, Sluyter D, Williamson P. Leading Change in Healthcare. London: Radcliffe, 2011

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