Embedding Reciprocal Relationships into Roles

Relational Coordination for High Performance:

Jody Hoffer Gittell

Professor, Heller School, Brandeis University

Operations Agents Baggage Agents

Flight departure process: A coordination challenge

Ramp Agents

Gate Agents
Cabin Cleaners

Ticket Agents

Passengers

Caterers

Fuelers

Freight Agents

Flight Attendants

Mechanics Pilots

Case Managers
Nurses

Patient care: A coordination challenge

Attending Physicians

Nursing Assistants

Patient/fami ly

Physical Therapists

Social Workers

Technicians

Referring Physicians

Administrators

Findings
Relationships shape the communication through which coordination occurs ...

For better...
Relationships
Shared goals Shared knowledge Mutual respect Communication Frequent Timely Accurate Problem-solving

 Or worse
Relationships
Functional goals Specialized knowledge Lack of respect

Communication
Infrequent Delayed Inaccurate Finger-pointing

This process is called

Communicating and relating for the purpose of task integration

Measuring relational coordination

RC dimensions 1. Frequent communication Survey questions How frequently do people in each of these groups communicate with you about [focal work process]?

2. Timely communication
3. Accurate communication 4. Problem solving communication 5. Shared goals

How timely is their communication with you about [focal work process]?
How accurate is their communication with you about [focal work process]? When there is a problem in [focal work process], do people in these groups blame others or try to solve the problem? How much do people in these groups share your goals for [focal work process]?

6. Shared knowledge
7. Mutual respect

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

Relational coordination and flight departure performance

SWA1 CON2 SWA2

Quality/efficiency performance index

UNI1 AMR1 AMR2 UNI2

CON1

UNI3

Relational coordination

Relational coordination and patient care performance

Hosp8

Hosp6

Hosp4

Quality/efficiency performance index

Hosp9 Hosp3 Hosp7 Hosp1 Hosp2

Hosp5

Relational coordination

Why and how does relational coordination work?

Shared goals enable participants to align their actions with each other Shared knowledge enables participants to understand how their tasks fit together Mutual respect encourages participants to value the contributions of others Together these high quality relationships support frequent, timely, accurate, problemsolving communication

Enables participants to connect in a meaningful way across functional and organizational boundaries -allowing them to coordinate on the fly

Enables participants to be more attentive and responsive to the situation and to one another promoting caring and compassion

RC has been studied in many contexts

Airlines Software Banking Pharmaceuticals Early intervention Early childhood education Surgical care Acute care Primary care Chronic care Long term care

Improves efficiency performance

Increased employee productivity Reduced turnaround time Reduced length of stay Reduced total cost of hospital care Reduced inpatient hospitalizations Reduced costs of chronic care Reduced costs of product development

Improves quality performance

Increased on-time performance Reduced customer complaints Reduced baggage handling errors Increased patient satisfaction with care Increased patient psychological well-being Increased patient intent to recommend Improved post-operative pain/ functioning Increased quality of life for long-term care residents Reduced family complaints Reduced medication errors Reduced hospital acquired infections Reduced patient fall-related injuries Increased product development quality

Improves customer engagement

Increased trust and confidence in the care provider team Increased family preparation for caregiving Increased evaluation, enrollment, retention of drug exposed infants Increased self-management support Increased decision support Increased community linkages

Improves worker outcomes

Increased job satisfaction Increased career satisfaction Increased professional efficacy Reduced burnout/emotional exhaustion Increased work engagement Increased proactive work behaviors Increased psychological safety Increased learning from failures Increased reciprocal learning Increased equity of team member contribution Increased collaborative knowledge creation

Relational coordination helps organizations to

achieve higher quality more efficiently, with greater customer and worker engagement
Quality

Relational coordination

Efficiency

How do organizations support relational coordination?

Lead with credibility & caring Select for teamwork Measure team performance

Organizational structures that support relational coordination

Relational Coordination
Relationships Shared goals Shared knowledge Mutual respect Communication Frequent Timely Accurate Problem-solving Quality Performance

Resolve conflicts proactively

Invest in frontline leadership Make job boundaries flexible

Efficiency Performance

Customer Engagement

Create boundary spanners Develop shared protocols

Worker Well-Being

Broaden participation in team meetings

Develop shared info systems Bridge work/family divide

Lead with credibility and caring

[Our leaders] communicate with customers and employees on every little issue. Their philosophy is to take care of the small problems. When someone has a problem here, even if it might seem small, I have to take care of it.

Select for teamwork

Youve got to be a nice person to work hereWe pick it up through their references. The doctors here are also sure to know someone who knows that doctor.. . . . Nurses like it here because physicians respect their input.

Resolve conflicts proactively

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

Make job boundaries flexible

Each person has a specific job, but part of the job is to help the other person. Then its easier to work in a more efficient manner.

Create boundary spanners

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

Develop shared information systems

In some cases, its added time for order entry, but the additional time has been outweighed by far less aggravation in trying to locate a record.People recognize the power of having a system like provider order entry because you can do incredible medical management just by providing information at the point of care.

Bridge the work/family divide

We make people take their vacations we need them to be good members of their families and communities.

Lead with credibility & caring Select for teamwork Measure team performance

Organizational structures that support relational coordination

Relational Coordination
Relationships Shared goals Shared knowledge Mutual respect Communication Frequent Timely Accurate Problem-solving Quality Performance

Resolve conflicts proactively

Invest in frontline leadership Make job boundaries flexible

Efficiency Performance

Customer Engagement

Create boundary spanners Develop shared protocols

Worker Well-Being

Broaden participation in team meetings

Develop shared info systems Bridge work/family divide

Bottom line
Organizations can embed reciprocal relationships of shared goals, shared knowledge and mutual respect into roles, enhancing sustainability scalability reliability

Do you know organizations that do this well?