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Relational Coordination for
High Performance:Embedding Reciprocal Relationships into Roles
Jody Hoffer GittellProfessor, Heller School, Brandeis University
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Operations
Agents
Pilots
Flight
Attendants
Mechanics
CaterersCabin
Cleaners
Gate
Agents
Ticket
Agents
Ramp
AgentsBaggage
Agents
Fuelers
Freight
Agents
Flight departure process:
A coordination challenge
Passengers
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Case
Managers
Nurses
Attending
Physicians
Physical
TherapistsNursing
Assistants
Social
Workers Technicians
Referring
PhysiciansAdministrators
Patient care:
A coordination challenge
Patient/fami
ly
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Relationships shape the
communication through whichcoordination occurs ...
Findings
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For better...
Relationships
Shared goals
Shared knowledge
Mutual respect
Communication
Frequent
Timely
Accurate
Problem-solving
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Or worse
Relationships
Functional goals
Specialized
knowledge
Lack of respect
Communication
Infrequent
Delayed
Inaccurate
Finger-pointing
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This process is called
Communicating and relating
for the purpose of task integration
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Measuring relational coordination
RC dimensions Survey questions
1. Frequentcommunication
How frequentlydo people in each of these groupscommunicate with you about [focal work process]?
2. Timelycommunication
How timelyis their communication with you about[focal work process]?
3. Accurate
communication
How accurateis their communication with you about
[focal work process]?
4. Problem solvingcommunication
When there is a problem in [focal work process], dopeople in these groups blame others or try to solvethe problem?
5. Shared goals How much do people in these groups share your goalsfor [focal work process]?
6. Sharedknowledge
How much do people in these groups knowabout thework you do with [focal work process]?
7. Mutual respect How much do people in these groups respect the
work you do with [focal work process]?
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Relational coordination and
flight departure performance
Relational coordination
Quality/efficiency
performance
index
AMR2
AMR1
UNI2
UNI1
CON1 UNI3
CON2
SWA2
SWA1
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Relational coordination and
patient care performance
Relational coordination
Quality/efficiency
performance index
Hosp2
Hosp1
Hosp7
Hosp3
Hosp9
Hosp5
Hosp6
Hosp8
Hosp4
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Why and howdoes
relational coordination work?
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Shared goals enable participants to align
their actions with each other
Shared knowledge enables participants to
understand how their tasks fit together
Mutual respectencourages participants tovalue the contributions of others
Together these high quality relationships
support frequent, timely, accurate, problem-solving communication
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Enables participants to connect in a
meaningful way across functional and
organizational boundaries --allowing them to coordinate on the fly
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Enables participants to be more
attentive and responsive to the situation
and to one another
promoting caring and compassion
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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
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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
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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
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Improves customer engagement
Increased trust and confidence in the care
provider team
Increased family preparation for caregiving
Increased evaluation, enrollment, retentionof drug exposed infants
Increased self-management support
Increased decision support Increased community linkages
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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
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Relational coordination helps organizations toachieve higher quality more efficiently, with greater
customer and worker engagement
Quality
Efficiency
Relational
coordination
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How do organizations support
relational coordination?
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Invest in frontline leadership
Resolve conflicts proactively
Measure team performance
Lead with credibility & caring
Select for teamwork
Make job boundaries flexible
Create boundary spanners
Develop shared protocols
Develop shared info systems
Bridge work/family divide
Relational
Coordination
Relationships
Shared goals
Shared knowledge
Mutual respect
Communication
Frequent
Timely
Accurate
Problem-solving
QualityPerformance
EfficiencyPerformance
Broaden participation in teammeetings
Organizational structures thatsuppor t relational coordination
Worker
Well-Being
CustomerEngagement
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[Our leaders] communicate with customers and
employees on every little issue. Theirphilosophy 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.
Lead with credibility
and caring
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Youve got to be a nice person to work
hereWe pick it up through theirreferences. The doctors here are also sure
to know someone who knows that
doctor.. . . . Nurses like it here because
physicians respect their input.
Select for teamwork
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We implemented training classes for all
employees that teach employees how to deal with
conflict resolution, including adopting appropriatebehaviors. 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.
Resolve conflicts proactively
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Each person has a specific job, but part of
the job is to help the other person. Thenits easier to work in a more efficient
manner.
Make job boundaries
flexible
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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 boxand have a system perspective.
Create boundary spanners
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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 cando incredible medical management just by
providing information at the point of care.
Develop shared
information systems
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We make people take their vacationswe need them to be good members of
their families and communities.
Bridge the work/family
divide
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Invest in frontline leadership
Resolve conflicts proactively
Measure team performance
Lead with credibility & caring
Select for teamwork
Make job boundaries flexible
Create boundary spanners
Develop shared protocols
Develop shared info systems
Bridge work/family divide
Relational
Coordination
Relationships
Shared goals
Shared knowledge
Mutual respect
Communication
Frequent
Timely
Accurate
Problem-solving
QualityPerformance
EfficiencyPerformance
Broaden participation in teammeetings
Organizational structures thatsuppor t relational coordination
Worker
Well-Being
CustomerEngagement
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Organizations can embed reciprocal
relationships of shared goals, shared
knowledge and mutual respect into roles,enhancing
sustainability
scalability
reliability
Bottom line
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Do you know organizations
that do this well?