Relational coordination

Definition

Relational coordination is communicating and relating for the purpose of task integration. More specifically, it is coordinating work through communication that is frequent, timely, accurate and problem-solving, supported by relationships of shared goals, shared knowledge and mutual respect.

History

Relational coordination was "discovered" in the airline industry in the 1990s by Jody Hoffer Gittell while conducting her dissertation research at the MIT Sloan School of Management. The theory of relational coordination was introduced to a wider audience in The Southwest Airlines Way: Using the Power of Relationships to Achieve High Performance (2003). High quality communication reinforced by relationships of shared goals, shared knowledge and mutual respect is pursued in tandem with process improvement to embed positive team behaviors and new ways of working together to achieve desired outcomes.

But it became apparent that relational coordination was not just about flight departures - it was also about patient care. With High Performance Healthcare (2009), relational coordination moved into the healthcare industry where it has become a useful framework for helping to transform that industry. The Relational Coordination Research Collaborative (RCRC) was founded in 2011 at Brandeis University to help organizations build relational coordination for high performance.

Now relational coordination has become a useful framework for understanding organizational performance in a wide range of sectors and across multiple countries, wherever work is highly interdependent, uncertain and time constrained. Relational coordination is also becoming a model to guide organizational change, as described in Transforming Relationships for High Performance: The Power of Relational Coordination (2016).¹

The Theory of Relational Coordination

As a form of social capital, relational coordination can be developed at the micro level between individuals, at the meso level between roles, and at the macro level between departments or organizations, creating a relational ecosystem for high performance. When co-workers have strong relational coordination with others across organizational boundaries who are serving the same clients, they are able to achieve higher quality outcomes more efficiently.²

Relational coordination has a solid research foundation, and has been associated with a wide range of desirable outcomes including quality and safety outcomes, efficiency and financial outcomes, worker wellbeing and client engagement, as well as learning and innovation. The bottom line is that a positive relational context enables people to achieve quality outcomes more efficiently with less wasted effort, while connecting across differences to foster innovation and learning - and that it matters most when work is highly interdependent, uncertain and time constrained.
Relational coordination tends to be weak in organizations with traditional bureaucratic structures that reinforce fragmentation and silos. Relational coordination expected to be stronger in the presence of horizontally designed structures that include selecting and training for teamwork, shared accountability and rewards, relational job design, boundary spanner roles, shared conflict resolution, shared meetings, shared protocols and shared information systems.³
The theory of relational coordination is summarized in the following graphic:

The Relational Model of Organizational Change

Professor Jody Hoffer Gittell has worked with Professors Edgar Schein and Amy Edmondson, influenced by colleagues in a variety of fields, to develop the Relational Model of Organizational Change. The relational model of organizational change extends relational coordination theory to make it dynamic. This model shows how organizations and their stakeholders strengthen relational coordination to achieve their desired outcomes.

This model has the following components:

• Relational Interventions to build new relational dynamics based on shared goals, shared knowledge and mutual respect
• Work Process Interventions to connect the new relational dynamics to improvements in the work itself
• Structural Interventions to support the changes with cross-cutting organizational structures

The relational model of organizational change is summarized in the following graphic:

Beyond Relational Coordination - Relational Coproduction and Relational Leadership

Relational coproduction is an extension of relational coordination to include clients and their families, based on the evidence that many desired outcomes cannot be achieved by professionals alone.⁴ Relational coproduction between workers, clients and their families has been shown to predict higher quality outcomes.⁵ In addition, leaders play a central role. Leaders can support relational coordination through their relational leadership, by fostering mutually supportive relationships with others and among others. These three relational dynamics are depicted in the following graphic:

Measuring Relational Coordination

Relational coordination can be measured using a validated tool to assess the communication and relationship dynamics between workgroups, organizations or individuals, for the purpose of research, organizational change, or ongoing feedback for frontline workers and leaders. The seven item survey measures communication and relationship networks across functional and organizational boundaries. This tool captures coordination among workers (relational coordination), between workers and clients (relational coproduction), and between workers and leaders (relational leadership). This validated measurement tool is offered by RC Analytics for the purpose of research, organizational change, or ongoing feedback for frontline workers and leaders. Sample survey results are shown below:

Relational Coordination Research Collaborative

The Relational Coordination Research Collaborative (RCRC) is an international learning community based at Brandeis University’s Heller School for Social Policy and Management. The vision of the RCRC is to transform relationships toward shared goals, shared knowledge and mutual respect.

RCRC was founded in 2011 to help organizations build relational coordination for high performance by Professor Jody Hoffer Gittell and then-PhD student Saleema Moore, who now serves as Chief Operating Officer of Relational Coordination Analytics. Gittell and Moore were inspired by colleagues such as Tony Suchman (Relational Centered Health Care), Ken Milne and Nancy Whitelaw (Salus Global Corporation), Dale Collins Vidal (Alice Peck Day Memorial Hospital), Margie Godfrey (Dartmouth Institute), Thomas Huber (Ohio State University), Gene Beyt (Indiana University Health), Kathryn McDonald (Stanford Health Policy), Deborah Ancona (MIT Leadership Center), John Carroll (MIT Lean Advancement Initiative) and Edgar Schein (MIT Sloan School of Management) who foresaw the potential for relational coordination to support the work of practitioners as well as researchers.

The RCRC has extensive experience working with partners in 22 countries and a wide variety of sectors. We provide consultation, training, intervention/change support, and evaluation for our partners. The core concept for RCRC is relational coordination – coordinating work across boundaries through relationships of shared goals, shared knowledge and mutual respect, supported by frequent, timely, accurate and problem-solving communication. Relational coordination can be measured and analyzed using a validated tool. This tool can capture the networks of coordination that exist among workers (relational coordination), between workers and clients (relational coproduction), and between workers and managers (relational leadership).

Footnotes

1. Gittell, J.H. (2003). The Southwest Airlines Way: Using the Power of Relationships to Achieve High Performance. New York: McGraw-Hill; Gittell, J.H. (2009). High Performance Healthcare: Using the Power of Relationships to Achieve Quality, Efficiency and Resilience. New York: McGraw-Hill; Gittell, J.H. (2016). Transforming Relationships for High Performance: The Power of Relational Coordination. Palo Alto: Stanford University Press.

2. Gittell, J.H. (2002). Relationships between service providers and their impact on customers. Journal of Service Research, 4(4): 299-311, Gittell, J.H., Fairfield, K., Bierbaum, B., Jackson, R., Kelly, M., Laskin, R., Lipson, S., Siliski, J., Thornhill, T., & Zuckerman, J. (2000). Impact of relational coordination on quality of care, post-operative pain and functioning, and length of stay: A nine hospital study of surgical patients. Medical Care, 38(8): 807-819, and Gittell, J.H. (2003). The Southwest Airlines Way: Using the Power of Relationships to Achieve High Performance. New York: McGraw-Hill. See also Gittell, J.H. (2006). Relational coordination: Coordinating work through relationships of shared goals, shared knowledge and mutual respect. In Relational Perspectives in Organizational Studies: A Research Companion, pp. 74-94, eds. O. Kyriakidou and M. Ozbilgin. Edward Elgar Publishers.
To understand relational coordination as a form of social capital, see Adler, P. and Kwon, S. (2002). Social capital: Prospects for a new concept. Academy of Management Review, 27(1): 17–40.
For more findings regarding relational coordination and performance outcomes, please see Gittell, J.H. and Logan, C.K. (2016). The impact of relational coordination on performance and how organizations support its development. Working Paper, Brandeis University.

3. For evidence regarding the structures that support relational coordination, please see Gittell, J.H., Seidner, R. & Wimbush, J. (2010). A relational model of how high-performance work systems work. Organization Science, 21(2): 490-506; McDermott, A.M., Conway, E., Cafferkey, K., Bosak, J. 
& Flood, P.C. (2017). Performance management in context: Formative cross-functional performance monitoring for improvement and the mediating role of relational coordination in hospitals. International Journal of Human Resource Management, 1-21; Gittell, J.H. (2000). Organizing work to support relational coordination. International Journal of Human Resource Management, 11(3): 517-539; Gittell, J.H. (2002b). Coordinating mechanisms in care provider groups: Relational coordination as a mediator and input uncertainty as a moderator of performance effects. Management Science, 48(11): 1408-1426; Gittell, J.H. (2001). Supervisory span, relational coordination and flight departure performance: a reassessment of post-bureaucracy theory. Organization Science, 12(4): 467-482; Gittell, J.H. (2008). Relationships and resilience: Care provider responses to pressures from managed care. Journal of Applied Behavioral Science, 44(1): 25-47; Gittell, J.H., Weinberg, D., Bennett, A. & Miller, J.A. (2008). Is the doctor in? A relational approach to job design and the coordination of work. Human Resource Management, 47(4): 729-755; Gittell, J.H. & Weiss, L. (2004). Coordination networks within and across organizations: A multi-level framework. Journal of Management Studies, 41(1): 127-153; Haase, M. & Grote, G. (2013). Introducing standards in rehabilitation medicine as support for relational coordination. Academy of Management Meetings, Orlando, FL; Kautz, C., Gittell, J.H., Lusenhop, W., Weinberg, D.B. & Wright, J. (2007). Patient benefits from participating in an integrated delivery system: Impact on the coordination of care. Health Care Management Review, 32(3): 1-11; McEvoy, P., Escott, D. & Bee, P. (2011). Case management for high-intensity service users: towards a relational approach to care coordination. Health and Social Care in the Community, 19(1): 60 – 69; Ross, D. (2015). In pursuit of high performing health care teams: A test of TeamSTEPPS as a model to improve relational coordination in ambulatory care teams. Ph.D. Dissertation, California School of Professional Psychology; Romanow, D.S. et al (2017). CPOE-enabled coordination:
 Appropriation for deep structure use and impacts on patient outcomes. Management of Information Systems Quarterly; Sebastien, I. (2014). The influence of information systems affordances on work practices in high velocity, high reliability organizations: A relational coordination approach. Ph.D. Dissertation, Shidler College of Business, University of Hawaii; Skakon, J. (2014). Relational and course coordination at the university: Can the principles of relational coordination incorporated into the course coordinator role strengthen constructive alignment? Human Factors in Organization Design and Management, 625-630; Wright, W. (2015). Extending relational coordination as a high performance work system: A case study of a New Zealand early childhood education and care company. Ph.D. Dissertation. Curtin University of Technology.
For a summary of all findings regarding structures that support relational coordination, please see Gittell, J.H. & Logan, C.K. (2017). The impact of relational coordination on performance and how organizations support its development. Working Paper, Brandeis University.

4. Batalden, M., Batalden, P., Margolis, P., Seid, M., Armstrong, G., Opipari-Arrigan, L. & Hartung, H. (2015). Coproduction of healthcare service. BMJ Quality and Safety, doi:10.1136/bmjqs-2015- 004315.

5. Cramm, J.M., & Nieboer, A.P. (2014a). The importance of productive patient-professional interaction for the well-being of chronically ill patients. Quality of Life Research, 24(4): 897 – 903; Meer, L., Nieboer, A.P., Finkenflügel, H., & Cramm, J.M. (2017). The importance of person‐centred care and co‐creation of care for the well‐being and job satisfaction of professionals working with people with intellectual disabilities. Scandinavian Journal of Caring Sciences; Tietbohl, C. et al (2015). Implementation of patient decision support interventions in primary care: The role of relational coordination. Medical Decision Making, 35(8): 987-998; Warfield, M.E., Chiri, G., Leutz, W.N., & Timberlake, M. (2013). Family well-being in a participant-directed autism waiver program: The role of relational coordination. Journal of Intellectual Disability Research, 58(12): 1091-1104; Weinberg, D.B., Lusenhop, W., Gittell, J.H., & Kautz, C. (2007). Coordination between formal providers and informal caregivers. Health Care Management Review, 32(2): 140-150.