Online Authorization for Using the Relational Coordination Survey

1. Online Authorization for Using the Relational Coordination Survey

2. Contents • Overview of online authorization • Training and certification on interventional uses of RC survey • Module 1: What is relational coordination and how does it affect performance? • Module 2: How do organizations support relational coordination? • Module 3: Getting from here to there • Module 4: Relational coproduction and relational leadership • Module 5: Measuring and mapping relational coordination • Module 6: Using the online relational coordination survey tool • Agreement regarding use of RC survey • Introducing the Relational Coordination Research Collaborative

3. Overview of online authorization • Intended for everyone who will be administering the RC survey – researchers, internal consultants and external consultants. • Covers the history and theory of RC, the research evidence that RC contributes to organizational performance, appropriate (and inappropriate) uses of the survey, how to set up and administer the survey and the basics of how to interpret the survey reports. • Successful completion allows access to the web-based RC survey. • We strongly caution against using the RC survey for interventional purposes without adequate preparation. It’s more complicated than it seems and the team or organization can be harmed.

4. Training and certification on interventional uses of the RC survey In addition to online authorization, you may consider… • RC training course • appropriate for individuals with at least one year of experience in longitudinal process consulting, and training in group dynamics (formal or on-the-job) • includes independent study, a 1.5 day workshop and an individual consultation to help with planning an initial intervention • RC certification • includes writing up and submitting descriptions of two intervention projects • followed by an oral exam – discussing the projects with certified RC faculty members

5. Module 1: What is relational coordination and how does it affect performance?

6. Relational coordination was discovered while studying flight departures in the airline industry…

7. Flight departure process: A coordination challenge Operations Agents Ramp Agents Baggage Agents Gate Agents Ticket Agents Cabin Cleaners Passengers Caterers Freight Agents Fuelers Mechanics Flight Attendants Pilots

8. American: Frequent and timely communication “Here you don’t communicate. And sometimes you end up not knowing things…On the gates I can’t tell you the number of times you get the wrong information from operations…The hardest thing at the gate when flights are delayed is to get information.”

9. Southwest: Frequent and timely communication “Here there’s constant communication between customer service and the ramp. When planes have to be switched and bags must be moved, customer service will advise the ramp directly or through operations…Operations keeps everyone informed. It happens smoothly.”

10. American: Problem solving communication “If you ask anyone here, what’s the last thing you think of when there’s a problem, I bet your bottom dollar it’s the customer. And these are guys who work hard everyday. But they’re thinking, how do I stay out of trouble?”

11. Southwest: Problem solving communication “We figure out the cause of the delay. We don’t necessarily chastise, though sometimes that comes into play. It’s a matter of working together. Figuring out what we can learn. Not finger-pointing.”

12. American: Shared goals “Ninety percent of the ramp employees don’t care what happens, even if the walls fall down, as long as they get their check.”

13. Southwest: Shared goals “I’ve never seen so many people work so hard to do one thing. You see people checking their watches to get the on-time departure. People work real hard. Then it’s over and you’re back on time.”

14. American: Shared knowledge Employees revealed little awareness of the overall process. They typically explained their own set of tasks without reference to the overall process of flight departures.

15. Southwest: Sharedknowledge Employees had relatively clear mental models of the overall process -- an understanding of the links between their own jobs and the jobs of their counterparts in other functions. Rather than just knowing what to do, they knew why, based on shared knowledge of how the process worked.

16. American: Mutual respect Site 1: Mutual Respect “There are employees working here who think they’re better than other employees. Gate and ticket agents think they’re better than the ramp. The ramp think they’re better than cabin cleaners -- think it’s a sissy, woman’s job. Then the cabin cleaners look down on the building cleaners. The mechanics think the ramp are a bunch of luggage handlers.”

17. Site 2: Mutual Respect Southwest: Mutual respect “No one takes the job of another person for granted. The skycap is just as critical as the pilot. You can always count on the next guy standing there. No one department is any more important than another.”

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

19. For better... Frequent comm Timely comm Accurate comm Problem-solving communication Shared goals Shared knowledge Mutual respect

20. … Or worse Infrequent comm Delayed comm Erroneous comm “Finger-pointing” communication Functional goals Specialized knowledge Lack of respect

21. This process is called relational coordination “Communicating and relating for the purpose of task integration”

22. Does relational coordination matter for performance?

23. Investigated performance effects of relational coordination • Nine site study of flight departures over 12 months of operation at Southwest, American, Continental and United • Measured relational coordination among pilots, flight attendants, gate agents, ticket agents, baggage agents, ramp agents, freight agents, mechanics, cabin cleaners, fuelers, caterers and operations agents • Measured quality and efficiency performance, adjusting for product differences

24. Relational coordination correlates with flight departure performance

25. Better flight departure performance with relational coordination SWA1 CON2 SWA2 Quality/efficiency performance index CON1 UNI3 UNI1 AMR1 AMR2 UNI2 Relational coordination

26. Does relational coordination matter in other industries?

27. Patient care: A coordination challenge Case Managers Attending Physicians Nurses Physical Therapists Nursing Assistants Patients Social Workers Technicians Referring Physicians Administrators

28. Institute of Medicine report “The current system shows too little cooperation and teamwork. Instead, each discipline and type of organization tends to defend its authority at the expense of the total system’s function.” (2003)

29. Physicians recognize the problem “The communication line just wasn’t there. We thought it was, but it wasn’t. We talk to nurses every day but we aren’t really communicating.”

30. Nurses observe the same problem “Miscommunication between the physician and the nurse is common because so many things are happening so quickly. But because patients are in and out so quickly, it’s even more important to communicate well.”

31. Same study conducted in hospital setting • Nine hospital study of 893 surgical patients • Measured relational coordination among doctors, nurses, physical therapists, social workers and case managers • Measured quality and efficiency performance -- and job satisfaction, adjusting for patient differences

32. Relational coordination correlates with surgical performance Observations are patients (n=878) in hospitals (n=9). Model also included gender, marital status, psychological well-being and race. Standardized coefficients are shown.

33. Better surgical performance with relational coordination Hosp6 Hosp4 Hosp8 Quality/efficiency performance index Hosp5 Hosp9 Hosp3 Hosp7 Hosp1 Hosp2 Relational coordination

34. Findings extended to other settings • Medical care units in Boston suburban hospital • RC reduces length of stay, total costs of care, readmissions • Medical, surgical and intensive care units in Pennsylvania rural hospitals • RC reduces patient falls, medication errors, improves quality • Nursing homes in Massachusetts • RC improves resident quality of life • Chronic care in Netherlands • RC improves quality of care • Early intervention agencies in Massachusetts • RC with hospital improves enrollment and retention of families

35. Relational coordination also improves worker outcomes • Increases job satisfaction • Increases career satisfaction • Increases professional efficacy • Reduces burnout • Reduces emotional exhaustion

36. Relational coordination pushes out the quality/efficiency frontier to achieve better outcomes with less waste Quality Relational coordination Efficiency

37. There are other useful responses to coordination challenges… • Reengineering • Total quality management • “Lean” strategies • Redesigning work flows

38. Addressing technical issues is necessary but not sufficient “We’ve been doing process improvement for several years, and we think we’re on the right track. But we’ve tried a number of tools for process improvement, and they just don’t address the relationship issues that are holding us back.” -- CMO, Tenet Healthcare Systems

39. Why does RC improve performance? Relationships of shared goals, shared knowledge and mutual respect provide an organizational culture that supportsprocess improvement

40. Why does RC improve performance? Relationships of shared goals, shared knowledge and mutual respect help workers to connect around the customer

41. Relational coordination: Connecting around the customer Case Managers Attending Physicians Nurses Physical Therapists Nursing Assistants Patient and family Social Workers Technicians Referring Physicians Administrators

42. Why does RC improve performance? • Shared goals help participants to align their actions with each other • Shared knowledge helps participants to understand how their tasks fit together • Mutual respect helps participants to value the contributions and input of others • Together these relationships support frequent, timely, accurate, problem-solving communication – and vice versa!

43. Why does RC improve worker outcomes? • Relational coordination is gratifying – a less stressful way to work! • Enables workers to achieve better quality outcomes • Enables workers to perform their jobs with less wasted effort

44. When does relational coordination matter most? • Task interdependence • What you do affects my ability to do my job, and vice versa • Uncertainty • We can’t know everything we need to know ahead of time; each of us has a unique line of sight to the work process • Time constraints • We can’t waste time

45. Why do these conditions increase need for relational coordination? • Positive relationships provide • Stress reduction • Information processing capacity to meet demands • Interdependence, uncertainty, time constraints • Increased stress • Increased information processing demands

46. Relational coordination and organizational performance Relational Coordination Shared goals Shared knowledge Mutual respect Frequent Timely Accurate Problem-solving Communication Quality Performance Efficiency Performance Worker Well-Being Task interdependence Uncertainty Time constraints

47. Module 1: Questions to assess your understanding

48. What is relational coordination? • Communicating and relating for the purpose of task integration • A process that is useful for improving quality, efficiency and job satisfaction, especially under conditions of task interdependence, uncertainty and time constraints • Both of the above • None of the above

49. Which of the following are not dimensions of relational coordination? • Mutual respect • Shared knowledge • Functional goals • Mutual liking • Timely communication • Accurate communication • Problem solving communication

50. Why is relational coordination especially helpful under conditions of task interdependence, uncertainty and time constraints? • These conditions increase the need for information processing capacity, which relational coordination provides • These conditions increase stress for workers, and relational coordination helps to reduce that stress • Both of the above • None of the above