Presentation on theme: "Learning to Coordinate: A Relational Model of Organizational Change"— Presentation transcript:
1Learning to Coordinate: A Relational Model of Organizational Change Jody Hoffer Gittell, Brandeis UniversityAmy Edmondson, Harvard Business SchoolEdgar Schein, MIT Sloan School of Management2011 Academy of ManagementSan Antonio, TX
2Learning to coordinate Coordination is a key organizational competence that drives performanceBut how do organizations learn to coordinate?If coordination is relational, people need to learn new patterns of interrelatingHow does this happen in an intentional way?What is the sequencing or interplay between changing relationships, and changing the structures that reinforce them?
3In this paper we will… Explore relational models of CoordinationLearning and changePropose a relational model of learning to coordinateDescribe three cases of learning to coordinateCanadian obstetrics unitsTexas primary care clinicsMaine health and human services
4Relationships shape the communication through which coordination occurs Frequent communicationTimely communicationAccurate communicationProblem-solving communicationShared goalsShared knowledgeMutual respectAre shared goals, knowledge and mutual respect = relationships? Or attributes of relationships? That makes sense I think.
5relational coordination This process is calledrelational coordination“A mutually reinforcing process ofcommunicating and relating for thepurpose of task integration” (Gittell 2011)
6How do organizations learn new ways to coordinate?Because relational coordination is a mutually reinforcing process, it is difficult to changeRelational dynamics tend to become deeply embedded in the form of assumptions and self-conceptsWhat do we know about organizational learning and change that might be helpful?
7Organizational learning (Edmondson 2002) Organizational learning is interpersonal and relational, and often involves learning to coordinate work in a new wayPsychological safety – the perception that it is safe to express disagreement and be fallible – is a necessary condition for this kind of interpersonal, relational learning to occurPsychological safety enables participants to identify and question current assumptions
8Changing structures is not enough Change cannot occur only through changing formal structures – new structures will not be embraced or sustained unless the assumptions that underlie them are identified and questioned (Fletcher, Bailyn, Blake-Beard 2009)Need ‘discursive’ or ‘relational’ space for identifying and questioning the current organizational assumptions (Fletcher, Bailyn, Blake-Beard 2009; Kellogg 2009)
9How to start the learning process (Schein 2010) Individuals or groups can participate in a ‘cultural island’ that enables examination of past practices, cultural norms and constraints to learningGoal is to identify and commit to shared goals based on a new compact with the organization and with each otherThis can improve relational coordination
10Off-site agenda: Learning and unlearning (Schein 2010) Step 1: Self-assessment of present stateStep 2: Identification of learning barriersStep 3: Identification of cultural constraints and aidesStep 4: Commitment process to shared goals and compactStep 5: Identification of desired new behaviorsTimely and relevant communicationRole-mapping and identification of interdependenceRole negotiation to build relationshipMutual sharing of knowledgeMutual agreement on how to measure progressStep 6: Ensure that rewards and incentive systems and other organizational structures are consistent with the new ways of working
11Organizational structures Relational intervention Learning to coordinate: A relational model of organizational changeRelational coordinationShared goalsShared knowledgeMutual respectFrequent communicationTimely communicationAccurate communicationProblem-solving commOrganizational structuresPerformanceRelational interventionCultural islandPsychological safetyRelationship mappingRole modeling
12Case studies of learning to coordinate Case 1: Canadian obstetricsCase 2: Texas primary careCase 3: Maine health and human services
13Canadian obstetricsCanadian obstetrician and obstetrics nurse discovered through their own work experience that relational approaches between providers and with patients seemed to result in fewer errors, better quality outcomes, less waste, fewer liability claimsWith support from a Canadian insurance association, they formed a consulting practice to teach their methods to obstetrics units throughout the country
14Canadian obstetrics (continued) Intervention works with frontline providers to improve work processes and relational dynamics, then seeks leadership support for new structures to support the new relational dynamics“We didn’t know what to call what we were doing, but after reading organizational theory in the late 1990s, I realized we were doing relational coordination” (Ken Milne, CEO, Salus Global Consulting)
15Canadian obstetrics (continued) Have worked with over 100 Canadian hospitals and about 30 U.S. hospitals, often achieving reductions in liability claims, and increases in satisfaction and other quality outcomesNow rolling out the model to other hospital units (surgery, ER, ICU), that have been requesting the same type of intervention
16Texas primary careResearch team from UT Health Science Center in San Antonio enrolled 40 rural primary care clinics in an effort to improve chronic care for their patientsIntervention team led by a physician/researcher helped clinics to measure their outcomes, their structures for chronic care delivery, as well as relational coordination and reciprocal learning
17Texas primary care (continued) Through coaching visits every 2-3 weeks over a one year period, the intervention team facilitated meetings, process improvement efforts and relational improvements among clinical and non-clinical members“We shared the data with them and let them decide what they wanted to do about it. We gave advice, like meeting with each other, doing regular huddles to coordinate care – but we were there to help them do what they wanted to do” (Raquel Romero, MD, Intervention Team Leader)
18Texas primary care (continued) Base-line cross-sectional data suggests that relational coordination and reciprocal learning among members predict greater adoption of chronic care structuresStill analyzing longitudinal data to assess changes over time
19Maine Dept. of HHSLeaders in Maine’s Office of Lean Management have been implementing lean principles in government for 6 yearsThey respond to requests for training and for assistance with process changes
20Maine Dept. of HHS (continued) “It is a blame/shame environment. During the training we started to see the goal alignment, the shared knowledge and the respect they were developing for each other. We saw it but didn’t know what it was” (Walter Lowell, Director, Office of Lean Management)“We realized that when the lean training works, it’s because they are changing their relationships in really important ways” (ibid)
21Maine Dept. of HHS (continued) “We designed a coaching intervention to foster relational coordination, and we call it the soft side of lean” (Kelly Grenier, Consultant, Office of Lean Management)“But people can get really discouraged when they go back to work – some say it was great training but within a couple of months they are back in their old boxes. Nothing has changed to support their new ways of working together” (ibid)
22Learning from casesIn cases 1 and 2, relational interventions were followed by changes in organizational structuresOur model predicts these structures will reinforce and sustain the new relational patternsIn case 3, relational interventions were not followed by changes in organizational structuresOur model predicts failure to sustain new relational patternsIn all three cases, relational interventions occurred along with process improvement interventionsWe revised our model to reflect this combined intervention
23Learning to coordinate: A relational model of organizational change Relational coordinationShared goalsShared knowledgeMutual respectFrequent communicationTimely communicationAccurate communicationProblem-solving commOrganizational structuresPerformanceRelational interventionCultural islandPsychological safetyRelationship mappingRole modelingProcess improvement interventionData gathering/analysisProcess mappingStructured problem solving