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Online Authorization for Using the Relational Coordination Survey.

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Presentation on theme: "Online Authorization for Using the Relational Coordination Survey."— Presentation transcript:

1 Online Authorization for Using the Relational Coordination Survey

2 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 Contents

3 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. Its more complicated than it seems and the team or organization can be harmed. Overview of online authorization

4 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 Training and certification on interventional uses of the RC survey

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

8 Here you dont communicate. And sometimes you end up not knowing things…On the gates I cant 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. American: Frequent and timely communication

9 Here theres 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. Southwest: Frequent and timely communication

10 If you ask anyone here, whats the last thing you think of when theres a problem, I bet your bottom dollar its the customer. And these are guys who work hard everyday. But theyre thinking, how do I stay out of trouble? American: Problem solving communication

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

12 Ninety percent of the ramp employees dont care what happens, even if the walls fall down, as long as they get their check. American: Shared goals

13 Ive 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 its over and youre back on time. Southwest: Shared goals

14 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. American: Shared knowledge

15 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. Southwest: Shared knowledge

16 Site 1: Mutual Respect There are employees working here who think theyre better than other employees. Gate and ticket agents think theyre better than the ramp. The ramp think theyre better than cabin cleaners -- think its a sissy, womans job. Then the cabin cleaners look down on the building cleaners. The mechanics think the ramp are a bunch of luggage handlers. American: Mutual respect

17 Site 2: 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. Southwest: Mutual respect

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

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

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

21 This process is called Communicating and relating for the purpose of task integration

22 Does relational coordination matter for performance?

23 Investigated performance effects of relational coordination n Nine site study of flight departures over 12 months of operation at Southwest, American, Continental and United n 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 n Measured quality and efficiency performance, adjusting for product differences

24 Relational coordination correlates with flight departure performance Efficiency Quality Gate time/ flight Staff time/ passenger Customer complaints Lost bags Late arrivals Relational coordination -.21***-.42***-.64***-.31*-.50** Flights/day-.19****-.37***-.30*** Flight length, passengers, cargo.79***.45*** ** Passenger connections.12**.19** R squared

25 Better flight departure performance with relational coordination Relational coordination Quality/efficiency performance index AMR2 AMR1 UNI2 UNI1 CON1UNI3 CON2 SWA2 SWA1

26 Does relational coordination matter in other industries?

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

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 systems function. (2003)

29 Physicians recognize the problem The communication line just wasnt there. We thought it was, but it wasnt. We talk to nurses every day but we arent 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, its even more important to communicate well.

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

32 Relational coordination correlates with surgical performance Length of stay Patient satisfaction Freedom from pain Mobility Relational coordination -.33***.26***.08*.06+ Patient age Comorbidities.09* Pre-op status ***.28*** Surgical volume.11**.10* R Squared 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 Relational coordination Quality/efficiency performance index Hosp2 Hosp1 Hosp7 Hosp3 Hosp9 Hosp5 Hosp6 Hosp8 Hosp4

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 Efficiency Relational coordination

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 Weve been doing process improvement for several years, and we think were on the right track. But weve tried a number of tools for process improvement, and they just dont address the relationship issues that are holding us back. -- CMO, Tenet Healthcare Systems

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

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

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

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

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

44 Task interdependence What you do affects my ability to do my job, and vice versa Uncertainty We cant 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 cant waste time When does relational coordination matter most?

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

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

47 Module 1: Questions to assess your understanding

48 What is relational coordination? 1.Communicating and relating for the purpose of task integration 2.A process that is useful for improving quality, efficiency and job satisfaction, especially under conditions of task interdependence, uncertainty and time constraints 3.Both of the above 4.None of the above

49 Which of the following are not dimensions of relational coordination? 1.Mutual respect 2.Shared knowledge 3.Functional goals 4.Mutual liking 5.Timely communication 6.Accurate communication 7.Problem solving communication

50 Why is relational coordination especially helpful under conditions of task interdependence, uncertainty and time constraints? 1.These conditions increase the need for information processing capacity, which relational coordination provides 2.These conditions increase stress for workers, and relational coordination helps to reduce that stress 3.Both of the above 4.None of the above

51 How does relational coordination fit with approaches like TQM, lean, process redesign? 1.Relational coordination is an alternative, more relational approach for improving performance 2.TQM, lean and process redesign approaches offer a set of tools that work well on their own 3.Relational coordination provides a cultural context for using TQM, lean and process redesign more effectively 4.All of the above 5.None of the above

52 Which of these worker outcomes has not been associated with relational coordination? 1.Reduced burnout 2.Reduced emotional exhaustion 3.Increased commitment 4.Increased job satisfaction 5.Increased career satisfaction 6.Increased professional efficacy

53 Module 2: How do organizations support relational coordination?

54 Evidence suggests that structural interventions are needed to support relational coordination. Team-supporting systems – also called relational work systems – help workers to understand and focus on their shared mission and goals, which furthers their ability to carry out their individual work within the larger perspective of the team. They promote a culture of collaboration and coordination rather than competition, and an orientation toward group problem solving rather than blame. A culture explicitly oriented to promote and reward team success enhances the motivation for members to share responsibility, maintain an openness to others ideas, and to trust, empathize, and act generously toward each other.

55 These systems recognize that the strength of the group is greater than any one individual, so they actively seek out multiple perspectives and foster appreciation of diversity (Suchman et al, 2011).

56 Gittell (2003, 2009) has identified organizational structures that support and promote relational coordination.

57 Invest in frontline leadership Resolve conflicts proactively Reward team performance Select for teamwork Measure team performance Make job boundaries flexible Create boundary spanners Develop shared protocols Develop shared info systems Partner with suppliers Relational Coordination Shared goals Shared knowledge Mutual respect Frequent Timely Accurate Problem-solving Communication Quality Performance Efficiency Performance Broaden participation in team meetings Organizational structures that support relational coordination Worker Well-Being

58 Some illustrations from the patient care context

59 Here technical expertise exceeds teamwork ability as a criterion; doctors expect teamwork of others simply by virtue of the fact that they are doctors, after all. Select for teamwork

60 Youve got to be a nice person to work here…We 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. Select for teamwork

61 The quality assurance (QA) committee is strictly departmental and its strictly reactive. Everybody is giving reports to QA but nobody is listening or learning. The QA committee satisfies hospital-wide reporting requirements. But its not effective. We have board members on that committee, but we still cant get it to work. People have a bad attitude when they go. Its a lengthy, cumbersome meeting. Measure team performance

62 Quality assurance used to be completely reactive here, with incident reports. There would be a review to determine injury or no injury. QA is more real-time now, not so reactive. But we dont have a full system in place. Its evolving… Its not cross-functional yet. Usually I take the nurses and the chief of the service takes the physicians. There is finger-pointing. Measure team performance

63 We have a Bone Team which includes the service line director, the case management supervisor, the head of rehab, the VP for nursing, the nurse manager, the clinical specialist, three social workers and three case managers. We generally look at system problems. Measure team performance

64 I would say that for any non-physician to challenge a physician has the whole episode laced with pitfalls. For a nurse, a therapist, a pharmacist, a social worker, a nutritionist, an occupational therapist to challenge a physician is up there with losing a job or getting a divorcevery stressful. And I can say personally as a nurse that in my more formative years that was something that you would try to avoid at all costs. Resolve conflicts proactively

65 The kinds of conflicts we often have are disagreements about the patients treatment plan: what it should be. It can go across all of the groups. The other big thing is getting a physician to come up to the unit, to be available.... We have a formal grievance process if youre fired, but not for conflicts among clinicians.... There are no particular processes. We just hope people use common sense and talk to each other. - Resolve conflicts proactively

66 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. Resolve conflicts proactively

67 There are customs – like the fact that a physical therapist will never deal with bedpans and such – that go above and beyond licensing. These customs have a negative effect, like when a physical therapist will go get a nurse just to deal with the bedpan, making things difficult. Make job boundaries flexible

68 [Here] physical therapists definitely do the bedpans. You see, length of stay is so compressed and time is so valuable. Youll only delay yourself if you try to hunt down the nurses aide. Make job boundaries flexible

69 The case manager does the discharge planning, utilization review and social work all rolled into one. The case manager discusses the patient with physical therapy and nursing and with the physician. He or she keeps everyone on track. The case manager has a key pivotal role – he or she coordinates the whole case. Create boundary spanners

70 Case managers 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. Create boundary spanners

71 I have about 30 patients – with that number I pretty much just go down the list and see who is ready for discharge. Create boundary spanners

72 You cant track down all of the physicians here because some of the physicians have their own system. Thats a problem – they dont talk. Independent physicians have their own independent systems, and they only talk to themselves. I mean, so theres a big problem. Some of them are on the system, and some of them arent. Develop shared information systems

73 Information systems are important for coordination, I think, but right now they are more a hope than a reality. Our chief information officer is building a clinical and administrative information system allowing patients to receive care anywhere across the continuum… But for automation to work, its important to get a format thats understood across all specialists. Develop shared information systems

74 Invest in frontline leadership Resolve conflicts proactively Reward team performance Select for teamwork Measure team performance Make job boundaries flexible Create boundary spanners Develop shared protocols Develop shared info systems Partner with suppliers Relational Coordination Shared goals Shared knowledge Mutual respect Frequent Timely Accurate Problem-solving Communication Quality Performance Efficiency Performance Broaden participation in team meetings Organizational structures that support relational coordination Worker Well-Being

75 Bottom line: Organizational structures can support relational coordination, if designed properly In organizations with traditional bureaucratic structures that reinforce functional silos, relational coordination networks exhibit strong ties within functions and weak ties between functions, resulting in fragmentation and poor handoffs among front-line workers. By contrast, in organizations with structures that cut across functional silos – structures that include selecting participants for cross-functional teamwork, measuring and rewarding participants for cross-functional teamwork, resolving conflicts proactively across functions, developing work protocols that span functional boundaries, designing jobs with flexible boundaries between areas of functional specialization, and designing boundary spanner roles to support the development of networks across functional boundaries – relationship and communication networks are more cohesive. These cross-cutting structures represent a redesign of traditional bureaucratic structures. Together they form a relational work system that strengthens cross- functional networks of relational coordination without sacrificing the benefits of the division of labor.

76 Module 2: Questions to assess your understanding

77 Which of these organizational structures support relational coordination? 1.Selection for teamwork 2.Cross-functional performance measurement 3.Cross-functional rewards 4.Cross-functional protocols 5.Cross-functional conflict resolution 6.Cross-functional information systems 7.Cross-functional boundary spanners 8.All of the above

78 How do these structures work? 1.They create cohesion by reducing specialization 2.They create cohesion by connecting frontline workers across their areas of specialization 3.Both of the above 4.None of the above

79 How do these structures influence performance outcomes? 1.They increase relational coordination, and as a result, they increase quality, efficiency and worker outcomes 2.They increase relational coordination 3.They increase quality, efficiency and worker outcomes 4.All of the above 5.None of the above

80 To support relational coordination, performance measures must… 1.Hold everyone accountable for their own performance 2.Hold everyone accountable for overall performance outcomes 3.Encourage problem solving, not finger pointing 4.All of the above 5.None of the above

81 To support relational coordination, conflict resolution must… 1.Prevent conflict in the workplace 2.Discover who started the conflict 3.Avoid conflicts at all costs 4.Find ways to surface, discuss and learn from conflicts, especially across functional groups where power differentials exist 5.All of the above

82 Module 3: Getting from here to there

83 How do organizations learn new ways to coordinate? n Many organizations are still traditional bureaucracies with workers in their silos n Relationship patterns are deeply engrained in organizational cultures and professional identities n Our structure/process/outcomes model may be an accurate description of the current state, but it doesnt tell us how to create change

84 Changing structures is not enough n Change rarely occurs simply by changing organizational structures n Need to identify and question current assumptions n Need discursive or relational space for doing this

85 Organizational learning n Organizational learning is interpersonal and relational n Psychological safety is a necessary condition for this kind of interpersonal, relational learning to occur n Psychological safety enables participants to identify and question current assumptions

86 How to start the learning process n Individuals or groups can participate in a relational space or a cultural island that enables examination of past practices, cultural norms and constraints to learning n In that space, they can identify and commit to shared goals with each other

87 Learning from real interventions n Canadian obstetrics n Maine Dept. of Health & Human Services n Mid-Atlantic intensive care unit

88 Canadian obstetrics n Canadian 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 claims n With support from a Canadian insurance association, they formed a consulting practice to teach their methods to obstetrics units throughout the country

89 Canadian obstetrics n First they help providers to improve their work processes and relational dynamics n Then they ask for leadership support for new structures to support the new ways of working n We didnt 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

90 Canadian obstetrics n So far: n 100 Canadian hospitals n 30 U.S. hospitals n achieving reductions in liability claims, and increases in satisfaction and other quality outcomes n Underway: n rolling out the model to other hospital units (surgery, ER, ICU) that have requested intervention

91 Maine Dept. of Health & Human Service n Leaders in Maines Office of Lean Management have been implementing lean principles in government for 6 years n They respond to requests for training and for assistance with work process improvement

92 Maine Dept. of Health & Human Service n 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 didnt know what it was. n We realized that when the lean training works, its because they are changing their relationships in really important ways Walter Lowell, Director, Office of Lean Management

93 Maine Dept. of Health & Human Service n We designed a coaching intervention to foster relational coordination, and we called it the soft side of lean. n 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. Kelly Grenier, Consultant, Office of Lean Management

94 Mid-Atlantic intensive care unit n Physicians considered to be a problem n Uncivil behaviors among themselves and with other work groups n Consultant was called in to help n Started with physician interviews, retreat, and baseline mapping of relational coordination

95 Physicians 3.70 Day nurses 4.42 Nurse mgrs 4.57 Secretaries 4.57 Night nurses Mid-Atlantic intensive care unit, before intervention

96 Mid-Atlantic intensive care unit n Mapping showed unusually weak ties n among physicians n between physicians and nurse managers n Also unusually strong ties n Between day nurses, night nurses and secretaries n Intervention focused on physicians and included –Appreciative inquiry –New physician group leader –Coaching and goal-setting –Accountability for relational behaviors –Weekly meetings to check in, make group decisions

97 4.22 Day nurses 4.30 Nurse mgrs 4.17 Secretaries 4.14 Night nurses 4.39 Mid-Atlantic intensive care unit, after six month intervention Shaded numbers indicate significant positive change Physicians

98 Partial success n Relational coordination improved –Among physicians –Between physicians and nurse managers –Between nurse managers and secretaries n But RC stayed the same or got worse –Between other groups nShared knowledge did not improve for anyone, even physicians n Lessons learned?

99 Lessons learned n Relational intervention –Build relational coordination more broadly, not just among physicians but with other work groups as well n Work process intervention –Improve relational coordination in the context of the work by doing process improvement – create shared knowledge n Structural intervention –Set up new structures -- forms of accountability, roles, meetings, conflict resolution -- not just for physicians but for other work groups as well

100 Three kinds of interventions may be needed for sustainable change n Relational intervention n Work process intervention n Structural intervention

101 A Relational Model of Organizational Change Relational Coordination Shared goals Shared knowledge Mutual respect Frequent communication Timely communication Accurate communication Problem-solving comm Relational Interventions Relationship mapping Create relational space Coaching/role modeling Structural Interventions Selection Training Conflict resolution Performance measures Rewards Meetings Boundary spanners Protocols Information systems Performance Outcomes Quality Efficiency Worker well-being Work Process Interventions Process mapping Goal and role clarification Structured problem solving

102 Module 3: Questions to assess your understanding

103 Why is it challenging to improve relational coordination? 1.People just dont like to change, no matter what 2.It is human nature to prefer hierarchy over reciprocal relationships 3.Current relational patterns are deeply embedded in our cultures and professional identities 4.All of the above 5.None of the above

104 Why is it not sufficient to change organizational structures? 1.Structures are artificial and they dont make a difference to how we behave 2.People will reject new structures that dont fit their current beliefs and relational patterns 3.Organizational structures cannot be changed 4.All of the above 5.None of the above

105 Why is it not sufficient to change relationships? 1.Relationship patterns cant be changed – they are too embedded in our culture and professional identities 2.Relationships dont really make a difference 3.If we change relationships but leave the old structures in place, before long we will revert to our old relationship patterns 4.All of the above 5.None of the above

106 Relational space allows participants to safely… (check all that apply) 1.Identify and question assumptions 2.Speak up and be heard 3.Determine who is at fault 4.Admit one does not know everything 5.Diminish the impact of power differentials 6.Understand each others perspective 7.Identify and commit to shared goals with each other

107 Module 4: Relational coproduction and relational leadership

108 Beyond relational coordination n Need relational coordination –Connecting workers with each other n But also relational coproduction –Connecting workers with the customer, family and community n And relational leadership as well –Connecting workers and managers

109 Relational coproduction – an innovative approach to professionalism Traditional professionals seek autonomy exclusive control of expertise power over Collaborative professionals see other professionals and non-professionals as sources of learning and support rather than interference

110 Relational coproduction A partnership approach based on power with rather than power over Partnering with the customer, family and the broader community Shared goals for alignment Shared knowledge for understanding the others role and the knowledge each party brings to the table Mutual respect for appreciating and respecting the roles played by other parties

111 Relational leadership – an innovative approach to leadership Traditional leaders are top down, feel they must know everything, hesitate to ask for help Relational leaders Defer to expertise - defer to any person or group with relevant knowledge, regardless of their status Lead through humble inquiry - no matter how much leaders know, there are many things they can only learn from others Create a relational space in which participants willingly share what they know and learn from others with relevant knowledge

112 Relational leadership A partnership approach based on power with rather than power over Relational leaders partner with others to get the job done, developing Shared goals for alignment Shared knowledge for understanding the others role and what each party brings to the table Mutual respect for respecting the roles played by other parties

113 Manager Relational coproduction Relational coordination Relational leadership These dynamics are mutually supportive Customers Workers Managers

114 Shared goals Identifying with and embracing the goals of the whole Shared knowledge Understanding the whole, how each role contributes Mutual respect Respecting each participant, role that he/she plays All three relationships benefit from…

115 Relational Model of Organizational Change Relational Coordination Relational Coproduction Relational Leadership Shared goals Shared knowledge Mutual respect Frequent communication Timely communication Accurate communication Problem-solving comm Relational Intervention Relationship mapping Coaching/role modeling Perspective taking Structural Intervention Selection Training Conflict resolution Performance measures Rewards Meetings Boundary spanners Protocols Information systems Performance Outcomes Quality Efficiency Worker well-being Work Process Intervention Process mapping Goal and role clarification Structured problem solving

116 Module 4: Questions to assess your understanding

117 Relational coproduction is… (check all that apply) 1.An innovative approach to professionalism 2.A customer/worker relationship that is primarily arms length 3.A reciprocal, relatively egalitarian relationship between customers and workers 4.Relying on customers to bring their knowledge to the table to help produce the desired outcomes 5.Reassuring customers that they can sit back and play a primarily passive role

118 Relational leadership is… (check all that apply) 1.A take charge approach to leadership 2.A way for leaders to be heroic in the eyes of their followers 3.A reciprocal, relatively egalitarian relationship between managers and workers 4.Relying on workers to bring their knowledge to the table to help produce the desired outcomes 5.Reassuring workers that they can sit back and play a primarily passive role

119 How do relational leaders influence relational coordination? 1.When leaders act in relational ways, relational coordination between workers is less important for achieving desired outcomes 2.By role-modeling deference to expertise and humble inquiry, relational leaders help to foster relational coordination between workers 3.Both of the above 4.None of the above

120 How does relational coordination influence relational coproduction? 1.When workers know how to relationally coordinate with each other, it is easier for them to build shared goals, shared knowledge and mutual respect with the customer 2.When relational coordination is really strong, customers do not need to engage in relational coproduction 3.Both of the above 4.None of the above

121 How does relational coproduction influence relational coordination? 1.When workers have a common goal of partnering with the customer, that provides a good starting point for building relational coordination among themselves 2.When all workers have individual relationships with the customer, there is little need for relational coordination between those workers 3.Both of the above 4.None of the above

122 Module 5: Measuring and mapping relational coordination

123 The RC Survey THE RELATIONAL COORDINATION (RC) SURVEY is the cornerstone of the resources made available through the Relational Coordination Research Collaborative. The RC survey is a seven question instrument based on the theory of relational coordination. Relational coordination is measured by surveying participants in a particular work process about their communication and relationships with other participants in that work process. Because coordination is the management of interdependencies between tasks, and because people are typically assigned to tasks through their roles, relational coordination is most often measured as coordination between roles rather than between individuals, though its also possible to measure relational coordination between individuals.

124 Measuring relational coordination RC dimensionsSurvey questions 1. Frequent communication How frequently do people in each of these groups communicate with you about [focal work process]? 2. Timely communication How timely is their communication with you about [focal work process]? 3. Accurate communication How accurate is their communication with you about [focal work process]? 4. Problem solving communication When there is a problem in [focal work process], do people in these groups blame others or try to solve the problem? 5. Shared goalsHow much do people in these groups share your goals for [focal work process]? 6. Shared knowledge How much do people in these groups know about the work you do with [focal work process]? 7. Mutual respectHow much do people in these groups respect the work you do with [focal work process]?

125 The RC Survey Dr. Jody Hoffer Gittell, joined by a growing number of researchers and practitioners, has spent the past decade and a half developing, validating, testing, and refining the relational coordination metric. The RC survey is a tool that enables organizations to understand where relationships are strongest and weakest amongst functional groups, or across distinct organizations. The survey provides a way to assess the impact of relational coordination on key performance outcomes, and a way to assess the impact of different organizational structures on the development of relational coordination. When creating change, the RC survey can serve as one of the first diagnostic steps to assess the existing pattern of relationships, and as a way to evaluate the impact of an intervention on that pattern of relationships. Sharing results with participants and fostering reflection about those results can also serve as a basic element of the intervention.

126 Survey formats THE RC SURVEY can be used in three different formats: 1)Paper –The RC survey is administered in hardcopy and manually analyzed or the data can be formatted and uploaded to the online survey tool for analyses and reports. 2)Your own survey platform – RC survey data is collected using your own survey platform and similar to the paper format, can be formatted and uploaded to the online survey tool for analyses and reports. 3)RC online survey tool– The online rc survey tool is a complete data collection, management and analyses tool. RCRC staff are available for set up, analysis or interpretation of results, with associated fees to ensure sustainability.

127 1. Paper survey If using the paper survey, rc resources are available to help you analyze the data on your own. Guidelines for Theory, Measurement and Analysis is available online to assist you with the data analysis process. You may also upload your data to the online rc survey tool for immediate analyses and results. There is a cost associated with using the online tool to analyze previously collected data. The RCRC team is available to provide support and assist with interpretation of results. See more about these analyses and reports under Our Online Survey.

128 2. Your own survey platform Similar to the paper survey, there are two options for getting your RC data analyzed: 1) You can analyze the data on your own or 2) You can upload your data to the online rc survey tool for immediate analyses and results. There is a cost associated with using the online tool to analyze previously collected data. The RCRC team is available to provide support and assist with interpretation of results. See more about these analyses and reports under Our Online Survey.

129 3. The Online RC Survey Tool The RC online survey tool can be accessed directly from the RCRC website once online authorization has been successfully completed. The online survey tool is a data collection, management and analysis tool that is easily administered and tracked online, with customizable notices and reminders automatically sent to your survey respondents, as well as automatic data entry. The online survey tool features built-in creation of the relational coordination index along with significance testing and benchmarking capabilities.

130 3. The Online RC Survey Tool A report is produced for your organization that presents the following analyses: the strength of relational coordination ties on each of the seven dimensions as well as the overall RC index, the strength of relational coordination ties for the work process as a whole, and the strength of those ties within and between each of the functional groups involved in that work process. Along with these results, the online survey tool also creates a network map that provides a graphic representation of relational coordination ties within and between each of the functional groups involved in that work process. See below. The RCRC team is available to assist with interpretation of results.

131 Work Group 1 Work Group 2 Work Group 5 Work Group 4 Work Group 3 Mapping relational coordination Customer

132 3. The Online RC Survey Tool In addition to the report, online survey users will receive their raw data in Excel format to allow additional analyses of the RC data and to allow them to link the RC data with data they have gathered from other sources. The online survey also offers an optional add-on module that captures demographic characteristics of the survey respondents. Working with RCRC partners, we plan to add other optional modules to the online survey such as job satisfaction, distributed leadership, psychological safety, knowledge sharing behaviors, and more.

133 3. The Online RC Survey Tool The RC survey has been translated into Danish, Dutch, Norwegian, Portuguese, Malaysian, Italian, Spanish, Farsi and other languages. We aim to add these language options to our online survey over time – please be in touch with us if you are interested in learning more!

134 RC survey set up Regardless of format, there are three key decisions that have to be made in order to customize the RC survey appropriately to the context of interest. The RCRC team is available to guide you through these decisions, or you can gain expertise by taking the RC Training Course.

135 RC survey set up Three key decisions for RC survey set up: 1)What is the work process of interest? It can be as general as serving our customers or delivering patient care or as specific as handoffs from the OR to the ICU or the flight departure process. 2)Which functions, organizations or individuals are involved in that work process? You will be surveying your respondents about their coordination with those entities or individuals. 3)Of those functions, organizations or individuals, who will you send the survey to? Could be all of them, or a subset. RCRC staff are available to guide you through these decisions.

136 Step 1 in measuring relational coordination is to identify a work process that serves a client population of interest - the focal work process. Step 2 is to identify the roles or functional groups that are involved in carrying out that focal work process. It is helpful to conduct informational interviews to identify all functional groups that are expected to impact the quality and efficiency outcomes of that focal work process. The set of functional groups involved in a patient care process, for example, may include physicians, nurses, therapists, case managers and social workers. These functional groups are listed in the relational coordination survey below each of the seven relational coordination questions, enabling the survey respondent to answer each of the questions about their coordination with members of each of these functional groups. RC survey set up

137 Step 3 is to identify which of these functional groups you will be able to survey. Perhaps you will have access to survey only a subset of the functional groups involved in the work process. Partial access is not unusual and is not insurmountable, so long as you sample the same subset of functional groups consistently throughout the study. If you are able to survey all of the functional groups you have identified as being central to the work process, you will end up with a complete or symmetrical matrix of relational coordination ties as shown below. If you can only survey a subset of those groups, you will end up with an incomplete or asymmetrical matrix of relational coordination ties as shown below. RC survey set up

138 Symmetrical matrix

139 Asymmetrical matrix

140 In the case of an asymmetrical matrix, you can still learn a great deal about relational coordination. You can learn about relational coordination between the functional groups that were surveyed, about relational coordination between them and the functional groups that were not surveyed, and about relational coordination within the functional groups that were surveyed. But you cannot learn about relational coordination between any two functional groups that were not surveyed, or about coordination within any of the functional groups that were not surveyed. For example, in the asymmetrical matrix shown above we can see that coordination with physicians and residents is consistently weaker than coordination with nurses, therapists, social workers and case managers. We can also see that participants tend to have stronger relational coordination with those in the same functional group than with those in other functional groups. But we cannot assess coordination among physicians, among residents, or between physicians and residents.

141 Bottom line If there are two functional groups between which you have reason to believe coordination is essential (due to task interdependence between them), you need to have access to at least one of those groups in order to assess that coordination. If there is a functional group for which you believe within-function coordination may be essential, you need to have access to members of that functional group in order to assess their within-function coordination.

142 It is also important to think about your study design – what are you comparing? 1)Multiple sites 2)Pre/post intervention 3)Multiple sites pre/post intervention What are you comparing?

143 You may have multiple sites that are carrying out the same work process. You suspect that they may have different levels of relational coordination, due to different leadership practices or organizational structures, which may result in different levels of performance. Administer the same RC survey in all sites, and compare RC scores. If you also measure leadership practices, organizational structures and/or performance, you can test whether differences in those variables are associated with differences in RC. 1. Multiple sites

144 You may have a single site where you are conducting an intervention that you believe may improve both relational coordination and performance. Administer the same RC survey before and after the intervention. Compare RC scores and see if RC or any of its dimensions changed significantly. If you also measure performance, you can test whether performance changed significantly. 2. Pre/post intervention

145 You may have multiple sites carrying out the same work process, where you are conducting an intervention that you believe may improve both relational coordination and performance. Administer the same RC survey in all sites before and after the intervention. Compare RC scores and see if RC or any of its dimensions changed significantly. If you also measure performance, you can test whether performance changed significantly. 3. Multiple sites pre/post intervention

146 If you measure all of these same variables in sites that do not carry out the intervention, you can test whether RC and/or performance change more with the intervention, than without it. If you also measure the intervention, you can test whether the intervention was implemented differently in different sites, and whether those differences correspond with differences in post-intervention RC and performance. 3. Multiple sites pre/post intervention

147 Module 5: Questions to assess your understanding

148 Which decisions must be made when setting up a relational coordination survey? 1.Identify the work process in need of coordination (could be very focused or very broad) 2.Identify the functional groups and/or individuals that are critical for coordinating that work process 3.Of those functional groups and/or individuals, identify who will be surveyed 4.All of the above 5.None of the above

149 Which survey format walks you through the set up process and produces an automatic report of your results? (check all that apply) 1.Online survey platform 2.Paper survey 3.Your own survey platform

150 Which survey format provides a spreadsheet of your data enabling you to analyze your own results? (check all that apply) 1.Online survey platform 2.Paper survey 3.Your own survey platform

151 Which survey format produces results that can be analyzed to produce RC network maps and matrices? (check all that apply) 1.Online survey platform 2.Paper survey 3.Your own survey platform

152 What are the 7 dimensions measured by the relational coordination survey? 1.Mutual respect, Frequent communication, Type of communication, Accurate communication, Problem solving communication, Shared knowledge, Shared Goals 2.Mutual respect, Shared values, Shared knowledge, Shared goals, Accurate communication, Timely communication, problem solving communication 3.Mutual respect, Shared goals, Accurate communication, Frequent communication, Timely communication, Problem solving communication, Shared knowledge 4.None of the above

153 RC network maps are useful because they… (check all that apply) 1.Show the strength of the relational coordination ties between each functional group in the work process 2.Show the strength of the relational coordination ties within each functional group in the work process 3.Show the difference in how two different functions view the relational coordination tie between them 4.Show the strength of relational coordination ties for the overall work process 5.Show the strength of each dimension of relational coordination 6.All of the above

154 RC matrices are useful because they… (check all that apply) 1.Show the strength of the relational coordination ties between each functional group in the work process 2.Show the strength of the relational coordination ties within each functional group in the work process 3.Show the difference in how two different functions view the relational coordination tie between them 4.Show the strength of relational coordination ties for the overall work process 5.Show the strength of each dimension of relational coordination 6.All of the above

155 Your RC study design may incorporate… 1.Multiple sites 2.Pre/post intervention 3.Multiple sites pre/post intervention 4.Any of the above 5.None of the above

156 When measuring multiple sites pre/post intervention you should… 1.Administer the same RC survey in all sites, and compare RC scores 2.Administer the same RC survey before and after the intervention, and compare RC scores 3.Both of the above 4.None of the above

157 Module 6: Using the online relational coordination survey tool

158 In order to access the online relational coordination survey tool, you will need to successfully complete online authorization. However, we have made available on the RCRC site an RC Survey Demo that will help you: Familiarize yourself with the presentation and format of the rc survey tool Think through the three key decisions related to setting up an rc survey Familiarize yourself with the functionality of the rc online survey tool

159 Getting Started with the RC Survey Demo This demo will allow you to experience the rc survey set-up process as an rc survey administrator. Using the demo, you will be able to create a new rc survey or modify an existing survey if one was previously created using the demo. Please note that surveys created using the demo will expire one week from the date of creation. As part of the set-up process, you will be able to: Provide descriptive information about your survey. This information is used to help you distinguish one survey from another. Be mindful that demo users share the same account. Do not include information that would allow others to identify the organization and/or individuals you intend to survey. Identify the focal work process or client population. Identifying the focal work process/client population will help you define and bound the parameters of your relational coordination survey. Identify the survey type. Identifying the survey type will help you think through the unit of analysis and who you would like to collect relational coordination information about as it relates to your purpose for using the survey: Individual Workgroup Both Identify the workgroup and/or individuals involved in your study. Similar to identifying the focal work process or client population, identifying the workgroups and/or individuals in your study will help you bound the parameters of your rc study as well as require you to think realistically about who you will have access to surveying. Customize correspondence for participants in your study. You will be able to modify the participants invitation as well as all follow-up correspondence. You also have the option of adding an demographic section to your survey. The RC Survey Demo will allow you to experience the rc survey set-up process as an rc survey administrator. Using the demo, you will be able to create a new rc survey or modify an existing survey if one was previously created using the demo. Please note that surveys created using the demo will expire one week from the date of creation. As part of the set-up process, you will be able to: Provide descriptive information about your survey. This information is used to help you distinguish one survey from another. Be mindful that demo users share the same account. Do not include information that would allow others to identify the organization and/or individuals you intend to survey. Identify the focal work process or client population. Identifying the focal work process/client population will help you define and bound the parameters of your relational coordination survey.

160 Getting Started with the RC Survey Demo This demo will allow you to experience the rc survey set-up process as an rc survey administrator. Using the demo, you will be able to create a new rc survey or modify an existing survey if one was previously created using the demo. Please note that surveys created using the demo will expire one week from the date of creation. As part of the set-up process, you will be able to: Provide descriptive information about your survey. This information is used to help you distinguish one survey from another. Be mindful that demo users share the same account. Do not include information that would allow others to identify the organization and/or individuals you intend to survey. Identify the focal work process or client population. Identifying the focal work process/client population will help you define and bound the parameters of your relational coordination survey. Identify the survey type. Identifying the survey type will help you think through the unit of analysis and who you would like to collect relational coordination information about as it relates to your purpose for using the survey: Individual Workgroup Both Identify the workgroup and/or individuals involved in your study. Similar to identifying the focal work process or client population, identifying the workgroups and/or individuals in your study will help you bound the parameters of your rc study as well as require you to think realistically about who you will have access to surveying. Customize correspondence for participants in your study. You will be able to modify the participants invitation as well as all follow-up correspondence. You also have the option of adding an demographic section to your survey. Identify the rc survey type. Identifying the rc survey type will help you think through the unit of analysis and who you would like to collect relational coordination information about as it relates to your purpose for using the survey: Individual Workgroup Both Identify the workgroup and/or individuals involved in your study or intervention. Similar to identifying the focal work process or client population, identifying the workgroups and/or individuals to be surveyed will help you bound the parameters of your rc study or intervention as well as require you to think realistically about who you will have access to surveying. Customize correspondence for participants in your study or itnervention. You will be able to modify the participants invitation as well as all follow-up correspondence. You also have the option of adding an demographic section to your survey.

161 Managing RC Survey Set-Up and Data Collection in the demo This demo will allow you to experience the rc survey set-up process as an rc survey administrator. Using the demo, you will be able to create a new rc survey or modify an existing survey if one was previously created using the demo. Please note that surveys created using the demo will expire one week from the date of creation. As part of the set-up process, you will be able to: Provide descriptive information about your survey. This information is used to help you distinguish one survey from another. Be mindful that demo users share the same account. Do not include information that would allow others to identify the organization and/or individuals you intend to survey. Identify the focal work process or client population. Identifying the focal work process/client population will help you define and bound the parameters of your relational coordination survey. Identify the survey type. Identifying the survey type will help you think through the unit of analysis and who you would like to collect relational coordination information about as it relates to your purpose for using the survey: Individual Workgroup Both Identify the workgroup and/or individuals involved in your study. Similar to identifying the focal work process or client population, identifying the workgroups and/or individuals in your study will help you bound the parameters of your rc study as well as require you to think realistically about who you will have access to surveying. Customize correspondence for participants in your study. You will be able to modify the participants invitation as well as all follow-up correspondence. You also have the option of adding an demographic section to your survey. Within the rc survey demo, there are 3 tabs that help you manage the rc survey set- up and data collection process: is where the Relational Coordination Survey Setup Wizard is housed. To create a new rc survey, click on the relational coordination survey set-up wizard to begin the survey set-up process. is where your Active rc surveys are stored once the set-up process is complete and your survey has been created. This tab will allow you to: Check the Status of your open rc survey or upload previously collected rc survey data to the online tool for analysis. Customize or modify Survey Info for your survey. This includes information entered during the set-up process as well as participant invitations and correspondence. Access your rc survey Results report in pdf or html format. Unlike the online survey tool, the rc survey demo does not allow you to Add Participants, edit Admin Info or Delete surveys. is where you will be able to provide feedback on the functionality of the rc survey demo. This message will go directly to the vendor that powers the online survey tool. If you have a content message, please RCRC directly at

162 Accessing the RC Survey Demo This demo will allow you to experience the rc survey set-up process as an rc survey administrator. Using the demo, you will be able to create a new rc survey or modify an existing survey if one was previously created using the demo. Please note that surveys created using the demo will expire one week from the date of creation. As part of the set-up process, you will be able to: Provide descriptive information about your survey. This information is used to help you distinguish one survey from another. Be mindful that demo users share the same account. Do not include information that would allow others to identify the organization and/or individuals you intend to survey. Identify the focal work process or client population. Identifying the focal work process/client population will help you define and bound the parameters of your relational coordination survey. Identify the survey type. Identifying the survey type will help you think through the unit of analysis and who you would like to collect relational coordination information about as it relates to your purpose for using the survey: Individual Workgroup Both Identify the workgroup and/or individuals involved in your study. Similar to identifying the focal work process or client population, identifying the workgroups and/or individuals in your study will help you bound the parameters of your rc study as well as require you to think realistically about who you will have access to surveying. Customize correspondence for participants in your study. You will be able to modify the participants invitation as well as all follow-up correspondence. You also have the option of adding an demographic section to your survey. The RC Survey Demo is accessible from under the tab on the RCRC website under the menu option.

163 While the Relational Coordination Survey (RCS) is now well- established as an observational research tool, its use as an intervention to improve communication and relationship behaviors is still in the early stages of development. It would be easy to underestimate the complexity and risks of this work. Overly simplistic interventions can cause great harm. Reviewing RCS scores can elicit shame, defensiveness, projection, triangulation and scapegoating; it can exacerbate conflict and compromise performance. The lower the level of relational coordination (and thus the greater the need for an intervention) the greater the likelihood of a dysfunctional response to the scores. Agreement regarding use of relational coordination survey

164 As elegant and straightforward as the RCS is as a measure, it is not a magic bullet for improving team performance or organizational culture. It needs to be used as one part of a broader intervention that also includes longitudinal individual and/or team coaching, trustworthy processes for relational learning and accountability, and leadership development to assure consistency in both respect and accountability across levels of the team or organization. Such work requires the involvement of skilled consultants with deep experience in group dynamics, systems work, conflict resolution, and the teaching of emotional self- management. Agreement regarding use of relational coordination survey

165 For all these reasons, we urge you not to tread lightly or naively into the realm of interventions. Be prepared to invest the necessary time and resources and be sure you have access to the skills and experience that the work requires. Agreement regarding use of relational coordination survey I have read and understand the advisory above. I agree to use the Relational Coordination Survey in accord with its recommendations.

166 Introducing the Relational Coordination Research Collaborative

167

168 RCRC Vision Making relational coordination the norm for how human beings work together RCRC Mission Building the knowledge, evidence and tools to enable the transformation of relationships for high performance

169 Building a global learning community for practitioners and researchers U.S. (East Coast, Southeast, Midwest, Southwest, West Coast) Canada Denmark, Norway, Sweden Netherlands, Belgium Spain, Italy Ireland, Scotland, England Australia Japan

170 Resources for RCRC Partners Online RC survey, reports and benchmarking Intervention data base Monthly webinars Annual roundtable, other gatherings Partner webpages to share efforts, visions Referrals to RC consultants Training and certification to become RC consultant

171 Resources for relational coordination and organizational change Visit relationalcoordination.org for many more


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