Research

• Empirical Findings - Outcomes of Relational Coordination

• Empirical Findings - Predictors of Relational Coordination

• Publications - Articles

• Publications - Books

• RC and Transformation of Primary Care

• RC and Leadership

• RC and Worker Outcomes

• RC, Complexity and Social Construction

• RC and System Redesign

• RC and Organizational Change

• RC and Customer Coproduction

• RC, Networks, Collaboration and Social Capital

• RC and Information Technology

• RC in Banking and Auditing

• RC and the Development of New Metrics

• RC and the Soft Side of Lean

Empirical Findings - Outcomes of Relational Coordination

Evidence regarding the outcomes of relational coordination is growing. Empirical findings thus far suggest that relational coordination predicts a wide range of quality, efficiency, financial and competitive outcomes that are of strategic importance to organizations. Relational coordination also predicts patient and family engagement, and outcomes for workers. Some evidence suggests that the impact of relational coordination on performance outcomes is greater under conditions of uncertainty - useful to know in these times of upheaval and transformation.  In addition, a wide array of predictors have been identified that support the development of relational coordination within and across organizations.  

Empirical findings regarding the outcomes of relational coordination are summarized below.  Please contact us at info@relationalcoordination.org to report additional findings regarding the outcomes of relational coordination.

Quality Outcomes  

• In a 4 airline study of 335 airline employees over 12 months of operation, relational coordination between pilots, flight attendants, gate agents, operations agents, mechanics, baggage handlers, cabin cleaners, caterers etc. predicted a higher rate of on-time arrivals, fewer customer complaints, and fewer baggage mishandling errors (Gittell, J.H., 2001, “Supervisory Span, Relational Coordination and Flight Departure Performance: A Reassessment of Post-Bureaucracy Theory,” Organization Science, 12(4): 467-482).  
• In a 9 hospital study of 313 care providers and 588 surgical patients that relational coordination between surgeons, nurses, physical therapists and social workers predicted increased patient quality of care (p<0.001), reduced postoperative pain (p<0.041) and increased postoperative functional status (p=0.044) (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). 
• In the same 9 hospital study of 313 care providers and 588 surgical patients, the positive effect of relational coordination on patient quality of care was greater when uncertainty was higher, in the form of greater variability of comorbid conditions in the surgical population being served (.09, p<0.05) (Gittell, J.H., 2002, “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).
• In a study of 3 hospitals and 16 ambulatory care clinics, including 1,177 patients with asthma, diabetes or heart failure and 302 providers and staff, relational coordination was associated with better quality outcomes for heart failure patients (p<.01) and asthma patients (p<.01) (Hagigi, F., 2013, "Team Coordination as a Driver of Cost and Quality Performance in Chronic Disease Management," AcademyHealth Research Meeting).
• In a 15 site study of 231 nursing aides and 93 long-term care residents, relational coordination between nursing aides, nurses, housekeeping and dietary staff predicted improved quality of life for long-term care residents (.37, p<0.008) (Gittell, J.H., Weinberg, D.B., Pfefferle, S., Bishop, C., 2008, “Impact of Relational Coordination on Job Satisfaction and Quality Outcomes: A Study of Nursing Homes,” Human Resource Management Journal, 18(2): 154-170).
• Relational coordination between healthcare providers and family members positively predicted patients’ risk-adjusted functional status (.20, p=0.035), freedom from pain (.17, p=0.032), and mental health (.21, p=0.006), 12 weeks after surgery (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).
• In a study of 39 community based primary care practices in Texas, relational coordination among members of the primary care team, and team member use of the elecronic medical record, both predicted higher scores on the Assessment of Chronic Illness Care (Noel, P., Lanham, H., Palmer, R., Leykhum, L. & Parchman, M., 2012, "The Importance of Relational Coordination and Reciprocal Learning for Chronic Illness Care in Primary Care Teams," Health Care Management Review).
• In a study of registered nurse and patients from 268 nursing units at 141 hospitals, work group cohesion and relational coordination predicted higher levels of patient satisfaction (p<0.01) (Bae, S.H., Mark, B., Fried, B., 2010, "Impact of Nursing Unit Turnover on Patient Outcomes in Hospitals," Journal of Nursing Scholarship, 42(1): 40-49.)
• In a study of 19 chronic care programs in the Netherlands, relational coordination among members of the chronic care team was positively associated with the strength of their community linkages (.210, p < 0.01), their self-management support (.217, p < 0.01), their decision support (.190, p < 0.01), their delivery system design (.278, p < .001), and their clinical information systems (.193, p < .01).  Regression analyses showed that after controlling for all background variables, relational coordination significantly improved chronic care delivery (.212, p < .01) (Cramm, J.M., Nieboer, A.P., 2012, "Relational Coordination Promotes Quality of Chronic Care Delivery in Dutch Disease Management Programs," Health Care Management Review). 
• In a study of 747 registered nurses in surgical, medical, intensive care and emergency units, high levels of relational coordination with colleagues in other departments and disciplines were associated with less frequent family complaints (p<0.01), less frequent medication errors (p<0.01), fewer hospital acquired infections (p<0.01) and fewer patient fall-related injuries (p<0.05) (Havens, D.S., Vasey, J., Gittell, J.H., Lin, W., 2010,  “Relational Coordination Among Nurses and Other Providers: Impact on the Quality of Care,” Journal of Nursing Management, 18: 926-937).
• In a study of health professionals in multiple hospital units, relational coordination was positively related to integrated care delivery for hospitalized patients (p<0.05).  Relational coordination was lower among professionals in the same discipline, and higher between nurses and others than between medical specialists and others. Relational coordination and integrated care delivery were significantly higher in geriatrics than in other units (both P ≤ 0.001) (Hartgerink, J.M., Cramm, J.M., Bakker, J.E.M., van Eijsden, R.A.M., Mackenbach, J.P., Nieboer, A.P. (2012).   ^"The Importance of Relational Coordination for Integrated Care Delivery to Older Patients in the Hospital, Journal of Nursing Management)
• In a qualititative study, the level of relational coordination between the internal audit function and the top management team was positively associated with internal audit effectiveness, including risk management, follow-up and timely implementation of recommendations (Lenz, R., Sarens, G., 2012, "Internal Auditing Effectiveness: Multiple Case Study Research in Germany That Hardens Role Theory and the Relational Theory of Coordination," Working Paper, Université Catholique de Louvain, under development).
• In an experimental design study, greater shared goals and mutual respect between the chief executive officer and the chief audit executive predicted more frequent, timely, accurate, problem-solving communication between the two roles (p<0.001), and also predicted greater internal audit effectiveness (p<0.005), including including risk management, follow-up and timely implementation of recommendations (Hoos, F., D'Arcy, A.C., Sarens, G., 2012, "Relational Coordination and the Communication between the Chief Audit Executive and Senior Management: Experimental Evidence," under development).
• In a study of pharmaceutical product development teams, relational coordination between team members predicted improved quality and on-time performance (Alvarez, H., 2012, "Collaborative Knowledge Creation," Working Paper, Maastricht University, under development).
• In a study of community-based efforts to reduce offender recidivism, higher relational coordination across agencies was associated with increased offender recidivism, unexpectedly, though the outcomes in this study were measured several years prior to the measurement of relational coordination (Bond, B., Gittell, J.H., 2010, “Cross-Agency Coordination of Offender Reentry: Testing Outcomes of Collaboration Policies,” Journal of Criminal Justice, 38: 118-29). 

Patient and Family Engagement Outcomes 

• In a study of hospitals and early intervention agencies, relational coordination between hospitals and agencies was the strongest predictor of the likelihood of families and their at-risk infants being evaluated, enrolled and retained in early intervention programs (Derrington, T., 2012, Drug-Exposed Young Children and Early Intervention: What Influences Early Engagement? PhD Dissertation, Brandeis University, Heller School). 
• In a study of surgical patients, family members, physicians, nurses, therapists, case managers and social workers, relational coordination between healthcare providers and family members positively predicted family member preparation for caregiving (19.2, p<0.001), which in turn predicted patients’ improved functional status (.20, p=0.035), freedom from pain (.17, p=0.032), and mental health (.21, p=0.006) 12 weeks after their surgery (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). 
• In a qualitative study of four early childhood education centers, relational coordination among teaching staff was associated with greater family engagement with teaching staff in their child's education (Douglass, A., Gittell, J.H., 2012, “Transforming Professionalism: Relational Bureaucracy and Parent-Teacher Partnerships in Child Care Settings,” Journal of Early Childhood Research, 10(3): 267-281).
• In a 9 hospital study of 313 care providers and 588 surgical patients, relational coordination between surgeons, nurses, physical therapists and social workers enhanced patients' trust and confidence in the care provider team (.12, p<.01), in turn improving patients' satisfaction with their care (.24, p<0.001) and their intent to recommend (.18, p<0.001) (Gittell, J.H., 2002, “Relationships between Service Providers and their Impact on Customers,” Journal of Service Research, 4(4): 299-311). 

Worker Outcomes