Customizing & Administering Your Survey

The Relational Coordination Survey

Prior to administering your relational coordination survey, several decisions will need to be made about the:

  • Focal work process
  • Functional groups involved in the work process
  • Functional groups to be surveyed
  • Demographic characteristics optional add-on (online survey tool only)

Additional decisions to be made involve whether the survey will gather information about workgroups, specific individuals or both. Making these decisions upfront will save time, resources, and energy and allow for a more seamless execution of the study and analysis of the survey results. Customization is conducted on a case-by-case basis. If it is your first time, we recommend working closely with RCRC staff or certified consultants to ensure proper execution. For additional information regarding our customization offerings, please Contact Us. When necessary, we will also work with members to modify the language of the RC survey questions so that they are more familiar for survey respondents, while still preserving the essence of the relational coordination survey questions.

The RC survey has been translated into Danish, Dutch, Norwegian, Portuguese, Malaysian and other languages. Our online survey presently supports English and Danish.

Who to Survey, About Whom and About What

The first step in measuring relational coordination is to identify a work process that serves a client population of interest - the focal work process - then 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 instrument 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.

The next step 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.Exhibit 10

If you are only able to survey a subset of the functional groups involved in the work process, you will end up with an incomplete or asymmetrical matrix of relational coordination ties as shown below in Exhibit 11:Exhibit 11

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.

The bottom line is as follows. 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.

Comparing Between Sites, Intervention/Non-Intervention, or Pre/Post Intervention?

The unit of observation for relational coordination is the individual participant in the work process, represented by the individual survey respondent. These individual respondents are then aggregated into a larger unit of analysis in order to construct a measure of relational coordination. That unit of analysis will depend on the hypothesis you are exploring.

If you are doing a cross-sectional study in which multiple sites that independently carry out the same work process are expected to have different levels of relational coordination, which are expected to result in different level of performance, your unit of analysis will be the site.

If you are studying an intervention that is expected to improve relational coordination of a particular work process, and the performance of that work process, your unit of analysis can again be sites, some of which conducted the intervention and some of which did not. Or your unit of analysis can be different periods of time, before and after an intervention conducted in a particular site.

If you are studying an intervention in multiple sites that independently carry out the same work process, your unit of analysis will be both the site and the period of time (pre and post-intervention).

Focal Work Process, Client Population, or Individual Client?

Instead of asking RC survey questions about a focal work process and/or a focal client population served by that work process, With this alternative approach, one can construct a measure of relational coordination that is specific to individual clients, which is useful in organizations where different practices or interventions are being used for different clients. In this case, questions are asked about specific clients, rather than asking for general perceptions of typical patterns. Questions are asked about the respondents’ specific interactions with other functions regarding a particular client. This introduces a greater potential for retrospective response error. To minimize that response error, it is desirable to survey participants as soon as possible after they have interacted with a particular client. The other challenge arises if the same participants are involved in providing service to multiple clients, thus requiring them to complete numerous surveys for the same study, one about each individual client, rather than a single survey about general patterns of interaction. Numerous surveys sent to a given participant about individual clients may be completed, but response rates are more challenging to achieve given the greater burden on the study participants.

One study that measured relational coordination for individual clients was reported in “Is the Doctor In? A Relational Approach to Job Design and the Coordination of Work.” This was a one-hospital study in which some patients were cared for by physicians with the traditional job design, while other patients were cared for by physicians with the new hospitalist job design. It was hypothesized that the new physician job design would result in higher levels of relational coordination between physicians and other members of the care provider team, thus resulting in better risk-adjusted patient outcomes including shorter lengths of stay, lower total costs, fewer readmissions and lower mortality. Measuring relational coordination for individual patients enabled the assessment of this new job design that had been adopted for some patients and not others.

Demographic Characteristics Optional Add-On (online survey only)

The online survey tool also features an optional add-on that allows members to collect demographic characteristics on each survey respondent. These demographic questions include a standard set of questions on ethnicity, gender, highest level of education, number of years working in focal work process or client population, and tenure in the organization.

While these questions may provide useful information for unpacking differences in relational coordination within and across functional groups, they may also compromise survey respondent anonymity. If the survey group is small, inclusion of the demographic questions may make it possible to identify individual respondents. If you would like to include the demographic questions, it will be important to alert participants that anonymity may not be guaranteed, though confidentiality is.

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