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A fundamental process improvement such as relational coordination enables organizations to improve both cost and quality outcomes, allowing simultaneous excellence along both dimensions. When relational coordination is improved, organizations can shift out the quality-efficiency frontier, thereby achieving higher performance on both dimensions.

In a time of enormous stress for the healthcare system, with so many unmet or poorly met needs, why should we care about something as ephemeral as relational coordination? It would be nice to have positive working relationships, but perhaps that is a luxury we can't afford until we resolve the more urgent problems of poor quality and wasted resources that plague the system.

To the contrary, we propose that investments in relational coordination—coordination that occurs through high quality communication supported by relationships of shared goals, shared knowledge, and mutual respect—contribute substantially to overcoming these urgent problems. The process of relational coordination discussed in Chapter 2 results in fewer missed signals among colleagues who work in different areas of functional expertise. As a result, there is more consistent communication with the patient and thus fewer chances for errors to occur, driving quality performance in a positive direction. Relational coordination also reduces the time spent carrying out redundant communication, searching for missing information, and waiting to hear from colleagues, allowing healthcare organizations to utilize all their resources more productively and driving efficiency performance in an upward direction. Let's take a look at four very different studies that show how relational coordination matters for surgical performance, medical performance, long-term care performance, and—outside the healthcare context—airline performance.


We measured relational coordination and performance in nine hospitals to find out whether relational coordination makes a difference for surgical performance.20 Data were collected in the orthopedic department of each hospital, focusing specifically on the care of joint replacement surgical patients. Joint replacement is a relatively high-volume, high-revenue surgical procedure that has been one of the early targets for hospital-based process improvement efforts because of its attractiveness from a revenue standpoint and because it is relatively well understood from a clinical standpoint. Clearly, the coordination needs for this surgical procedure are more straightforward than they are for complex medical cases. Still, even for this fairly straightforward surgical procedure, relational coordination among physicians, nurses, physical therapists, social workers, and case managers was a significant and substantial driver of both quality and efficiency performance.

All nine hospitals were nonprofit. They were in three different urban areas—Boston, New York City, and Dallas—and were three different types of hospitals—general, specialty, and specialty institutes within general hospitals. In Boston, they included Massachusetts General Hospital, Brigham and Women's Hospital, Beth Israel Deaconess, and New England Baptist. In New York City, they were the Hospital for Special Surgery, the Hospital for Joint Diseases, and Beth Israel Medical Center. In the Dallas area, they were Baylor University Medical Center and Presbyterian Plano. Managed ...

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