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Throughout Part 2, we have explored high performance work practices that strengthen relational coordination among care providers, enabling them to deliver high quality patient care while using resources efficiently. Chapter 16 showed how those practices can be extended beyond an organization's boundaries to include its key supply partners, including even the patient and his or her family. We have seen however that healthcare organizations vary greatly in their implementation of those work practices. One common pattern we observed was the repeated failure to apply these work systems fully to physicians. Whether it was selection for teamwork, cross-functional performance measurement, cross-functional rewards, conflict resolution, patient rounds, or clinical pathways, physicians were often the least likely of any care provider discipline to be included. This failure to include physicians helps to explain why relational coordination between physicians and the rest of the care provider team was systematically weaker than for any other care provider discipline (see Chapter 3) despite the fact that physicians play a central role in delivering patient care.

In the preceding chapters, we estimated the impact of each individual work practice on relational coordination and on the quality and efficiency of patient care. We found that the size of these estimated effects varied from work practice to work practice. On the low end, we found that doubling the intensity of the boundary spanner role was estimated to increase relational coordination by 11 percent; on the high end, doubling the inclusiveness of team meetings was estimated to increase relational coordination by 20 percent. Because the hospitals in our study have adopted these work practices in combinations or clusters, however, our statistical estimates cannot assess the impact of each individual practice as accurately as we would like. It is more accurate to measure their impact together, as a high performance work system.

When we combine all the individual practices into a high performance work system, how does that system affect relational coordination? Exhibit 17-1 suggests that doubling the strength of this high performance work system produces a 44 percent increase in relational coordination among nurses, physicians, residents, therapists, case managers, and social workers. When relational coordination is plotted for each of the nine hospitals against the strength of their high performance work systems, as shown in Exhibit 17-2, the plot suggests a strong positive impact of the high performance work system on relational coordination among care providers.

Exhibit 17-1Impact of a High Performance Work System on Relational Coordination

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