Relational coordination among nurses and other providers: impact on the quality of patient care

Abstract

Enhancing relational coordination between nurses and other providers is central to improving the quality of patient care. IMPLICATIONS FOR NURSE MANAGERS AND NEW KNOWLEDGE: The emerging theory of relational coordination provides a useful new research-based framework for managers to use to improve provider relationships, communication and the quality of care.

Performance management in context: formative cross-functional performance monitoring for improvement and the mediating role of relational coordination in hospitals

“…This corresponds with findings from other studies (e.g. Hartgerink et al 2014;Havens et al 2010) and supports the viewpoint that perceptions of coordination are weaker across contested boundaries that are also associated with power and status differentials (Abbott 1988). The findings also show that perceptions of patient care are significantly lower among direct care…”

“…Patient outcomes linked to higher levels of relational coordination include improved quality of care and reduced length of hospital stay ; reduced postoperative pain (Gittell et al 2000c); frequency of medication errors, hospital acquired infections and patient and family complaints (Havens, Vasey, Gittell, and Lin 2010); and improved quality of life in nursing homes (Gittell et al 2008). Regarding employee outcomes, Gittell et al (2008) argue that relational coordination is a form of social capital, making it easier to access role-related resources, and supporting personal wellbeing.…”

“…We therefore included only two control variables in the analysis -hospital size (number of beds) and respondent type -which have been found to impact the outcome variables in prior research (e.g. Bacon and Mark 2009;Baernholdt and Mark 2009;Havens et al 2010). We created two dummy variables for management respondents (1= general manager/HR, 0 = Other) and care providers (1 = yes, 0 = Other), using respondents with a clinical management role as the referent group.…”

Teamlet Structure and Early Experiences of Medical Home Implementation for Veterans

“…These findings suggest that much closer attention to issues of high turnover, timely replacement of teamlet members, and practice coverage policies is a major challenge warranting much closer attention by VA leadership. While having the full complement of teamlet staff and better defined paired coverage policies may foster increased relational coordination of patient care responsibilities, [12][13][14] other interim approaches are also possible. For example, in Bodenheimer's teamlet model, the two health coaches share the same scope of responsibilities and work together with the PCP to conduct a range of patient care activities, including agenda-setting with the patient, 15 ordering routine services, tracking history, documenting the PCP's findings, recapitulating the PCP's advice, setting goals with the patient, and tracking patient history.…”

“…The teamlets are responsible for all major patient care activities, including phone calls, scheduling, and check-in. Core features for improving patient-centered care in these teamlets under the PACT include: improving PCP-patient continuity by changing appointment booking practices, 12 providing health coaching for Veterans, conducting shared medical appointments (or group visits) for patients with diabetes and other chronic illnesses, 13 increasing planned follow-up telephone encounters, 14 improving panel management, 15 improving appointment access by preventing unscheduled patient visits, 16 and promoting secure messaging with Veterans. 17 The VA also set several performance goals for PACT teamlets, including high PCP-patient visit continuity 6 (77 % of patient encounters should be with their PCP in any given month), same-day urgent access and 7-day routine appointment access (70 % and 92 %, respectively), a minimum of 20 % of primary care encounters by telephone, and contact with at least 75 % of patients within two business days of hospital discharge.…”