Interprofessional collaborative practice and relational coordination: improving healthcare through relationships.

Interprofessional collaborative practice (IPCP) and relational coordination (RC) are two concepts with much in common. IPCP is a concept that is familiar to many readers of this journal but the definition is worth repeating in order to consider its connection to RC. As stated in the WHO Framework for Action (WHO, 2010), interprofessional “collaborative practice happens when multiple health workers from different professional backgrounds work together with patients, families, carers and communities to deliver the highest quality of care. It allows health workers to engage any individual whose skills can help achieve local health goals” (p. 7). RC is defined as “a mutually reinforcing process of communicating and relating for the purpose of task integration” (Gittell, 2002, p. 300) or more simply as “coordinating work through relationships of shared goals, shared knowledge and mutual respect” (Gittell, 2006, p. 74). After this concept first emerged from a study of flight departures within the commercial aviation industry (Gittell, 2000, 2003), its applicability to another highly interdependent, uncertain and time-constrained work process – patient care – became apparent (Gittell et al., 2000). RC is measured as a network of communication and relationship ties among workgroups engaged in a common work process (Figure 1) – for example, flight departures, patient care, the transfer of patients from the operating room to the intensive care unit or their discharge across organizational boundaries, for example, from the hospital to the community. It is a validated measure based on seven survey questions, including four survey questions that assess the frequency, timeliness, accuracy, problem-solving nature of communication and three survey questions that assess the quality of the underlying relationships – in particular the degree of shared goals, shared knowledge and mutual respect. The overlap between RC and IPCP is obvious, particularly their common focus on sharing, respect and communication. RC is also a theory about how people and organizations work. According to the theory, and as supported by the evidence, higher levels of RC produce higher levels of quality and efficiency performance by enabling participants to manage their task interdependencies with fewer dropped balls and less wasted effort (e.g. Gittell et al., 2000; Gittell, 2002, 2003). RC also improves job satisfaction by enabling participants to effectively carry out their work, and by providing the social support to enable their resilience in the face of stress (Gittell, 2008; Gittell, Weinberg, Pfefferle & Bishop, 2008). The organizational structures that predict high levels of RC are those that connect across workgroups rather than reinforcing the silos that separate them (Gittell, Seidner & Wimbush, 2010). The theory, therefore, calls for organizations to replace traditional bureaucratic structures with more relational structures – such as hiring and training for cross-functional teamwork, cross-functional conflict resolution, cross-functional performance measurement and rewards, cross-functional boundary spanners (such as case managers or care coordinators), cross-functional protocols (such as clinical pathways) and cross-functional information systems (Gittell & Douglass, 2012). But communication and relationship patterns are deeply embedded in professional identities and organizational cultures, and not easily changed. What are the leverage points for changing these patterns? The Relational Coordination Research Collaborative was formed in 2011 to bring scholars and practitioners around the world together to transform these deeply embedded patterns of interaction. These transformational efforts are captured in the Relational