A relational coordination training intervention to improve job satisfaction and intent to stay in the intensive care unit: A pilot study.

BACKGROUND: Relational coordination (RC) explores the coordination of work between and among professionals in a workgroup. RC is associated with higher job satisfaction and retention; however, researchers have not tested RC training interventions to improve job satisfaction and retention. PURPOSE: To explore changes in job satisfaction and intent to stay among health care professionals following a virtual RC training intervention. METHODS: We conducted a pilot, parallel group randomized controlled trial in four intensive care units. Data collection occurred via survey. Difference-in-difference regression models were used to analyze the job satisfaction and intent to stay outcomes. DISCUSSION: The RC training intervention did not influence job satisfaction or intent to stay. Participants with baccalaureate degrees and African American/Black participants reported lower intent to stay. CONCLUSION: The results from this pilot study are a critical first step in testing the efficacy of an RC training intervention to improve staff outcomes in a larger powered study.

Relationships and resilience at work and at home: Impact of relational coordination on clinician work-life balance and well-being in times of crisis.

BACKGROUND: The COVID-19 pandemic has been an unusually comprehensive crisis that has taken a toll on people in their roles both at work and at home, giving rise to a new normal. PURPOSE: Relational coordination theory shows how communicating and relating for the purpose of task integration drives positive outcomes for workers, their clients, and their employers. The ecological theory of work-family spillover shows how relational dynamics from work spillover into family life, and vice versa. We build upon these two theories to understand how relationships at work impact work-life balance and worker well-being, especially in times of crisis. METHODOLOGY: This study was based on surveys of clinicians affiliated with a large California health system during the COVID-19 pandemic. Mediation and multilevel logistic regression models were used to assess how relational coordination among colleagues impacts well-being (job satisfaction and lack of burnout) through its effects on work-life balance (schedule control and personal time). RESULTS: A 1-point increase in relational coordination tripled clinician odds of having schedule control ( OR = 3.33, p < .001) and nearly doubled the odds of having adequate personal time ( OR = 1.83, p < .001). A 1-point increase in relational coordination nearly quadrupled odds of being satisfied with their job ( OR = 3.92, p < .001) and decreased odds of burnout by 64% ( OR = 0.36, p < .001). The impact of relational coordination on worker well-being was mediated by greater schedule control and personal time. CONCLUSION: Relational coordination among colleagues impacts worker well-being by enabling greater control over one's schedule and more personal time, thus creating a positive spillover from work to home in times of crisis. PRACTICE IMPLICATIONS: In times of crisis, leaders should prioritize relational coordination among colleagues in order to support their resilience both at work and at home.

Strengthening networks for healthcare integration: A commentary.

In their paper "Integrating Network Theory into the Study of Integrated Healthcare," Burns, Nembhard and Shortell set out to change how we think about healthcare, and ultimately how we design and deliver healthcare. They aim to do this by focusing attention on the networks through which care is delivered, with particular attention to the relational dimensions of those networks. Inspired by social network, care integration, and relational coordination theories, Burns et al. (2022) offer recommendations for moving the healthcare sector toward a fresh approach to care integration that reflects the realities of relationships and networks. In this commentary, we analyze the main recommendations by Burns et al. and present our view of the field's current standing with regards to each of them. We then suggest potential research questions, contexts and designs to move this proposed work forward, drawing upon insights from a conversation with the authors in addition to their original article. We end by recommending the formation of a research collaborative to carry out the work.

Strengthening Community Participation by People With Disabilities in Community-Based Group Homes Through Innovative Action Research.

In the US and beyond, a paradigm shift is underway toward community-based care, motivated by changes in policies, payment models and social norms. A significant aspect of this shift for disability activists and policy makers is ensuring participation in community life for individuals with disabilities living in residential homes. Despite a U.S. government ruling that encourages community participation and provides federal and state funding to realize it, little progress has been made. This study builds on and integrates the expanded model of value creation with relational coordination theory by investigating how the resources and relationships between care providers, adults with disabilities, family members, and community members can be leveraged to create value for residents through meaningful community participation. The purpose of our community case study was to assess and improve the quality of relationships between stakeholder groups, including direct care staff and managers, residents, family members, and the community through an action research intervention. This study took place in a residential group home in a Northeastern US community serving adults with disabilities from acquired brain injury. A pre-test post-test design was used and quantitative assessments of relational coordination were collected through electronic surveys, administered at baseline, and post-intervention. Direct care staff, supervisors, the house manager, and nursing staff completed the survey. Qualitative data were collected through focus groups, change team meetings, and key informant interviews. Direct care staff formed a change team to reflect on their baseline relational coordination data and identified the weak ties between direct care staff, family members, and the community as an area of concern. Staff chose to hold a community-wide open house to provide an opportunity to foster greater understanding among staff, residents, family, and community members. The change team and other staff members coordinated with local schools, business owners, town officials, churches, and neighbors. The event was attended by 50 people, about two-thirds from the community. Following the intervention, there was an increase in staff relational coordination with the community. While statistical significance could not be assessed, the change in staff RC with the community was considered qualitatively significant in that real connections were made with members of the community both directly and afterwards. Despite a small sample size, a residential setting where management was favorable to initiating staff-led interventions, and no comparison or control group, our small pilot study provides tentative evidence that engaging direct care staff in efforts to improve relational coordination with community members may succeed in building relationships that are essential to realizing the goal of greater participation in community life.

Adaptations to relational facilitation for two national care coordination programs during COVID-19.

Background: Adaptations to implementation strategies are often necessary to support adoption and scale-up of evidence-based practices. Tracking adaptations to implementation strategies is critical for understanding any impacts on outcomes. However, these adaptations are infrequently collected. In this article we present a case study of how we used a new method during COVID-19 to systematically track and report adaptations to relational facilitation, a novel implementation strategy grounded in relational coordination theory. Relational facilitation aims to assess and improve communication and relationships in teams and is being implemented to support adoption of two Quadruple Aim Quality Enhancement Research Initiative (QA QUERI) initiatives: Care Coordination and Integrated Case Management (CC&ICM) and the Transitions Nurse Program for Home Health Care (TNP-HHC) in the Veterans Health Administration (VA). Methods: During 2021-2022, relational facilitation training, activities and support were designed as in-person and/or virtual sessions. These included a site group coaching session to create a social network map of care coordination roles and assessment of baseline relationships and communication between roles. Following this we administered the Relational Coordination Survey to assess the relational coordination strength within and between roles. COVID-19 caused challenges implementing relational facilitation, warranting adaptations. We tracked relational facilitation adaptations using a logic model, REDCap tracking tool based on the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) with expanded Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) dimensions, and member checking. Adaptations were analyzed descriptively and for themes using matrix content analysis. Results: COVID-19's impact within the VA caused barriers for implementing relational facilitation, warranting eight unique adaptations to the implementation strategy. Most adaptations pertained to changing the format of relational facilitation activities (n = 6; 75%), were based on external factors (n = 8; 100%), were planned (n = 8; 100%) and initiated by the QA QUERI implementation team (n = 8; 100%). Most adaptations impacted adoption (n = 6; 75%) and some impacted implementation (n = 2; 25%) of the CC&ICM and TNP-HHC interventions. Discussion: Systematically tracking and discussing adaptations to relational facilitation during the COVID-19 pandemic enhanced engagement and adoption of two VA care coordination interventions. The impact of these rapid, early course adaptations will be followed in subsequent years of CC&ICM and TNP-HHC implementation.

Sustaining improvements in relational coordination following team training and practice change: A longitudinal analysis.

BACKGROUND: Poor communication is a leading cause of errors in health care. Structured interprofessional bedside rounds are a promising model to improve communication. PURPOSE: The aim of the study was to test if an intervention to improve communication and coordination in an inpatient heart failure care unit would result in lasting change. METHODOLOGY/APPROACH: The relational coordination (RC) survey was administered to seven workgroups (i.e., nurses, physicians) at baseline (2015) and three subsequent years following the intervention (team training, leadership development workshops, and structured interprofessional bedside round implementation). Descriptive analysis and mixed-effects models were used to assess the impact of the intervention on improving RC. RESULTS: During the study period (2015-2018), 344 participants completed the survey for an overall response rate of 53.5% (n = 643). Postintervention, the RC index significantly increased from 3.79 to 4.08 (p < .001) and remained significantly higher over 2 years, with an RC index of 4.12 and 4.04, respectively (p < .001). The range of RC scores between and within workgroups narrowed over time, with nonrotating workgroups showing the most improvements. CONCLUSION: Findings indicate that positive changes as a result of the intervention have been sustained, despite high rates of turnover among all workgroups. Notably, positive change in RC was found to be more pronounced for nonrotating workgroups compared to team members who rotate within the hospital (i.e., pharmacists who rotate to other units every month). PRACTICE IMPLICATIONS: This intervention holds promise for teams seeking best practice models of "high-reliability" care organization and delivery. Sustained changes from this intervention represent an important area of future practice-based research.