Illuminating power dynamics that influenced a relational coordination program in a tertiary hospital: An institutional ethnography study.

Abstract

Background: Amidst the difficulty and contentiousness of improving hospitals, a relatively new approach is the Relational Model of Organizational Change (RMOC). However, this approach has its own challenges, including reports that its focus on communication and relationships is undervalued despite evidence supporting its use to facilitate practice improvements in hospitals. Research suggests power dynamics in hospitals influences how the RMOC is used, but the precise mechanisms through which this occurs have not been fully examined.

Purpose: The purpose of this study was to examine how power dynamics shaped the implementation of a program using the RMOC in a hospital: the QPH RC Program.

Methodology: Institutional ethnography was applied to explicate textually mediated ruling relations (power dynamics) and examine how they exerted their influence on the QPH RC Program. This involved interviewing people and analyzing texts embedded in work processes that organized the implementation of the program.

Results: The QPH RC Program was embedded in a cluster of ruling relations comprising an economic rationalist and scientific discourse and project management methodology. These ruling relations exerted their power via textually mediated social processes that influenced the focus and management of the program.

Conclusion: The ruling relations functioned to align the QPH RC Program with the priorities of the hospital, suggesting that financial objectives were prioritized over objectives to improve communication or culture.

Practice implications: Future research and practice change should include investigating and addressing the intersection of institutional contexts and the application of the RMOC to facilitate practice improvements in health care organizations, particularly hospitals.