Relational coordination and team-based care: Change initiative overload and other challenges in a learning health system

Introduction

Most change interventions to address quality of care and lower costs focus on technical aspects of the work through process improvements, which have not consistently delivered the anticipated impact for healthcare organizations. This study aims to (1) understand how relational interventions including shared huddles and cross-role shadowing opportunities, impact team dynamics and functioning and (2) describe the challenges and opportunities associated with implementing relational interventions at an Academic Medical Center in a large metropolitan city in the United States.

Methods

This paper is a mixed method, pre–post-intervention study in which data were collected using a validated survey, observations, interviews, and one focus group. Relational coordination survey data were analyzed within and across eight interdependent workgroups on three inpatient medical units at baseline and 16 months post-intervention. Qualitative data were coded and analyzed for themes.

Results

While there were some improvements in overall relational coordination between baseline and post-intervention measures, the findings were not statistically significant. Qualitative data reveal four themes, highlighting the strengths and barriers to the intervention: (1) incomplete fidelity to the relational coordination framework, (2) leadership, (3) meeting structure and participation, and (4) stakeholder engagement.

Conclusions

Within the healthcare context, this study contributes to our learning about implementing and measuring relational interventions. We offer insights for future research and practice on change initiative overload and operational constraints, socializing relational interventions, and balancing core and non-core roles in the intervention strategy.