High Performance Health Care by Jody Hoffer Gittell

The key message of this book is if you improve relational coordination you improve quality and efficiency. Relational coordination is the coordination of work through relationships of shared goals, shared knowledge and mutual respect.

Jody has done a fantastic job of researching and summarizing 12 attributes in hospitals that increase relational coordination (RC). The book is a summary of studies conducted at 9 diverse hospitals. The book is well documented. She sites many examples for those interested in deeper learning. She explains how the research was conducted and summarizes with wonderful graphs!

While none of this data is surprising, it is great to have it validated. When looking at relationships it seems on the surface to require a lot of extra resources in time, people, and money. Jody’s work validates the extra resources pay back with increases in quality and efficiency.

Select for teamwork,   page 57

Reluctance to select highly skilled professionals for teamwork is not unique to physicians or the healthcare industry. The studies indicate the selection of care providers with an eye to their teamwork helps to foster relational coordination. It appears that the selection of physicians for teamwork represents a promising new frontier.

Measure team performance,  page 67

Being proactive rather than reactive to quality and efficiency issues increases RC. All cross-functions in the process are held accountable to the performance not just one isolated department or person. These positive relationships support frequent, timely, problem solving communication.

Reward team performance,  page 81

Shared rewards strengthen relational coordination when they include all care providers who are working with the same patients and whose work is highly independent. When merit pay is based on individual performance it makes the work environment less congenial.

Resolve Conflict proactively,  page 91

The critical element is that conflict resolution practices are available to resolve conflicts across all functions, including physicians.
Invest in frontline leadership

Supervisory staffing greatly increases RC. From the standpoint of being able to coach and advocate for employees. The fewer staff per supervisor the better the outcomes.

Design jobs for focus,  page 115

Not related to organizational focus (specialty hospitals), the more specialized workers were to a specific patient population the higher the RC. This applies to physicians who are Hospitalists.

Make job boundaries flexible, page 127

Rigid boundaries between healthcare professionals are one of the key inhibitors of care coordination and performance improvement. Increasing flexibility is difficult because it threatens people’s sense of security and status.

Create boundary spanners,  page 137
Organizations that invest in smaller caseloads and broader coordination roles for their case managers benefit from higher levels of RC across all disciplines.

Connect through pathways, page 149

The more inclusive cross-functional pathways are of the care providers who are engaged in the care of the same patients, the more they strengthen RC. Cross-functional pathways help providers to conceptualize how their tasks are distinct yet interdependent, helping to build share goals and shared knowledge.

Broaden participation in patient rounds, page 161

The cost to convene people on a frequent basis outweighs the value gained if the meetings provide a convenient forum for high quality communication those whose tasks are most highly interdependent. The meetings do not have to be long.

Develop shared information systems,  page 171

The key is to develop information systems that are accessible to a broad array of care providers including both administrative and clinical information. This has not been widely achieved by healthcare organizations.

Partner with suppliers, page 185

Creating the same relationship coordination externally as internally follows the same strategies as discussed.