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Impact of relational coordination on staff and patient outcomes in outpatient surgical clinics

Gittell, Jody Hoffer; Logan, Caroline; Cronenwett, Jack; Foster, Tina C.; Freeman, Richard; Godfrey, Marjorie; Vidal, Dale Collins

doi: 10.1097/HMR.0000000000000192

Background: Pressures are increasing for clinicians to provide high-quality, efficient care, leading to increased concerns about staff burnout.

Purpose: This study asks whether staff well-being can be achieved in ways that are also beneficial for the patient’s experience of care. It explores whether relational coordination can contribute to both staff well-being and patient satisfaction in outpatient surgical clinics where time constraints paired with high needs for information transfer increase both the need for and the challenge of achieving timely and accurate communication.

Methodology/Approach: We studied relational coordination among surgeons, nurses, residents, administrators, technicians, and secretaries in 11 outpatient surgical clinics. Data were combined from a staff and a patient survey to conduct a cross-sectional study. Data were analyzed using ordinary least squares and random effects regression models.

Results: Relational coordination among all workgroups was significantly associated with staff outcomes, including job satisfaction, work engagement, and burnout. Relational coordination was also significantly associated with patients’ satisfaction with staff and their overall visit, though the association between relational coordination and patients’ satisfaction with their providers did not reach statistical significance.

Practice Implications: Even when patient–staff interactions are relatively brief, as in outpatient settings, high levels of relational coordination among interdependent workgroups contribute to positive outcomes for both staff and patients, and low levels tend to have the opposite effect. Clinical leaders can increase the expectation of positive outcomes for both staff and their patients by implementing interventions to strengthen relational coordination.

Jody Hoffer Gittell, PhD, is Professor, Heller School, Brandeis University, Waltham, Massachusetts. E-mail:

Caroline Logan, PhD, is Associate, Division of Health and Environment, Abt Associates, Cambridge, Massachusetts.

Jack Cronenwett, MD, is Professor of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

Tina C. Foster, MD, is Director and Associate Professor, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

Richard Freeman, MD, is Vice Dean for Clinical Affairs, Dell Medical School, The University of Texas at Austin.

Marjorie Godfrey, PhD, MS, BSN, FAAN, is Co-Director, The Dartmouth Institute, Abt Associates, Cambridge, Massachusetts.

Dale Collins Vidal, MD, is Executive Director, Multi-Specialty Clinic, Alice Peck Day Memorial Hospital, Lebanon, New Hampshire.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

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Online date: January 5, 2018

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