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The influence of leadership facilitation on relational coordination among primary care team members of accountable care organizations

Huber, Thomas P.; Rodriguez, Hector P.; Shortell, Stephen M.

doi: 10.1097/HMR.0000000000000241
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Background Teamwork is a central aspect of integrated care delivery and increasingly critical to primary care practices of accountable care organizations. Although the importance of leadership facilitation in implementing organizational change is well documented, less is known about the extent to which strong leadership facilitation can positively influence relational coordination among primary care team members.

Purpose The aim of this study was to examine the association of leadership facilitation of change and relational coordination among primary care teams of accountable care organization-affiliated practices and explore the role of team participation and solidarity culture as mediators of the relationship between leadership facilitation and relational coordination among team members.

Methodology/Approach Survey responses of primary care clinicians and staff (n = 764) were analyzed. Multilevel linear regression estimated the relationships among leadership facilitation, team participation, group solidarity, and relational coordination controlling for age, time, occupation, gender, team tenure, and team size. Models included practice site random effects to account for the clustering of respondents within practices.

Results Leadership facilitation (β = 0.19, p < .001) and team participation (β = 0.18, p < .001) were positively associated with relational coordination, but solidarity culture was not associated. The association of leadership facilitation and relational coordination was only partially mediated (9%) by team participation.

Conclusions Leadership facilitation of change is positively associated with relational coordination of primary care team members. The relationship is only partially explained by better team participation, indicating that leadership facilitation has a strong direct effect on relational coordination. Greater solidarity was not associated with better relational coordination and may not contribute to better team task coordination.

Practice Implications Leadership facilitation of change may have a positive and direct impact on high relational coordination among primary care team members.

Thomas P. Huber, PhD, MPH, is Assistant Professor, The Ohio State University College of Public Health, Columbus. E-mail:

Hector P. Rodriguez, PhD, MPH, is Professor, University of California Berkeley School of Public Health.

Stephen M. Shortell, PhD, MPH, MBA, is Co-Director, Center for Lean Engagement and Research in Healthcare, University of California Berkeley School of Public Health.

This research was supported by the Patient-Centered Outcomes Research Institute (Grant IHS-1310-06821). This work was also supported in part by Agency for Healthcare Research and Quality's Comparative Health System Performance Initiative under Grant 1U19HS024075, which studies how health care delivery systems promote evidence-based practices and patient-centered outcomes research in delivering care.

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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