Learning to Coordinate: A Relational Model of Organizational Change

Learning to Coordinate:
A Relational Model of Organizational Change
Jody Hoffer Gittell, Brandeis University
Amy Edmondson, Harvard Business School
Edgar Schein, MIT Sloan School of Management
2011 Academy of Management
San Antonio, TX
Learning to coordinate
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Coordination is a key organizational
competence that drives performance
But how do organizations learn to coordinate?
If coordination is relational, people need to
learn new patterns of interrelating
How does this happen in an intentional way?
What is the sequencing or interplay between
changing relationships, and changing the
structures that reinforce them?
In this paper we will…
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Explore relational models of
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Coordination
Learning and change
Propose a relational model of learning to
coordinate
Describe three cases of learning to coordinate
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Canadian obstetrics units
Texas primary care clinics
Maine health and human services
Relationships shape the communication
through which coordination occurs
Frequent
communication
Shared goals
Shared knowledge
Mutual respect
Timely
communication
Accurate
communication
Problem-solving
communication
This process is called
“A mutually reinforcing process of
communicating and relating for the
purpose of task integration” (Gittell 2011)
How do organizations learn
new ways to coordinate?
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Because relational coordination is a mutually
reinforcing process, it is difficult to change
Relational dynamics tend to become deeply
embedded in the form of assumptions and
self-concepts
What do we know about organizational
learning and change that might be helpful?
Organizational learning (Edmondson 2002)
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Organizational learning is interpersonal and
relational, and often involves learning to
coordinate work in a new way
Psychological safety – the perception that it is
safe to express disagreement and be fallible –
is a necessary condition for this kind of
interpersonal, relational learning to occur
Psychological safety enables participants to
identify and question current assumptions
Changing structures is not enough
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Change cannot occur only through changing
formal structures – new structures will not be
embraced or sustained unless the
assumptions that underlie them are identified
and questioned (Fletcher, Bailyn, Blake-Beard
2009)
Need ‘discursive’ or ‘relational’ space for
identifying and questioning the current
organizational assumptions (Fletcher, Bailyn,
Blake-Beard 2009; Kellogg 2009)
How to start the learning process (Schein 2010)
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Individuals or groups can participate in a
‘cultural island’ that enables examination of
past practices, cultural norms and constraints
to learning
Goal is to identify and commit to shared goals
based on a new compact with the
organization and with each other
This can improve relational coordination
Off-site agenda: Learning and unlearning
(Schein 2010)
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Step 1:
Step 2:
Step 3:
Step 4:
Step 5:
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Self-assessment of present state
Identification of learning barriers
Identification of cultural constraints and aides
Commitment process to shared goals and compact
Identification of desired new behaviors
Timely and relevant communication
Role-mapping and identification of interdependence
Role negotiation to build relationship
Mutual sharing of knowledge
Mutual agreement on how to measure progress
Step 6: Ensure that rewards and incentive systems and
other organizational structures are consistent with the new
ways of working
Learning to coordinate:
A relational model of organizational change
Relational coordination
Organizational
structures
Shared goals
Shared knowledge
Mutual respect
Performance
Frequent communication
Timely communication
Accurate communication
Problem-solving comm
Relational intervention
Cultural island
Psychological safety
Relationship mapping
Role modeling
Case studies of learning to coordinate
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Case 1: Canadian obstetrics
Case 2: Texas primary care
Case 3: Maine health and human services
Canadian obstetrics
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Canadian obstetrician and obstetrics nurse
discovered through their own work experience
that relational approaches between providers
and with patients seemed to result in fewer
errors, better quality outcomes, less waste, fewer
liability claims
With support from a Canadian insurance
association, they formed a consulting practice to
teach their methods to obstetrics units
throughout the country
Canadian obstetrics (continued)
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Intervention works with frontline providers to
improve work processes and relational dynamics,
then seeks leadership support for new structures
to support the new relational dynamics
“We didn’t know what to call what we were
doing, but after reading organizational theory in
the late 1990s, I realized we were doing relational
coordination” (Ken Milne, CEO, Salus Global
Consulting)
Canadian obstetrics (continued)
Have worked with over 100 Canadian hospitals
and about 30 U.S. hospitals, often achieving
reductions in liability claims, and increases in
satisfaction and other quality outcomes
 Now rolling out the model to other hospital
units (surgery, ER, ICU), that have been
requesting the same type of intervention
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Texas primary care
Research team from UT Health Science Center
in San Antonio enrolled 40 rural primary care
clinics in an effort to improve chronic care for
their patients
 Intervention team led by a
physician/researcher helped clinics to measure
their outcomes, their structures for chronic
care delivery, as well as relational coordination
and reciprocal learning
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Texas primary care (continued)
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Through coaching visits every 2-3 weeks over a one
year period, the intervention team facilitated
meetings, process improvement efforts and relational
improvements among clinical and non-clinical
members
“We shared the data with them and let them decide
what they wanted to do about it. We gave advice, like
meeting with each other, doing regular huddles to
coordinate care – but we were there to help them do
what they wanted to do” (Raquel Romero, MD,
Intervention Team Leader)
Texas primary care (continued)
Base-line cross-sectional data suggests
that relational coordination and reciprocal
learning among members predict greater
adoption of chronic care structures
 Still analyzing longitudinal data to assess
changes over time
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Maine Dept. of HHS
Leaders in Maine’s Office of Lean
Management have been implementing
lean principles in government for 6 years
 They respond to requests for training and
for assistance with process changes
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Maine Dept. of HHS (continued)
“It is a blame/shame environment. During the
training we started to see the goal alignment,
the shared knowledge and the respect they
were developing for each other. We saw it but
didn’t know what it was” (Walter Lowell,
Director, Office of Lean Management)
 “We realized that when the lean training
works, it’s because they are changing their
relationships in really important ways” (ibid)
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Maine Dept. of HHS (continued)
“We designed a coaching intervention to
foster relational coordination, and we call it
the soft side of lean” (Kelly Grenier,
Consultant, Office of Lean Management)
 “But people can get really discouraged when
they go back to work – some say it was great
training but within a couple of months they
are back in their old boxes. Nothing has
changed to support their new ways of working
together” (ibid)
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Learning from cases
In cases 1 and 2, relational interventions were
followed by changes in organizational structures
 Our model predicts these structures will reinforce and
sustain the new relational patterns
In case 3, relational interventions were not
followed by changes in organizational structures
 Our model predicts failure to sustain new relational
patterns
In all three cases, relational interventions occurred
along with process improvement interventions
 We revised our model to reflect this combined
intervention
Learning to coordinate:
A relational model of organizational change
Relational coordination
Organizational
structures
Shared goals
Shared knowledge
Mutual respect
Performance
Frequent communication
Timely communication
Accurate communication
Problem-solving comm
Relational intervention
Cultural island
Psychological safety
Relationship mapping
Role modeling
Process improvement
intervention
Data gathering/analysis
Process mapping
Structured problem solving