By Rachel Fleming, Clinical Programme Manager CLIC
CLIC have been using a tool to understand inter-team dynamic better for the last 2 years. We have tested it out with some willing teams, and have found it to be useful in understanding where issues arise and in helping to address the issues. CLIC have been funded by the Health Foundation for this work as we are the first area in the NHS in England to use this framework.
The framework is called Relational Coordination (RC). Not a very catchy title I know, but it does describe what it is, which is a framework to help teams become better coordinated in their work through thinking and addressing the relationship side of the workplace. RC is used widely around the world in healthcare, education, airline business and in manufacturing. There is a growing evidence-base supporting this approach to care. A recent King’s Fund publication reporting on the first wave Integrated Care Systems opened with the quote:
“Transforming systems is ultimately about transforming relationships among people who shape those systems. Many otherwise well intentioned change efforts fail because their leaders are unable or unwilling to embrace this simple truth”
(Senge et al 2015)
So what is it?
Relational Coordination is a framework which is all about communicating and relating for the purpose of integrating our work. The framework identifies 7 evidence-based elements that make work processes and pathways more coordinated from a relational perspective. These elements are:
These elements are found to matter most where work processes are complex and interdependent, uncertain and time constrained - I am sure this sounds very familiar. The way we work between teams is of significant importance to pathways of care where we are working with multi-professional groups, sometimes in different organisations. If we think about the average referral for a diagnostic test, for example: there is a GP or hospital doctor as referrer, the administration team who receive and process the referral, the technicians who implement the test, the specialist doctors who interpret the findings, and the service user themselves who turn up when they are asked to and experience all the links in the process. All these groups need to work in a coordinated way together to ensure the service user gets what they need. The correct and right amount of information needs to be given at each stage so the next person can perform their task effectively, otherwise delays occur while information is bounced back and forth. Each group of professionals needs to be trusted to do their bit, or work arounds are created and duplication of effort takes place 'just to make sure'.
We may feel we have good relationships within our teams, but how much do you really know about the work of the other teams your service users come into contact with? Do you know enough to make sure you can communicate with them in a timely way so as not to hold them up or put pressure onto their work area?
The impact on performance where teams work in a highly relationally coordinated fashion has been seen in a number of areas including staff and service user experience, quality and effectiveness of care delivered and efficiency and productivity of care delivered.
We have tested this framework out using the survey tool that sits alongside it, and the information it generates is really useful to enable teams to have a different conversation about how to improve their work. It moves them away from only focusing on technical and process/pathway fixes into thinking about behavioural and adaptive approaches too. The combination of both leads to improved outcomes and better inter team working.
We are also using RC within team development to make staff aware of the elements and help them to identify where improvement around specific elements can take place.
We think this is a really useful framework to use with teams and have found it to be very intuitive to understand and grasp. We were recently asked to feedback to the Relational Coordination Roundtable Conference about the work we have done and our findings:
We would like to help more teams understand and use this framework to improve our work processes and outcomes.
If you would like CLIC to help you to understand your team better and those you work with please get in touch via: www.theclic.org.uk/contact-us
You might also be interested in attending one of our 'Understanding Teams Better' Bitesize Sessions - find out more and book your place via: www.theclic.org.uk/training-and-events/training-and-events