Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay: a nine-hospital study of surgical patients.
BACKGROUND
Health care organizations face pressures from patients to improve the quality of care and clinical outcomes, as well as pressures from managed care to do so more efficiently. Coordination, the management of task interdependencies, is one way that health care organizations have attempted to meet these conflicting demands.


OBJECTIVE
The objectives of this study were to introduce the concept of relational coordination and to determine its impact on the quality of care, postoperative pain and functioning, and the length of stay for patients undergoing an elective surgical procedure. Relational coordination comprises frequent, timely, accurate communication, as well as problem-solving, shared goals, shared knowledge, and mutual respect among health care providers.


METHODS
Relational coordination was measured by a cross-sectional questionnaire of health care providers. Quality of care was measured by a cross-sectional postoperative questionnaire of total hip and knee arthroplasty patients. On the same questionnaire, postoperative pain and functioning were measured by the WOMAC osteoarthritis instrument. Length of stay was measured from individual patient hospital records.


METHODS
The subjects for this study were 338 care providers and 878 patients who completed questionnaires from 9 hospitals in Boston, MA, New York, NY, and Dallas, TX, between July and December 1997.


METHODS
Quality of care, postoperative pain and functioning, and length of acute hospital stay.


RESULTS
Relational coordination varied significantly between sites, ranging from 3.86 to 4.22 (P <0.001). Quality of care was significantly improved by relational coordination (P <0.001) and each of its dimensions. Postoperative pain was significantly reduced by relational coordination (P = 0.041), whereas postoperative functioning was significantly improved by several dimensions of relational coordination, including the frequency of communication (P = 0.044), the strength of shared goals (P = 0.035), and the degree of mutual respect (P = 0.030) among care providers. Length of stay was significantly shortened (53.77%, P <0.001) by relational coordination and each of its dimensions.


CONCLUSIONS
Relational coordination across health care providers is associated with improved quality of care, reduced postoperative pain, and decreased lengths of hospital stay for patients undergoing total joint arthroplasty. These findings support the design of formal practices to strengthen communication and relationships among key caregivers on surgical units.
Gittell
J H
JH
Harvard Business School, Boston, Massachusetts 02163, USA. jgittell@hbs.edu
Fairfield
K M
KM
Bierbaum
B
B
Head
W
W
Jackson
R
R
Kelly
M
M
Laskin
R
R
Lipson
S
S
Siliski
J
J
Thornhill
T
T
Zuckerman
J
J
D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D006761:Hospitals / Q000592:standards; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010149:Postoperative Pain; D010348:Patient Care Team; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D014481:United States