Institute on Healthcare Systems

Relating Across Differences

An Improvement Process for Clinical Units

Despite the benefits of increasing workforce diversity, if left unmanaged it can weaken the relationships that are needed for care delivery due to biases, misunderstandings and subgroup formations. The improvement process offered here helps clinical units to create a work and learning environment characterized by relationships of shared goals, shared knowledge and mutual respect, supported by high quality communication across professional, gender, racial, ethnic and other differences.  As a result, clinical units will be able to more readily leverage the rich information offered by diversity to achieve better outcomes for all participants. 

Six clinical units in three health systems will participate in the Relating Across Differences intervention over a three-year period, with one health system on-boarded in the Spring of each year.  We expect that interprofessional workers on participating clinical units will experience higher levels of awareness of and comfort with professional and social identity differences following the intervention compared to before.  As a result, these workers will also experience higher levels of relational coordination and psychological safety across professional and social identity differences, greater job satisfaction, work engagement, reduced burnout and increased intent to stay.  We also expect that participating clinical units will be more successful in achieving their patient care goals than they were prior to participation.

RAD is a training curriculum that

  • Combines diversity/equity/inclusion and interprofessional practice to improve team functioning and performance outcomes
  • Develops relationships across social differences (e.g., race, gender, class) and professional differences (e.g., nurse, doctor, medical assistant, pharmacists)
  • Works with QI teams using a coach-the-coach model to help them build relationships across differences as part of their quality improvement work
  • Uses relational coordination as a validated model of interdependence
  • Will be developed and tested with University of Washington Medical Center, Massachusetts General Hospital, and Cleveland Clinic/Case Western Reserve University – and the RAD Consortium for Curriculum Development
  • Is housed at Brandeis University and supported by funding from the Josiah Macy Foundation