2019 RCRC Roundtable

Can we get better at creating positive change intentionally, as individuals, organizations, communities, institutions, and countries, through mindful attention to the consequences of our actions? How can we embrace unintended consequences that add value, and better anticipate those that destroy value? To do so is likely to require approaches - such as human-centered design, systems thinking, collective action, and relational coordination - that are inclusive and mindful of interdependence.

In Transforming Relationships for High Performance (2016), we learned how change agents are leveraging  relational coordination as a methodology for intentional change.  Using the relational model of change, they identify the relevant stakeholders, map out complex coordination challenges, and begin to develop the shared goals, shared knowledge and mutual respect needed to meet these challenges together.  

Roundtable presenters this year will share how this process works within and between organizations in healthcare, education, community safety and private industry, in the face of growing inequality and deepening divisions.  Our keynote speakers Christi Zuber (human-centered designer) and David Sloan Wilson (evolutionary biologist) will show how relational coordination informs the process of human centered design and how it contributes to the collective process of evolution in our larger society.  

This topic could not be more timely given the urgent coordination challenges that we face locally and globally and the need for a relational response that recognizes our growing interdependence. 

At the 2019 RCRC Roundtable, Friday and Saturday, October 11 and 12 in Denver, Colorado, the RC community gathered to learn about tools and a vision to meet these challenges together!  


David Sloan Wilson
SUNY Distinguished Professor Biology and Anthropology, Binghamton University
2019 RCRC Roundtable Keynote Speaker

Christi Zuber
Founder & Managing Director, Aspen Labs
Executive Director, Innovation Learning Network
2019 RCRC Roundtable Keynote Speaker


Roundtable venue address:
  Catalyst HTI - Front office building, follow signs to the Event Center
  3513 Brighton Blvd
  Denver, CO 80216

  Catalyst Event Center - Roundtable space (entrance around corner from the front Catalyst building)
  1881 35th Street
  Denver, Colorado 80216

Join us on Thursday, Oct 10th, for an informal gathering to welcome Roundtable participants.  We will meet in the lobby of The Source Hotel at 8:30pm.

Hotel Information

Transportation Info

Denver International Airport
Destination DEN for airline flights


Denver RTD (Regional Transportation District)
Light rail and commuter rail services

  • 38th & Blake is the nearest station to the venue, Catalyst HTI on the A Line and it is the 1st station eastbound from Union Station (5 min ride) in downtown Denver and the 6th westbound from the Denver airport (30 min ride). 
  • 38th & Blake station is also served by The Ride bus service

eTuk Ride 
Explore Denver in a tuk-tuk!

Denver B-cycle
Bring your helmet! The bike-share service B-cycle bikes have 3 speeds, a basket, lock, bell and pedal powered lights 

Things to do in the Denver area

"Royal Arch" Hike
This 3.5 mile hike starts at the Chautauqua Trailhead and includes a half-mile stretch known as "Boulder's StairMaster." 

16th Street Mall
Pedestrian mall in downtown Denver with shopping, restaurants and attractions

Elevated Dining
Dining (and bar) located on the top floor of the Hyatt, with a magnificent view of the city and mountains

River North
Nicknamed "RiNo" by locals, location of Catalyst HTI 

Lower Downtown Denver
Known by locals as "LoDo," home to Coors Field, restaurants, galleries and shops

Denver Museum of Nature and Science

Confluence Park
Located in LoDo, site of the beginning of the Colorado Gold Rush in 1858

City Parks

Mission Ballroom 
State-of-the-art concert venue in RiNo

Red Rocks
This park and amphitheater features guided tours, hiking, biking, shopping, dining and summer concerts

National Center for Atmospheric Research

The Colorado Chautauqua National Historic Landmark

The Flatirons
Location of one of our welcoming activities!

Pearl Street
Restaurants and shops in nearby Boulder, CO

Golden, CO
Golden is a cool throwback to an old western mining town, with the historic Golden Hotel back patio overlooking the creek and a sidewalk along the creek

National Renewable Energy Laboratory
Located in nearby Golden, CO


Please don't hesitate to share additional suggestions!

Traveling to Denver

With an elevation of 5,280 feet, Denver earns the nickname "mile high city." Weather can vary greatly and change quickly through the day -- and with changes in altitude.  In October, temperatures range from highs in the mid-60s to lows in the mid-30s.

Travel tips:  

  • Drink plenty of water to stay hydrated and to help adjust to the altitute and dry climate  
  • Pack layers -- if participating in the welcoming activity hike, pack hiking boots/shoes
  • Wear sunscreen and sunglasses to protect yourself from the strong alpine sun


Leaders, researchers and change agents who want to engage with colleagues in a multi-sectoral international community and share their ideas and methodologies in a forum to identify opportunities to apply the transformative approach of relational coordination in their own work.


Our venue is Catalyst Health Tech Innovation, an innovative, collaborative space designed to bring together private sector, government, academic and non-profit organizations with providers and payers to deliver impactful change through innovative research driven by design thinking.

Catalyst is located in Denver’s River North District, locally known as "RiNo," a historic area that is home to a growing innovation and technology center. Catalyst is a 5 minute walk to the commuter rail and there is an excellent selection of restaurants nearby. 

PRIMER on Relational Coordination, 
Human-Centered Design, and the Evolutionary Worldview

Interested in learning more about the shared principles of relational coordination, human-centered design and the evolutionary world view?  Read host committee member Skip Grieser's Primer, highlighting the philosophies, components and tools with each framework. 


Welcome Activities

  • Activity 1: Catalyst Hub Crawl - join us for an Innovation Tour with interactive discussions on hot topics in healthcare and technology. 
  • Activity 2: Hike Iconic Boulder, CO Flatirons - 2.5 mile hike at the foot of the Rocky Mountains.  ($30 to cover the cost of transportation).  
  • Activity 3: Meet the Author, with Roundtable keynote speaker David Sloan Wilson at Logan House Coffee cafe in the Catalyst building, 1:30-3:30 pm. 


Heading 1

8:00 am - Breakfast & Registration

Grab your nametag and enjoy breakfast while you connect with colleagues.   

8:20 am - Welcome from Host Committee

Members of our host committee will welcome you to Denver and share what you can expect from our two exciting days together.

  • Rachel Dixon, Prime Health

  • Dylan Ross, Optum/UnitedHealth

  • Janet Steinkamp, Health Systems Development LLC

Dylan Ross and Heather Gilmartin

8:30 am - Welcome from RCRC Executive Director, Jody Hoffer Gittell 

8:45 - Transition, Choose a Breakout Session

9:00 am - Breakout 1

Breakout 1.1 - Leading Relational Change

Facilitator:  Monica Higgins, Harvard Graduate School of Education 

1) Teacher Leadership in Continuous Quality Improvement: How Teachers Make and Lead Change in Urban Early Care and Education Settings

Presented by Anne Douglass, University of Massachusetts, Boston

Early care and education (ECE) programs are uniquely positioned to support children and families exposed to trauma, yet need access to resources and supports that can enhance their capacity to deliver trauma-informed care. This multiple case study investigated how urban ECE programs became more trauma-informed through their participation in a Breakthrough Series Collaborative (BSC) on Trauma Informed Care.

In particular, this study examined how the BSC promoted and elevated teachers as change agents to improve trauma-informed practices in urban child care centers. Adopting new practices involves change, yet studies suggest that most organizational change efforts fail to achieve their desired results. Relational organizational change research reveals that individual teachers are unlikely to adopt and sustain new practices without simultaneous changes in the broader organizational context in which they work. This research also shows that the active engagement and leadership of frontline staff, those who work most closely with children and families, is essential to successful improvement and sustainment over time.

The research team collected multiple sources of data from and about the BSC and the six child care centers that participated in the BSC, including data collected through in-depth interviews, observations (of classroom quality and the BSC interventions), surveys, and document review. These data were analyzed and compared within and across the six cases based on a structured multiple case study design.

Results showed that teachers 1) became empowered to see themselves as leaders and to test changes and innovations to improve practices, 2) spread new practices across their programs, 3) partnered with program administrators and parents to implement change, 4) worked together to better take care of each other and themselves, and 5) adopted new mindsets about trauma and challenging behaviors that supported changes in practice.

This study also examined the mechanisms and processes through which teachers became empowered to lead change. Consistent with emerging theories of relational organizational change, we found that a set of structural, relational, and work process changes that were the result of the BSC intervention facilitated the leadership of teachers in making improvement.

2) Leadership Self-Awareness and Trust as Pre-Requisites to Team Construction

Presented by Valerie Gauthier, HEC Paris

This reserach in progress measures the impact of a methodology based on relational leadership principles (the Savoir-Relier protocol) that enhances self-confidence for individuals and trust within teams. The methodology relies on the capacity to “come down the ladder of inference” by using the primary sense of sight and listening to better capture reality.

With 10 years of practice among 4 000 individuals and 9 companies, the data proves that increasing self-awareness with a rigorous process develops the self-confidence to open up to others and build trust in others. The resulting shared trust sets the ground for enhanced efficiency in teams and creates the conditions for a constructive collaborative environment based on strong relational coordination.

Data and analytics also prove that the same process of self-awareness and trust building lead to greater capacity for entrepreneurship and decision making.

3) Improving Outcomes Using Relational Coordination and Adaptive Leadership

Presented by Julie Cary, Washington State University College of Veterinary Medicine

The evolution of practice and societal expectations facing food producers is considerable; antimicrobial resistance, methane production, and animal welfare are just some of the issues. Veterinarians are meant to be a trusted source of information and advice for farmers and ranchers, but recent evidence demonstrates that they are falling short in this role. Veterinary medical education as historically focused on technical solutions: vaccine schedules and treatment protocols, with little to no recognition of the adaptive challenges presented. The complex nature of this work requires a strong understanding of how people make decisions and work together. Relational Coordination (RD) is a timely and clear paradigm that applies to farming and ranching, but has not been introduced in the training of production animal veterinarian.

Situated learning theory provides guidance in developing instructional processes that support behavior change within a profession. Simulation is one way to introduce concepts and opportunities to test approaches in a safe, yet challenging, environment. We designed a simulation exercise to allow students to explore the idea of RC in production animal medicine. Second-year veterinary students in an elective course on disease investigation were presented data illustrating a high rate of failure of passive transfer; a relatively straightforward medical issue common in bovine practice. During a pre-brief, learners explored their interpretations of the data, formulated questions to explore the problem further with stakeholders, were introduced to RC and encouraged to consider how it might influence their case exploration.

Materials to inform simulated stakeholders (owner, manager, referring veterinarian, and calf worker) from a dairy farm were developed based on actual events. Four individuals from a regional dairy of the same size and structure of the simulated one were recruited to serve as simulated clients and were trained to the case and process. During the simulation, students in groups of four interviewed each of the stakeholders (1 student/stakeholder) with the remaining students watching the interview. Following each interview, a facilitator encouraged the group to reflect on their communication, what they had learned, and what information was missing. They were also considered the impact on subsequent interview questions. Student groups rotated to each stakeholder. A debrief included facilitators, simulated clients, and students focused on the medical finding, stakeholder RC elements, and the impact of those on their consulting process moving forward.

This simulation forces to confront their own biases and assumptions about the stakeholders, their knowledge and motivations, as well as the impact of RC on the disease process. Because this is not a clear and well-defined process, learners work collaboratively during the debrief to make sense of the situation and to consider how best to support the dairy farm moving forward. The active learning process involved with this approach may allow learners to confront the idea of technical versus adaptive challenges and their role in using RC to address the adaptive aspect in a more robust and meaningful way than traditional education.


Breakout 1.2 - Designing and Testing RC Interventions
Facilitator:  Rich Freeman, Dell Medical School  

Abstract 3.2 Presenters

1) Positive Learning from an Innovative Approach to Improve Relational Coordination in an Australian Trauma Care Team

Presented by Darren McLean & Eve Purdy, Gold Coast Health System

Intervening to improve Relational Coordination (RC) in clinical teams is complex and challenging. However, fresh insights into how this can be done effectively have come to light in a recent innovative research project to explore team relationships, and develop performance improvement interventions, in the initial management of trauma care at the Gold Coast Hospital and Health Service (GCHHS), Australia.

We are conducting a mixed-method multi-phase research study that is based on collaborative ethnography research principles and incorporates RC, translational simulation training and ethnographic research methods. In the first phase we measured and analysed the current relationships and communication patterns across the trauma care team using the RC Survey, including a new functionality that provided addition qualitative responses, and ethnographic participant observations and interviews. Findings from this phase were then presented back to the trauma care team to facilitate the co-creation of targeted interventions designed to improve team relationships and outcomes.

The project encompassed a complex network of almost 500 care providers dispersed across seven core interdependent work groups. Early findings exposed how RC manifests in the unique and face-paced environment of trauma care and how translational simulation might serve to foster RC between disparate groups. Reflection on those findings and RC metrics has led to the community development of 16 interventions – a range of structural, process and relational interventions. These are at various phases of implementation – most being led by trauma care providers. The intention is to repeat the RC Survey and assess the impact of the interventions at the end of year one.

Notably, in comparison to the other RC inspired projects conducted at GCHHS over the past four years, this project stands apart in terms of the high level of staff engagement and participation in the co-creation, implementation and up-take of interventions to improve RC. Reflecting on the project to date we have come to believe that following four factors have been key to achieving this: (i) engaging with a leadership team that demonstrated an overt commitment to continual performance improvement and high levels of mutual respect towards each other, (ii) starting with a team that was already high performing which provided a fertile context to leverage from, (iii) making use of new features in the RC Survey to capture additional qualitative data, being the first to use this aspect of the survey tool, (iv) using translation simulation as a creative and novel approach to focus on cultural dimensions of teamwork and reinforce positive practices.

We believe the insights we have gained from this innovative research project can be used by other healthcare leaders and change agents to support and enhance the application of RC to improve team relationships and outcomes in their teams.

2) Improving Surgery Room Climate with Relational Coordination

Presented by David Simpson, Stanford Medicine

In 2017, a task force made up of nurses, physicians, anesthesiologists, and managers convened to make unintended foreign objects (UFRO’s) a non-occurrence in surgery rooms. The group recognized the culture or climate in the rooms was an important influencer, however, improving processes and reward structures seemed easier to tackle.

After implementing several new processes, checklists, and signage, the task force believed the team climate was still an issue. The consulting team recommended an assessment of team climate and two assessments were presented: the team performance indicator for the Grove Consultants and RC. The task force chose the RC survey for two major reasons: the survey groups were not intact teams and RC was an evidence-based practice that had been correlated with TeamStepps interventions.

A survey was completed in the main surgery center groups and five satellite centers. The data was cut several was for the task forces steering committee and the same three issues bubbled up: timely and accurate communication, and respect, primarily in the form of speaking up, or psychological safety.

As a result of the assessment, the group has chosen to introduce three TeamStepps modules combined with simulation training. A post-training and implementation RC survey will be completed within the next nine months.

The focal stakeholder group for the study is the surgery team, which includes the surgeon, anesthesiologist, circulation nurse, scrub nurse, and residents/fellows who assist the surgeon or anesthesiologist. This team is responsible for ensuring that all sponges and instruments that are used during the surgery are removed and counted. The goal of zero UFRO's was identified by the Joint Commission, a professional oversight organization, in 2013, and Stanford Health Care’s Chief Medical Officer in 2017. The Quality group tracks progress towards the goal, as well as tracking compliance to processes, and provides feedback to surgery staff. The risk of an object left in a patient after surgery can result in patient harm, legal action, sanctions, and termination of employment for clinical staff, and can affect a hospital’s reputation and revenue by affecting a hospitals accreditation and rankings in publicly available scorecards.

3) Relational Coordination at the Construction Site:  Planned Intervention and Initial Experience

Presented by Inger-Marie Wiegman and Flemming Pedersen, Team Working Life

Background:The construction industry is characterized by many accidents, high incidence of muscle skeletal problems and a limited focus on the psychosocial work environment. Large construction projects are characterized by interdependent work processes with a high level of unpredictability and a tight timeframe.

Aim: The purpose of the project is to contribute to better cooperation and thus better the work environment and effectiveness of the task solution at construction sites by developing the Relational Coordination (RC) among the different groups of craftsmen and other stakeholders on the construction site.

Focus in the presentation: Will be on the initial findings and challenges from implementation of the interventions in one or two constructions sites, where they at the time of the roundtable 2019 is expected to be well under way. We want to bring the experiences and challenges to discussion with the participants and to bring this discussion and reflections back into the further development of the intervention and project.

Planned intervention: The RC-approach will be applied in an intervention in four steps: Competence development of resource persons in the form of RC coordinators who will learn about the principles and practical use of RC and will be acting as driving agents in the effort and cultural change (teach the teacher). Introducing leaders of every group of craftsmen to the principles of better cooperation through Relational Coordination on a ‘startup-meeting’. Interventions in the day-to-day operation at the construction sites, where the RC coordinator focuses on RC at construction meetings and security meetings and at suitable intervals contacts the individual crafts groups and has a dialogue with them about their current collaborative relationships with others in the site. Intervention in so-called critical processes (DeJoy's Integrated Security Management Theory) involving craftsmen in working with RC in relation to a current task solution where different groups of craftsmen are interdependent on each other's work. Experiences of challenges in the cooperation will be put to words using the dimensions of the RC and agreed on improvements. The efforts will be carried out by the RC coordinator with access to consultancy support.

Methods: The concept of intervention has not yet been fully developed, but we intend to bring elements from three different methods, commonly used by Team Working Life in supporting organizations and workplaces strengthening their relational coordination. The methods are: • The “Dance Card Method” (invented by Team Working Life) where each workgroup analyze their relations to other interdependent workgroups and invite selected groups to have a dialogue on a specific topic concerning their working relationship. • A LEAN-inspired ‘Work Process Analyses”, mapping the different workgroup’s contribution to the work process on a large piece of brown paper on the wall. • “Dialogue Card” where members of different workgroups ask members of other workgroups appreciative enquiring questions from preprinted cards.

[1] This abstract is in continuation of an abstract and presentation by Karen Albertsen at the RCRC Roundtable in 2018 (Relational coordination at the construction site – Design of an Intervention Study at five construction sites), where she outlined the background, design, research questions and assumptions of a research project applied for (and now approved by) the Danish Work Environment Research Fund.

10:00 am - Transition, Choose a Breakout Session

10:15 am - Breakout 2

Breakout 2.1 - Scaling Up Change
Facilitator: Holly Lanham, UT San Antonio Health Science Center 

Presenters 2.1

1) Radical Transparency: How CCOs’ Governance Structure Advances Health Transformation and Relational Coordination

Presented by Erin Fair Taylor & Mindy Stadtlander, CareOregon

Local accountability is a key component of Oregon's Medicaid Coordinated Care Model. Coordinated Care Organizations (CCOs) are charged with transformative improvement in the quality of care delivered, the sustainability of costs, the cultural responsiveness of services, and the support and wellbeing of service providers in their communities. Enabling legislation requires that each CCO has local providers, community stakeholders, and enrollees involved in the governance and performance oversight. To effect broad-based transformation, CCOs must coordinate across systems, ensure clear and efficient communication, spend dollars efficaciously, and use data to drive decisions. CareOregon provides all manner of support – administrative, strategic, clinical, financial – to three CCOs in Oregon. These three CCOs provide services for about a third of Oregonians enrolled in the state’s Medicaid program.

CareOregon has learned that “radical transparency” among and between those governing the CCO, and those providing services under the auspices of the CCO is the most efficient, effective way to: (1) arrive at solutions that are commonly understood; (2) garner buy-in and alignment from all stakeholders; (3) implement interventions that stick; (4) secure meaningful metrics; and (5) mitigate complaints that can undermine the tasks at hand. By “radical transparency,” CareOregon means sharing at all levels of its governing bodies all aspects of budget-making, including revenue and expenses and the sources of each, strategic planning and prioritization, metrics related to performance, payment methodologies and incentive programs, and compliance and risk management activities. In other words, CCOs are fully transparent and share in decision-making about how they are paid, what they pay for and invest in, the criteria for decision-making and prioritization, and how and what to measure and ultimately what those measures are. Such discussions are complex and require each participant to commit to listen, to suspend judgment, to ask questions, and to seek to understand. Ultimately discussions are outcomes-focused: “in our community, in order to achieve [tobacco cessation, kindergarten readiness, stable housing, food security, diabetes management and prevention], collectively, we need to better understand X, and then we need to do Y…” Radical transparency means that each table that is discussing their interventions or solutions knows the data they already have, or that they may ask for all available data to inform their discussion. They also know where their topic falls in the overall prioritization of work in their community and what resources are available to invest.

This approach has also had ripple effects in other parts of the system. Because the CCO readily shares its own data, it begs the question why other parts of the system have not been as transparent and whether they may reconsider that practice in light of their participation in the CCO and the outcomes CCOs have realized. CCOs’ place in health care land them squarely among the conditions that increase the need for Relational Coordination: interdependence among service providers, tremendous uncertainty, and intense time constraint. CareOregon’s radical transparency approach to governance has built a structure that has enabled the CCOs to strengthen relational coordination across systems in their communities.

2) Transforming VHA to a Whole Health System of Care: The Role of Relational Coordination in Implementation

Presented by Rendelle Bolton, VA Center for Healthcare Organization and Implementation Research, Brandeis University, Boston University

BACKGROUND: The US Veterans Health Administration (VHA) is implementing new approaches to care, including Whole Health, to address high priority concerns and better meet patients’ health and social needs. The Whole Health System of Care is a complex multilevel intervention comprising peer-based programming, skill-building classes, integrative medicine, and patient-centered communication. The goal is to transform healthcare to prioritize wellness through the provision of holistic, person-centered practices aligned with what matters most to patients. In 2018, eighteen VHA facilities (one from each of VHA’s geographic regions) began implementing Whole Health across their organizations.

Led by a local core team, implementation is an iterative process that involves planning, designing, setting up services, and educating staff about this new approach to care. To effectively integrate Whole Health into the existing healthcare system and ensure patients’ personal health goals remain the primary driver of care, the core team in each facility must coordinate closely with diverse clinical, administrative, and leadership stakeholders. Ideally, these diverse groups involved in implementation should develop a shared vision of Whole Health for their facility, understand and respect the work that each role is doing to support implementation, and communicate effectively to facilitate local adoption and spread. Given the highly complex and interdependent nature of Whole Health implementation, assessing relational coordination among those responsible for implementation can provide deeper insight into variation in implementation progress and outcomes across the facilities. We hypothesize that strong relational coordination among the key stakeholders involved in implementation will be associated with greater success in implementing the Whole Health System of Care model.

METHODS: As part of a large multi-method evaluation of the Whole Health System of Care, we will use the Relational Coordination Survey in late summer 2019 to examine the association between relational coordination and Whole Health implementation in the eighteen facilities. Stakeholders surveyed will include those most responsible for cultural transformation associated with Whole Health, including the core team, education champions, clinical champions, and leaders from key clinical areas (primary care, mental health, pain care, rehabilitation, wellness services, complementary and integrative health). Participants will be asked about relational coordination with each other and with other key groups in each facility including executive leadership and employee health. We will examine whether relational coordination is associated with implementation progress in each facility using correlation and regression analyses. As part of the larger study, implementation progress is measured quarterly by triangulating data from qualitative interviews, implementation surveys, and national healthcare utilization and employee training databases. We will present preliminary survey results and correlation analyses.

IMPACT: Understanding the role of relational coordination in organizational change is identified as an important new direction for relational coordination research. This novel study tests relational coordination in the context of large-scale organizational transformation to provide insights into how relational coordination facilitates implementation of a complex multilevel intervention designed to transform the VHA into a system of care that prioritizes wellness. Its results will be used to facilitate future interventions to improve coordination and implementation of the Whole Health model.

3) Applying Relational Coordination to Improve Large-Scale Veterans Health Administration Evaluations

Presented by Rachael Kenney and Leah Haverhals, VA Eastern Colorado Health Care System

Context: In the Veterans Health Administration (VHA), evaluation teams are frequently called upon to evaluate VHA initiatives designed to improve access to quality health care. These initiatives are often already underway or ongoing and the evaluations are usually at the bequest of whichever VHA department is funding the initiative. Normally, the evaluations are initiated with the intention to identify barriers and facilitators to the implementation of the initiatives. Evaluators are often given little context of the initiatives before being tasked with evaluating them, requiring extensive time and effort for the evaluation teams to familiarize themselves with the initiatives, let alone the specific sites. Once teams are formed and travel to sites, evaluators request practitioners at sites be generous with their time and share intimate information about processes they may feel are sensitive. After two to three days, evaluators return home, compile and analyze findings, which are shared with the funding VA department and with sites, although months later or sometimes not at all.

The VA Collaborative Evaluation Center (VACE) is a consortium of researchers based at the Denver, Puget Sound, and Cleveland VA Medical Centers (VAMCs). In 2017, VACE was tasked with evaluating the MyVA Access initiative (now Choose VA), a national VA initiative that mandated VAMCs to improve access to care through a variety of efforts. One component of this evaluation was 21 site visits to VAMCs across the country. During the visits, evaluation teams conducted interviews, focus groups, and field observations with numerous VA staff, ranging from administrators to medical support assistants. This process required navigating complexities that characterize internal evaluation efforts (i.e. building rapport, ensuring participants that evaluation efforts are not punitive, and working closely with VA leadership in a variety of roles).

Methodology: This project explores how the Theory of Relational Coordination (RC) can be applied retrospectively to the My VA Access site visit and evaluation process. The goal is to identify points in the course of the evaluation site visits (which spanned seven months) where design could have been strengthened through application of the elements of RC: frequent, timely, accurate, and problem-solving communication; shared goals; shared knowledge; and mutual respect (Gittel 2002). In this process, we will overlay Michael Quinn Patton’s (2017) 12 site visit standards (Documented evaluation competence of site visitors, methodological competence, interpersonal competence, cultural competence, planning and preparation, site participation, do no harm, credible fieldwork, neutrality as an evaluator, debriefing and feedback, site review, and follow-u) with elements of RC.

Expected Findings: Conceptually, the merging of Patton’s site visit standards and the RC’s various factors should prove to be useful tools in identifying successes and challenges from the MyVA Access site visits, with the hopes to use the model developed from this project to inform future evaluation and implementation efforts in the VHA, both large and small scale, that employ site visits. We anticipate creating timelines/process maps illustrating the site visit process utilizing Patton’s site visit standards and the Theory of RC to illustrate successes, pitfalls, and opportunities for improvement.


Breakout 2.2 - Building Cross-Organizational Interventions 
Facilitator:  Sally Retecki, CareOregon 

Presenters 2.2

1) Readiness and Relationships are Crucial for Coalitions and Collaboratives: Concepts and Evaluation Tools

Presented by Lauren Hajjar, Suffolk University

Collaboration has been widely identified as an essential component for the successful implementation of a wide range of policies and programs. A major collaboration challenge, particularly in large community initiatives, is the need for multiple organizations to develop strategic partnerships (Bond & Gebo, 2016) around a shared purpose. Due to the importance of collaboration in achieving desired outcomes, the readiness of organizations to collaborate and quality of relationships between organizations are key, particularly in the formation stage. This is especially true of community coalitions, where collaboration requires comprehensive planning, shared decision-making among stakeholders, a high level of productivity and quality of relationships based on trust and mutual respect. We have two aims for this chapter: 1) we present two evidence-based frameworks – readiness and relational coordination – which together can be used as evaluation tools to build collective community capacity and achieve long-term, sustainable outcomes and 2) we describe how the frameworks are being applied to build a community coalition focused on increasing youth safety and police-community relationships in a high-crime neighborhood in South Carolina.

Finally, we discuss an integrated model of readiness and relationships that can be applied to other communities seeking to enhance public trust and community safety.

2) Designing Successful Digital Ecosystems Using Relational Coordination Principles

Presented by Ina Sebastian, MIT Center for Information Systems Research

Companies across industries are increasingly building or joining digital business ecosystems. They digitally partner in ecosystems to provide customers more value working together with real-time digital connections.

Building ecosystems with digital partners requires a mindset shift from the traditional partnering model, which is about making a few deep, tightly integrated, exclusive partnerships successful, accompanied by personal relationships that build trust over time. Many companies have developed strategic partnerships in value chains for years. These partnerships will continue to exist and be important for traditional and born-digital companies. But there is a limit to scale because strategic partnerships come with high overheads of investment. Digital partnering, like digital marketplaces or app stores that offer products and services by many partners, is more plug-and-play with less overhead and more automation. We will present findings from our ongoing MIT CISR research on ecosystem partnerships, based on the MIT CISR 2017 ecosystem survey (N=158), interviews with 48 executives at 24 companies in 2018 and with 21 executives in 13 companies in 2019. We plan to field a new survey in June.

Our research shows that digital partnering can play an important role for solving pressing challenges in government and healthcare. We are conducting a case study of a digital government, which builds a digital marketplace to offer partner services to government agencies, creates a platform for NGOs and government agencies to connect via API’s, and leads frequent digital innovation initiatives. We are also speaking with health systems that are working to create interoperability for more digital partnering among their provider organizations and opening up patient data to Apple and other specialty apps.

An important question is how we can design these ecosystems using a relational approach for intentional, positive change. Based on the MIT CISR 2017 ecosystem survey and interviews, companies that do well with ecosystems develop two important capabilities, which we call Player Strength and Partnering Strength. Player Strength is a set of capabilities to become a strong player in an ecosystem, which includes developing a company’s distinctiveness, identifying the value proposition in the ecosystem, creating openness via API’s, and building organizational readiness to engage with digital partners. Partnering Strength is a set of capabilities needed to coordinate effectively with digital partners based on relational coordination principles. In our study, companies with higher Player Strength and Partnering Strength had higher firm performance and bigger ecosystem market shares.

At the Relational Coordination Roundtable in October, we will introduce several case studies – including one on digital government – about how organizations have developed Player Strength and Partnering Strength create healthy ecosystems with value for their customers, themselves, and digital partners.

3) RC Measurement and Implementation in Supply Chains: The Case of a Footwear Manufacturing Firm in Ecuador

Presented by Vasilica Maria Margalina, Universidad Tecnica de Ambato

The lack of coordination between the supplying process, the industrialization of models and arrival of materials leads to delays in the footwear production process. Therefore, achieving high levels of coordination is important for the performance of the supply chain in the footwear manufacturing industry. Relational coordination is measured as coordination between roles or functional groups rather then between unique individuals, as generally tasks are assigned to people trough their roles. But, usually, SMEs have no clear definition of roles or functions and employees are involved in more than one process. This characteristic makes it difficult to identify roles or functional groups. Other characteristics that affect the measurement and implementation of RC in SMEs are the lack of formal strategy and defined processes; the tendency to focus on operational planning, neglecting the strategical planning; the lack of financial resources, specialized human resources and physical resources; lack of specialization of the employees, each one of them doing what is presently needed; the decision making is based on day-to-day survival; and the organizational structures tends to be flat, the owner being involved in each stage of operation.

But, the size of the company not only affects the intra-organizational relationships and coordination, but also inter-organizational relationships. The owner’s personality can influence employees’ behavior and firm’s relationships with clients and supplier. Additionally a footwear manufacturing SME establishes business relationships with companies of different size. The size asymmetry between them affects their relationships and cooperation because of differences in bargaining power.

All these characteristics make it essential that interviews be conducted to identify the roles or functional groups that could impact the outcomes of the work process or of the relationships with other firm, before applying the Gittell’s seven-item questionnaire. Another decision that must be made is if relational coordination survey questions will be asked about the focal work process of interest or about the firm population served by that work process. The reduced capacity for change because of the lack of specialized human resources must be taken into account when forming work teams for the implementation of relational coordination mechanisms. Furthermore, the owner’s support and involvement in the work of each team becomes a key for relational coordination implementation success.

11:15 am - Break 

11:30 am - Keynote:  Christi Zuber

Christi Zuber, founder and managing director of Aspen Labs and Executive Director, Innovation Learning Network, is internationally recognized for her trailblazing work in the field of innovation and design thinking. 

Zuber focuses on the collaborative capabilities of change agents who have been successful in bringing Human Centered Design into large complex organizations and the evolution toward integrating innovative design processes into the fabric of the entire organization.

Aspen LabsILNChristi Zuber

Facilitator:  Joel Cutcher-Gershenfeld, Brandeis University 

Joel Cutcher-Gershenfeld is a professor in the Heller School for Social Policy and Management at Brandeis University, where he leads research on agile institutions and teaches classes on strategy and operations. Previously he served as a professor and dean in the School of Labor and Employment Relations at the University of Illinois, United States. Joel serves as editor for the Negotiation Journal at the Program on Negotiation at the Harvard Law School. Joel is an award-winning author who has co-authored or co-edited eleven books, including Designing Reality: How to Survive and Thrive in the Third Digital Revolution (Basic Books, 2017).

Joel Cutcher Gershenfeld

Learn more about Christi and her work

Aspen Labs

Innovation Learning Network

McCreary, L. (2010). Kaiser Permanente's Innovation on the Front LinesHARVARD BUSINESS REVIEW.

Brown, T. (2015). Design ThinkingHARVARD BUSINESS REVIEW.

Lin, M., Hughes, B., Katica, M., Dining-Zuber, C., & Plsek, P. (2011). Service design and change of systems: Human-centered approaches to implementing and spreading service design. INTERNATIONAL JOURNAL OF DESIGN, 5(2), 73-86. >

Excerpt"The cake model implies that talking to staff about “what to do” (the conversation of action) is only valuable after giving appropriate time and effort to helping them relate to the underlying goals of the action and involving them in seeing a variety of possibilities of how to achieve that goal. Specifically, we were encouraged to spend more time talking about the issues driving the need for change, with special emphasis on whether staff could relate to those issues. Likewise, we were also encouraged to be aware of individuals that made up the collective whole."

Zuber, CD., Mood, L. (2018). Creativity and Innovation in Health Care: Tapping Into Organizational Enablers Through Human-Centered DesignNURSING ADMINISTRATION QUARTERLY, 42(1): 62-75.

12:30 pm - Lunch

Connect with colleagues and refuel with a delicious lunch! 

1:15 pm - Welcoming Activities

Our host committee will introduce us to a dynamic mix of the old and the new Colorado through welcoming activities that include an Innovation Tour with HTI integrator organizations and a revitalizing hike in the nearby Boulder foothills of the Rocky Mountains.

[Source: Catalyst HTI]

OPTION 1:  Hub Crawl Innovation Tour of Catalyst HTI
(Host:  Rachel Dixon, Prime Health)

Join us for this exciting opportunity to participate in a Catalyst Hub Crawl! Catalyst innovators will lead interactive discussions on hot topics like open API’s, data interoperability, artificial intelligence, social determinants of health, telemedicine and more!

Learn more about our presenters:  Prime Health,  Integrated WorkIMIDEX CliexaThe Big Calling, Colorado School of Mines, Medra Labs, The Unlearning Institute and Storyvine.   

[Source: Skip Grieser]

OPTION 2:  Hike the Iconic Boulder, CO Flatirons 
(Host: Skip Grieser, Colorado State University, Children's Hospital Colorado)

Visitors from around the world come to Colorado to enjoy Boulder's iconic Flatirons, at the foothills of the Rocky Mountains. Experience the energizing natural beauty and refreshing mountain air as we hike the Enchanted Mesa trail along the scenic Flatirons -- hopefully, with the bonus of fall colors! We'll begin our hike at the National Center for Atmospheric Research (NCAR) and finish in the tranquil beauty of the 26 acre Chautauqua Park, a national historic landmark (see "Things to Do" section for links). The 2.5 mile trail is rugged in many places, with boulders, rocks and roots requiring mindful footwork. There are two moderately steep uphill segments, of about 50 and 100 yards, where short rest pauses are commonly taken; but overall, it's mostly flat or downhill and our journey should take under 2 hours.  After the hike, we may have time to end our adventure in the bar of the Chautauqua Dining Hall, built in 1898. Hats and sunglasses, hiking shoes/boots, or running shoes are highly recommended, and you may want to carry a water bottle on the trail.

Your guide is host committee member Skip Grieser, who lives at Chautauqua and has hiked and run this trail many times. 

OPTION 3:  Meet the Author
Meet Roundtable keynote speaker David Sloan Wilson at Logan House Coffee cafe in the Catalyst building, 1:30-3:30 pm.  Hub Crawl participants will have an opportunity to stop by the cafe.

5:00 pm - Break

5:30 pm - Reception 

Join us at Great Divide Brewing Barrel Bar (located next door to Catalyst) to connect with RCRC friends and colleagues and enjoy featured local craft beers from Great Divide and light bites from Wander & Graze.


[Source: Great Divide Brewing Co.]


[Source:  Wander & Graze]


 Day 2

8:00 am - Breakfast

Reconnect and prepare for a new day of learning and sharing. 

8:20 am - Welcome from Host Committee

Members of our host committee will reflect on day one and prepare you for day two.

  • Heather Gilmartin, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care

  • Skip Grieser, Colorado State University, Children's Hospital Colorado

Rachel and Skip

8:30 am - Transition, Choose a Breakout Session

8:45 am - Breakout 3

Breakout 3.1 - Building a Relational Society
Facilitator:  Shyamal Sharma, Brandeis University 

Presenters 1.1

1) From a Neoliberal Agenda to a Relational Society: Introducing Relational Coordination in the Garment Industry

Presented by Gabriela Corbera, Global Social Innovation, LLC

In developing countries, the Washington Consensus and neoliberal reform has dictated the shape of economic development fabricating particular types of social relations in the workplace. In the ready-made garment industry, due to the collapse of the Rana Plaza, the Fashion industry is experiencing changes for the ready-made garment industry. With structural changes, social compliance, new international labour standards, and relational coordination, the ready-made garment industry can experience outcomes for a relational societal workplace. Through the principles of mutual respect, frequent and timely communication, and shared goals, garment workers, factory managers, and all of its relevant stakeholders can integrate goals better aligned to uplift workers and enhance their well-being.

Through the seven stages of Relational Coordination, this developing practice in Dhaka, Bangladesh, we will share the developing initiative from the Relational Coordination Research Collaborative (RCRC) on the process, intended outcomes, and existing related practices in relational coordination in Bangladesh. Work from the Business for Social Responsibility (BSR) and Labor Link (CISCO) will be shared with the community. Conclusions will be made from the disciplines of International Business and Supply Chain Management. 

2) A Relational Society: Mary Parker Follett’s Vision of Integrative Democracy

Presented by Graham Wright, Brandeis University

Political theorists have long advocated the idea that democratic legitimacy is grounded on the public deliberation of citizens, an idea known as deliberative democracy. Critics, however, have argued that using deliberation as the basis of democratic legitimacy has the potential to reinforce pre-existing structural inequalities, may lead to “groupthink,” and is unfeasible in practice. In her book, The New State, Mary Parker Follett outlines a conception of democracy based on the process of integration, instead of deliberation, which I argue has the potential solve many of these challenges. Because it rejects domination through persuasion integration is more accommodating of marginalized perspectives than deliberation. Because it demands the co-creation of new solutions from diverse perspectives, integration is likewise less vulnerable to the dangers of groupthink or expert domination. Because it never requires participants to “admit defeat” and submit to the domination of their opponents, integration may be a more feasible method of conflict resolution for citizens who would never willingly engage in classical deliberation.

Finally, in the American system of government, which was explicitly designed to make unconditional political victories difficult or impossible to achieve under most circumstances, integration may be the only feasible method of resolving many of the most contentious political conflicts in contemporary society. However, despite these theoretical benefits, the practical efficacy of integration in regard to political conflicts has yet to be conclusively determined, due to a paucity of empirical research. Although past work on deliberative “minipublics” provides some insights into the effectiveness of deliberation in practice, this research has not been adapted to study integration rather than deliberation.

Research has also studied the effectiveness of “integrative bargaining” in a labor negotiations context, but the applicability of these results to political debates or negotiations has yet to be determined. In this piece I will lay out the theoretical benefits of integration as a method of resolving political conflicts, and discuss Follett’s strategies for achieving it. I then lay out a program of research, building on earlier studies of minipublics and integrative bargaining, as well as participatory action research on dialogue between church groups, that could help evaluate the efficacy and feasibility of integration in different contexts.

3) Relational Public Welfare: Organizing and Leading for Holistic Outcomes

Presented by Jacob Storch, Joint Action Analytics

We are seeing a relational turn in how we talk and practice public welfare in the Nordic countries. The traditional asymmetry between citizens and the public sector is being replaced by a more dialogic and solution focused partnership. This workshop will present how this work is being developed both in the relationship between public professionals in meeting citizens in new ways (co-production and co-creation), and in how organizations must build the necessary capacity to work holistically, across silos and professions in order to achieve outcomes that meet citizen needs inspired by RC. The action research applied draws on a combination of RC analysis, RCT and qualitative studies.

The findings show that the proposed correlation between citizen experienced quality and outcomes and RC among professionals is confirmed. Though, it also shows, that there is a great variety from case to case in relation to whether a citizen gets a coordinated experience or not. Our research has explored why we find these great variations and has led us to develop RC to match the challenges of working with cases characterized by; inability of punctuate time of task beginning and completion, teams of professionals are different from case to case, competing tasks across units often regulated by legislation, lack of knowledge of who the other professionals are and what task they perform.


Breakout 3.2 - Designing the Future of Relationship Science
Facilitator:  Angela Aristidou, Warwick University  

Presentations 1.2

1) Ambivalence in Ambidexterity: A Systems Psychodynamic Lens on Organizational Paradox

Presented by Renee Rinehart, Harvard University

This paper uses a systems psychodynamic lens to examine the relational and emotional dynamics that emerge within subunits focused on opposing poles of an organizational paradox. The research site was a public prison that had recently adopted an ambidextrous structure to implement a restorative justice program in one unit while maintaining the traditional punishment-oriented focus in the other units, thus addressing both poles of the punishment-rehabilitation paradox. Drawing on 25 interviews and 56 hours of observation of work activities, staff meetings, and training sessions, I find that the primary tasks of each subunit become embedded within the sets of relationships among inmates, officers, and managers in a form of reverse “symmetry” (Mehta & Fine, 2019). In the traditional units, the primary task of punishment led to emotional distancing between officers and inmates as well as the officers’ relationships with one another and with their managers. In the restorative unit, the primary task of providing restorative services for inmates created a secondary task: healing of officers and managers.

The reciprocal interrelating (Hoffer Gittell & Douglass, 2012) among inmates, officers, and managers, coupled with the reverse-symmetrical focus on healing, allowed the restorative unit to function as a temporary holding environment where staff could surface and manage deeper organizational anxieties. The restorative unit could only achieve their primary task of healing inmates after they addressed the secondary task of healing staff. In contrast, the traditional units had no mechanism for such a release, and thus deeper organizational anxieties continued to interfere with their ability to carry out basic functions of their primary task. At the organizational level, the link between each units’ primary and secondary tasks highlights ambivalence about not only the punishment-rehabilitation paradox, but also the organization’s desire to both confront and defend against deeper anxieties, pain, and trauma.

2) Human Sustainability, Relational Coordination, and Worker Outcomes: A Conceptual Framework

Presented by Elli Meleti, University of Glasgow

The study examines how designing for human sustainability enhances relational coordination, and how the two of them together influence worker outcomes, such as work engagement, proactive work behaviour, and job satisfaction. The contribution to knowledge is to integrate the theory of relational coordination with the theory of human sustainability in order to explain the personal transformation of employees in organizations, which according to the theory of relational coordination is fundamental for organizational and societal transformation. The definition of human sustainability is based on Kantian principles and the aim of the research is to create a conceptual framework of “The Human Sustainability Cycle” which shows the associations between the three constructs of human sustainability, relational coordination and worker outcomes as follows: if there is design for human sustainability, the associations are more likely to be positive (higher human sustainability, higher relational coordination and higher worker outcomes) and if there is no design for human sustainability, they are more likely to be negative (lower human sustainability, lower relational coordination, lower worker outcomes).

The research question is: “How does design for human sustainability influence relational coordination, and how do these dynamics together influence worker outcomes (work engagement, proactive work behaviour, job satisfaction)?” The research is cross-sectional in the higher education sector, and studies the associations, not causal relationships, between the constructs of human sustainability, relational coordination, and worker outcomes. The context is a large, world-known university in the United Kingdom. The study includes four schools in four different colleges, and it is undertaken in a strictly confidential manner (i.e., not revealing names of university and participants). The focus of the study is on programme administrators, and the work they do to support the students, because research on relational coordination has demonstrated that frontline employees are crucial for the effectiveness of the organization. The unit of analysis is the program administrators, nested within their relationships with each other professional role, nested within a particular unit/school in the university. It is therefore a multi-level analysis.

The methodology is qualitative research. The study includes 45, semi-structured, 60-90 minutes, face-to-face interviews with administrative and academic staff. The method of analysis is thematic analysis, which is currently at its second phase. Preliminary findings include a money-driven, high administrative bureaucracy, “top-down” decision making, extreme workload and more specialized tasks for frontline employees. The focus of the research is on employees, but, once developed this theoretical and practical framework, it could be expanded to include more stakeholders, as they are all people (i.e., clients, managers, members of the broader community).

This study is significant because: 1) it focuses on human sustainability, which needs further research (Pfeffer, 2010; Pfeffer 2018); 2) it focuses on relationships, which are an alternative narrative to describe successful businesses and organizations that create value for customers, suppliers, employees, communities, and financiers (Freeman & Moutchnic, 2013); 3) it focuses on improving and facilitating not only intra-organizational relationships, but also inter-organizational relationships, as well as relationships between the organizations and the community, aiming at personal, relational, organizational and societal transformation.

3) Designing the Future of Relationship Science

Presented by John Paul Stephens, Case Western Reserve University and Daniel Massie, Norwegian Business School

Following from the presentations by Renee and Elli, we will hold a panel discussion on the boundary conditions that surround the applicability of a role-based perspective to various kinds of organizational work. The panel of scholars and practitioners will provide reflections on the prior presentations, as well as on their own research and work experiences, focusing particularly on how they tie into the distinction between “role” and “personal” relationships. We propose that different types of coordinative or work relationships are appropriate for different work situations. Role-based forms of interrelating at work – such as relational coordination (Gittell 2002) – are beneficial under conditions of uncertainty, time pressure and interdependence.

Role-based coordination allows actors to develop rapid understandings about who the others are and how they work, thus increasing predictability, accountability and common understanding (Okhuysen and Bechky 2009). On the other hand, more "personal" aspects of interrelating at work, such as trust and commitment may be required to customize responses for specific individuals, and not just their roles. This may be necessary under some conditions, for instance in teams, innovation and the transfer of tacit knowledge. This panel discussion will involve all attendees in reflecting on when and where role-based and personalized forms of work relationships may be of consequence or even in conflict. Relational coordination is one form of role-based coordination, but implicitly draws on more personalized forms of coordination when the goal is to customize responses to meet the needs of particular others.

While focusing on the role-based elements may be effective when discussing and developing relationships at work, the improved personalized relationships that follow from working with relational coordination in practice is arguably a source of improved coordination and performance. In our discussion, we invite panelists and attendees to consider theoretical and practical means of addressing these distinctions and reflect in direction of a contingency theory elaborating the dynamics of different forms of coordination.


Breakout 3.3 - Partnering with Clients through Relational Coproduction
Faciltator:  Laura Cooley, Academy of Communication in Healthcare

1) Collaboration in the Nurse-Family Partnership: Measuring Relational Coordination and its Effects on Program Outcomes

Presented by Venice Ng Williams, Colorado School of Public Health

Context: Nurse-Family Partnership (NFP) is an evidence-based nurse home-visitation program that improves the health and well-being of first-time low-income mothers and their babies. In the original NFP trials, nurses and community service providers worked together to ensure the child’s safety and to support parents. However, in community replication, there is variation in the extent to which nurses coordinate care with providers. This study aimed to assess 1) the degree of collaboration between NFP nurses and service providers and 2) the effect of collaboration on program outcomes.

Methodology: We constructed a web-based survey to quantify collaboration across all NFP sites in the United States. The survey was informed by findings from a qualitative study on NFP collaboration and included the Relational Coordination Survey and adapted items from the Interagency Collaboration Activities Scale to measure shared resources. Other survey domains included collaboration attitudes, beliefs, contact persons and champions. The survey was pretested with NFP experts (n=3) and piloted with NFP nurses (n=7). The final 30-item survey was implemented over six weeks and 263 NFP nurses from 199 sites completed the survey (response rate of 71%). Descriptive statistics were conducted, along with relational coordination scores for nine provider types, average relational coordination dimension scores, shared resources scores for each provider, and average shared resources dimension scores. One-way ANOVA was conducted to determine collaboration variation by agency type. Survey collaboration measures were then merged with NFP implementation data of clients enrolled from January 2014 to April 2019. Due to clustered data, logit random intercept models were fitted with nurse-level random effects, controlling for client-, nurse- and agency-level covariates to assess the relationship between collaboration and program outcomes (client retention, smoking cessation and childhood injury).

Findings: Survey results suggest that collaboration varies by provider type and community. Relational coordination scores ranged from 1 to 5; highest with Women, Infants & Children - WIC (mean=3.77), early intervention (mean=3.44), and obstetrics (mean=3.39); and lowest with housing (mean=2.55) and substance use treatment providers (mean=2.74). The strongest rated relational coordination dimensions were shared goals (mean=3.55) and mutual respect (mean=3.54), while frequency of communication (mean=2.87) and timely communication (mean=3.06) could be improved. In terms of shared resources where higher scores indicated greater sharing of resources across multiple dimensions, nurses reported scores ranging from 1 to 30. The greatest sharing of resources was with WIC (mean=12.95), mental health providers (mean=11.81), and obstetrics (mean=11.00), and least with housing (mean=7.26) and substance use treatment providers (mean=8.23). The strongest rated shared resources dimension was joint activities (mean=2.31) while shared funding (mean=1.31) was the lowest. Agency type affected the degree of collaboration, where public health sites had greater relational coordination with WIC than hospital sites; and hospital sites had greater coordination with obstetrics than public health sites. Preliminary results suggest that stronger relational coordination with providers is associated with higher rates of client retention at various time points in the program, as well as some measures of childhood injury and unintentional ingestion. This study’s findings identified the degree to which NFP nurses collaborate with providers and the effect of collaboration on outcomes. Integration of this information into NFP nursing practice will maximize nurse productivity to serve vulnerable families.

2) Leveraging Social Care with MyChart

Presented by Benjamin Kragen, Brandeis University

Background: The social care team, including family and friends, can provide high quality and low-cost support to patients with type 1 and type 2 diabetes. MyChart with Family Sharing is an eHealth software application bundle which functions as a web based portal that the patient, family, and friends can use to access and share information with the clinical team. This software aims to facilitate structured involvement of the patient and their social care team in the care plan. Relational coordination (RC) breaks down processes of communication and relating into seven components. RC as a measurement tool enables specific understanding of the aspects of communication between the patient, providers, and the social care team that are affected by the implementation of MyChart with Family Sharing.

Purpose: This study has two goals. First, to understand how the processes of communication and relating, as measured with RC, are affected by the implementation of MyChart with Family Sharing. The second goal of this study is to collect information about user experience to inform a broader design of eHealth platforms.

Methods: This mixed methods pre/post study will take place at a community health center in Boston, Massachusetts. The study populations will consist of 1) patients with diabetes who request to make their health care information available to family or friends using the MyChart software application, 2) the family and friends of the patients, and 3) the providers involved in the management of diabetes of the patients. The seven item RC Survey will be used to measure RC before and after an intervention consisting of six months of use of MyChart with Family Sharing. Additional information will be collected before and after the intervention using semi-structured interviews developed to identify issues that are most relevant to respondents.

Hypotheses: The intervention of MyChart with Family Sharing will increase frequency, accuracy, and timeliness of communication between stakeholders, including the patient, the provider, and the social care team. Additionally, the intervention will increase shared knowledge between stakeholders.

3) Co-productive Equity in the Delivery of Services: Children of Immigrants with Special Needs

Presented by Cady Landa, Institute for Community Inclusion

Schools have inherited bureaucratic structures designed to provide siloed services to groups of students. Their structures to support collaboration among staff and between staff and parents in providing integrated services to individual students tend to be relatively weak. The absence of immigrant integration policy creates additional disadvantage for children of immigrants who struggle in school, because as newcomers, their parents do not have the systems knowledge and often don’t have the English language proficiency to effectively co-produce on behalf of their child at school and make sure the school is meeting their child’s needs and honoring their educational rights.

This is a mixed methods study that explores the ability of public elementary schools to meet special needs of children of immigrants with low income. A quantitative study uses state administrative data and multivariate logistic regression analysis and finds that children of immigrants are less likely than children of U.S.-born parents to receive special education. It also finds that children of immigrants who do receive special education are more likely than children of U.S.-born parents to be placed in substantially separate settings. A companion case study of a public elementary school within the same state explores how school organizational structure and public policies may be contributing to this disparity.

The case study draws on (1) in-depth interviews with the parents of, and school staff serving, 11 children of immigrants whose academic or social experience at school is the object of parental concern, and (2) policy and procedural documents. Interview questions and analyses are informed by ecological systems, relational coordination, and relational bureaucracy theories. While the quantitative analysis generalizes to the population, the case study generalizes to theory its findings about the factors that shape the school’s response to children of immigrants who have difficulty in school.

The case study finds that the ability of the school to address the needs of the students in a timely way was compromised and inadequate. Weak co-productive structure to support parents' participation in their children's education emerged as a critical causal factor. The findings demonstrate that, in the case of immigrant parents, co-productive structures, to be effective in allowing immigrant parents to participate, have to include mechanisms that account for the special needs these newcomer parents may have for language interpretation and translation services, the building of systems knowledge, and support with understanding what is seen as acceptable behavior.

The findings of this study can be generalized to other human service contexts in which the quality of co-production affects service quality and outcomes. Implications of the findings can be used to develop strategies to prevent a widening of disparities through service delivery and to promote equity of service quality and outcomes.

9:45 am - Transition, Choose a Breakout Session

10:00 am - Breakout 4

Breakout 4.1 - Designing and Testing RC Interventions
Facilitator:  Nancy Whitelaw, Nevans Consulting

1) Sustaining Improvements in Relational Coordination Following Team Training and Practice Change: A Longitudinal Analysis

Presented by: Erin Blakeney, University of Washington, Hebatallah Naim Ali, Brandeis University

Context: Poor communication is a leading cause of errors and harm in health care. Structured interprofessional bedside rounds (SIBR) are a promising approach to improving communication. In this study, we collaboratively adapted and implemented interprofessional team training and SIBR in an inpatient advanced heart failure setting. Team training and SIBR implementation occurred between baseline and a first follow-up year and were associated with significant improvements in Relational Coordination (RC). This abstract presents the results of two additional years of follow-up surveys and represents the longest known study of RC.

Methodology: The RC survey was distributed at baseline in 2015 and annually three subsequent years (2016, 2017, 2017) following SIBR implementation. This study collected RC data from seven workgroups; four groups held fixed positions [Registered Nurses at Unit 1 & Unit 2, Social Workers, and Advanced Practice Providers (APPs)], while members of the other three workgroups rotate periodically to different units or specialties [Cardiology Fellows, Attending Physicians, Pharmacists]. Response rates, among invited workgroups per year, were measured and used to generate proportional weights to adjust for unequal workgroup responsiveness. Descriptive analysis and mixed effects models were used to assess the impact of SIBR on improving RC and its seven dimensions, as well as the sustainability of change over time.

Findings: During the study period, a total of 344 participants successfully finished the RC survey for an overall response rate of 53.5% (total invited n=643). Post Intervention, using a mixed effects model, the RC Index significantly increased from 3.79 to 4.08 (P<0.001) and remained significantly higher compared to baseline over the 2 follow-up years with an RC index of 4.12 and 4.04, respectively (P<0.001). Additionally, at the first follow-up, scores of four domains (frequency, timeliness, shared goals, and mutual respect) were significantly higher compared to baseline and remained significantly higher during the follow-up years. The domain of shared knowledge was not statistically significantly improved in year 2 (Post-intervention) but was in years 3 and 4. In two domains (accuracy, problem-solving) RC improvements from baseline were statistically significantly different during years 2 and 3 but not in year 4. We also found the range of RC scores between and within workgroups to narrow over time (to become more aligned with each other from baseline to year 4) and that RC among fixed (non-rotating) groups (APP’s and RN’s) to show the most improvements over time.

Study findings indicate that changes as a result of SIBR have been sustained over time. Improvements in care team communication and relationships generated by team training and SIBR implementation have, to large extent, been self-reinforcing as improvements have been sustained without continued training. Findings also indicate that select RC domains may be more amenable to improvement and reinforcement with one-time team-training and/or SIBR implementation while others may need to be targeted in other ways (i.e. booster sessions, onboarding).

2) Transforming Collaboration in Health Professionals Education and Training

Presented by: Birgitte Tørring, University College Northern Denmark, act2learn

Background: An increased specialization in the health professions, demands for continuity, and higher quality of patient care have highlighted the needs for a stronger interprofessional collaboration and practice in the health care system of today. Based on the assumption that a strong interprofessional collaboration in clinical practice is formed by health professionals’ education and training, the health professional education in Denmark has been revised in 2016. The concept of interprofessional collaboration is now incorporated into professional programs to a greater extent now than before. In the implementation process of the education reforms, post graduate courses for experienced clinical nurse supervisors have been completed including themes as interprofessional collaboration, relational coordination, and the concept of professional identity.

Purpose: The goals of these courses were to pay attention to the interprofessional learning spaces in the clinical practice, to raise awareness of the clinical nurse supervisors’ important role in forming the professional identity of the nursing students, and thereby support an improvement of the nursing students’ skills for building relationships, communication and collaboration.
Teaching methods: A post graduate course with a duration of four days was designed, including one day dedicated to themes as interprofessional collaboration, relational coordination, and the concept of professional identity. The theory of relational coordination was presented, and the participants were invited to analyse their current state of the interprofessional collaboration using relational mapping and develop proposal for improving the interprofessional collaboration regarding education and training in clinical practice. Results: In total 330 experienced clinical nurse supervisors have participated in the 14 post graduate courses completed in the period from April 2017 to January 2019. When evaluating the course, the participants stated that relational mapping based on the theory of relational coordination had been an eye-opener in understanding the challenges of collaboration regarding education and training in clinical practice and facilitated the drafting of proposals for improvement.

Implications: The relational mapping analyses provided by the participants at the courses have identified collaboration challenges and highlighted a need for improvement of cross-sectional collaboration between the nursing school and the hospital units. A cross-sectional improvement project using relational coordination theory and methods is therefore now in the pipeline focusing on strengthening the cross-sectional collaboration between teachers at the nursing school, clinical nurse supervisors at the hospital units, and nursing students.


3) Care Coordination and Relational Coordination: Building Relationships and Communication Mechanisms to Support Veterans

Presented by: Heather Gilmartin, Denver/Seattle Center of Innovation, Rocky Mountain Regional VA Medical Center

Objectives: Care coordination programs are designed to organize patient care and share information among all participants concerned with a patient’s care to overcome the silos of healthcare organizations. The goal is an ideal transition between healthcare settings to achieve a safe, patient-centered and quality care experience for Veterans. An ideal transition in care can occur if evidence-based work practices are consistently applied. These include frequent, timely, accurate and problem-solving communication between healthcare professionals, patients and caregivers and creating relational mechanisms so providers can connect with each other to share knowledge and coordinate their work (e.g. relational coordination [RC]). Previous research has shown that RC positively predicts high-performing teams along with quality and efficiency outcomes. We hypothesized that high-levels of RC would be found in established care coordination teams that consistently adhered to a four-step intensive care coordination practice: (1) identify, assess, and educate Veterans; (2) coordinate follow-up appointments and warm hand-off to next provider; (3) facilitate health information exchange; (4) conduct follow-up call with Veteran. We examined these relationships between healthcare professionals in the VA rural Transitions Nurse Program (TNP).

Methods: To measure months of program enrollment, number of enrollees, and adherence to the care coordination practice, process measures from study databases were accessed. To assess RC, TNP teams completed the RC Survey. We used a cross-sectional study design, descriptive and correlational statistics.

Results: TNP (n=12) programs were enrolling, on average, 262 Veterans (range 62-534) per month, for 14 months (range: 5-20). Intervention adherence (mean=96%; range 84-99) and RC scores (mean=4.19; 1 to 5 Likert scale) were high. Significant relationships were noted between months of enrollments (rs=0.66), number of enrollees (rs=0.63) and higher RC scores (p < 0.05). No relationship was noted between RC scores and intervention adherence.

Conclusions: This study identified high-levels of RC in established TNP care coordination teams. The absence of association between RC and the care coordination practice is attributable to the >96% adherence rates. These findings provide support for RC as a framework to guide care coordination activities.

Impact Statements: Care coordination interventions that build relationships and communication mechanisms are a viable path to high performance. This may positively impact Veteran care.


Breakout 4.2 - Creating Cross-Organizational Interventions
Facilitator: Janet Steinkamp, Health Systems Development

1) Coaching Cultural Changes in Cystic Fibrosis Lung Transplant Processes with Relational Coordination

Presented by Marjorie Godfrey & Tina Foster, The Dartmouth Institute Microsystem Academy

Ten Lung Transplant Programs across the USA partnered with ten Cystic Fibrosis Adult referring programs to partner to explore current CF lung transplant and transition processes and systems with the aim of identifying variation and improving interprogram communication and relationships. Central to the improvement efforts was relational coordination. The pre/post RC scores following multiple structural, work and communication interventions are significantly significant and offer ideas for other transfer/transition programs. 2) Following the 18 month learning and leadership collaborative of ten lung transplant and CF Adult referring programs exploring and improving process and clinical outcomes, the post RC scores show significant improvement from baseline assessments between the two programs. Dissemination of the identified interventions and best practices to more CF referring programs was desired and accomplished through a regional dissemination program with impressive RC pre/post results and improved communication and process outcomes in large regions.

2) Intermediating: Relational Coordination and Teacher Residencies

Presented by Liam Honigsberg, Brandeis University

Background: Many outside organizations work alongside the K-12 education system to provide support services for district or school personnel. These support organizations, sometimes referred to as “intermediaries”, can be involved in many different types of support engagements -- redesigning school curriculum, providing instructional coaching to novice teachers at the school, strategic planning for districts -- the list is expansive.

This research study proposes to explore how the strength of ties among participants in the intermediary work process is associated with changes to outcomes. Drawing on theories from the business literature and from health sciences, this investigation uses a validated measure of relational coordination to predict how these intermediary services impact outcomes at the school site. Findings from this research will increase knowledge about how to best support schools’ improvement efforts, while also field testing a formative tool to diagnose the health and investment in a growing number of cross-organizational, intermediated initiatives in public education.

Teacher Residencies
One commonplace example of intermediary initiatives is the teacher residency model. Teacher residencies are designed to encourage novice teachers, teacher trainers, and school staff to engage in a highly relational, interdependent, and coordinated process to develop the skills of novice teachers. This study proposes to explore whether the strength of ties among participants in the residency work process is predictive of intermediate- and longer-term outcomes for novice teachers in residency models, drawing on the following three theories:

The Donabedian model: suggesting that inferences about the quality of a system can be drawn by analyzing structures, processes, and outcomes of the system. Freeman’s stakeholder theory: positing that a breadth of stakeholder classes have a vested interest activities of the “firm” (in this case, the resident training) -- as such, these multiple perspective must be considered for the future success of the firm, even if those stakeholders are seen as having less power, legitimacy, or urgency. Gittell’s relational coordination theory (RCT): arguing that networks of shared goals, shared knowledge and mutual respect supported by frequent, timely, accurate, problem-solving communication enable participants involved in interdependent work to better achieve their desired outcomes. Together these seven dimensions form an empirically validated construct called “relational coordination” (RC). This project hypothesizes that RC predicts resident-level intermediate- and longer-term outcomes (Y), mediated by structural/process components of the resident experience (M), as follows:
Y = i1 + cRC + e1 (1)
Y = i2 + c′RC + bM + e2 (2)
M = i3 + aRC + e3 (3)

Real-world example: relational coordination (RC) would predict Residents’ persistence in the program (intermediate-term outcome, Y) in equation #1; RC would also predict the number of meetings held between school leaders and resident advisors (structural/process measure, M) in equation #3; together, the predictive effect of RC on Y (persistence) would be attenuated when controlling for M (# of meetings), per equation #2.

A central goal of this project is to field test a formative tool to diagnose resident teachers’ apprenticeship and environmental context, and to generate findings about how to best support those teachers’ development. For the project to be successful, the residency program must have a pre-existing hypothesis or theory about what structural factors drive outcomes, and a pre-existing position regarding what outcomes matter most. Relational Coordination Theory can only map to an existing theory of performance; it does not provide one of its own accord. This project endeavors to study how relational coordination interacts with both the structural/process components of the residency model and the key performance indicators for the program at-large.

3) Teamwork for Diagnosing Patients: Using Relational Coordination to Help Ambulatory Care Organizations Improve Diagnostic Safety

Presented by Kathryn McDonald, Stanford University

Context: Health care outside of the hospital setting, known as ambulatory care, comprises a major and increasingly important part of the U.S. and other countries’ health care sectors. Primary care and specialty clinic organizations handle over one billion patient encounters in the U.S. each year. Diagnostic work is part of most ambulatory care, and central to over 40% of patient visits that originate due to a new problem or a flare-up of an ongoing chronic problem. Yet, significant risks associated with diagnostic failures have not garnered much attention from health care leaders and policy makers until a National Academy of Medicine (NAM 2015) report synthesized research data with the statement that “most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences.” The NAM report also recommended greater attention to the organizational and teamwork context for diagnostic work.

Theory and Methods: This conceptual study seeks to connect relational coordination theory to ambulatory care diagnostic safety challenges identified in three research papers on organizational factors enabling or thwarting timely and accurate diagnosis. The first project targeted delayed diagnosis from missed evidence-based monitoring in high-risk conditions (e.g., cancer) within five specialty clinics in an urban publicly funded health system. The second project analyzed staff-reported office problems that could lead to diagnostic error (e.g., not having test results when needed) in over 900 primary and specialty clinics across the nation. The third project examined associations between two types of time pressure (i.e., encounter-level and practice-level), organizational factors including measured relational coordination, and patient effects including perceptions of missed diagnostic opportunities in 16 primary care clinics. Each project used appropriate and rigorous qualitative and quantitative methods, reported in separate published papers.

Findings: Based on the first project, health care professionals worry about missed monitoring (diagnostic failures) across primary and specialty clinics due to challenges with data systems, communications handoffs, population-level tracking, and patient-centered activities, all relevant to motivations for and implementation of effective relational coordination. In the second project, two organizational factors – stage of health information technology (HIT) deployment and patient safety culture (including teamwork components reflective of relational coordination) were associated with diagnostic-related office problems. The third study found that time stressors in primary care clinics were associated with greater perception of adverse effects on diagnosis, and in turn, several organizational factors appear protective including HIT capabilities, patient-centered culture, positive relational coordination, and leadership facilitation of changes to address frontline practice challenges.

Implications: Taken together, these three research studies of ambulatory care diagnostic safety provide factors that map explicitly or implicitly to relational coordination theory and empirical associations. As shown in these studies, interdependent teamwork challenges exist for those carrying out the diagnostic process, suggesting a role for relational coordination. Drawing from relational coordination theory offers a novel approach to understanding the role ambulatory care organizations could assume in assuring diagnostic safety for their patients.


4.3 Scaling Up Collaboration
Facilitator:  Dylan Ross, Optum Health  

1) Collaborative Community Engagement and Co-production as a Pathway to Address Mental Health Disorders

Presented by Dušan Stojičić, Brandeis University

Mental illness is one of the leading causes of medical burden in the US. Remarkable progress has been made on developing evidence-based interventions that work; however, the misfortune is that one-third of the ten million people who live in the US with mental illness receive no treatment. Current models of mental health organization of care in the US are showing many imperfections and limitations to address this ongoing need. One critique of the design of U.S. social services is that people who are suffering from medical and mental health challenges need to cope with three different systems: the medical care system, the mental health system, and if they are dealing with substance use disorder, the substance use service system. Another critique argues that both the traditional and the new organization of care model fail to recognize the role of the community in the provision of services. Lastly, increased demand for care puts pressure on public policy makers to improve access to mental health services and address stigma and discrimination, particularly among people who are facing anxiety and depression. Therefore, there is an urgent need for reconstructing current models of mental health care delivery.

This study aims to examine community co-production as a strategic approach that combines resources between state and non-state actors, and the community. Consequently, the findings recognize the role of the community as an essential partner in the planning and provision of critical services for mental health needs. To collect information for the study, a literature review and analysis approach was used. A qualitative literature review methodology was supported by quantitative meta-analyses conducted by international and government agencies and other sources. In regards to the future of mental health treatment, this analysis will go beyond the distinction of public and private spheres and deeply look into a way to establish a relational society.

The analysis from this study shows three reasons and builds the strong case for why co-production could be relevant for major problems in the US delivery of mental health services:

  1. Co-production might be a good approach to strategically encourage all parties involved to develop new governance structures between government (professional), private (professional), and civic actors. This tactic could challenge the current siloed and fragmented approach to mental health service provision. 
  2. The implementation of co-production requires a transformation of the user- professional relationship. The crucial parts in transforming that relationship are investing in organizational culture change within existing institutions. This transformation could help address disempowered and inadequate mental health workforce and activate additional and dormant resources.
  3. Co-production as an approach creates conditions for the community-driven collective action and therefore could raise collective power and agency. Increased individual and collective agency could address both the stigma and social determinants of health of individuals suffering from mental health illnesses.

Lastly, this study recognizes that co-production is a nascent practice that is needed to challenge the conventional framings of service provision in contemporary mental health systems. However, there are many things that we need to learn about in order to improve care for individuals dealing with mental illness in an equitable way.

2) Building a Collaborative School Culture

Presented by Jody Hoffer Gittell, Brandeis University, Monica Higgins, Harvard University,
Lauren Hajjar, 
Suffolk University, Callie Watkins Liu and Lainie Loveless, Brandeis University

Accountability has been one approach to increasing school performance, with growing attention to felt accountability by teachers themselves (Childress, et al, 2010). Others have argued however that schools by themselves can only do so much given the social determinants of education outcomes, and given the multiple parties involved in shaping those social determinants (Harvard Education Redesign Lab). From the perspective of relational coordination theory, this argument suggests the need to first identify the broader web of interdependence for achieving desired outcomes, and then to create shared accountability among the participants in that broader web, to support the development of shared goals, shared knowledge and mutual respect among those participants (Gittell, 2016).

In our Roundtable presentation, we will summarize the project, and share the tools we are using to support its success in the field.

3) Health System Transformation Through Cross-Sectoral Collaboration

Presented by Grace Liu & Peter Tsasis, York University

Context: Health Systems are facing challenges to meet the needs of complex patients and to address population health needs. Expanding relationships through cross-sectoral collaboration may be a way to achieve health system transformation to address these challenges. However, the process of evaluating the impact of intersectoral action on social determinants of health to improve health equity is complex (World Health Organization, 2008). In order to implement effective inter-sectoral collaboration requires political will and innovative solutions in building communication across all sectors with important stakeholders to address local population health needs (WHO, 2017). In the literature, the impact of intersectoral action on population health outcomes were mixed and limited, as per systematic review paper “Assessing the Impact and Effectiveness of Intersectoral Action on the Social Determinants of Health and Health Equity” (National Collaborating Centre for Determinants of Health, 2012).

As intersectoral action is a complex relational process, further documentation and research taking into account contextual factors is required to better understand the impact of intersectoral action (NCCDH, 2012). In the province of Ontario (Canada), cross-sectoral collaborative teams (known as ‘Tables’) were created made up of various stakeholders across sectors in addressing population health needs at the local level. Since the Tables were newly formed (2017), this study served as a pilot study which focused on six Tables. The conceptual theoretical frameworks explored in this research included Relational Coordination (Gittell, 2016), Complex Adaptive Systems and Organizational Readiness (Wandersman & Scaccia, 2017) to understand the co-evolution and development of these newly formed inter-sectoral collaborative tables.

Purpose: The purpose of this study is to get a deeper understanding of the processes in building and managing relationships among participants of the Table in an interactive context. We have taken a Complex Adaptive Systems approach in relation to Relational Coordination and Organizational Readiness frameworks. As Relational Coordination plays a role in adaptive capacity (Gittell, 2016), the results will be useful for developing capacities and effective partnerships among the members of the Tables for transforming care delivery.

Methodology: A mixed methods approach was undertaken for data collection through a baseline Relational Coordination survey, interviews, and twelve (12) month follow-up surveys. A purposive sampling method was selected with participants who consented to participate in the study and who were members of the ‘Tables’.

  • In Phase 1, the Relational Coordination (Baseline) survey was used to assess the communication (frequent, accurate, timely, problem-solving) and relationships (shared goals, shared knowledge, & mutual respect) to understand the patterns of collaboration among the various stakeholders.
  • In Phase 2, participants who volunteered provided their views and experience from participating in the Table(s) through semi-structured telephone interviews. Qualitative thematic analysis was conducted.
  • In Phase 3, the Relational Coordination and Organizational Readiness surveys was used to assess the communication and relationships, as well as, the Readiness (motivation, innovation-specific capacity, and general capacity) for collaboration among the various stakeholders.

Findings will be presented as they become available. 


11:00 am - Break

11:15 am - Keynote: David Sloan Wilson

David Sloan WilsonThe Evolution Institute
David Sloan Wilson is an evolutionary biologist who is known for his steadfast and highly creative support for group selection theory and the importance of altruism in a period, roughly the years 1965 to 2000, when the notion was considered beyond the pale by most biologists. Wilson serves as a Distinguished Professor of Biological Sciences and Anthropology at Binghamton University and as co-founder of the Evolution Institute.

Facilitator: Joel Cutcher-Gershenfeld, Brandeis University

Joel Cutcher-Gershenfeld is a professor in the Heller School for Social Policy and Management at Brandeis University, where he leads research on agile institutions and teaches classes on strategy and operations. Previously he served as a professor and dean in the School of Labor and Employment Relations at the University of Illinois, United States. Joel serves as editor for the Negotiation Journal at the Program on Negotiation at the Harvard Law School. Joel is an award-winning author who has co-authored or co-edited eleven books, including Designing Reality: How to Survive and Thrive in the Third Digital Revolution (Basic Books, 2017).

Joel Cutcher Gershenfeld

Learn more about David and his work

The Evolution Institute
Wilson, D. S., Hayes, S. C., Biglan, A., & Embry, D. D. (2014). Evolving the future: Toward a science of intentional change. BEHAVIORAL AND BRAIN SCIENCES37(4), 395-416. doi:10.1017/s0140525x13001593

The Best Schools. (2016). David Sloan Wilson Interview
Wilson, D. S. (2019). This view of life: Completing the Darwinian revolution. New York: Pantheon Books.

Synopsis: It is widely understood that Charles Darwin’s theory of evolution completely revolutionized the study of biology. Yet, according to David Sloan Wilson, the Darwinian revolution won’t be truly complete until it is applied more broadly—to everything associated with the words “human,” “culture,” and “policy.”

In a series of engaging and insightful examples—from the breeding of hens to the timing of cataract surgeries to the organization of an automobile plant—Wilson shows how an evolutionary worldview provides a practical tool kit for understanding not only genetic evolution but also the fast-paced changes that are having an impact on our world and ourselves. What emerges is an incredibly empowering argument: If we can become wise managers of evolutionary processes, we can solve the problems of our age at all scales—from the efficacy of our groups to our well-being as individuals to our stewardship of the planet Earth.

 12:15 pm - Lunch

Connect with colleagues, check out poster presentations and enjoy some delicious food. 

1:15 pm - Panel Discussion

Leading Change from the Front Line to the C-Suite
Facilitator: Tony Suchman, Relationship Centered Healthcare

Panelists will describe their successes and challenges as change leaders as well as what is most meaningful about their work.

  • Barbara Belk, Kaiser Permanente Northwest
  • Rich Freeman, Dell Medical School 

  • Darren McLean, Gold Coast Health

  • Erik Nicholson, United Farm Workers

  • Jennifer Potts, Billings Clinic

  • David Simpson, Stanford Health

  • Julius Yang, Beth Israel Deaconess Medical Center 

2:15 pm - Transition, Choose a Workshop

2:30 pm - RC in Practice: Tools Workshops

Take home some practical tools for using relational coordination in your work - including:

  • RC Mapping (pictured below), with Lauren Hajjar, Suffolk University
  • RC Survey, with Jody Hoffer Gittell, RCRC
  • Relational Job Design, with Heather Gilmartin, Veterans Administration
  • Coaching Model, with Margie Godfrey, The Dartmouth Institute Microsystem Academy

Relational mapping

3:30 pm - Break 

3:45 pm - Evolving Relational Coordination: What Have We Learned?

Jody Hoffer Gittell, RCRC and John Paul Stephens, Case Western Reserve University


4:15 pm - Open Mic and Farewell

We look forward to seeing you next year!


Workshop Following the Roundtable

Offered by Aspen Labs:  Human Centered Design Workshop
Human-Centered Design

October 13 at Catalyst HTI in Denver Colorado (8:30 am to 3:00 pm)
Register above

Click for more information about this workshop

Human-Centered Design (HCD) is used in many industries to better create products and services that match the needs of the user. After this hands-on HCD workshop, you will be able to describe Human-Centered Design, apply these tools to your user base, and know where to incorporate them at your organization.

Participants will have a chance to practice:

  • Customer shadowing

  • Synthesizing findings into usable insights

  • Framing the opportunity

  • Rapid prototyping

  • Working with personas

Recommended prerequisite: Christi Zuber’s RCRC keynote presentation.

Instructor Bios:

Kari is certified in human-centered design and change management, and a curator of out-of-the box ideas, who can also successfully convert them into impactful solutions. 18+ years healthcare experience developing new products, go-to-market strategies and patient experience improvements. Known for tackling large-scale implementations, and my love of dogs and soccer.  

Monica has 15 years experience playing rugby, and also as a healthcare administrator. She embraced design thinking after reluctantly accepting that numbers don't tell the whole story. Her passion is changing the financial incentives in the healthcare market to keep people healthy. She is a KP certified HCD Practitioner/Trainer and Lean Green Belt.

“People grow through experience if they meet life honestly and courageously.” Eleanor Roosevelt

Kari CoughlinMonica

2019 Host Committee

Host committee

Our local host committee will welcome us and show us the best of Colorado, both old and new!  

Rachel Dixon, Prime Health

Rachel Dixon is experienced in the clinical, operational, and technological implementation of tele-based modes of care delivery. She specializes in Medicaid-focused services and has worked with numerous provider organizations to successfully design, implement and maintain virtual collaborative care in various settings including primary care, community mental health center, and residential. She also has expertise in the Medicaid payer space, and her work has given her an in-depth understanding of payer, primary care, specialist, mental health, and community perspectives.

She has ten years of experience in consulting, program development, and product and program management roles, ensuring satisfaction and success to a diverse set of clients. Rachel is an energetic leader in the healthcare innovation field with experience in strategic planning, program development, implementation, management, web technologies, product management, and organizational development. Rachel is interested in the variations and commonalities of how some of today’s most complex healthcare challenges are experienced across the continuum of care. She believes healthcare is a human right and is passionate about serving the underserved.

Heather Gilmartin, Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care

Heather Gilmartin is an investigator and nurse scientist with the Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VA Eastern Colorado Healthcare System, an assistant professor at the University of Colorado, School of Public Health, and adjunct faculty at the University of Colorado, School of Nursing. Her research focuses on understanding and optimizing the culture of healthcare to enhance patient safety and facilitate organizational learning. She is interested in relational coordination for communication, coordination, and teamwork are the backbone of learning healthcare systems and high-reliability organizations. Her current area of interest is the impact of relational coordination on care coordination programs in the Veterans Health Administration.

Skip Grieser, Quality and Safety Committee of the Board, Children's Hospital Colorado

Skip Grieser is a doctoral candidate in organizational learning, performance, and change at Colorado State University. He was a career frontline air traffic controller, most recently at Denver International Airport; and was the lead developer, facilitator, and consultant for national programs in air traffic control crew resource management (CRM) and safety culture for the U.S. Federal Aviation Administration.  His current interests are in healthcare patient safety and clinician well-being, organization development, and helping frontline workers succeed and thrive in high-consequence industries—such as healthcare and aviation—where people's safety and lives are at stake.  Relational coordination is a major theory in the conceptual framework for his qualitative dissertation study with surgery teams, on collaboratively speaking up about safety concerns, and responding heedfully to concerns that are voiced.  

Skip serves on the Quality, Safety, and Experience Committee of the Board and on the MRI Safety Reform Steering Committee at Children’s Hospital Colorado in Denver.  He lives in Boulder, where he enjoys trail running in the Flatirons, nature, movies, and live music.  His son John owns Elemental Energy, a solar energy company in Portland and Bend, Oregon, and Twende Solar, a global foundation.  His daughter Laura is a thriving nursing student and leader on the Olympic Peninsula in Washington.  

Dylan Ross, Optum, UnitedHealth

Dylan Ross is an organizational psychologist; healthcare consultant and managing healthcare professional with over 15 years of experience helping healthcare organizations and consumers reach their highest potential. Dylan currently serves as National Director of Behavioral Health Clinical Products at Optum, UnitedHealth Group. Dylan’s doctoral research focused on the application of a collaborative team-based training model as a means to improve the effectiveness of care teams in healthcare. He is also a clinically trained psychotherapist (LPCC, LMFT).

Janet Steinkamp, Health Systems Development, LLC and Grand Canyon University

Janet Steinkamp started Health Systems Development LLC in 2015 an effort to put some structure around a number of projects she was working on in the health care field. As owner and senior consultant she was leading the effort to re-establish a national non-profit associated with emergency medicine and cardiac arrest., working with Colorado's State Innovation Model grant, and local health care workforce projects.

Janet is a current Ed.D. candidate studying Organization Leadership in Health Care Administration. Her research topic is the potential impact of training on integrating team communication in the medical home setting. Anticipated graduation is summer '19.

As an administrator/educator in higher education for the past 30 years, the last 12 of which focused on medical and health care education, Janet finds the principles of Relational Coordination to be highly relevant and pragmatic in the design and delivery of competency-based, concise and effective team learning opportunities. In her professional experience, she has come to believe in the power of learning through training as it impacts the development of an organizational culture within which integrated primary care teams can thrive – reaching their full potential as they work to deliver the highest quality of safe, affordable and whole-patient care.


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