Cafe Archives

February 22, 3:00-4:00 pm ET

Thursday, December 7, 3:00 - 4:00 PM

How can health systems and community organizations build relational coordination to achieve more equitable outcomes? What role can community health workers play?

Community health workers (CHWs) are defined by the American Public Health Association as liaisons between the community and health systems (APHA, 2023), serving in effect as boundary spanners to build relationships between health systems and communities that are divided by significant power differentials (e.g. Franz et al, 2019; Taylor & Byhoff, 2021). CHWs work with clients and with fellow professionals in health systems and community-based organizations to address underlying causes of poor health such as systemic racism and violence (APHA, 2023) by spanning the social identity and power differentials between the two sectors (Franz et al, 2019; Rabbani, 2019). Given the challenges of the CHW role, it is not surprising that some studies have shown that CHW programs positively impact outcomes (ASTHO, 2023), while other studies have shown little or no impact (Truchil et al, 2013).

The goal of the proposed study is to assess how to strengthen CHWs’ role as boundary spanners between health systems and communities. We propose to test two interventions that are expected to increase CHW ability to play the boundary spanner role. The first intervention is empowerment training, which provides CHWs with new skills to build power in communities and to work more effectively across power differentials between health systems and communities (Rabbani, 2019; 2020). The second intervention provides CHWs with the skills to assess and build relational coordination and readiness between health systems and communities to achieve more equitable outcomes for the populations they serve (Hajjar et al, 2020).

Join us to explore interventions to address the social determinants of health by strengthening relational coordination across sectors that currently lack shared goals, shared knowledge and mutual respect.

Thursday, September 14, 2023, 3-4:00 pm ET

Presenters/Facilitators: Jennifer Claggett, School of Business, Wake Forest University; Kartik Trivedi, The Heller School, Brandeis University

Artificial intelligence has become deeply ingrained into our lives and our work.  While AI is not a recent phenomenon, its ability to engage in deep learning  is relatively new and highly disruptive.  Kate Kellogg and colleagues (2020) have asked how algorithms change the nature of control at work.  How does AI change the way we coordinate our work?  And is relational coordination between humans and AI possible?  Claggett and Karahanna (2018) argue that algorithms learn through relational coordination with human users, and Trivedi (2023) finds that transparency strengthens trust, potentially strengthening relational coordination between AI and its users.  Join us to explore these questions with organizational and policy experts Jennifer Claggett and Kartik Trivedi - and bring your own questions to the conversation!

What is resilience and how can we build it at multiple levels by building relational capacity?  How long can we ask people to be resilient without fixing the underlying problems, and where does resilience fit as we are trying to transform the world?  

As calls for “whole-of-society” approaches to complex challenges like the COVID-19 pandemic (Clarke, Hellowell, O’Hanlon, & Eldridge, 2020), social justice (Zheng, 2020), and authoritarianism grow louder, organizations of all types must be prepared to meet these demands (Bartunek, 2022).  Communities often serve as ground zero for stakeholders to collectively respond.

There are no simple solutions for communities that are seeking to respond. Communities have multiple stakeholders at multiple levels, many of whom have competing interests. Approaches to large-scale change often do not account for the relational aspects of change and therefore fail to address underlying issues of siloed accountability, goals and knowledge, and the lack of trust and respect (Bartunek, Halogen & Do, 2011).  Prior research suggests that developing strong relationships and organizational structures to support collaboration and coordination across professional, organizational and geographical boundaries is essential, especially developing common understandings, shared goals, shared values, mutual respect and trust (Gittell, 2016; Okhuysen & Bechky, 2009).

But can we get stuck in resilience and fail to engage in transformational change?

Thursday, April 13, 2023, 3-4:00 pm ET

• Mary Anne Peabody, University of Southern Maine
• Helen Gorgas Goulding, University of Southern Maine
• Elizabeth Higgins, University of Southern Maine
• Ali Al Fazari, American Hospital Dubai
• Jeffrey Grim, University of Iowa
• Caroline Shanti, University of Southern Maine

Higher education institutions face pressures to adapt to ever-changing student populations and a constantly evolving landscape of knowledge requirements and policy mandates.  State and federal governments along with the philanthropic community have increasingly invested resources to encourage and hold institutions accountable for the success of the students they admit.

The inability of students to access services and resources can be a significant inhibitor to their success. This is especially true for populations of students who have been historically and systemically under-resourced, marginalized, and discriminated against, for example students of color, low-income students, first-generation students, disabled students, LGBTQ students, and immigrant students, especially those who lack familial networks to help navigate policies and structures that can be confusing and daunting. In addition to student success, there are other challenges in higher education such as curricular innovation, campus social climate, faculty and staff retention, research and development, financial sustainability, alumni relations, and external stakeholder relations more broadly.

Relational coordination helps diverse stakeholders achieve their desired outcomes through the development of shared goals, shared knowledge and mutual respect, supported by communication that's frequent, timely, accurate and focused on problem-solving rather than blaming.  We propose that strengthening relational coordination between departments and across levels of leadership within higher education institutions, with their broader networks of external stakeholders, and with students themselves, will enable higher education institutions to adapt to the changing environment and more easily achieve their desired outcomes. Join this Cafe to share about and learn about RC interventions that work.

Thursday, March 9, 2023, 3-4:00 pm ET

• Jennifer Perloff, Institute on Healthcare Systems, The Heller School, Brandeis University
• Palmira Santos, Institute on Healthcare Systems, The Heller School, Brandeis University
• Masami Tabata-Kelly, Institute on Healthcare Systems, The Heller School, Brandeis University
• John Chapman, Institute on Healthcare Systems, The Heller School, Brandeis University

The push for more value from healthcare has shined a light on the importance of well-functioning and broadly conceived teams of caregivers (not all currently considered 'healthcare'), and on social factors not previously considered part of the healthcare system such as safe housing, adequate food and adequate financial resources, for impacting patients’ health and well-being. 

As the definition of care and the locus of control begin to shift towards the joint production of health, community actors such as public health departments and social and economic non-profits have increasingly key roles to play.  And population health initiatives such as accountable care organizations have tremendous potential to reallocate resources from acute medical care to prevention and social services (Mechanic & Fitch, 2023).  But there are very few models for how these disparate sectors can work together.  

In this RC Cafe, we will engage with the research and practitioner community to take stock of what we know about using relational coordination, co-production and social networks to build multi-disciplinary teams of care-givers and multi-sector partnerships for equitable value creation (Burns, Nembhard & Shortell, 2022; Gittell & Ali, 2023).  We will identify gaps needing research exploration, and explore how to more effectively strengthen these relational dynamics (Bolton, Logan & Gittell, 2021).

Thursday, February 9, 2023, 3-4:00 pm ET

• Tony Suchman, MD, MA, Relationship Centered Health Care
• Wale Olaleye, MBA, PhD, Deloitte Human Capital
• Jody Hoffer Gittell, PhD, Brandeis University

In this RC Café, we’ll be exploring ways to help people work together more effectively to improve performance. What’s at the learning edge of RC-informed approaches? The state of practice has advanced so far over the last 15 years. It will be both useful and fun to celebrate this progress and push it farther. And we’ll be trying out a new community dialogue format. At the beginning we’ll offer the floor to anyone who has a thought to contribute and then head into open dialogue.

RC practitioners will have a chance to compare notes and add to their toolkits. Researchers will have a chance to learn about or enhance the impact of previous projects and to identify new emerging topics for future studies of RC change. Students can have it all!  We hope you’ll join us. 

Featuring

• Bram Hendriks, Solve Consulting; Innovation Partners
• Harold Alvarez, Royal Dutch Shell; Erasmus University School of Management
• Ina Sebastian, MIT Center for Information Systems Research

Facilitator

• Jody Hoffer Gittell, RCC, Brandeis University

Our social systems and organizational structures are under stress as they struggle to address the increasingly complex and interdependent challenges such as the transition from fossil to renewable energy. New structures such as inter-organizational collaborations emerge to overcome these grand challenges, where internal and external knowledge is integrated to develop and implement new technologies or products. However, this organizational diversity is like a double-edged sword - while it can be a fountain of creativity and knowledge creation, it can also be a hotbed of coordinating challenges that can fuel conflict and cause projects to fail. 

In this Cafe, Harold Alvarez, Digital Integration Lead at Royal Dutch Shell, will share about the need for relational ecosystems to coordinate the transition to clean energy, based on two live cases. Then Bram Hendriks, Innovation Consultant from Innovation Boosters, will show how the highly practical theory of Relational Coordination can support coordination of the relational dynamics of collaborative knowledge creation based on his preliminary work with diverse stakeholders in the energy transition.  His findings are outlined in detail in Accelerating the Energy Transition - The Power of Relational Coordination.  Ina Sebastian, Research Scientist at MIT Center for Information Research, will use Relational Ecosystems and the Relational Model of Change to comment on the work of Harold and Bram, and to show how we can apply the learning to other complex challenges.

• Alice Andrews, The Value Institute for Health and Care, UT Austin
• Kenny Cole, Ochsner Health
• Zofia Das Gupta, International Consortium on Health Outcomes Measurement
• Jennifer Perloff, Research Institute for Accountable Care; Institute on Healthcare Systems, Heller School, Brandeis

• Christina Nielsen, International Consortium on Health Outcomes Measurement
• Jody Hoffer Gittell, RCC, Institute on Healthcare Systems, Heller, Brandeis

Multiple stakeholders are talking about the need to deliver high-value care and avoid the delivery of low-value care.  But who decides what high-value care is - and how do we deliver it?  According to the Value Institute for Health and Care "value is created by improving the health outcomes that matter most to individuals and families."  Others argue that delivering high-value care may require a whole systems approach supported by networks of shared goals, shared knowledge and mutual respect among patients, care providers, and community partners.   This RC Cafe features a conversation among leaders from Ochsner Health, The Value Institute for Health and Care, The International Consortium on Health Outcomes Measurement, The Research Institute for Accountable Care, and The Institute on Healthcare Systems at The Heller School, Brandeis University.  Open to all members of the RCC and their guests.

Featuring
Kenny Cole, Ochsner Health
Rushika Fernandopulle, Iora Health
Alice Andrews, Value Institute for Health and Care
Heather Gilmartin, Denver/Seattle Center for Innovation, Veterans Health Administration
Jen Perloff, Institute on Healthcare Systems, Brandeis University

Facilitator
Jody Hoffer Gittell, RCRC, Brandeis University

Resilience - the ability to “recover from or adjust easily to misfortune or change” - is a valuable  asset in times of  crisis. Positive relationships provide resilience by affecting the hormonal, cardiovascular and immune systems of the body, thus enhancing health and well-being (Dutton & Heaphy, 2003, Positive Organizational Scholarship). Positive relationships also provide organizational resilience by affecting our ability to share information and coordinate work under pressure.

A handful of studies have shown that financial factors are also critically important for organizational resilience. A post-9/11 study of airlines showed that resilience requires both relational and financial reserves (Gittell, Cameron, Rivas & Liu, 2006, Journal of Applied Behavioral Science). 

In the June Cafe, we will explore health system resilience in the face of the pandemic and ask which models are most resilient both relationally and financially. We consider value-based care models that rely less on low-value elective surgeries, and focus more resources on building high quality relationships with patients to achieve wellness, supported by high levels of relational coordination among care providers and high levels of relational leadership. How can we rebuild our health systems in a way that is more relational, more inclusive, and more resilient?

Featuring
Shyamal Sharma, RCRC Brandeis University
Robert Kahn, Cincinnati Childrens Hospital
Jacob Storch, Joint Action Analytics
Ninna Meier, Aalborg University

Facilitator
Jody Hoffer Gittell, RCRC, Brandeis University

Relational Society is a state of generalized reciprocity and robust social capital, created through goodwill, empathetic fellowship and virtuous social interactions among all entities, whether individuals or organizations, in a community as parts of a whole. Thus, we are a product of our environment in every small and large measure, individually and collectively.

Organizations are embedded in this larger social context and it is currently at grave risk. In a pandemic, the moral and economic imperatives of the solidarity of the human condition belong most urgently in the context of health care. Before the COVID-19 crisis, the U.S. was already struggling with health disparities arising from social determinants of health that put minorities and low-income populations at risk of adverse health outcomes, severely compromising their quality of life and overall well-being.

The pandemic has laid bare these inequalities, calling our attention to the urgent need for rebalancing of social values toward a more sustainable, more relational society, in addition to our evolutionary survival as a species in the longer term. We are ultimately bound by a common destiny and it is in our hands how we shape it; we are all in this together.

In this RC Cafe, we come together to learn how some of our RCRC partners are advancing these ideals through their tireless efforts, as they evolve within their local context during this historic crisis and beyond.

Presenters
Rosa Carrillo, Carrillo & Associates Safety Leadership Consulting
David Christenson, Paradigm Human Performance, The Taos Institute
Skip Grieser, Air Traffic Controller (Retired); Colorado State University
Nate Woods, GE Aviation Ethiopia, Antioch University

Discussant
Jody Hoffer Gittell, RCRC, Brandeis University

The Coronavirus has helped us to appreciate our common capabilities and limitations in very new ways. Interest in safety and health from our global, national, and local community is surfacing in response to this new threat. We plan to introduce the latest perspectives on safety and health in a complex, fast changing environment.

Communication failures are at the heart of most health, safety and environmental incidents. Thus, trust and transparency are essential to surviving this pandemic. How do holistic relational perspectives help us understand others and collaborate with a genuine interest in addressing common issues? How can leaders respond?

Relational coordination can provide a general framework to focus and start positive conversations that reveal interdependence and build relationships. Adding appreciative inquiry to the dialogue helps to bring out the specifics that generate empathy and efficacy. Emotional and social intelligence learning opportunities may surface. 

Principles from humble inquiry, psychological safety, high reliability organizing, human organization performance, safety differently, and resilience engineering shape social relations within families, neighborhoods, as well as workplace tribes. These perspectives can help to enhance physical safety by strengthening connections across traditional tribal boundaries and common polarities.

In short, while crisis intensifies risk, it also provides an opportunity for leaders to strengthen relationships. Join us to learn and share lessons for creating workplaces and communities that are psychologically and physically safe.

Presenters
Carsten Hornstrup, Joint Action Analytics
Daniel Massie, Norwegian Business School

Discussants
Jody Hoffer Gittell, RCRC, Brandeis University
Ragnhild Kvålshaugen, Norwegian Business School 

Relational approaches to coordination are well-suited for addressing ill-structured problems (ISPs). ISPs are problems that are blurred, do not have a clear solution pathway, can productively be understood from diverse perspectives and are riddled with uncertainty, complexity and interdependencies (Simon, 1973). Two streams of research; Relational Coordination Theory (Gittell, 2002) and Extreme Teaming (Edmondson & Harvey, 2018), offer insights into collective coordination processes of coping with ISPs. 

Relational Coordination Theory illuminates coordination as a mutually reinforcing process of communicating and relating for task integration (Gittell, 2002), especially impactful under conditions of high uncertainty, interdependence and time constraints. RC is a network of ties between roles and/or organizations that enables participants to see and act in terms of the whole. There is strong empirical support for both the outcomes of relational coordination and the management practices that help to support it, such as shared accountability, shared rewards, relational job design and relational leadership (e.g. Gittell,  Seidner & Wimbush, 2010; Gittell & Douglass, 2012). 

Extreme Teaming (ET) describes a process and principles for effectively integrating diverse professionals and skill sets around complex challenges. ET provides relevant insights for understanding how teams come together and productively carry out problem-solving (Edmondson & Harvey, 2017). This is especially important when dealing with ISPs. The integration of different professional perspectives, knowledge sets and capabilities, in finding competent and innovative solutions, is helping professionals to engage as a collective, in solving the most pressing and complex problems (Edmondson & Harvey, 2017). Extreme teaming gives us a good understanding of how diverse cross professional teams can come together to productively engage in problem-solving processes and helps us understand how cross-professional and cross-organizational team-based arrangements, with fluid membership, can develop a capacity for coordination and act as a collective.

In this Cafe we will explore the synergies and complementarities between these two theories and the implications for practice.

Featuring
Bill Gunn, NH Region 1 Integrated Delivery Network
Erin Fair Taylor and Sally Retecki, Care Oregon

Discussants
Jody Hoffer Gittell, RCRC, Brandeis University
Shyamal Sharma, Brandeis University

Addressing the social determinants of health is a cost-effective way to achieve health outcomes. But our knowledge of how to do so is still in early stages of development, particularly in the U.S. compared to traditional approaches, addressing the social determinants requires coordination across a wider array of stakeholders - for example primary care, behavioral health, hospitals, schools, family services, youth services, public safety, and employers.   

In this RC Cafe, we will learn about efforts by our partners to address social determinants of health in New Hampshire, New York, Oregon and beyond.They will share insights about the multi-stakeholder coordination that has been central to their success, and about the challenges that still remain. All partners are welcome to register - bring your questions, ideas and experiences to share!

Featuring
Ole Dalvang, Joint Action Analytics
Khwezi Mbolekwa, Collaborative Leadership Works
Anne Douglass, University of Massachusetts

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

Relational leaders create connections based on shared goals, shared knowledge and mutual respect with others and among others. By doing so, they become role models and create the foundation for strengthening relational coordination throughout their organizations and beyond. Experts from the RCRC community will present in the January RC Cafe about their experiences with relational leadership, from their perspective as researchers, consultants and leaders.  We anticipate a dynamic session with short presentations followed by an open discussion. 

Featuring
Karlene Roberts, University of California, Berkeley
Peter Martelli, Suffolk University

Discussants
Jody Hoffer Gittell, RCRC, Brandeis University
David Christenson, Christenson & Associates

High reliability organizing is a way of organizing work that seeks to achieve consistent results under high stakes conditions.  In the December RC Cafe, our presenters will explore the synergies between high reliability organizing and relational coordination. Together we will explore the importance of frequent, timely, accurate and problem-solving communication, supported by shared goals, shared knowledge and mutual respect across key roles, for enabling high reliability organizing to occur.  All partners are welcome to register. Bring your questions, ideas and experiences to share!

Featuring
Brenda Bond and Erika Gebo, Suffolk University
Keri Randolph, Harvard Graduate School of Education

Discussant
Lauren Hajjar, Suffolk University

Relational coordination is increasingly in demand as a framework for interventions. RC interventions have most often been carried out at the unit level in large multi-organizational systems, as documented in Transforming Relationships for High Performance (Gittell, 2016), in Purposeful Interprofessional Team Intervention Improves Relational Coordination Among Advanced Heart Failure Team (Blakeney, et al, 2019) and in Communication and Relationship Dynamics in the Operating Room (Toring, et al, 2019).  But other settings are possible too. In this Cafe, we will hear from colleagues who are engaging whole communities in RC interventions.  We will ask, what kinds of challenges can you address using the RC framework at the community level, and what does the process look like?

Featuring
Steve Martino, Veterans Health Administration
Brenda Fenton, Veterans Health Administration
Ninna Meier, Aalborg University

Discussant
Jody Hoffer Gittell, RCRC, Brandeis University

Hub and spoke networks are often used by organizations to efficiently increase access to services, perhaps most famously in the airline industry. In this Cafe, we will explore the use of hub and spoke networks for health and human service delivery. What are the benefits and challenges of these networks?  What do we know about the role of relational coordination in their success?

Join us Thursday afternoon to hear from Brenda Fenton and Steve Martino about organizing pain care through a hub and spoke model in the Veteran's Administration, and from Ninna Meier about organizing cancer care through a similar model in Northern Denmark.  Learn how this model applies to your work!