A Primer on Relational Coordination, 
Human-Centered Design & the Evolutionary Worldview

by Skip Grieser

The relational coordination, human-centered design and evolutionary worldview frameworks are distinct in many ways. But they all support the following principles:

  • Intentional collective change is possible.

  • Relationships are of critical importance in the change process.

  • High quality relationships make intentional collective change more likely to occur.

  • Structures and processes can be designed to support the high quality relationships that are needed for intentional collective change.

  • Similar concepts for conscious evolution toward intentional change include mutual respect and problem-solving communication from relational coordination, empathy and human desirability from human-centered design, and natural selection of harmony and order from the evolutionary worldview.

  • Personal transformation, co-evolution, readiness, engagement, contribution, and collaboration of people within and among small groups (or microsystems)—from the front lines through all levels of the organization to the top leaders—are keys to co-creating positive change.

Learn more at the 2019 Roundtable and see additional information about each framework in the links below!


Primer Summary Table

(A one-page PDF summarizing the philosophies, components and tools for each framework).

Learn more about Relational Coordination

Relational coordination is the coordination of work through relationships of shared goals, shared knowledge and mutual respect, supported by sufficiently frequent, timely, accurate communication that is focused on problem solving rather than blaming.

Jody Hoffer Gittell's Relational Model of Organizational Change is a dynamic model of change in which organizational structures shape relationships, while relationships shape organizational structures. It is a multi-level model of change that spans from personal and interpersonal to structural and institutional. Mahatma Gandhi’s advice to "be the change we wish to see in the world" is a key to success because "there can be no organizational transformation—or social transformation—without personal transformation" (Gittell, 2016, p. 12).

According to the Relational Model of Organizational Change and supported by much of the research, relational coordination drives quality, safety, efficiency, well-being, cost savings, adaptive capacity, psychological safety, trust and confidence, learning from failures, reciprocal learning, collaborative knowledge creation, innovation, and more (Gittell, 2016, pp. 22-28). 
Relational coordination is of growing interest given the trend towards work that is more uncertain, time constrained, and increasingly interdependent with others, both seen and unseen. These trends can intensify stress and negatively impact worker well-being. Numerous recent studies indicate widespread clinician burnout as well as suicide. A growing number of studies show that relational coordination is associated with reduced burnout, as well as increased job satisfaction and engagement. One recent study using relational coordination survey methods (Havens, Gittell, & Vasey, 2018) explored the association of relational coordination among clinicians with their well-being. Participants included 382 direct care registered nurses from the emergency, intensive care, medical-surgical, obstetrics, post-anesthesia care, and surgical units in five acute care community hospitals. The study found that “relational coordination was significantly related to increased job satisfaction, increased work engagement, and reduced burnout [concluding that] “relational coordination contributes to the well-being of direct care nurses, addressing the Quadruple Aim by improving the experience of providing care” (p. 132).
According to the Relational Model of Organizational Change, three types of interventions are expected to help build and sustain relational coordination: 

  • Relational interventions help to build new, evolved ways of relating to replace old ways in which participants may not collaborate “because it threatens their power or sense of identity” (p. 11). Relational interventions such as relational mapping, facilitated dialogue, coaching, and role modeling help participants examine, reflect on, and transform their interdependencies and their relational dynamics (p. 198). 
  • Work process interventions are “informed by improvement science and are carried out with tools from continuous improvement, lean/six sigma and microsystems” (p. 198). Carried out in a relational way, they help to further strengthen relational coordination. 
  • Structural interventions include human resource management tools such as job design, hiring and training for teamwork, supervisory roles and actions, team meetings and huddles, conflict resolution, boundary spanners, protocols, shared information systems, and shared accountability and rewards. Implementing these structures effectively can require a baseline level of relational coordination, given that people tend to undermine structures that require skills and perspectives they do not have (p. 198).

Learn more about Human-Centered Design

At the same time, “there is an increasing drive in health care for creativity and innovation to tackle key health challenges, improve quality and access, and reduce harm and costs” (Zuber & Moody, 2018, p. 62). And, human-centered design (HCD) is a “collaborative, people-focused, and impactful approach to organizational innovation” (p. 63).

Human-centered design, also known as design thinking, is based on the work of Tim Brown and David Kelly of IDEO, a global design company headquartered in Palo Alto, California; and Roger Martin, Director of the Martin Prosperity Institute and former Dean of the Rotman School of Management at Toronto University. Three key components of human-centered design are “geared toward iterative cycles and deep user empathy and involvement” (p. 64):

  • Need Finding – involve people in identifying their deeper needs; and in framing or reframing the problem
  • Ideation – involve people in generating potential solutions
  • Experimentation – involve people in multidisciplinary teams to prototype solutions

Christi Zuber is a human centered designer who identifies potential solutions focused on three additional criteria: desirability (human), feasibility (technical), and viability (business).  Innovation opportunities are best pursued where desirability, feasibility, and viability merge. “The uniqueness of HCD is that it begins with desirability and needs from the perspective of human beings … driven through deep empathy for users and the context of their lives to cocreate better products, services, or experiences” (p. 64).

For example, although the large nursing workforce has great capacity to contribute to transformational change, studies suggest that nurses feel “unsupported to take the risks necessary for innovation, and that leaders may not understand the conditions required to fully support them” (p. 62). To fill those gaps, Zuber and Moody (2018) conducted a human-centered design workshop with 125 Kaiser Permanente clinical practice nurses who were also union representatives. To collect data, they used two methods:  narrative story empathy maps of what nurses saw, did, thought, and felt when they had been able to champion innovation; along with semi-structured questions that nurses in pairs used to interview each other. Data were then thematically analyzed using grounded theory methods. The analysis identified key enabling conditions for nurses and implications for leaders:

Enabling Conditions for Nurses Leadership Implications for Support
Feeling a personal need for a solution Match challenges with people who have personal needs for solutions
Challenges that have meaningful purposes Articulate the bigger vision and purpose
Clarity of goal and control of resources Empower staff with clear goals and the ability to control a set of resources
Active experimentation Provide time and places for active testing and experimentation
Experiencing progress – quickly and visibly Break down efforts into smaller components
Positive encouragement and confidence Give encouraging feedback; celebrate successes
Psychological safety Support learning to move the work forward, including beyond perceived failures
Table adapted from Zuber & Moody, 2018, Table 3, p. 72; above table used with permission (most wording verbatim).

Learn more about the Evolutionary Worldview

Because cultural adaptations are not always positive, the science of intentional change focuses on desirable human behavior and culture change. In This View of Life: Completing the Darwinian Revolution (2019), David Sloan Wilson maintains that Darwin’s theory of evolution can be expanded beyond genetic evolution to include cultural evolution and personal change. What all of these processes share in common are the three ingredients of variation, selection, and replication.

Wilson cites Pierre Teilhard de Chardin’s 1955 magnum opus, The Phenomenon of Man and its prophetic vision, based on Darwin’s theory, of human capacities for positive cultural evolution, as “a blueprint for what ought to become”  [emphasis in original] (p. xiv). For Wilson, Teilhard’s key insight that culture change is an evolutionary process, and his vision of harmony and order at all levels, are “worth pursuing with one’s heart and soul” (p. xiii). Wilson considers This View of Life (2019) to be an updated version of Teilhard’s groundbreaking, panoramic vision.

Paradigm shifts in academia can be difficult. Teilhard, an anthropologist and Jesuit theologian whose conclusions were science-based, not religion-based, had to patiently negotiate with the Catholic church to arrange for his magnum opus to be published posthumously. Further, Wilson argues against the “intellectual apartheid” revealed in the uproar over the final chapter of Edward O. Wilson’s Sociobiology: The New Synthesis (1975). The book’s thesis that evolution provides understanding for the social behavior of all species was highly acclaimed, except for the final chapter applying the thesis to humans as one of those species. Misconceptions of both Darwin and E. O. Wilson resulted in the dark view that social Darwinism could lead only to brutal competition and pernicious outcomes such as fascism, ignoring Darwin’s emphasis on the “grandeur in this view of life” – evolving forms toward the “most beautiful and most wonderful.”

David Sloan Wilson’s (2019) call for an intentional science of positive cultural evolution begins by “confronting the dark past of social Darwinism” (p. 13). He then introduces an “evolutionary toolkit” posited by Niko Tinbergen, a Dutch biologist who shared the 1973 Nobel Prize in medicine. The toolkit consists of the four most important questions “that must be addressed to fully understand any product of evolution … [and] essential for understanding the arguments in this book” (p. 36).  The questions are about function, history, mechanism, and development:

  • “What is the function of a given trait, if any? Why does it exist?”
  • “What is the history of the trait as it evolved?”
  • “What is its physical mechanism?”
  • “How does the trait develop?” (p. 37)

Wilson addresses multilevel change in individuals, small groups, schools, neighborhoods, religions, organizations, governments, societies, and the world. “Because well-functioning groups are required for both individual well-being and for efficacious action at larger scales” (p.114), small groups are Wilson’s primary and central level of analysis for natural selection.

Elinor Ostrom, a political scientist and 2009 Nobel Prize winner for economics, offers core design principles (CDPs) for groups. The CDPs are: strong group identity and purpose; proportional equivalence of benefits and costs; fair, inclusive decision-making; monitoring agreed-upon behaviors; graduated sanctions for violations of those behaviors; fast, fair conflict resolution; local autonomy; and polycentric governance. Auxiliary design principles (ADPs) may be added in local contexts.


Atkins, P. W. B., Wilson, D. S., & Hayes, S. C. (2019). Prosocial: Using Evolutionary Science to Build Productive, Equitable, and Collaborative Groups. New Harbinger.

Gittell, J. H. (2016). Transforming Relationships for High Performance: The Power of Relational Coordination. Stanford University Press.

Havens, Gittell, & Vasey (2018). Impact of Relational Coordination on Nurse Job Satisfaction, Work Engagement and Burnout.  Journal of Nursing Administration.

Wilson, D. S. (2019). This View of Life: Completing the Darwinian Revolution.

Wilson, D. S., & Hayes, S. C. (2018). Evolution and Contextual Behavioral Science: An Integrated Framework for Understanding, Predicting, and Influencing Behavior. Menlo Park, CA: New Harbinger Press.

Wilson, D. S., Hayes, S. C., Biglan, A., & Embry, D. (2014). Evolving the Future: Toward a Science of Intentional Change. Behavioral and Brain Sciences, 37, 395–460. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4331065/.

Zuber, C. & Moody, L. (2018). Creativity and Innovation in Healthcare: Tapping into Organizational Enablers in Human-Centered Design.

Zuber, C. & Moody, L. (2016). Learning from the Best: Unpacking the Journey of Organizational Design Leaders.