Roundtable 2025 Program

Facilitators: Lauren Hajjar (Suffolk University) & Skip Perham (Suffolk University)

Facilitator: Glenn Omanio (Bavarian Nordic)

Facilitators: Jody Hoffer Gittell (Brandeis University) & Jim Best (Independent Consultant)

Authors: Jody Hoffer Gittell (Brandeis University), Anne Douglass (UMass Boston) & Kurt Lebeck (Brandeis University)

Humans are interdependent actors who influence each other in ways that are both visible and invisible. Social movement leaders such as Dr. Martin Luther King, Jr. have suggested that this interdependence is not only inescapable but potentially liberating.

“We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly. I can never be what I ought to be until you are what you ought to be, and you can never be what you ought to be until I am what I ought to be...This is the inter-related structure of reality.”

How can interdependence be liberating? Relational coordination theory has long argued that, as interdependence increases from pooled to sequential to reciprocal (Thompson, 1968), coordination is most effectively carried out through relationships of shared goals, shared knowledge and mutual respect (Gittell, 2011). But this argument has radical implications for equity that have not been fully explored.

In this presentation we will argue that growing interdependence creates a need for more equitable patterns of coordination based on shared goals, shared knowledge and mutual respect, to solve the challenges created by interdependence.

More equitable patterns of coordination require new structures to support them (Douglass & Gittell, 2025), for example conflict resolution structures that move parties from domination and compromise toward integration (Follett, 1924). But these structures don’t simply come out of nowhere. How do we design and implement structures to support more equitable patterns of coordination at a scale that is sufficient to solve the challenges created by our growing interdependence? These are the collective action problems that Elinor Ostrom and colleagues recognized and sought to address through new institutional theory.

The relational model of change has also sought to address these questions, offering a dynamic model in which stakeholders use interventions to strengthen patterns of relational coordination to achieve a wide range of desired outcomes (Gittell, 2016). A growing number of scholars have built on this relational model of change, especially at the organizational and cross-organizational levels (Klindt, et al, 2023; Gebo & Bond, 2025; McLean, et al, 2025). The relational model of change is implicitly about creating change toward greater equity through a process that is itself equitable, striving to give voice to stakeholders who begin with very unequal levels of status and power.

In this presentation, we will explore practical ways for real world actors to use the relational model of change to build more equitable relationships and structures - from the intra- and interpersonal to the organizational and institutional levels - to achieve their desired outcomes in the face of growing interdependence. We look forward to your feedback.

Authors: Richard Wylde (Leeds and York Partnership NHS Foundation Trust) & Claire Kenwood (Leeds and York Partnership NHS Foundation Trust)

Context: Delivering safe, equitable, and person-centred perinatal mental healthcare requires effective collaboration across a diverse range of partners from a number of sectors.

Within Yorkshire and Humber, there is one centrally commissioned inpatient unit and nine community teams delivered by seven provider organisations. Locally commissioned community teams vary in criteria, resource and population. Whilst admission criteria to the shared Mother and Baby inpatient Unit (MBU) are national, opinions differ regarding what would work for whom and whether the criteria should be broadened within existing cost frameworks.

Model: In this context, our project explored a blended approach to the Relational Coordination (RC) and Relational Identity Theory (RIT). RIT seeks to understand individual and group identities in contested environments. It was hypothesised that acknowledging a disputed past would be important to move from commissioning predicated on competition to a relationally coordinated collaborative future. With a stable cohort of clinical leaders, distributed in geography and employer, personal relationships needed attention as well as role relationships. In common with other stretched systems these leaders often only interacted when there were disputes across boundaries.

Practice and Methods: The first step in this work was to bring together clinical leaders from each service along with experts by experience to establish a new shared identity as the Clinical Reference Group (CRG). The group collectively decided to adopt the RC framework to guide this work. The RC model was socialised with the group with an emphasis on the use of data and the evidence base around the impact on clinical outcomes. The wider plan includes working at other levels within the collaborative, with the initial agreement to work on the leadership group in the year before the Collaborative ‘went live’ in April 2025. Our method included agreement of the question for the RC survey that would begin the process of emphasising the affiliation of the leaders with an identity as part of the collaborative CRG. We used the results to shape a series of facilitated workshops and interventions to explore shared understanding of priorities and collective building of the processes and structures to support the collaborative as it grew. Elements of RIT were used to inform the tone of interventions and to frame a ‘relentless we’ in addition to the transparency required to gain a shared understanding of and to move beyond historical disputes

Learning: We have recently completed the second RC survey and plan to share the results with the CRG. Initial analysis shows positive improvements across all dimensions of RC, ranging from 15% to 25%. Whilst further work is planned, we have learned that a mixed intervention methodology can be effectively used alongside the RC survey measure, especially as the external environment shifts from promoting competition to expecting collaboration. We are currently exploring this blended model further in a second clinical setting.

Author: Danny Nussbaum (Brandeis University)

Strategic adaptation of sub-organizational identities (SASSI) is proposed as a novel expansion of the relational model of organizational change (RMOC; Gittell, 2016). Developed in reaction to the 2025 organizational changes at Brandeis University, SASSI aims to address relational and psychological dynamics of organizational and sub-organizational social identities during organizational change. SASSI expands on RMOC with applications of Follett’s integrative method of constructive conflict (1926/1942) and theories of social identity (Branscombe et al, 1999; Gaertner et al., 1993; Tajfel & Turner, 1979).

The framework has four key tenets: relational coordination (RC) and RMOC are important in fostering positive social identity outcomes and intergroup relations during change; leaders should have sensitivity to and respect of the varied social identities at multiple levels held by individuals in the organization; changes that directly impact organizational subgroups should be driven by members of those subgroups; and an iterative and integrative relational approach should be used in producing decisions about maintaining and adapting those groups within the organization.

Beyond the structural, relational, and work process interventions found in RMOC (Gittell, 2016), SASSI suggests a fourth type of intervention for improving relational coordination and performance outcomes: sub-organizational unit identity interventions. Each of the proposed sub-organizational unit identity interventions aims to enhance aspects of RC by empowering individuals of sub-organizational units to decide how their subgroup and identity will adapt to the changing organization. SASSI proposes structures that codify this empowerment.

Inclusion of SASSI principles and strategies are likely essential for leaders to successfully manage changes in an organization’s structures, relationships, and multiple identities of its members. Effective application of SASSI and RMOC together may strengthen organizational and sub-organizational identities among the organization’s members and help leaders navigate and effectuate change.

Author: Darren McLean (Gold Coast Health System)

Introduction: Healthcare improvement remains a contested domain, with neoliberal priorities often conflicting with foundational principals of socially-just healthcare (e.g., equity and patient-centred care). This tension has sparked concern among those supportive of socially-just healthcare systems, highlighting the need for transformative change. Relatedly, the Relational Model of Organizational Change (RMOC) provides a promising approach to support transformative change, but its use must be carefully assessed to ensure it addresses existing barriers to desired change, such as challenging ideologies.

Summary of the Project: In this research project the application of the RMOC as a strategy to improve hospital work processes within a complex and contested healthcare system was critically assessed. Drawing on findings from my doctoral research and ten years of professional practice, I synthesise both theoretical and experiential knowledge to provide further direction for research and practice regarding the use of the RMOC within ideologically driven healthcare systems.

The Context: The research was conducted at a tertiary public hospital in Australia, operating within a national healthcare system established on the principles of universal healthcare—aimed at ensuring all Australians have equitable access to quality care based on their clinical need, not their ability to pay. Hence, hospitals, like this study site, are highly regulated, politically sensitive, and professionalised organisations. The RMOC has been used in this hospital to improve targeted work processes since 2015.

Methods: This research used institutional ethnography to examine how ruling relations (institutionalised power-dynamics) shaped the implementation of the RMOC. This involved analysing work processes and texts to reveal how change efforts were organised. I also incorporated insights from my professional experience of working with numerous hospital-based teams to improve targeted work processes.

Findings: The RMOC was applied in my hospital workplace to improve clinical work processes, such as in trauma and postpartum haemorrhage management, but evidence of improvement of broader organisational outcomes—like length of stay and discharge efficiency—remains limited. Contradictions emerged during implementation of the RMOC: though the value of improving relationships was widely accepted, there was a sense that financial objectives were prioritised over relational activities. Correspondingly, it appeared that gendered work connotations contributed to this view of relational activities. Moreover, institutional processes steered implementation towards organisational objectives reflective of economic rationalism (a neoliberal ideology), emphasising financial and systemic efficiencies. This contrasted with views amongst those implementing the RMOC, who prioritised aligning improvements with the interests of staff and patients. Additionally, implementation of the RMOC relied heavily on project management methodology. This appeared to help maintain alignment with organisational priorities and reinforce economic rationalist agendas.

Implications for Action: Researchers and change practitioners should consider how institutional ideologies impact everyday work, particularly the impact on the use of the RMOC in healthcare improvement. Further research is needed to understand more deeply how dominant ideologies affect the use of the RMOC, ensuring its use leads to desired outcomes. These findings highlight the need to recognize and address external ideological factors influencing organisational improvement efforts.

Author: Maher Tabba (Tufts University School of Medicine)

Introduction: There are several challenges facing crisis management, including the sudden occurrence, limited preparation time, quick decision-making, anticipation, collaboration among multiple working groups, constant monitoring of the operation, processing received information, continuous data analysis, logistic difficulties, modifications to operational techniques, and the ability to receive criticism continuously. Additionally, the operation is complex, specialized, and interdependent, requiring coordination across roles, disciplines, organizations, and sectors to achieve desired performance outcomes. Furthermore, in crisis management, pressures for just-in-time service call for coordination across widely distributed working groups and supply chains. Moreover, crisis management requires workers from multiple disciplines to coordinate several service deliveries across disciplinary and organizational boundaries, in addition to the coordination already required to achieve desired outcomes. As a result, under such stressful conditions, there is a high likelihood of making an incorrect decision or experiencing an operational breakdown. For these reasons, organizations that may encounter a crisis should be adequately prepared and trained in advance to respond effectively to crises. The effectiveness of multidisciplinary crisis response has traditionally been assessed within individual services, with limited evaluation across contributing units as an integrated system. The development of standardized evaluation processes remains challenging due to the distinct characteristics of each crisis. Consequently, there is a critical need for a standardized methodology that systematically assesses the interrelationships among participating agencies, taking into account organizational structure, performance, personnel, and outcomes, to enhance the effectiveness of future crisis management efforts.

Methods: The crisis management structure typically comprises a multidisciplinary framework that includes leadership, administrative support, finance, operations, recovery, project management, human resources, information technology, legal affairs, communications, risk management, compliance, and security. This prospective study aims to develop predefined outcome metrics based on benchmarks from relational coordination theory to enable systematic evaluation of crisis management intervention strategies. A cross-sectional survey will subsequently be conducted to explore the relationship between coordination dynamics and the structural components of each participating team. Based on the data analysis, an interventional task force will collaborate with key stakeholders to identify gaps and opportunities for improvement. Two categories of interventions may be deployed: workforce-focused interventions, targeting staff roles and relational coordination, and organizational structure interventions, addressing core operational systems. A post-intervention survey will then assess the impact of these strategies on team effectiveness in crisis response. This framework enables a comprehensive evaluation and enhancement of both intra-team coordination and inter-team collaboration within the broader crisis management system.

Implementation: The application of relational coordination theory in crisis management offers significant advantages for analyzing the organizational dynamics underlying emergency response efforts. This approach facilitates the identification of areas requiring improvement and informs the design of targeted interventions aimed at optimizing both organizational structures and workforce interactions to enhance overall performance. Moreover, the systematic collection of data across multiple crisis events presents an opportunity to establish national benchmarks for crisis management effectiveness. Methods such as Data Envelopment Analysis (DEA) can be employed to evaluate relative performance and guide the development of evidence-based standards for crisis response.

Author: Glenn Omanio (Bavarian Nordic)

Following the 2022 mpox outbreak, vaccination efforts in the United States were initially managed through federal stockpile distribution. As the public health emergency receded, the response shifted in 2024 to a more conventional, market-based model. This transition required coordinated action across multiple stakeholders, including the manufacturer, government partners, payers, healthcare providers, and community-based organizations serving at-risk populations.

This case study draws on the author’s direct experience as the brand lead overseeing the mpox vaccine’s transition from public-sector allocation to commercial availability. Using a reflective practice methodology, the presentation applies Relational Coordination (RC) theory to examine collaboration across these stakeholders.

The case highlights how shared goals (ensuring continuity of access and maintaining public trust), shared knowledge (on vaccine epidemiology, policy, and payer dynamics), and mutual respect were essential in navigating the complexities of commercialization after the public health emergency ended. It also explores the importance of timely, frequent, and problem-solving communication, particularly as stakeholders confronted misaligned incentives, shifting demand, and limited precedent for transitioning a biodefense asset into the private sector.

By reflecting on both moments of alignment and breakdown, this case study contributes to the growing body of RC-informed implementation science and offers practical insights for future public-to-private transitions in vaccine commercial strategy and delivery.

Authors: Tanja Kirkegaard (Aalborg University) & Søren Bjerregaard Kjær (Danish Organization of Masters and PhDs)

Summary of Project: In this project we aim to bridge research within the field of psychosocial wellbeing at work with the theory and practice of relational coordination (RC). We propose that collective coping represents an understudied but central relational practice that both reflects and reinforces RC in teams under pressure. Based on research on coping strategies carried out by psychologist Tanja Kirkegaard (Aalborg University), we have developed a conceptual matrix and a web-based tool made for assessing coping strategies in work groups. The matrix distinguishes between four coping types – individual/adaptive, individual/change-oriented, collective/adaptive and collective/change-oriented. The tool generates feedback on the coping culture of a workgroup, helping teams reflect on how they handle high job demands together. We aim to strengthen the usability of the tool and together with the participants at the roundtable discuss how the tool might contribute to the RC toolbox as a diagnostic and developmental resource.

Context: In a time of growing work pressures, hybrid collaboration, and psychological strain, teams need tools that help them reflect on how they respond to this collectively, not just individually. Relating to the relational model of organizational change,we position this assessment tool and coping-pattern feedback as a relational intervention that enables workgroups to collectively reflect on their ways of coping and explore how these strategies influence their relational dynamics and choose more collectively responses to pressure.

Methods: The project is based on a two-part research design. The first study explored the sociocultural shaping of coping strategies using a mixed methods approach: stress and coping questionnaires were combined with five months of ethnographic fieldwork, including interviews and observations. The findings revealed two distinct coping cultures, which informed the development of a conceptual coping matrix distinguishing between individual vs. collective and adaptation-oriented vs. change-oriented coping. In the second study, we empirically validated this matrix. Based on focus group interviews and literature review, 81 items were constructed and distributed to 86 respondents across various workplaces. Factor analysis identified four distinct subscales aligned with the matrix: individual-adaptive, individual-change-oriented, collective-adaptive, and collective-change-oriented coping.
The findings led to the development of a web-based tool that assesses coping strategies individually and on team levels (when facing high job demands), providing feedback that supports reflection and discussion in teams facing high job demands.

Expected Findings and Implications for Action: With this project we hope to contribute to the RC toolbox by suggesting our tool (and the knowledge it is based on) as one of the ways to carry out relational interventions. Our key findings in the research project include the four coping dimensions. In the further use of the developed tool to assess coping strategies, we expect to learn how the tool might support improved coordination, communication, trust, and responsiveness under pressure. Teams dominated by individual-adaptive coping may struggle with timely or accurate communication, while collective-change-oriented coping may foster problem-solving and mutual respect – thus reinforcing RC dimensions.

Author: Alankrita Pandey (Eastern Michigan University)

This study utilizes the Relational Coordination framework (Gittell, 2002, 2006, 2009; Bolton, 2021) to investigate workplace safety at the organizational, managerial, and employee levels, and its impact on employee mental health and performance outcomes in grocery stores during the COVID-19 pandemic. The study examines these critical non-healthcare workplaces that were uniquely impacted by the pandemic as they had to adapt rapidly and in unprecedented ways. Physical safety has been grounded in tangible measures such as protective equipment, hazard control and compliance, but with the pandemic, employee perceptions of safety became more salient. The research focuses on employee mental health and its components—emotional, social and psychological—as outcomes.

The COVID-19 pandemic revealed various safety vulnerabilities for grocery stores. Their work environment underwent significant changes, employees were unable to work from home or maintain social distancing but were required to work long hours in these critical yet hazardous roles dealing with fearful customers, uncooperative coworkers, and seemingly indifferent supervisors (Rosemberg et al., 2021). In this challenging environment, managers played a crucial role as intermediaries between evolving corporate guidelines and employee concerns.

This study employed a multi-level mixed methods approach focusing on the levels of organizational intention and communication, managerial implementation, and employee perception. It involved a survey of 217 grocery store employees who provided self-report measures about their experiences during and after the COVID-19 pandemic, including their perceptions of workplace safety, relational coordination, and their mental health and work outcomes. They also answered a qualitative survey about their relationships with managers and coworkers. Managerial experience was assessed through interviews, while the organization's perspective was collected from annual reports from 2019-2023 and news stories.

Preliminary analysis of the quantitative data revealed that relational coordination mediated the relationship between perceptions of workplace safety and employee mental health. Employee workplace outcomes such as intent to leave, and affect were also connected to workplace safety in serial mediation relationships through relational coordination. Qualitative responses highlighted that employees who viewed managers as concerned about their safety responded positively to questions about their relationships with managers and organizations. Employees stated that sometimes they felt "abandoned" by their organizations. Interview responses from managers revealed the divide between corporate office decisions and store floor reality. A qualitative analysis of organization annual reports indicated the reason for this divide. Very few annual reports acknowledged the employee issued due to the ongoing nature of the problems, revealing that their response to the crisis was superficial rather than grounded in process change

These initial results supported previous research showing that organizations which value a culture of employee safety develop processes with rich communication and high-quality interactions between managers and employees, developing mutual trust, strong relationships, and improved outcomes for employees (Torner, 2011).The findings therefore extend previous research (Bolton et al., 2021; Pagell et al., 2015) on relational coordination and safety.

Authors: Tomaz Sedej (LF Decentralized Trust), Ina Sebastian (MIT Center for Information Systems Research), Kartik Trivedi (University of New Hampshire), Paulo Gomes (Florida International University) & Dan Moriarty (Ingleside Group)

Overview:  How does AI—especially agentic AI—reshape coordination in ecosystems and the evolving concept of agency?    With four short cases and then in-depth table discussions with participants, we will explore different ways to understand relational coordination in the context of AI.  This presentation is organized by the Digital Ecosystems Innovation Lab building on our discussion at the recent RC Café called “Coordinating Ecosystems in the Age of AI – What is the Role of Relationships?”

Case 1: Paulo Gomes will share his research on coordinated multi-agent systems with human interaction for complex problem solving. This research includes designing AI agents, such as orchestrator and stakeholder agents, and training AI within ethical frameworks.

Case 2: Tomaz Sedej and Ina Sebastian will explore trust in AI-enabled ecosystems based on qualitative research and based on Tomaz’s work at Linux Foundation Decentralized Trust.

Case 3: Dan Moriarty will describe a relational information design method that helps his work supporting healthcare facilities to effectively respond to AI-driven cyber threats, and understanding how agentic AI can support threat response.

Case 4: Kartik Trivedi will discuss how generative AI changes relational coordination at the team level with his research on the relational consequences of revealing LLM use in team formation. He will explore lessons for coordination with agentic AI. 

Authors: Wiljeana Glover (Babson College) & Dessislava Pachamanova (Babson College)

Summary: Hospital at Home (HaH) programs provide acute-level care and can extend the capacity of traditional hospitals while maintaining quality of care at similar or lower cost. While previous studies have examined patient satisfaction with HaH, scholars note that additional research is needed to examine clinician satisfaction with HaH. We leverage the service quality and satisfaction literature and Herzberg two-factor theory to examine how clinician needs and experiences with HaH influence clinician satisfaction with HaH.

Context: North Hospital & Medical Center (NHMC, pseud.) began implementing its Hospital at Home model in August 2023, providing patients inpatient care at home by implementing a comprehensive, multistakeholder care model that incorporates technology for treatment and monitoring of progress throughout the patient stay. The model has been used to support a wide range of conditions, including pneumonia, COVID, CHF, and brain tumors. The model aims to enhance patient choice, family involvement, and efficiency in hospital resources. Challenges include varying payer models and the inability to serve observation patients. Of particular note to the relational coordination community, the technology-enabled HaH model requires communication across multiple stakeholders and various in-person and virtual environments. This provides a unique setting to observe team-based care and to examine frequent, timely, accurate, and problem-solving oriented communication for future research.

Methods: Our study takes a qualitative approach using a semi-structured interview guide. We interviewed twenty clinicians, including hospitalists, advanced practice providers, and registered nurses who treated patients in the HaH program at NHMC between August 2023-June 2025.

Key Results: We find that, overall, clinicians express positive experiences with HaH patients, technology, teams, and the overall HaH system that are comparable or better than their “brick-and-mortar" experiences. These experiences may positively influence clinician satisfaction with HaH. We also find that HaH may be a pathway to fulfill clinicians’ motivational needs (e.g., need for achievement) and hygiene needs (e.g., need for safety and prevent burnout). We also identify opportunities for improvement for the HaH model that may improve satisfaction.

Implications for Action: This study provides evidence that can be helpful for encouraging clinicians to practice via the HaH model. It also suggests that HaH may provide a positive team-based care experience for clinicians and patients alike while leveraging technology to extend capacity for health systems. Finally, while previous frameworks of clinician satisfaction with technology-enabled care models identified motivational factors, this study also considers some of the most pressing hygiene needs regarding burnout that may have implications for balancing clinician workloads over time.

Author: Mary Jo Gamper (Johns Hopkins University School of Nursing)

Electronic communication (e-communication) has become an essential component of modern healthcare (Alpert et al., 2017). Asynchronous modes (e.g. patient portal messaging, texting, and email) now supplement face-to-face care, allowing continuous connection between caregivers and healthcare teams (Crotty, 2014; Jensen et al., 2022; Runaas et al., 2017; Sriraman et al., 2024; USGA, 2017). While these tools offer great promise, especially for parental caregivers of children with complex health needs, the impact of the quality and equity of e-communication on overall care satisfaction remains poorly understood (CDC, 2024; Gentles, 2010; IOM, 2001; Marshall et al., 2024). A recent scoping review conducted by the author identified limited research examining how e-communication affects caregiver experiences (Gamper et al., 2024). This gap is particularly evident in high-stakes contexts like pediatric oncology, where families navigate uncertainty, time sensitivity, high stress, and complex relational interdependence (Gemmill et al., 2011).

This mixed-methods study explores how the quality and equity of e-communication influence caregivers’ overall satisfaction with their child’s care. Conducted in a single pediatric oncology department at a major academic medical center in the United States, the study enrolled caregivers of children aged 0–13 undergoing active treatment in the department within the past two years. Survey data (n=96) assessed e-communication quality using the Relational Coordination Survey and examined equity through caregiver demographics, digital health literacy, and general health literacy. Satisfaction was measured using a validated parent-reported experience tool. Semi-structured interviews (n=16), grounded in Relational Coordination Theory, further contextualize the quantitative findings by capturing caregivers’ lived experiences with e-communication across the care continuum.

As of June 2025, 121 caregivers have been enrolled, with 96 completing the survey and 16 participating in semi-structured interviews. The sample is demographically concentrated, with a median caregiver age of 37 years (range: 20-61). Most participants identify as female (80%), white (66%), English-speaking (92%), and married (75%). Nearly 40% had completed college, and income levels ranged widely, with over one-third reporting household incomes above $150,000 and 27% reporting below $90,000.

Caregivers across groups reported high satisfaction with care and strong digital literacy. A clear majority (67%) preferred secure patient portal messaging, with fewer favoring texting (20%) or email (13%). Early interviews suggest that while e-communication is widely used, many caregivers are unable to distinguish between members of their healthcare team (e.g., physician vs. nurse practitioner) and are unfamiliar with how provider-facing features of the patient portal function. These findings raise questions about role clarity and system transparency, which may have implications for how caregivers assess relational coordination. Ongoing analysis will clarify how these patterns relate to relational coordination and caregiver satisfaction.

Authors: Sijia Wei (Northwestern University), Tom Wolff (Northwestern University) & Heba Ali (Lancaster University, Relational Coordination Analytics) 

The ability to foster strong, high-quality relationships is increasingly critical for achieving outcomes across complex systems, from health care to public safety. Two leading frameworks and approaches for studying relationships, social network analysis (SNA) and relational coordination (RC), offer complementary but rarely integrated perspectives. SNA provides structural insights into how people or entities are positioned and connected within a broader system that matter to system performance. RC provides insights into the relationship and communication ties through which work is coordinated, from teams to ecosystems, how these ties drive outcomes, and how the design of organizational structures supports or weakens these ties.

This study demonstrates the value of integrating RC and SNA by applying SNA techniques to existing RC data collected during a relational change intervention study aimed at violence reduction. This intervention study involved 102 respondents from four Massachusetts cities, with two receiving the RC intervention and two serving as control sites. For each city, we construct a bipartite network wherein one mode represents organizational respondents and the other mode represents the roles played in the work process (thier work role). We then adapt these bipartite networks for use with the igraph and ideanet R packages to produce novel analyses and visualizations of existing data.

Integrating SNA with RC provides additional insights into relational processes and system dynamics underlying interorganizational initiatives. Network visualizations provide intuitive maps of relational dynamics that support cross-site comparisons and hypothesis generation. Bipartite networks reveal how organizations in the cities variably engaged in and rated specific initiative roles.

Node-level metrics (e.g., centrality) help identify key work roles within the system. Betweenness centrality highlights bridging roles, whose good RC link otherwise siloed or weakly connected subgroups, facilitating the flow of information across boundaries. Degree and eigenvector centrality underline highly connected and influential actors who can anchor an initiative and promote alignment across participants.

System-level metrics (e.g., centralization, clustering) treat each research site as a whole network, allowing comparison across cities in our study. Highly centralized networks concentrate interactions around a few dominant roles, which can enhance coordination efficiency but also introduce vulnerability if those roles are lost or overloaded. Sites with high clustering coefficients tend to have tightly knit subgroups useful for localized coordination but risk fragmentation if cross-cluster ties are weak. These patterns show variation across sites in terms of collaboration, siloing, and potential polarization.

Finally, network role analysis can identify shared structural positions in networks across sites, illuminating how work roles may experience common or different communication or relational challenges across different sites.

Our study shows that integrating SNA with RC data deepens understandings of both individual experiences and system-level functioning. Although our current analysis is limited to RC among work roles, network-based RC approaches can also be applied to individual-level data within those work roles to explore multilevel relational structures. This expanded approach supports the design of more targeted, tailored, network-aware interventions that can account for both the work roles and the social roles of interdependent actors.

Author: Jim Best (Independent Consultant)

At its core, Mary Parker Follett’s concept of integration is about building relationships with sufficient capacity to develop generative communication across differences to achieve better outcomes together. RC theory provides a multi-level framework for understanding how seven dimensions of relationships and communication at the role-to-role level of analysis predict better outcomes for tasks requiring coordination especially under conditions of uncertainty and time pressure. The RC Survey provides a role-to-role map that is a powerful sensemaking tool supporting transformation at that level. However, there is much less multi-level visibility in the literature about the impacts on role-to-role RC by the personal attitudes and relationships of the members between themselves and about the roles. As scholars and practitioners this leaves us wondering what are the critical elements at play at the individual and person-to-person levels that result in increases in RC between roles. Theories of change at the personal level could be tested if there were tools to make personal attitudes and relationships visible.

Using iterative survey questions that capture activity, attitudes, and relational qualities beyond the seven RC dimensions, Social System Mapping (SSM) is a tool that can test theories of change that support increases in RC at these more granular levels and visualize this important data and the patterns that evolve over time. Even more importantly, using SSM is itself a tool of transformation for the people mapping themselves and making sense of the maps as they see the whole, their place within it, and beyond their network horizons.

Examples of specific theories of change at the person-to-person and person-to-role levels are described and how they can be visualized using a Social System Map. Focus Theory (Homans; Feld) – common foci (shared goals) between individuals lead to activities in which the interactions (sharing knowledge, problem-solving communication) tend to develop positive sentiment (mutual respect) Shared goals v. mutual and specific inter-personal goals – motivators are perhaps stronger the closer they are to the individuals at the person-to-person level. Structural Balance Theory (Heider; Cartwright & Harary) – the network dynamics and forces of positive sentiment in a mesh of triads and across levels gives us the chance to rethink what might have happened if Romeo and Juliet had been stronger influencers among the Montagues and Capulets causing them instead to rally behind the lovers and resolve the animosity between families. One might hypothesize a similar dynamic when a highly-respected influencer in one role intentionally expresses positive sentiment and co-creates with another highly-respected influencer in an adversarial role. This creates structural tensions at the person-to-person and person-to-role levels that tend to resolve as the members of each role adjust by softening their negative view of the adversarial role to align with the influencers new relationship, thereby increasing role-to-role RC.

The SSM can visualize these person-to-person and person-to-role sentiments in a time-series as they change during an intervention or in response to some change in context. Whatever factors the scholar or practitioner hypothesizes are relevant can be added to the network survey and the patterns of change visualized. The original person-to-role RC survey data can be anonymously mapped leveraging data already collected. The increased visibility at these personal levels promises to stimulate theorizing on factors and processes underlying the role-to-role dynamics of RC and contribute to more transformative and focused interventions.

Author: Jimmy Belotte (Glaxo Smith Kline)

Background: Organizational structures shape how work is coordinated and outcomes are achieved. This study applies the Relational Coordination (RC) framework, incorporating the Organizational Structure Assessment Tool (OSAT), to evaluate team dynamics in an oncology clinical development unit of a large pharmaceutical organization. The objective was to assess the applicability of this tool in this setting and gather insights on how structural dimensions support or hinder performance across two clinical matrix teams.

Methods: Two Phase 2 non-registrational studies were analyzed—Study A (single-arm, U.S.-only, post-primary endpoint) and Study B (global, randomized, pre-primary endpoint). A modified OSAT was used in a virtual and global workspace to rate dimensions such as teamwork selection, training, leadership, shared space, and rewards (Figure 1). Quantitative and descriptive statistics were generated based on numerical and color-coded interaction scores.

Results: Both teams demonstrated moderate to strong overall performance (Table below). Key findings include:
- Study A: Mean score 3.7 ± 0.8; strongest dimension was "Selection for Teamwork" (mean = 4.3), suggesting a dedicated effort for talent selection. CS, MM, and LDL functions had highest functional scores, indicating the depth of RC in these teams.
- Study B: Mean score 3.73 ± 0.79; strongest dimensions included "Selection for Teamwork" (4.5 ± 0.53), "Training for Teamwork" (4.0 ± 0.94), and "Relational Leadership" (4.1 ± 0.74), indicating dedicated effort for talent selection, development beyond the study teams. Lowest-scoring dimensions were "Shared Space" (3.3 ± 0.82) and "Shared Rewards and Outcomes" (3.2 ± 0.79), reflecting the features of hybrid work setting and opportunities for change.
- CS function scored lower in Study B (3.4 ± 0.51) compared to Study A (4.1), may indicate study specificity.
Metric Study A Study B
Total Mean Score 3.70 3.73
Total Standard Deviation 0.80 0.79
Total Minimum 2 2
Total Maximum 5 5
Total Range 3 3
Total Median 4 4

Conclusion: The OSAT, applied via the RC framework, provided measurable insights into team dynamics within oncology clinical development. Structural dimensions such as relational leadership and teamwork selection are robust dimensions and may be key contributors to performance. Identified gaps—particularly in shared rewards, space, and select functions (e.g., S&P, LDL, CoAL)—highlight areas for targeted intervention. Expanding OSAT application to upper management may further enhance relational performance and organizational effectiveness.

Author: Daniel Moriarty (Ingleside Group)

The Rolfe et al. reflective model, often called the “What? So what? Now what?” framework, is a simple yet powerful tool for structured reflection. Developed by Gary Rolfe and colleagues in 2001, it is widely used in nursing, education, and other professional development settings to support reflective practice.

This model has strengths and limitations. Its strengths include simplicity and clarity; adaptability for use in personal reflection, team debriefs, and formal professional development; and an action-orientation that moves beyond mere understanding toward planning and action.

Its limitations include: a risk of superficiality; a lack of theoretical underpinning unless theories or broader frameworks are added; and a linear format that can limit or “flatten” real-life reflections into a tidy progression.

This work proposes to improve upon and adapt the model for use as “scaffolding” for information design, and to encourage greater numbers and types of individuals to interact with research papers and studies, encouraging interdisciplinary collaboration. These aims recognize an inherent challenge with respect to academic studies: non-academics rarely read them, while fellow academics and researchers are likely to approach them instrumentally. The information design method described in this abstract proposes to “disrupt” how people interact with academic research papers and studies and directly supports Relational Collaboration.

Building from private consulting practice and decades of professional experience in management consulting, I have refined an innovative information design method that fuses the Rolfe et al.’s model with gestalt design principles and creative diagramming and document editing skills. This produces a visual structure as follows:

Layer 1 (What?) allows for different zoom levels, from baseline map (an objective representation of events and structures.)

Layer(s) 2 (So what?) one or more layers provide an interpretive overlay (where it is possible to capture the “lived experience of different stakeholders, including tensions, pain points, meaning, impact zones, and relational dynamics." This layer is the most powerful as it challenges a single authoritative narrative and promotes a more nuanced understanding of complex situations.

Layer 3 (Now what?) provides a canvas to design responses to Layer 2 interpretations, including innovative pathways, decisions, next steps and interdisciplinary action planning.

Combined, the three layers invite polyvocality that supports dialogical thinking, co-reflection and shared sensemaking.

This information design method reveals progression and depth by casting Rolfe et al.’s three reflective stages into visual and cognitive scaffolding of technical information, using graphical techniques such as the use of iconography, foregrounding and backgrounding, magnification, proximity and contrast. It displays the evolution of meaning, from observation or description to interpretation to action. The result is a transformed experience with technical information, moving from informational consumption through reading to informational interaction through dynamic visual and tactile navigation, reflection or dialog. This shift from verbal to visual opens new pathways for visualizing collaboration and relational coordination by moving beyond propositional knowledge and tapping into embodied cognition, including a sense of belonging within a given context.

Thus, information design offers a powerful new tool for bridging cognition and collaboration in complex, multi-stakeholder environments.

Author: Steven Tizio (Riverview Medical Center)

Summary: Shared accountability and shared goals between physicians and nurses are critical for effective clinical teams, yet these factors appear to be lacking on the medical/surgical floor in my hospital. A contributing problem seems to be the finger pointing, rather than problem solving, following the reporting of errors on the ONELINK electronic reporting system used in the hospital. In this abstract, I will discuss how I used the implementation of the Enhanced Recovery After Surgery (ERAS) pathway to improve shared accountability and shared goals between physicians and nurses on a colorectal surgery unit, drawing on several change frameworks including the relational model of organizational change.

Context: The ERAS pathways improve return of bowel function by decreasing the use of intravenous fluids, limiting narcotics, early ambulation, and early resumption of diet. There is also data showing that ERAS pathways decrease length of stay and decrease complications. On this basis, our health system requires all 18 hospitals to use ERAS pathways available in the new EPIC system. However, a major obstacle is getting the surgeons to change their postoperative paradigm. Thinking innovatively, I decided to use the implementation of the new ERAS system to empower the nursing staff and improve shared accountability and shared goals between physicians and nurses on a colorectal surgery unit in which I worked.

Methods: Initially, I used the Kotter 8 Step Model to implement the ERAS pathway. There was a sense of urgency to improve colorectal length of stay and ultimately decrease complications. The Director of Clinical Nursing and the Quality Officer became my early change team. One hospital floor became the colorectal surgical floor with the nurse manager and the nurse educator to support the new pathway. The ERAS pathway went live October 2024. While creating the change team, I also drew on the relational model of organizational change and created relational maps showing all the interactions between the patient and the caregiver team. Throughout the implementation of the pathway, we used Plan-Do-Study-Act cycles to create short term wins. We are now analyzing the length of stay data compared to patients who are not in the pathway.

Key Findings: We found that we were missing shared accountability. The physicians and nurses are now working together to run the pathway, ultimately sharing the boundary spanner role. For our first 9 patients, we decreased our length of stay from 5.22 to 3.33 (national average 4.38) days. We used this pathway for elective colon resection patients who were admitted day of surgery, not all patients. Only one surgeon is using the pathway, not the entire surgical department.

Implications for Action: We expect our experience will encourage all surgeons to use the ERAS pathway and that improved length of stay data can be translated into revenue gained. This should allow hospital administrative support. The ultimate goal is to benefit the patient, which was one part of the Relational Map with complete agreement amongst all providers.

Authors: Tricia Boulton (Utah Pediatric Trauma Network), Katie Russell (Utah Pediatric Trauma Network) & Angie Ingraham (True North Patient Advocates)

Summary: The Utah Pediatric Trauma Network (UPTN) was founded in 2019 to establish a statewide network, inclusive of all regions and hospitals in Utah. The Network collectively implements injury prevention initiatives, evidence-based best practice, and transfer guidelines to improve outcomes for pediatric victims of trauma, to decrease the financial and personal cost to the families of Utah. Context The UPTN will benefit from relational coordination by improving the integration of information and collaboration through and across all disciplines and roles involved in pediatric trauma care. Relational coordination improves fostering shared goals, mutual respect, and timely communication; This can help reduce fragmentation, increase trust, and align coordinated work across the entire state. This model increases integration of health system structure, increasing consistency in applying clinical guidelines, improving patient outcomes, and optimizing the experience of families and providers. This shifts the paradigm from individual trauma centers to a true unified statewide system of care network.

Methods: The first iteration of this project involved constructing a relational map to pinpoint stakeholders and their interconnections within the UPTN which includes trauma surgeons, trauma program managers, emergency physicians, program managers, EMS, and administrators from affiliated organizations. This exercise assisted us in mapping out the relationships and pathways of communication within the network. In the next stage of the project, we will apply the validated RC Survey to evaluate the level of communication and relationships among the stakeholders. Based on the results from the surveys, we will implement the RC 6-step process focusing on building communication frameworks alongside defining shared goals to enhance network collaboration as defined by the survey outcome. This approach is aligned with the intended outcome of improving integration and fragmentation within the system towards coherent coordinated trauma services across the state.

Key Findings: The initial mapping outcomes suggest that there is a widespread existence of roles, responsibilities, and engagement across the sites as an indication of both existing strong partnerships and weak connectivity. We expect that participants will identify gaps related to the communications that have value, shared understanding, and respect to others and especially within higher resource trauma centers and with small or rural facilities. Such understanding will inform actions during the RC 6-step process supporting prioritization of relationship-building interventions across disciplines and geography.

Implications for Action: This project serves as an innovative implementation of relational coordination theory in a pediatric trauma network covering an entire state. By focusing on the relationships and communication in the system, we hope to enhance care integration and uniformity across all the participating sites. Our vision is to construct the most comprehensive pediatric trauma network in the nation and offer a model blueprint for other states or health systems aiming to enhance trauma care outcomes through a design based on relationship-centered systems.

Author: Jillian White (WellSpan Health

Operating rooms are intricate environments that demand effective communication and collaboration to ensure safe and efficient patient care. The WellSpan Good Samaritan Hospital operating room currently faces a range of systemic and cultural challenges that have diminished operational efficiency and lowered staff morale. These issues have resulted in declining surgical case volumes and increased staff turnover. Reduced volumes, compounded by inefficiencies and higher turnover, are adversely affecting patient outcomes, hospital throughput, and operating revenue. In the face of rising operational costs and decreasing reimbursements, achieving operational excellence is vital for financial sustainability and for fulfilling our commitment to serving the residents of Lebanon County.

We continue to observe declining volumes in key specialties such as orthopedics, urology, and cardiovascular services. Additionally, operating room efficiency has been further challenged by the closure of our outpatient surgical center, leading to a greater influx of cases into an already constrained acute care environment. Recent leadership transitions, insufficient accountability, and siloed operations have contributed to a negative workplace culture, resulting in multiple resignations over the past year.

To address these concerns, we are leveraging relational analytics as the foundation for redesigning our operating room systems to drive performance and improve outcomes. By utilizing insights from relational coordination mapping and organizational structures assessment, we have identified several friction points between staff groups, highlighting significant opportunities to enhance organizational structure and collaboration. This data-driven approach informs targeted changes such as the reallocation of block schedules, comprehensive evaluations of interdepartmental relationships, and a renewed focus on fostering a positive organizational culture.

Specific areas of measurement during this study include first case on-time starts, room turnover times, length of stay for surgical patients, total case volumes to budget, employee engagement scores such as “would recommend as a good place to work,” and operating room staff turnover rates. These metrics will guide our efforts in achieving operational excellence and meeting key performance goals, including improved turnover times, higher block utilization, reduced staff turnover, and increased employee engagement.

Authors: Dorna Hairston, (Johns Hopkins University), Elizabeth Tanner (Johns Hopkins University), Erin Abu-Rish Blakeney (University of Washington) & Ginger Hanson (Johns Hopkins University)

Summary:  Teamwork is essential for delivering effective, safe inpatient care; however, it is a complex process, requiring coordination across roles and disciplines. This study examines teamwork in interprofessional health care team (HCT) members on an inpatient stroke unit using the Relational Coordination Scale (RCS) and psychological safety (PS) and develops, implements, and evaluates an adapted model of Interprofessional Bedside Rounding (IBR), using baseline assessment results. We will discuss IBR model with RCS adaptation in stroke care during a “Shift-and-Share” session.

Context: Effective teamwork improves quality and safety in clinical care delivery. Although interprofessional education (IPE) is included in health professions curricula, most interprofessional teams lack specific team training. Relational coordination theory proposes that relationships of shared goals, shared knowledge, and mutual respect help to support frequent, timely, accurate problem-solving communication, which enables coordination of work across boundaries (Bolton, Logan, Gittell, 2021). Thus, assessment using the Relational Coordination Scale and Psychological Safety provides a framework for a model of team collaboration.

Methods: We measured baseline teamwork (RCS) and PS and applied findings, adapting and implementing a scripted model of IBR to stroke care context. Following one-year implementation, we conducted individual phone interviews using a semi-structured interview guide assessing RC-teamwork (quality of relationships and communication). 22 stroke team professionals participating in the new model of IBR (15 attending physicians and trainees, 6 registered nurses, and 1 pharmacist) were included. Qualitative analysis was conducted.

Key Findings: The baseline RCS teamwork score (including all unit clinicians) was 3.83, indicating moderate unit coordination patterns. The frequent communication domain scored best (4.07, strong); the shared knowledge domain was weakest (3.44, weak), with all others moderate. Typical with RCS results, intra-professional scores were higher than interprofessional scores. Therapists, social workers, and pharmacists had the strongest intra-professional relational coordination (RC), while attending physicians, case managers, medical trainees, and nurses had moderate intra-professional RC. Interprofessional RCS results showed non-reciprocal ties: between attending physicians and RNs; pharmacists and therapists; medical trainees and case managers. Regression models indicated that inter-professional differences in RC were mediated by psychological safety.

Adapting the IBR model, we targeted RC domains and specified assigned speaking roles for each professional workgroup, using strategies to enhance mutual respect and planning goals of care with all present to hear and contribute to shared teamwork.
After one-year of implementation, semi-structured interviews indicated that IBR practice improved teamwork. Physicians expressed high collaboration and valued a team approach. Most participants knew their roles and were comfortable speaking, although some new nurses spoke only when invited. Nurse attendance was inconsistent; however, nurses reported learning valuable information, enhancing competence with providing timely care.

Implications for Action: While most stroke unit professionals viewed the IBR model positively, challenges still exist. To improve team collaboration, nurse participation must be consistent; the importance of nursing contributions should be emphasized, and communication strategies should be taught and practiced improving mutual respect and psychological safety. We will conduct follow up evaluation using the RCS and PS to guide IBR model implementation and improvement of outcomes.

Author: Heidi Sjoberg (Veterans Administration Seattle-Denver)

Background: Veterans who receive care both within the Veterans Health Administration (VA) and in the community often face poorly coordinated services, leading to adverse clinical outcomes, unsatisfactory experiences, and increased costs. Evidence-based care coordination programs are available in the VA, but their implementation has been challenging for Veterans with moderate to complex needs. The Quadruple Aim Quality Enhancement Research Initiative (QUERI) program was developed to enhance advanced care coordination for Veterans with complex case management, home health care, or multidisciplinary pain management needs. Grounded in the theory of Relational Coordination (RC), the program aims to foster high-quality communication and collaboration within and between clinical teams through the adoption of Relational Facilitation as the primary implementation strategy. This abstract details the Relational Facilitation implementation strategy and its impact on the Quadruple AIM outcomes.

Context: The Quadruple AIM QUERI Relational Facilitation strategy was implemented by three facilitators, each trained in RC and possessing backgrounds in social work, nursing, and psychology. From 2021-2025, the virtual strategy supported three national care coordination interventions across 15 VA medical centers. The implementation team adhered to the six-steps outlined in the Relational Facilitation Guidebook: 1) Identify team roles and responsibilities, 2) create a relational map, 3) rate RC within and between roles, 4) assess the larger team network using the RC Survey, 5) establish RC-related SMART goals based on RC Survey findings, and 6) evaluate the impact of Relational Facilitation using the RC Survey 6-9 months after the implementation of SMART goals.

Methods: The Quadruple AIM QUERI is a Type 2 Hybrid Implementation Effectiveness mixed methods study. The RC Survey was administered before implementation and again 6–9-months after implementation of SMART goals. Data were descriptively analyzed for trends and categorized using the RC Index and the seven RC domains, based on a 1-5 ascending Likert scale. Post-implementation interviews are currently being conducted with key site staff to gather their perspectives on the experience and impact of Relational Facilitation on care coordination processes and Veteran outcomes. An explanatory sequential (QUANT qual) mixed methods design will be employed to interpret findings.

Key Findings: Fifteen sites implemented the care coordination interventions supported by Relational Facilitation. Baseline RC Index scores across all sites ranged from weak (2.87) to strong (4.33). Nine out of fifteen sites (60%) completed the follow-up RC Surveys. From baseline to follow-up, RC Index scores improved for 87% of the sites (13/15) by an average of 3.2%, and decreased for 13% of the sites (2/15) by an average of 3.25%. All fifteen sites successfully implemented the care coordination interventions with nine in sustainment. The mixed methods results will be ready for presentation at the Relational Coordination Roundtable.

Implications for Action: Clinical teams need support to implement and sustain interventions in real-word settings. Relational Facilitation, a novel implementation strategy, enhanced RC within and between teams implementing three care coordination interventions. Mixed methods data explaining how and why Relational Facilitation supported intervention adoption and sustainment will contribute to the scientific understanding of the impact or relational-based interventions on care coordination processes and outcomes.

Author: Graham Wright (Brandeis University)

In the US, improved political deliberation and dialogue have often been proposed as an antidote to affective polarization and democratic backsliding. Unfortunately, the most commonly discussed forms of political dialogue are frequently undermined by the very problems they are trying to solve. Deliberative democrats usually conceptualize political dialogue as fundamentally about non-coercive persuasion, which is ineffective in polarized contexts where citizens cannot admit they are wrong without threatening their social identity. Less adversarial forms of dialogue focused on listening and perspective sharing may help to reduce partisan animosity but provide no framework for actually making collective decisions or resolving substantive political conflicts.

Integrative dialogue, first developed in the early 1900s by the philosopher Mary Parker Follett, can help address both of these challenges. In an integrative dialogue opposing parties to work together to co-create a solution that addresses the core interests of all sides. This is done by shifting the debate from the original conflict to the more foundational desires driving that conflict, because even when opposing positions in a conflict are mutually exclusive, the desires underlying those positions may not be.

Integration reflects the same normative principles, and can accomplish the same goals, as persuasion-based deliberation, but is likely to be more effective in situations of extreme polarization because it does not require participants to admit they are wrong and provides a stronger incentive for self-interested citizens to participate. Integration is frequently and effectively used by professional negotiators in legislatures, international diplomacy, and in the business world. Incorporating it into our understanding of political deliberation could help address the current crisis of democracy, in America and elsewhere.

In this session, after providing an overview of an integrative approach to deliberative democracy, I will focus specifically on the role of integrative deliberation in political activism and political communication. This includes opinion pieces in popular media, campaign messaging, slogans and protests, and political dialogue on social media. Under what circumstances could each of these modes of communication promote or frustrate opportunities for integrative deliberation? Under what circumstances does seeking integrative dialogue undermine or reinforce alternative approaches to achieving democratic political change? Answering these questions will help to clarify what concrete roles integration could play in responding to the current democratic crisis in the United States. This session draws on arguments from my recent book “Persuasion, Integration, and Deliberative Democracy: The Will of the Whole.”

Author: Miranda Jane Safir (Brandeis University)

Harm reduction has often required people to form a safe space for participants to keep them returning for safer substance use supplies. Safe spaces in this context refers to a sense of community, which can be established with or without a physical space. This safe space is a function of psychological safety as well as mutual respect.

The success of a harm reduction intervention is partially due to the relationships staff form with the clients. It seems simple, but treating others with respect, care, and concern helps form a bond. This bond can result in people being more willing to become returning clients. By ensuring continued use of a harm reduction program, people can remain in touch with the greater community, check-in with medical professionals, and even get additional harm reduction education. This tie to the community could assist with service delivery, follow-through on service referrals, and be a stabilizing force.

This presentation will be an exploration of existing studies of harm reduction interventions to identify how they have established a rapport with clients and how it has impacted the “success” of the intervention. The methods of measuring the relationships will be detailed. This exploratory analysis will inform practitioners on the impact of creating an inviting space for clients. These potential conclusions can be applied to interventions in a spectrum of disciplines. It does not need to be confined to harm reduction.

Additionally, the concept of mutual suffering as a motivation to utilize services and deliver them will be introduced. Mutual suffering can be a form of motivation for the community to organize to address the negative externalities of substance use. These externalities can have a micro to macro (even meso to meta) impact. They are rarely confined to one level of society. They can serve as motivation to establish an intervention which would assist people who use drugs gain access to treatment for or preventatives for blood borne illness. The negative externalities of substance use are vast and can create a common motivator among people or organizations. Through harm reduction centers, everyone is benefiting from community care.

Author: Fernanda Artimos de Oliveira (Brandeis University)

As of September 2024, over 25 million individuals had been disenrolled from Medicaid, with 69% of these terminations attributed to procedural issues, such as failure to submit required paperwork (KFF, 2025). Access to health care in the United States is heavily mediated by bureaucratic systems that reflect a fundamental asymmetry in functionality: they are swift and coordinated when imposing penalties, yet slow and inconsistent when delivering assistance. Minor administrative issues (such as a missing document) can result in immediate loss of coverage. In contrast, supportive processes, such as coordinating eligibility across providers and insurers, remain underdeveloped.

Individuals who rely on long-term care (especially those with disabilities and complex needs) are particularly impacted by procedural disenrollments, often flagged by automated fraud detection systems deployed in welfare programs. Limited agency to navigate complex systems further exacerbates their vulnerability. Even brief interruptions in coverage can result in adverse health outcomes, including deterioration of chronic conditions, avoidable hospitalizations, and financial hardship.
This asymmetry (burdensome when delivering help, efficient when imposing harm) is built into the system. Bureaucracies are not naturally inclined to detect and minimize burden (Herd & Moynihan, 2018), especially given the complexity and fragmentation across multiple levels of the American healthcare system. Guided by Relational Bureaucracy (Gittell & Douglass, 2012) as a multi-level framework for change, this analysis proposes a shift from traditional, compliance-driven bureaucratic models toward a relational approach, building on relational coordination and co-production of public service.

This policy analysis explores potential strategies (macro, meso, and street level) to mitigate coverage interruptions and advance equity in healthcare access, focusing on a core aspect of relational bureaucracy: how structures can be (re)designed to support relational processes.

Relational coordination can be achieved through: (i) automatic grace periods and re-enrollment protections for individuals with complex healthcare needs, enabling timely, problem-solving interactions between caseworkers and beneficiaries, minimizing coverage gaps (ii) cross-agency data sharing and integrated eligibility systems, such as coordination between Social Security, disability services, and Medicaid (iii) multi-agency programs, which integrate medical, behavioral health, dual eligibility, and social services through coordinated care teams and shared planning.

Relational co-production actively involves beneficiaries with long-term care needs in shaping and improving service delivery, rather than treating them as passive recipients. Collaboration with disability organizations by incorporating beneficiaries’ experiences, promotes more responsive care. Advocacy groups like Upturn and the Benefits Tech Advocacy Hub can monitor automated welfare systems, expose harms, and push for policy changes. By partnering with these groups, programs can co-create solutions that reduce barriers, humanize AI decisions, and promote fair, accessible systems through coordinated efforts across agencies and stakeholders.

Relational Bureaucracy offers a multi-level framework for change—aimed at rebalancing this asymmetry by fostering connection, responsiveness, and equity within healthcare systems. This study aim to examine a selected natural experiment in the U.S. context, using a mixed methods approach that combines qualitative and quantitative data, analyzing how relational bureaucracy is established within the U.S. health and human services system, what obstacles it faces, and what outcomes it produces.

Authors: Jody Hoffer Gittell (Brandeis University) & Amanda Brewster (University of California Berkeley School of Public Health)

Overview: The healthcare sector has been impacted dramatically by the phenomena creating turbulence around the globe - pandemics, the climate critics, disruptive technologies, war and rising inequality. This turbulence creates challenges in healthcare that differ from country to country but many of these challenges are shared across countries. Some challenges are new; while others have been challenges for years and are now becoming more perturbing due to the turbulent times.

Each of these challenges can be navigated in ways that increase human well-being, or not. Human well-being refers to the well-being of humans and has multiple domains including physical, mental and economic well-being. Human well-being is achieved in connection with other humans and with the earth. “Take the Māori concept of Whānau Ora — meaning ‘well-being of the extended family’ — in Aotearoa, New Zealand, which flips the standard approach to public services on its head. Instead of assuming that an individual’s well-being can be achieved by focusing on the individual alone (the dominant story in the West), it recognises that it’s deeply dependent on the collective well-being. If you want to improve the former, you must then first improve the latter. And if you want a truly thriving society, you must build systems that nourish the entire social fabric, not just patch up its individual threads. The Whānau Ora approach even became integrated into New Zealand’s health and social services in 2010, formalising what its Indigenous communities had long practised.”

Achieving human well-being in a holistic way appears to be at the heart of many healthcare innovations over the years including public health, integrated delivery systems, value based payment, patient centered care, relationship centered care, and attention to the social determinants of health. To what extent have these innovations succeeded thus far in achieving their purpose?

The well-being of healthcare workers is tied to a similar purpose. According to Kedar Mate, former CEO and President of the Institute for Healthcare Improvement: “As a clinician, … my sense of purpose is challenged on a regular basis. Our health care system in the US is designed to secure as much value out of every clinical interaction. This leads to increasing pressure and an emphasis on activities and not on building the relationships that we know are the key to healing and providing more lasting impacts on health. When I am in a clinical practice environment, my desire to spend time developing a connection to someone can run into direct conflict with the need to move to the next activity….”

‘Our purpose as health care professionals is to make people healthier. When the system we are working in gets in the way of that, it undermines our sense of purpose. The things that interfere with us doing what is right for our patients — the things that cause moral injury — separate us from joy and meaning. As health care leaders, we can retreat from these challenges, or we can tackle them head on. We have an obligation to remember that finding and maintaining our sense of purpose as health care professionals is not only a personal quest, but also a collective responsibility. How can we create and sustain a culture that values and supports the human connection between us and our patients, as well as among ourselves?"

Building on these ideas, we will seek feedback from Roundtable participants on the opening chapter for a forthcoming book called Healthcare Management and Human Well-Being in a Turbulent Era.

Authors: Ingrid Nembhard (The Wharton School), Vicky Parker (University of New Hampshire) & David Rosenbloom (Boston University School of Public Health)

Overview: How can health system leaders, in collaboration with payers, policy makers, staff, patients, families and communities, navigate turbulence successfully and with clarity of purpose?  We will share ideas for the concluding chapter - Leading Change in a Turbulent Era - of a forthcoming book on Healthcare Management and Human Well-Being in a Turbulent Era.  We will be seeking feedback from Roundtable participants.

Facilitator: Kartik Trivedi (University of New Hampshire)

As large language models (LLMs) such as ChatGPT, Claude, and Gemini are increasingly integrated into research workflows, social scientists must navigate both their immense potential and the inherent risks associated with them. These models can accelerate tasks like text generation, summarization, classification, and qualitative coding, but they also raise concerns related to bias, reproducibility, epistemic authority, and transparency. This workshop equips participants with the conceptual foundations and hands-on skills necessary to use responsibly, audit, and critically engage with LLMs in social science research, while co-creating scenarios applicable to relational coordination.

The first half of the workshop introduces participants to the dual role of LLMs as tools and objects of empirical investigation. We will explore emerging use cases, including AI-assisted content analysis, and audit studies that evaluate bias in model responses. Participants will be introduced to the basics of model behavior, including temperature, sampling variance, and model-specific quirks. A special focus will be placed on prompting strategies, how changes in wording, formatting, or structure can lead to significantly different outputs, and how these effects can be systematically studied. We will cover prompt engineering tactics such as few-shot prompting, role framing, instruction tuning, alongside their methodological implications for experimental control, interpretability, and validity.

The second half of the workshop consists of a hands-on lab using Qually, an open-source LLM auditing tool developed for social science applications. Qually enables researchers to design controlled experiments across prompt variations, model types, and parameter settings. Participants will learn how to structure experimental prompts and create condition groups, configure and run batched model queries across different LLMs, and export outputs for downstream analysis (e.g., human coding, ratings, text classification).

Key learning objectives of this workshop include understanding the opportunities and limitations of LLMs in social science research, including ethical and methodological considerations. Also, to learn how to design effective and interpretable prompts for various research tasks, and how prompt variations impact model outputs. Further, participants will gain experience designing and executing LLM audit studies, with a focus on replicability, fairness assessment, and model comparison.

Participants will interact with sample data and multiple large language models (LLMs) to gain a deeper understanding of LLMs' applications in social science research. The workshop will include a live demonstration of how prompt changes influence LLM behavior, small-group discussions on prompt design, and experimental framing. Correspondingly, participants will design audit experiments using Qually with shared or custom prompts. And if time permitting, participants will work on collaborative mini-audit projects designed during the session. Along with a critical understanding of the scope of using LLMs in social science research, participants will leave with a toolkit for designing LLM-based studies, auditing model behavior, and critically leveraging generative AI in social science research.

Facilitator: Lester Fitzgerald Bussey (Virginia Health Sciences)

"Change doesn't begin with strategy. It begins with people working together with awareness and purpose." —Bussey, 2025

I am a 58-year-old human who was born black and gay. As an OB-GYN and PhD candidate in Health Professions Education, I developed the Spiral Mirror- a relational framework born from rupture and reimagined through reflection. The Safe Motherhood Initiative in the U.S. has had a complex and, in many ways, disappointing impact. While it has spurred important improvements, the rising maternal mortality rate and persistent disparities indicate that its goals are far from realized. A more holistic and equitable approach, targeting systemic issues and social determinants of health, is crucial to reversing the current trend and ensuring that no one dies from preventable causes in childbirth. The heightened attention to these issues in recent years offers a hopeful outlook for future progress. In a postmodernist world where knowledge, memory, and meaning are created socially, I argue the lived experiences of marginalized birthing individuals mirror the experiences of marginalized faculty and trainees in OBGYN.

The Spiral Staircase, an autoethnographic relational intervention in theory, pedagogy, and lived experience. The planned workshop is a 90-minute multimodal learning experience that combines storytelling, music, and systems theory to explore how power, identity, and relational structures shape belonging in educational spaces. The workshop centers on Dr. Evander Cross, whose journey reflects patterns of marginalization, resistance, and transformation in academic medicine.

The Spiral Staircase is the first module of a 7-month blended curriculum designed to cultivate inclusive excellence in OBGYN. Using ClassPoint's interactive platform, participants respond to structured reflection prompts at each stage of the spiral. Digital engagement captures emotional responses during the session. The data inform post-session emotional mapping through mixed-methods social network analysis, revealing how emotions function as relational bridges or barriers in health professions education. This is not a checklist-style DEI training. It is a relational learning experience grounded in performance, vulnerability, and empirical insight. Participants leave with clarity about their role in building just, inclusive learning environments where belonging is cultivated, not presumed.Learning Objectives.

By the end of the session, participants will be able to:
1. Experience how story, sound, and multimedia design can foster reflection and relational insight.
2. Apply the MICRS framework (Motivation, Identity, Collaboration, Respect, Safety) to analyze relational dynamics in educational and clinical teams.
3. Understand the role of emotional mapping in evaluating affective engagement and relational barriers.
4. Reflect on their own positionality and opportunities for inclusive leadership in their spheres of influence

Facilitators: Carolyn Ordowich (Sociotechnical Systems Associates), Douglas Austrom (Indiana University) & Erik Nicholson (Pandion Strategy)

Learning Objectives of the Workshop
1. Explore the convergence of a relational model of change and contemporary thinking on open sociotechnical systems (OST), Dynamic Deliberation Designing (3D), grounded in three diverse cases with wide applicability: a manufacturing site (GE Aviation Bromont), a government agency (Indiana Department of Revenue/DOR), and cross-sector coordination in agriculture (Semillero de Ideas).
2. Identify the key synergies between relational models of change and OST/3D designing for the future of work and our workplaces.
Interactive Elements of the Workshop: After an overview of OST/3D designing and the first case, the DOR cultural transformation (20m), participants will engage in the first round of breakout group discussions on common themes and implications for their work on relational models of change (25m). This will be followed with the Bromont and cross-sector collaboration cases (20m) and a second round of breakout group discussions and whole group discussion of the common themes and implications for research and practice (25m).

Conceptual Foundation of the Workshop: The goals of relational coordination and sociotechnical systems designing are to achieve a healthy balance between humanity and technology, making organizations more sustainable, efficient, and innovative while ensuring high quality of working life for all participants in the system. Given the ever-increasing complexity and velocity of change coupled with the changing nature of work from routine, manual labor to non-routine, knowledge work across virtually all industries, we propose an interactive exploration of the relational model of change and a model and process of work design based on OST first principles and dynamic deliberation designing.

A pre-requisite for a dramatic cultural transformation is an organizational mindset shift (Schein, 2010). To that end, we have identified OST first principles as the foundational mindset for the humanity-centered design of work systems (Austrom and Ordowich, 2024). This mindset shift was evident in the dramatic cultural transformation of the Indiana Department of Revenue, in GE Aviation Bromont’s alternative work system of self-managing teams in a participative governance structure and in Semillero de Ideas engagement of agricultural workers across the US and Mexico as knowledge workers. Furthermore, these OST first principles serve as the foundation for the numerous STS design principles that reorient enterprises toward trust, respect, and care for workers and a move from top-down, transactional coordination to relational coordination systems (Gittell, 2009), especially the foundational principle of respecting people as people and not viewing them instrumentally.

Recognizing the structural shift from predominantly routine manual work to nonroutine knowledge or cognitive work, Cal Pava astutely identified deliberations as the fundamental unit of knowledge work analysis, which he defined as: reflective and communicative behaviors concerning a particular topic. They are patterns of exchange and communication in which people engage with themselves or others to reduce the equivocality of a problematic issue (Pava, 1983 ). As such, knowledge advancement fundamentally occurs via relational and deliberative interaction.

Facilitator: Lynn Snow (The University of Alabama & Tuscaloosa VA Medical Center)

Introducing an innovation in any complex system is a wicked problem we all face regardless of industry or sector. In this workshop, participants will engage with role plays designed as experiential learning tools that allow team members to embody key team roles, coaching competencies, and development principles. We will introduce our method of grounding the role plays in context-specific assessments and competencies for coach capabilities, which provides a dynamic method to support the implementation of innovation in complex systems. Our approach is guided by a blended approach integrating relational coordination theory with the systemic team of teams coaching framework (Hawkins & Carr, 2025), which emphasizes working side-by-side with teams and organizations as a developmental partner. Our examples come from two ongoing federally funded clinical trials in complex healthcare settings.

This interactive workshop includes three learning objectives: 1) Participants will develop knowledge around systemic team of teams coaching and how it can help embed relational coordination innovations in complex healthcare environments; 2) Participants will develop knowledge around how coach and team assessments of competencies and capabilities can be created and used to advance context-specific implementation objectives; 3) Participants will apply a role play framework to achieve skill development and mindset shifts.

Our interactive workshop agenda includes:
• 10 m – Presentation & sharing: developing relationship between presenters and participants
• 10 m - Think, pair, share: discuss with your partner and then the group the innovation implementation/sustainment challenges in your setting
• 10 m - Presentation: overview of possibilities when using team coaching and competency/capacity assessment
• 10 m - Table discussion and share out: discuss experiences around innovation work especially using coaching and facilitation and developing and using competencies
• 15 m -Presentation: Introduce role play / simulation best practices and how we innovate by integrating relational coordination and team coaching elements to bring multi-vision lenses to the development experience. The multiple perspectives and experiential elements we focus on include: team members, team as a whole, team coaches, and the larger system. The framework encompasses the role play, debrief, and feedback to co-design space for the awareness to emerge, insight to spark, and intention toward action to occur. This approach results in role plays that can be customized to represent important aspects of your world and create small experiments for learning and feedback.
• 20 m – Role play: tables of 8 will choose between 2 role plays and engage in a role play with everyone taking on assigned roles to include a team coach or facilitator, team leader, team members, and 2 – 3 observers (each with different lenses, e.g., the voice of the team, the voice of an unrepresented stakeholder)
• 15 m - Debrief, Q&A

Participants will leave with role play competency and role play frameworks and templates to apply in their own work. Participants will leave understanding how clarity around team and coach competencies and capacities can serve to guide flexible enactment in volatile and uncertain environments. Participants will experience how role plays founded on relational coordination framework can guide breakthroughs in communication, relationship, and interdependence.

Author: Andre Morgan (Beverly School District)

The Commonwealth of Massachusetts is widely viewed as having some of the highest achieving schools in the U.S. (CBS, 2022; Tucker, 2016), supported by recent and prior data and rankings. Massachusetts students have and continue to achieve top scores on the National Assessment of Educational Progress (NAEP), also known as the “Nation’s Report Card.” In 2024, Massachusetts ranked #1 in the nation for overall NAEP scores, including the highest numeric scores in all four assessments; fourth-grade math and reading, and eighth-grade math and reading. Previously, Massachusetts high schoolers were among the top-performing students in the world, according to the results of the 2012 and 2023 Program for International Student Assessment (PISA) and the Trends in International Mathematics and Science Study (TIMSS ) assessments (von Davier et.al, 2024; Khalid, 2013).

While Massachusetts leads the nation in overall academic performance, there are achievement gaps between different student groups, particularly based on race and socioeconomic status. The Commonwealth’s public schools are not succeeding for all students and its successes are juxtaposed with stubborn achievement gaps between different student groups. In 2016, the Commonwealth’s achievement gap was the third-largest achievement gap in the U.S. (Rosen, 2016). In 2024, the Commonwealth’s achievement gap became the second largest in the U.S. (CEPR, 2024). In an effort to reach students who are not being well served by the Commonwealth’s current public education system, public school districts are employing numerous services for different student groups. In a recent survey created by the Massachusetts Business Alliance for Education (MBAE), 75% of respondents reported difficulty in hiring employees with the right skills; 72% of respondents agreed public schools have to change how they serve students in order to help them meet workforce needs. In summary, Massachusetts employers desire to hire students who graduate from the Commonwealth’s high schools, but are not convinced that students are graduating with the skills necessary to be successful in a 21st century job market (MBAE, 2023).

Perhaps the widening achievement gap can be attributed, not to post-COVID impacts (as Commonwealth public schools note), but to the attempts by practitioners to correct racial and socioeconomic inequities, without applying a diversity lens. As long as the work of diversity is absent from the work of eradicating systemic inequities, closing achievement gaps in the Commonwealth of Massachusetts, and in public school districts across the U.S., will remain a goal deferred.

This research will suggest that in order to best deliver on closing achievement gaps with student groups, particularly based on race and socioeconomic status, the education sector may need to consider and utilize a different set of options. One option in particular includes the work of Relational Coordination, a (research-based) process of communicating and relating for the purpose of task integration (RCC, 2025).

This model will be implemented in two public schools, in two school districts, in Massachusetts. Through a Relational Coordination model, school district personnel and other stakeholders may: 1) understand and integrate a complex definition of diversity; 2) impactfully address and begin to close stubborn achievement gaps between different student groups; and 3) create authentic culturally responsive schools and classrooms. Closing achievement gaps will help to ensure that each student served in public education, has an opportunity to succeed tomorrow in a stronger America.

Author: Jeffrey Grim (George Mason University), et al

 

Author: Jessica Chaikof (Brandeis University)

In their pursuit of higher education, students with disabilities encounter numerous obstacles, ranging from the stigma associated with being disabled to a lack of support and access from institutions. Current research has spotlighted the barriers these students face as they navigate their academic experiences. However, disabled students are not the only ones struggling and feeling silenced due to insufficient support; accessibility/disability service providers are also facing challenges. Furthermore, the number of students with disabilities attending college has steadily increased, thus placing additional pressure on the workload of accessibility/disability service offices.

By acknowledging how accessibility needs are organized and executed, we can identify the gaps and challenges that accessibility/disability service providers encounter in ensuring that disabled students can fully access their academic environment. Investigating various levels of the broader system that delivers academic accommodations—especially the relationships among students, faculty, accessibility/disability service providers, and other stakeholders such as policymakers and university administrators—enables us to recognize how bureaucratic structures in higher education influence both these interactions and a disabled student’s ability to gain access. To understand the multiple levels of power and the roles that various stakeholders play in supporting disabled students, the following theories and concepts will be employed: inequality regimes, street-level bureaucrats, relational bureaucracy, and racial tasks.

While these theoretical frameworks emphasize race, class, gender, and professional identity, we can adopt an intersectional lens because they have commonalities concerning the interests of persons with disabilities. To understand how inequalities have persisted, I will build on these theories and concepts to focus on efforts that actively serve to create and sustain an environment where able-bodiedness is treated as standard, a concept I call “ability task.” This concept will enable us to understand how various structures and relationships influence one’s access.

The successful implementation of student accommodations largely depends on the interpersonal relationships among service providers, university administration, faculty, and students, as well as their ability to collaborate effectively within the bureaucratic framework. Gittell and Douglass (2012) refer to these connections as elements of relational bureaucracy, which encompasses three relational processes: 1) relational coordination, 2) relational coproduction, and 3) relational leadership. Relational coordination occurs when accessibility/disability service providers need to collaborate not only with colleagues but also with students and faculty to effectively implement academic accommodations.

However, to ensure that students receive appropriate accommodations, each individual must engage in relational coproduction by combining their collective expertise to identify accommodations that address the students’ needs. While each person holds a distinct role in the higher education hierarchy, they all practice relational leadership through their expertise, with each contributing to the creation of solutions and policies that address accessibility challenges.

When higher education institutions are able to successfully foster the development of these vital relationships through relational bureaucracy within their community, they can enhance accessibility for everyone. By creating a more accessible environment for students with disabilities at their respective institutions, these colleges and universities can serve as models not only for other schools but also for developing policies that support these students.

Authors: Jody Hoffer Gittell (Brandeis University, Relational Coordination Analytics), Wale Olaleye (Brandeis University, Relational Coordination Analytics), Tony Suchman (Relationship Centered Health Care) & Chiedozie Udeh (Cleveland Clinic)

Organizations exist to carry out work that is too complex or too large a scale for individuals to accomplish on their own. This requires specialization of roles and the coordination of specialized tasks, and many critical interdependencies. We know from Relational Coordination Theory (RCT) that working interdependently requires relationships based on a shared purpose that transcends roles, a shared understanding of each other’s work (a systems perspective) and mutual respect for each other’s contributions. These relationships both support and are supported by communication that is sufficiently frequent, timely, accurate and, when problems arise, focused on problem-solving rather than blaming. Together, the relationships and communications make possible the ongoing conversations across the work system through which the participants can keep their goals aligned, maintain a systems view, and share information and feedback to closely manage their interdependence. For those conversations to succeed, everyone must be willing and able to contribute their unique perspectives, which requires trust and psychological safety.

This relational account of how an organization’s work gets done makes clear the importance of differences. Each person’s unique perspectives (including those associated with their various identities) add to the resourcefulness of the group – its capacity for innovation and adaptation. But at the same time, identity differences sometimes give rise to oppressive power dynamics that undermine people’s sense of safety and belonging, interfere with the open sharing of their diverse perspectives and hinder the conversations about shared purpose, systems perspective and interdependence. Individuals suffer (which then extends into the community) and organizational performance is impaired.

To help organizations harness their diversity as a resource, we designed a new approach to diversity and inclusion training that focuses on relationships. Specifically the program helps participants learn the skills they need to:

• Create an inclusive environment for each other, which is beneficial in its own right and also makes it possible for people to bring their differences forward.
• Engage in open and respectful dialog to learn about each other’s identities and differences
• Recognize and interrupt patterns of exclusion and oppression.

We wanted our participants to leave feeling better prepared for situations involving difference and to understand that inclusion and exclusion are universal human experiences. The goal is to establish a welcoming work and care environment not just for disfavored identity groups but for everyone.

Authors: John Paul Stephens (Case Western Reserve University), Amy Bertleff (Case Western Reserve University), Gabriela Cuconato (Case Western Reserve University) & Ragnhild Kvålshaugen (BI Norwegian Business School)

Projects unfold over time and under time pressure, requiring members to coordinate across diverse roles, tasks, and schedules (Chan et al., 2021; van den Ende & van Marrewijk, 2014). Team members often differ in their temporal focus—how much they attend to the past, present, or future—shaping how they interpret tasks and coordinate decisions (Shipp et al., 2009). This variation, or heterogeneity, in temporal focus can complicate communication, disrupt coordination, and undermine project outcomes (e.g., Mohammed & Nadkarni, 2011), especially in role-based project teams where responsibilities and decision-making authority shift as the project progresses. While prior research has examined temporal focus in student or single-organization teams (Gevers & Peeters, 2009; Mohammed & Nadkarni, 2011), we know little about how this heterogeneity unfolds over time or how it interacts with qualitative shifts in project phases.

To better understand this interaction, we conducted a longitudinal, mixed-methods ethnographic study of six large-scale construction projects: five private healthcare projects in the United States (2016–2025) and one public infrastructure project in Norway (2021–2025). Our data include eight waves of relational coordination surveys (Bolton et al., 2021; Gittell et al., 2010) among key roles (e.g., owner, architect, construction manager, engineer), 122 interviews, and observational data from over 650 project meetings.

Preliminary findings from the U.S. projects show that project members consistently rated the timeliness of communication as lower than other relational coordination dimensions (e.g., shared knowledge). Interviews revealed that team members perceive and generalize temporal foci based on roles—e.g., architects are seen as future-focused, while construction managers and trade contractors are more present-focused. These perceptions shape coordination efforts, suggesting that role-based temporal stereotypes may influence relationships and coordination between roles. Qualitative data also revealed that shifts in project phases coincided with shifts in the decision interdependence among project roles over time (i.e., the degree of interconnectedness of decision choices; Im & Rai, 2014) and which roles hold higher decision-making power (i.e., the formal authority or ability to make decisions; Pfeffer, 1981), which highlighted tensions of temporal foci heterogeneity. That is, these shifts in features of decision-making through project phases led to a match—or mismatch—between a role’s temporal focus and its decision-making responsibilities, further influencing processes of communicating and relating in task integration.

Our findings suggest several implications. First, project teams may need to address not only individual-level differences in temporal focus but also role-based stereotypes, requiring intervention in group-based beliefs. Second, the temporal focus of the decision-making roles in a project phase can shape perceptions of timely communication and decision-making. This may explain why and how perceived relational quality, which predicts project performance, varies across project phases. Thus, while some research has identified the importance of temporal leadership across project phases (e.g., planning and reminding; Siddiquei et al., 2022), our study illustrates that it is important to account for how project leadership shifts over time and the fit between project leaders’ temporal cognitions and shifting demands across project phases (Lin & Liao, 2020).

Authors: Erin Sullivan (Suffolk University) & Lauren Hajjar (Suffolk University)

This pilot study examines how three rural communities participating in the Communities of Excellence 2026 (COE) national learning collaborative are implementing integrative, cross-sector solutions to complex, interconnected challenges in health, education, housing, and economic development. The COE model applies the Baldrige Excellence Framework at the community level, promoting a structured, systems-oriented approach to community transformation through collaboration, shared measurement, and stakeholder alignment. Our research investigates how relational structures—leadership configurations, communication practices, and shared goals—support or hinder the adoption of this model and the achievement of measurable community outcomes.

Rural communities often face distinct systemic challenges: limited institutional capacity, persistent disparities in health and education, and constrained local economies. Addressing these issues requires not only integrated strategies but also strong relational coordination across historically siloed sectors. Through qualitative case study methods, this research examines how cross-sector leadership teams—referred to as “community excellence groups”—in three rural U.S. communities organize their work, align strategy, and mobilize action to drive results. Data sources include document review, outcome dashboards, and semi-structured interviews with local leaders across public, private, and nonprofit sectors. We also plan to attend the annual COE conference to enhance contextual understanding.

In this context, the study will provide timely insights into how diverse stakeholders create integrative solutions by coordinating across organizational and professional boundaries. As the COE model matures and the U.S. expands national recognition for community-level excellence (as formalized in the 2022 CHIPS and Science Act), this research will contribute to a better understanding of how rural systems organize for sustained, measurable change.

The study aligns with the Roundtable’s focus on systems thinking, relational dynamics, and integrative problem solving. It emphasizes not only what outcomes rural communities are achieving, but how they are getting there—through structures of collaboration, inclusive leadership, and continuous learning. Findings will inform both practice and theory related to rural resilience, performance improvement, and relational coordination at the community level.

Authors: Emily Woltman (Michigan Value Collaborative), Gan Shi (University of Michigan Medical School), Rohini Perera (University of Michigan Medical School) & Christina Yuan (Johns Hopkins School of Public Health)

Summary: We first examine the factors associated with perceived high versus low relational coordination among community mental health workers and nurses working together to coordinate care related to cardiovascular disease risk reduction for people living with serious mental illnesses. We then characterize how relational, structural, and process-focused interventions were used to facilitate this care coordination among behavioral health home care team members for improved integrated health care in community mental health settings.

Context: Our study setting includes behavioral health homes, which use financial incentives to support community mental health programs in coordinating primary care services for individuals with serious mental illness. Despite the promise of this model, grave disparities in quality and health outcomes persist, with limited understanding of how relational dynamics influence effective care coordination between physical and mental health professionals within these integrated care settings.  In-depth studies examining 1) how relational factors influence implementation of evidence-based interventions that involve high degrees of interdependent work, and 2) how relational, structural, and process-focused interventions could be used to better implement these evidence-based interventions in the field are currently lacking in the implementation science literature.

Methods: We conducted qualitative interviews with 26 nurses and 44 mental health staff from 18 behavioral health homes as part of a needs assessment for a hybrid implementation-effectiveness trial of an evidence-based care coordination intervention. Using thematic analysis, we sought to understand relational, structural, and process-based factors associated with higher self-reported coordination and collaboration among behavioral health home teams. We then mapped our thematic analysis onto the relational coordination framework for each site to understand how relational, structural, and process-based interventions support relational coordination.

Expected Key Findings and Learnings: While this work is ongoing, several relational factors appeared to be associated with higher levels of care coordination, including the brokering role of frontline mental health staff between nurses and primary care teams. Here, nurses and frontline staff actively, though mostly via informal channels, sought to routinize regular interaction and facilitate information-sharing between nurses and primary care providers. Brokering was thought helpful due to the limited time nurses had available to foster these relationships directly. Other important factors for improved coordination were shared meetings between nurses and frontline staff and shared physical space between community mental health organizations. The second part of our project, which is still undergoing analysis, will holistically examine the relational, structural, and work process interventions used to enhance care coordination among these teams.

Implications for Action: Based on our work and expected key findings, community mental health leaders can take concrete steps to improve care coordination by 1) formally recognizing and supporting the brokering role of frontline staff with dedicated time and resources, 2) reserving and protecting dedicated time for brief, regular team huddles and/or meetings, and 3) when possible, promoting the co-location of interdisciplinary team members to facilitate communication crucial for care coordination and building trust.

Author: Ignacio Pavez del Barrio (Universidad de Chile)

Project Summary: Organizational change efforts frequently falter due to insufficient relational integration rather than technical inadequacies. This research addresses the crucial question of how organizations can foster proactive responses to change by emphasizing generative relational dynamics. Specifically, the project aims to develop a theory of positive organizational change by establishing Generative Organizing (GO), defined as a dynamic state of life-enhancing collective functioning, as a catalyst for recipients’ proactive responses to change. This is a longitudinal study (3 waves of surveys) conducted within public organizations in Chile.

Context: I have recently completed the first wave of surveys in the largest public transportation system in the country, and I am finishing data collection in a public hospital. In the case of the public hospital, the Chilean Ministry of Health has launched extensive change management initiatives as part of a large-scale healthcare infrastructure investment plan. Given the noted resistance to change and low adaptive capacities of public hospitals, one of the objectives of this study is to improve public policies in Chile regarding hospitals undergoing substantial strategic transitions.

Methods: Longitudinal, multilevel research design, that includes data collected across three waves from approximately 150 teams. The first wave captures initial perceptions of the change design quality (index composed of top management support, information clarity, participation, and change fairness), generative organizing, psychological empowerment, psychological safety, and relational coordination (those variables vary depending on the site). Subsequent waves will measure perceptions of positive change beliefs, emotional responses, and proactive change behaviors, in order to track recipients’ responses at different stages of the change process. Data analysis employs latent multilevel structural equation modeling to accurately capture complex relationships and ensure rigorous empirical testing of hypotheses.

Key Findings: Preliminary findings from the first wave (N=147) in the institution that operates the public transportation system in Santiago highlight significant variation in perceptions of the initial change design quality across organizational units and hierarchical levels, underscoring critical relational integration challenges. Early regression analyses reveal that psychological empowerment and generative organizing significantly predict higher perceptions of change design quality. Furthermore, results show that cumulative exposure to multiple relational interventions (e.g., structured communication sessions) enhances positive perceptions of change design substantially, mitigating negative hierarchical disparities. In addition, dominance analysis suggests that psychological empowerment and participation in communication interventions at the team level are key predictors, demonstrating the critical role of relational empowerment strategies in successful change management at early stages of the process(*).

Implications for Action: This research highlights generative organizing and psychological empowerment as critical relational states influencing proactive and integrative organizational responses. Practically, these findings underscore the importance of targeted relational interventions and empowerment-focused strategies as actionable pathways for fostering cross-level relational coordination. For practitioners and policymakers, particularly within healthcare systems, these insights might offer strategic guidance on leveraging relational dynamics to enhance organizational adaptability and resilience amidst complex, large-scale change processes.

(*) Note: By the time of the 2025 RCC, I will have findings from the first wave of surveys for the public hospital, where Relational Coordination and Psychological Safety were also measured.

Authors: Alexander Mansour, Matthew Lewis, Nikki Stecker & Anais Tuepker (Oregon Health Science University; RELATE Lab)

Summary: Training chief residents in a family medicine residency program in relational leadership tools shows early promise as a methodology for increasing the communication and collaboration capacity of physician leaders.

Context: The current literature indicates that newly practicing physicians are experiencing the largest gaps in work readiness in competencies related to 1) interpersonal communication skills and 2) ability to work effectively within teams. As the U.S. population becomes increasingly older, sicker, and more complex, the need for healthcare teams to collaborate effectively is at an all-time high. The importance of this skillset for early career physicians is reflected in the existing ACGME Common Program requirements for interpersonal and communication skills in the context of system-based practices. Within graduate medical education (GME) programs, chief residents often serve in a “boundary spanner” role, expected to represent the needs of both program faculty and fellow learners while also functioning as supervisors and liaisons with program administrative staff. The multi-faceted boundary spanning of the chief resident role requires highly skillful relational navigation.

Methods: This pilot program was targeted at enhancing the collaboration skills of chief residents in an academic family medicine program. The program included twenty hours of curriculum focused on:

• developing greater competency in identifying personal and shared values
• integrating values into everyday communication, ranging from low stakes interpersonal conversations to high stakes conflict scenarios
• and clear and empathetic communication regarding institutional policies, challenges, and opportunities for growth

The curriculum was delivered as a two-day intensive prior to the chief residents beginning in their role, and three two-hour sessions spaced over the course of the chief year.

Evaluation and Findings: Due to their ‘boundary spanner’ role, the working hypothesis is that chief residents both learning and applying relational leadership tools offers the possibility for important downstream impact on the overall program dynamics. Three months prior to the end of the academic year, the chief residents in the pilot participated in a Ripple Effects Mapping (REM) evaluation. Following a focus group, a ripple effects map was created and shared with both the program participants and program directors and assistant directors with the invitation for feedback, divergent thinking, and clarification. Outcomes reported separately by both program participants and program leadership included 1) an increased sense of trust between the group of chief residents, program leadership, and their resident colleagues, and 2) for chief residents, an increased sense of resilience and engagement in program leadership duties. Program leadership reported this group of chief residents were 1) more trusted by program faculty due to their noteable capacity for collaboration and 2) that this group of chief residents filled important gaps in understanding between faculty and residents compared to prior chief resident groups.

Implications: Based on the pilot results, integrating training on Relational Leadership tools with a focus on shared values demonstrated promise in enhancing the ability of newly graduated physicians to communicate and collaborate across boundaries in a manner that increased team-wide trust and physician resilience.

Authors: Teresa Cochran (University of Nebraska Medical Center) & Heba Ali (Lancaster University; Relational Coordination Analytics)

Project Summary/ Context: The importance of effective healthcare teams is well established, yet optimal strategies for education and evaluation remain an area of ongoing exploration, particularly in pre-clinical health professions education. The Interprofessional Collaborative Competency Attainment Scale (ICCAS) is frequently used in interprofessional education (IPE) to assess students’ self-perceived team skills across domains such as communication, roles and responsibilities, conflict management, collaboration, team functioning, and patient-centered care. However, direct measures of team dynamics are rarely integrated into IPE. While relational coordination (RC) is associated with high-functioning healthcare teams, it is seldom examined in pre-clinical IPE settings. Health professions students require immersive experiences to develop essential team skills, yet logistical barriers, including scheduling conflicts and geographic distance, often hinder cohesive team formation. Teleconferencing technology presents a viable solution, fostering engagement and providing a structured environment for deliberate collaboration. This study created “tele-teams” of students and stroke survivors over six-monthly visits. The presentation evaluates student team dynamics and cohesion using RC alongside traditional ICCAS assessments in this virtual context.

Methods:  A longitudinal, convergent mixed-methods design formed nine interprofessional tele-teams consisting of students from the University of Nebraska Medical Center, University of Nebraska-Kearney, and Creighton University. Each tele-team consisted of three to four students representing medical nutrition therapy (MNT), nursing (BSN), occupational therapy (OTD), physical therapy (DPT), or speech-language pathology (SLP). Over six-monthly virtual meetings conducted via Zoom, students collaborated with stroke survivors to support progress toward self-selected goals. To evaluate team skills, students completed the Relational Coordination Survey (RCS) after each of the six debriefing sessions. The ICCAS was administered as a retrospective pre/post-project measure at the final session.

Key Findings: Quantitative analysis of data from 32 students revealed significant increases in all subscale scores for pre-post ICCAS (p< 0.001), but there was no significant difference in ICCAS across students’ roles. Similarly, RCS scores showed significant improvement, with a linear effect coefficient of 0.06 across months 1 through 6 (SE=0.016, p<0.001). Accounting for visit number and team as a random effect, the mixed-effects model demonstrated that the MNT group scored significantly lower on the RCS than the OTD- reference group (β = –0.90, p < 0.001). Relational network mapping highlighted student challenges in establishing shared goals, and effective teams experienced cohesion evidenced in alignment on the RCS by the second or third meeting. Implementation of a structured debriefing template, role-modeling, and reflection on team values emphasizing respect for the stroke survivor’s mentorship may have contributed to improved team formation.

Implications for Action: Student team skills significantly improved across professions and institutions in the virtual environment. The RCS captured longitudinal changes indicative of team development in the tele-team setting. This model could expand to additional health professions or populations with chronic conditions beyond stroke. While ICCAS offers a self-assessed snapshot of individual competencies, RCS provides insight into evolving team dynamics. Furthermore, RCS underscores the foundational role of mindset and mutual respect, making it a valuable tool for educators seeking to foster lasting collaboration skills applicable across professional contexts.

Authors: Yujin Lee (UMass Boston) & Anne Douglass (UMass Boston)

Summary of the Project: The Essential Leadership Model (ELM) is a professional development (PD) initiative designed to support center-based ECE programs in strengthening instructional leadership as a driver of continuous quality improvement in high-quality teaching and learning. Informed by Relational Coordination (RC) theory, ELM intentionally integrates RC into the design and delivery of its model. Cultivating RC is a key strategy ELM uses to ensure that leadership practices lead to meaningful improvements for programs.

We will examine the learning opportunities, tools, and routines that ELM offers to help programs build strong RC. Through our discussion, we aim to offer practical guidance on how RC can be integrated into PD models and what it takes to support that integration in practice.

Context: Our recent research found that the impact of instructional leadership on teacher outcomes–such as engagement in collaborative job-embedded professional learning (JEPL) and their commitment to the workplace–is significantly mediated by RC. This means that leadership efforts are most effective when the program has strong RC. RC includes two reinforcing dimensions: the relational dimension (shared goals, shared knowledge, and mutual respect) and the communication dimension (frequent, timely, accurate, and focus on problem-solving). Building RC takes intentional efforts, especially in high-stress work environments, like ECE programs. Challenges, such as low wages, staff shortages, increased behavioral needs among children, and limited time for planning and collaboration create barriers to cultivating strong relational and communication capacities.

The Early Care and Education Leadership Study (ExCELS study; Kirby et al., 2021) identifies RC as a key organizational influence on quality improvement. Yet, despite its promise, RC remains understudied in ECE, and RC-informed interventions are rare. This gap highlights the importance of studying a model like ELM that explicitly seeks to build RC as a foundation for leadership and instructional improvement.

Methods: We will review the ELM curriculum and related materials (e.g., tools and routines) to examine how the model supports the development of RC. In addition, we will conduct interviews with ELM coaches to understand how they help programs build RC in practice—what strategies they use, and what conditions help or hinder those efforts.

Key Learnings: Through this review and interviews, we will share what we have learned about how RC is embedded into the ELM model and how coaches support RC-building efforts. We will highlight the specific tools, routines, and learning activities that support relational and communication practices. We will also identify contextual conditions, such as organizational culture and protected time for collaboration–that influence RC-building efforts.

Implications for Action: This study offers two key implications. First, it provides actionable insights for designing PD models that aim to improve teaching and learning by helping programs build RC. Second, it contributes to the refinement of the ExCELS study’s Theory of Change by offering applied examples of how RC can be strengthened through PD. These findings can inform both system-level strategies and local program efforts to strengthen leadership and drive program improvement.

Author: Heather Gilmartin (Denver/Seattle Center of Innovation)

Summary and Context: Rural healthcare systems often struggle with limited resources, leading to provider shortages and higher patient mortality rates. These challenges necessitate innovative workforce development strategies that offer professional support for interdisciplinary teams to improve healthcare delivery and outcomes. The Acute Inpatient Medicine – High Reliability, Learning Environment, and Workforce Development Initiative (AIM-HI) is an evidence-based workforce development program designed to foster supportive learning environments within Veterans Affairs (VA) rural hospital medicine teams. AIM-HI aims to optimize interprofessional relationships and care delivery through relational coordination informed training and support to enhance staff engagement and well-being.

Methods: AIM-HI is a type II hybrid implementation study employing a convergent mixed methods approach to evaluate the Relational Playbook, a 6-month virtual team training program. The target population includes physician, nursing, social work, and pharmacy leaders. AIM-HI is supported by three implementation strategies: behavioral nudges, learning collaboratives, and leadership coaching. In 2023, AIM-HI was implemented in three rural VA hospitals with inpatient hospital medicine programs. In 2024, AIM-HI expanded to seven additional VA hospitals. The primary outcome was the acceptability, appropriateness, and feasibility of AIM-HI, assessed using a validated tool by Weiner et al. (1-5 Likert scale). Secondary outcomes were the impacts of AIM-HI on leaders, staff, and the learning environment, evaluated through surveys and interviews. Quantitative data were summarized, while qualitative data were thematically analyzed and triangulated with the quantitative data to enhance understanding.

Findings: In 2023, AIM-HI enrolled 24 clinical leaders across three VA rural hospitals. Participants rated AIM-HI as acceptable, appropriate, and feasible for implementation (range 4.0-4.3; n=11/24; 46%). They reported that Playbook practices enhanced team dynamics, increased team engagement, required minimal time commitment, and delivered significant benefits. In 2024, AIM-HI enrolled 76 clinical leaders across seven VA rural hospitals. Participants expressed a significant need for the program and positive impacts on their professional development and well-being, improved staff relationships, and more positive work environments. Across years, engagement was challenging for many due to clinical demands. Facilitators to engagement included leadership coaching and the learning collaboratives. Barriers were staffing shortages and increased workloads requiring a singular focus on patient care versus team development.

Implications: AIM-HI is a feasible and impactful rural hospital medicine workforce development program that can support the professional growth and well-being of clinical leaders. Despite engagement challenges related to staffing and workloads, the program's positive impact on staff relationships, and work environments highlights its potential to optimize VA workforce capacity to meet the needs of rural Veterans.

Authors: Sarah Yardley (Marie Curie Palliative Care Research Department, University College London) & Sally-Anne Francis (Marie Curie Palliative Care Research Department, University College London)

One in five serious palliative care incidents involve prescription medications (Yardley et al., 2018), highlighting the need for effective boundary-crossing coordination. More broadly, palliative care outcomes are shaped by social determinants, interdependencies, and advocacy capacities, necessitating a relational, whole-systems approach to care delivery.

Authentic relationship exists when people share understanding of the meaningful use of resources and demonstrate willingness to change one another through genuine exchange (Jay, 2024). Relationality refers to the ability of environments to nurture such relationship. (Jay, 2024). Neglecting relational aspects exacerbates structural vulnerabilities, disproportionately harming populations with limited resources and social capital, resulting in both poor health outcomes and wastage of system resources that do not meet needs. Healthcare systems should be designed around relationships, treating agency and structure as interdependent rather than opposing forces.

While human narratives profoundly influence healthcare practices, system (re)design often overlooks their significance. I propose a rewilding approach to ensure healthcare functions to provide not just what is ‘safe’ but also what is ‘good’. This is not to create a wilderness but to create space for thoughtful positive risk-taking. Relationship-driven healthcare prioritizes systemic effectiveness over isolated operational gains, measuring success by the extent to which relationships generate both anticipated and unanticipated positive outcomes.

Achieving different results requires systemic transformation rather than increased effort within flawed structures. In palliative care, improving organizational conditions can reveal hidden relational work that mitigates structural deficiencies. To achieve these benefits, healthcare must be conceptualized as an open ecosystem—an archipelago- fostering balance by redeeming and reclaiming the central role of relationships in system (re)design.

Instead of debating when to prioritize human or structural factors, healthcare systems must integrate relational approaches throughout. This requires system structures that are porous relational containers allowing people to create relational glue and chains of knowing each other to reach across care boundaries. Weaving relationships into system design, including relational role design—such as visible coordination processes and embedded transition roles enabling more effective resource stewardship while delivering need-oriented care and mitigating social harms. New relational measures should assess whether relationships are fostering whole-system effectiveness, creating a culture of interdependence, transparency, and visibility. A system where relational workarounds are no longer hidden ensures genuine and sustainable improvements.

To illustrate these findings, we will present examples spanning individual and systemic perspectives, drawn from multiple relationship-based ethnographic studies in the United Kingdom, framed through Cultural Historical Activity Theory (Engeström, 1999). These examples illuminate gaps between work-as-imagined and work-as-done (Hollnagel et al, 2015), including relational dynamics in out-of-hours palliative care, the social dimensions of palliative prescription medicines management (such as the work of an ‘accidental carer’), and the risks of criterion-led service models. The concept of collective social safety will be introduced , emphasizing trust and co-creation in care systems.

Additionally, insights from the first author's recent Churchill Fellowship, will highlight international models that successfully integrate boundary-crossing relational work into care systems. These examples provide a foundation for further discussion, reimagining healthcare solutions that prioritize relationships as the cornerstone of healthcare transformation.

Author: Nick Mirin (Brandeis University)

Each year, an estimated 38 million ‘informal’ caregivers provide roughly 36 billion hours of care to an adult with limitations in daily activities – contributions representing approximately $600 billion in unpaid labor annually (Reinhard et al. 2023). Within this group, at least 17.7 million family caregivers are assisting someone age 65 or older with limitations in physical, mental, or cognitive functioning (National Academies of Sciences, Engineering, and Medicine 2016). Despite the substantial contributions these family members make to the care economy, their work remains underacknowledged in popular discourse and policy. The same can be said for direct care workers (DCWs) who provide the majority of long-term services and supports (LTSS) to older adults living in home- and community-based settings (HCBS) (Paraprofessional Healthcare Institute 2022). This lack of acknowledgement coupled with low (or non-existent) wages and limited structural supports to help defray the strain of caregiving work can leave both parties vulnerable to interpersonal friction, despite their mutual investment in caring for the same person (Hostetter and Klein 2022).

In these fraught circumstances it is imperative to reflect on the relationality of the older adult HCBS care environment – that is, its capacity to nurture trusting relationships through genuine exchange – and consider how it can be enhanced to the benefit of DCWs, family caregivers, and care recipients alike. This presentation proposes a participatory action research (PAR) project designed to engage DCWs and family caregivers of older adults in joint inquiry and collective knowledge construction around this topic. In practice this means DCWs and FCGs will be treated not as research participants but as co-researchers helping shape the questions, methods, analysis, and interpretation of data.

Attendees of the session will be introduced to several PAR techniques for collaborative study design and inclusive decision-making, as well as strategies for participatory data analysis and the reflexive application of findings into practice. By the end of the session, participants will be familiar with several approaches that can be used to cultivate relational coordination even in contexts where the overall relational bureaucracy is under strain.

Author: Micah Webster (Brandeis University)

Relationships are intrinsically valuable for our health and wellbeing. Alarmingly, about one third of US adults are lonely some or most of the time (Bruss et al., 2024). Social isolation and loneliness cause morbidity and premature mortality, but the US lacks a public health approach to coordinate policy in support of social connection. In this paper, we build out a theoretical basis for a systematic approach to supporting social connection as a health-related social need.

The SOCIAL Framework theory suggests multisectoral, multilevel contributors to an individual’s social connectedness. The SOCIAL Framework indicates that an individual’s health, employment, education, housing, transportation, food, and leisure may contribute to their level of social connection, isolation, or loneliness. Similarly, the SOCIAL Framework mentions the possibility of multi-sector collaborations to support social connection (Holt-Lunstad, 2022). Unfortunately, the SOCIAL Framework stops there, lacking sufficient detail to be applied and empirically tested as a means to reduce social isolation and loneliness.

We operationalize and extend the SOCIAL Framework by centering the care coordinator role within healthcare as a boundary spanner, adding the sector of spirituality and religion, and highlighting the factor of stigma. We draw on the social prescribing model to explain how care coordinators can act as “link workers” for patients, asking the patient what matters to them and linking the patient with professional and community-based social services to support the patient’s goals (WHO, 2022; Muhl et al., 2023). We use a hypothetical healthcare program which includes a care coordinator to explicate some of the theoretical direct and indirect mechanisms through which services in each sector of the adapted SOCIAL Framework affect social isolation and loneliness (Mann et al., 2017). We add the social and spiritual elements of stigma, spirituality, and religion to further contextualize the complex social experiences of loneliness and isolation. These specifics may help healthcare and partners in social services develop and measure services to address social connection as a health-related social need.

We theorize that healthcare programs with care coordinators reduce patients’ social isolation and loneliness through multisectoral collaborations with social services. Care coordinators can act as linchpins for coordinating sectors and delivering person-centered solutions to factors underlying patients’ social isolation and loneliness. Care plans that match more closely and comprehensively to an individual’s barriers to social connection across levels and sectors will be more effective in reducing social isolation and loneliness.

US society should take a truly comprehensive, systemic approach to supporting social connection, with boundary spanners to support coordination. Healthcare payers should reimburse for multisectoral services supporting social connection and more explicitly deliver services with the intent to reduce social isolation and loneliness.

Author: Heba Ali (Lancaster University; Relational Coordination Analytics)

Home- and Community-Based Services (HCBS) are services that deliver person-centered care within home and community settings. Encompassing a broad range of health and human services, HCBS programs aim to help individuals with functional limitations, who require support with daily activities such as dressing or bathing, remain in their homes and avoid the need for institutional care. In the United States, one major Medicaid-funded Home and Community-Based Services (HCBS) option is the Self-Directed Waiver program, which enables older adults and individuals with disabilities to manage their care independently. Through this model, participants select the services and providers that best meet their needs, promoting greater autonomy and person-centered care (HHS, 2019). Self-directed waivers typically operate under two distinct models: the Employer-Authority track and the Budget-Authority track. Under the Employer-Authority track, participants act as the direct employers, gaining the authority to hire, train, supervise, and, if necessary, terminate their care providers. In contrast, the Budget-Authority track grants participants full control over their individualized budgets, giving them the flexibility to allocate funds toward services and supports as they see fit. Both tracks aim to enhance participant choice and control, ultimately improving the quality and personalization of care (Bradley et al., 2021; Murray et al., 2024).

The self-direction model is rooted in participant-centeredness, with services co-produced by program participants and their support networks. Drawing on the co-production of public services model and the relational coordination framework, this paper investigates the role of support brokers in a budget authority self-direction waiver program, emphasizing how internal teams—relational structures designed to encourage peer-based guidance and advice-sharing—bolster brokers’ relationships with both newly enrolled and established participants. We also compare brokers’ ties with these two groups, underscoring their differing communication and coordination needs and examining how brokers’ sociodemographic attributes influence the strength of these ties.

Key findings from surveying 95 support brokers showed that brokers report stronger relational ties with established participants, aligning with prior research on the importance of shared knowledge and familiarity. Brokers with a financial background report notably stronger ties with newly enrolled participants, underscoring the value of financial expertise in the early stages of managing budget authority. Brokers with significantly stronger relational coordination ties with peers in their internal teams report higher co-production effectiveness, demonstrated by stronger broker-participant connections and reduced broker burnout. Overall, this study highlights the importance of relational supportive structures in reinforcing the broker-participant relationship in self-direction waiver programs.

Author: Brad Brown (Grand Rapids Fire Department)

Strategic planning is the most popular management tool and/or process in the world (Rigby & Bilodeau, 2018). Unfortunately, Mankins (2004) purported that not enough time was spent to ensure the success of strategic planning. A Midwest fire department (MFD), which engaged in the strategic planning process over a decade ago, has experienced the same challenge.

In response, the MFD has implemented Hoshin Kanri (HK) to aid in translating this process into desired actions. The prior research on HK has focused primarily on the alignment of work processes, but very little has centered on the quality of relationships and communication methods needed to coordinate time-constrained and interdependent work, otherwise referred to as relational coordination (RC).

The purpose of this research was to assess HK-related routines (e.g., huddles) and their connection to RC dimensions present within the context of a strategic planning process.

This researcher conducted an explanatory sequential quantitative-leading, mixed-methods multisite case study analysis within a pragmatic philosophical worldview on a convenience sample of two fire departments to determine the level of RC (as measured by a validated RC Likert-style questionnaire) within the context of strategic planning.

The results generally show heightened RC among teams who are practicing a HK-style management system that includes huddles. In the case of the MFD, strategic planning is vitally important to the long-term health and sustainability of not only an organization but to the community as well. Therefore, additional research is warranted surrounding the use of huddles within the context of strategic planning.

Keywords: Hoshin Kanri, relational coordination, strategic planning, huddles.

Authors: Matthew Barter (Manchester Police Department) & Cory Haberman (University of Cincinnati)

In early 2025, the Manchester Police Department launched a change initiative aimed at improving investigative rigor and coordination across units through the introduction of standardized investigative checklists. Designed to support frontline officers at crime scenes, these checklists serve as cognitive aids to ensure critical steps are not missed, helping to improve report quality, case solvability, and collaboration with detectives, prosecutors, and analysts.

As with many change efforts in policing, implementation was met with early resistance. Patrol officers expressed concern that the checklist might be used punitively or would add unnecessary complexity to their already demanding workload. Recognizing the risks of a top-down rollout, Manchester PD pivoted to a more participatory, systems-oriented approach that emphasized relationships and interdependencies, not just compliance.

On April 3, 2025, MPD hosted a Relational Mapping Workshop with 19 members from 9 functional areas, including patrol, investigations, prosecution, records, and analysis. Participants mapped key communication flows and interdependencies, identifying both strengths and fractures in the current system. Across the board, weak ties, particularly between patrol and downstream units, were linked to redundancies, report errors, and breakdowns in follow-up. The mapping also revealed shared knowledge, problem-solving communication, and accuracy as the most essential relational dimensions for high-quality investigations.

Additionally, participants were engaged on elements included on the checklist as well as the best modalities of checklist implementation (such as a mobile application, paper, etc). Inclusion of a diverse set of stakeholders prior to implementation was an intentional effort to gain buy-in for successful adoption of the tool.

The workshop was integral to a co-development process. Patrol officers, detectives, and prosecutors worked together to refine the checklist, test its use in the field, and shape policies around its deployment. The result was not just a better tool, but shared ownership.

This presentation will walk through Manchester PD’s process, highlight key relational insights from the mapping exercise, and outline next steps, including strengthening weak ties through joint briefings, structured communication, and targeted training. More broadly, it offers a case study in how law enforcement agencies can use relational coordination to drive cultural change from within.

Author: Paulo Gomes (Florida International University)

Healthcare organizations frequently implement process improvement (PI) initiatives to enhance access, efficiency, and quality of care. However, these initiatives often encounter internal tensions that hinder their success. This study examines the inherent tension between two ways of setting objectives within PI initiatives: deliberate (top-down) objectives driven by leadership’s strategic priorities, and emergent (bottom-up) objectives grounded in frontline staff’s operational realities. Although both approaches reflect legitimate and necessary perspectives, they often diverge in practice, creating resistance, disengagement, or implementation breakdowns. The intent of this research is to explore how these tensions play out during the implementation of the Group Practice Manager (GPM) role—an initiative by the Veterans Health Administration (VHA) aimed at improving patient access through enhanced care team coordination.

The study draws on a qualitative, multi-site case study design, focusing on five VHA prototype sites that piloted the GPM initiative. Data were collected through semi-structured interviews with 56 key informants, including GPMs, clinic leaders, and frontline clinical and administrative staff. Interviews explored participants’ experiences with PI objective-setting, perceptions of top-down versus bottom-up goal alignment, and the dynamics of role integration and communication. Thematic analysis was conducted using an abductive approach, iteratively combining inductive coding with sensitizing concepts from relational coordination theory.

Our findings reveal several core tensions that emerge in the process of implementing system-level changes. First, deliberate goals (e.g., improved access metrics) often lacked operational grounding, leading frontline staff to question their feasibility. Second, bottom-up goals were sometimes viewed by leadership as insufficiently ambitious or misaligned with strategic imperatives. These tensions were magnified when communication was infrequent or one-directional, and when frontline knowledge was not incorporated into planning. However, some sites demonstrated the ability to reconcile these tensions. These “virtuous cycles” emerged when GPMs served as relational brokers—facilitating mutual understanding, aligning shared goals, and enabling timely, problem-solving communication across hierarchical boundaries. In contrast, sites experiencing “vicious cycles” were marked by relational breakdowns, persistent misalignment, and deteriorating trust.

This study contributes to both theory and practice by offering a relational coordination-informed framework for understanding and managing goal-setting tensions in PI initiatives. Rather than viewing deliberate and emergent approaches as competing, we argue for structures and practices that enable their integration. Key recommendations include early-stage stakeholder co-design of goals, explicit role clarity for relational intermediaries like the GPM, and continuous feedback mechanisms to align strategy with operational learning.

Ultimately, the success of PI initiatives in complex healthcare systems depends not only on the technical soundness of proposed solutions but also on the quality of relationships and communication among those responsible for implementing them. By addressing relational gaps and fostering shared ownership of objectives, organizations can move beyond compliance to cultivate more sustainable, adaptive forms of improvement.

Author: Brooke Moore (Delta School District)

Project Summary: In fields as complex as education–its complexity due to infinite variables and conflicting narratives–high relational coordination amongst the adults in the system is necessary for the development of sustainably positive outcomes and experiences for learners. As a District Principal in a mid-sized school district, I occupy a boundary spanning meso-leadership space where I can see the influence of two work processes in increasing relational coordination, both developed by educators in British Columbia. Based on the evidence in British Columbia, from across extremely diverse contexts, both work processes could contribute to the creation and then increasing of relational coordination in other complex organizations because they increase mutual respect, build shared knowledge, and clarify shared goals.

Decision Making Process.  In collaboration with educators from a school district, decision scientists created a plain language model called the decision maker moves (DMMS) (Failing et al., 2019) with the goal of getting decision skills explicitly into classrooms. The resultant framework is a sequential model based in a structured decision making model made popular by Hammond et al. (1999) grounded in the interdisciplinary decision sciences explored by Kahneman (2003) and many others since then (Gregory et al., 2012). The DMMs have proven popular and useful in school district boardrooms, school staff meetings, and, indeed, in classrooms (Gregory and Moore, 2024). The DMMs can be used at any point in the Relational Model of Change to build or deepen relational coordination. The DMM steps can be summarized as follows:
- frame the problem,
- clarify what matters,
- generate options,
- weigh consequences,
- make trade-offs and decide, and
- stay curious.

The Spiral of Inquiry.  This inquiry framework (Halbert and Kaser, 2013, 2022) emerged from the work educators decades ago and is now used in eighteen countries to improve learning outcomes for students. In brief, the phases of the spiral of inquiry are as follows:
- scan,
- focus,
- develop a hunch,
- engage in new learning,
- take action, and
- check for impact.

Key Findings: My presentation will present the two models and feature stories about how these two frameworks can be used, together and on their own, to help move complex organizations move toward relational coordination.

Author: Judith Merel (Atrius Health)

Project Summary: At Atrius Health, RC was introduced as a framework to address challenges that arose following implementation of a regional pediatric access/triage model. As we have previously shared, AH developed regional huddles with a facilitator also serving as boundary spanner. We aim to share refinements in our model that have enhanced leadership’s ability to close the loop with huddle participants in a way that has improved outcomes and ameliorated agency. By compiling huddle topics and developing a prioritization and resolution structure, we have had greater success with relational coordination across service line disciplines and sustaining positive outcomes.

Context: Regional huddles have addressed many of the pain points that arose from regionalization. Though huddles have demonstrated RC improvements over time1.2.3, they have led to a “parking lot” full of new ideas, suggestions and concerns that require solutions. Atrius Health Pediatrics did not have a suitable structure for cataloging, prioritizing and addressing these new inputs.

Methods: The most impactful RC initiative was the introduction of twice monthly 20-minute huddles for each of five pediatric regions. All staff disciplines are invited to participate. Given huddle brevity and inability to solve problems in this forum, each agenda includes a topic “parking lot”. A small workgroup organized by the boundary spanner and comprised of senior leaders addresses parking lot topics, establishes prioritization, and identifies a topic “champion”. In the given timeframe, topics are addressed, and the loop is subsequently closed with huddle participants. The RCC Roundtable presentation will include sharing sample huddle minutes, the new parking lot follow-up structure, and dramatization of an RC huddle with workgroup participants.

Key Findings or Learnings: Pediatrics is no longer challenged by lack of trust, shared values, and mutual respect. As a result of RC initiatives, clinicians report reductions in burnout and increased fulfillment. All staff appreciate having a regular and open forum to share information, contribute to practice function, and learn.

The boundary spanner has become a key role within the service line and has been referred to as “glue” that connects the team. Notably, leadership’s commitment to following through on ideas and concerns raised by all participants regardless of discipline has garnered appreciation and enhanced confidence and trust. Clinicians continue to participate in significant numbers because their ideas are considered and acted upon. The practice has benefitted from the wisdom created by our interdependent teams.

Implications for Action: In AH’s experience, challenges could not be efficiently or effectively solved by one sector. Coordination is essential and a designated boundary spanner deployed to facilitate the RC cross-sector change journey has proven to be an invaluable asset. The implication is that by establishing an effective boundary spanner, the relational engagement across stakeholders improves and results in an organization’s ability to make desired changes and sustain positive outcomes.

Author: Chinue Uecker (JWMI/LPI Consultants, LLC)

As artificial intelligence (AI) and digital technologies transform healthcare work, maintaining the relational fabric that underpins effective coordination becomes increasingly complex. This study investigates how health centers integrate AI-enabled tools into value-added services for rural hospitals, focusing on how these technologies influence Relational Coordination among care teams.

The theoretical framework draws on paradox theory (Smith & Lewis, 2011), which explores the tensions between seemingly competing demands. For health centers, the competing demands stem from financial, resource, and technology constraints. Using a qualitative case study design, we examine how frontline and clinical staff experience and navigate the dual pressures of automation and relational work.

Data collection includes interviews and document analysis, centering on how digital tools are used to foster shared goals, shared knowledge, and mutual respect across distributed teams. This research provides insights into how health systems can intentionally embed RC into human-AI relationships, not by resolving tensions but by embracing them to promote innovation and collaboration. Practical implications include design considerations for AI implementation that support trust, team alignment, and sustainable care coordination, particularly in underserved and remote care settings.

Author: Qian Zhang (University of Toronto, Tellfer School of Management)

Overview: This paper explores how the increasing adoption of artificial intelligence (AI) in human resource management (HRM) is transforming the relational fabric of workplaces. Grounded in the emerging framework of Strategic Relational Human Resource Management (SRHRM), this paper investigates how AI and relational HRM systems can be designed to complement one another to foster sustainable organizational advantage. SRHRM emphasizes HRM practices that intentionally develop relational knowledge, skills, and abilities (KSAs), which are essential for building social capital and enhancing collective performance. However, as AI becomes embedded in HRM functions—such as recruitment, performance appraisal, and development—concerns emerge about its potential to undermine trust, fairness, and interpersonal connection.

Context: The paper situates this inquiry within the context of rapid technological change and the growing use of algorithmic decision-making in organizational settings. It addresses the paradox wherein AI offers efficiency and bias reduction yet risks depersonalizing employee experiences and damaging relational mechanisms. Thus, to sustain competitive advantage, organizations are encouraged to integrate AI into HRM systems in ways that reinforce rather than erode the relational foundations of work.

Methods:  Methodologically, this paper is based on an extensive conceptual analysis of recent literature on strategic HRM, social capital theory, algorithmic management, and sociotechnical systems. It synthesizes these perspectives to build an AI-enabled model of SRHRM systems. This model extends traditional SRHRM by introducing five key adaptations: (1) inclusive relational KSAs, incorporating digital empathy and algorithmic awareness; (2) stakeholder co-creation of AI systems to enhance transparency and trust; (3) hybrid human-AI HRM practice design that balances automation with social interaction; (4) relational analytics to monitor and optimize workplace relationships; and (5) an AI-adaptive relational culture that proactively addresses risks such as digital disconnection and algorithm aversion.

Key Findings: Key findings from this theoretical development highlight that AI and SRHRM are not competing logics but mutually reinforcing systems when jointly optimized. AI can support social capital by providing relational insights and enabling targeted interventions, while strong workplace relationships make AI adoption more effective, trusted, and sustainable. Organizations that prioritize relational transparency, human-centered AI design, and relational learning stand to benefit from higher trust, inclusion, and adaptive capacity.

Implications for Action:  The implications for action are: HR professionals and organizational leaders should redesign HRM systems that embed both technological sophistication and relational intelligence. Practical recommendations include implementing explainable AI in performance reviews, designing onboarding processes that combine algorithmic support with human mentorship, and developing training programs that build human-AI interaction skills. Furthermore, organizations should establish inclusive governance mechanisms, such as ethics boards and employee feedback loops, to guide responsible AI use.

By aligning AI capabilities with relational HRM principles, the AI-enabled SRHRM model offers a path toward resilient, inclusive, and high-performing organizations. This paper contributes to strategic HRM theory by reframing AI as a relational amplifier rather than a relational disruptor, and provides a blueprint for designing future-ready HRM systems that are both digitally advanced and deeply human-centered.

Author: Bishan Wang (Wuhan University)

Summary. Relational Coordination (RC)—a theory that emphasizes high-quality communication and strong working relationships among interdependent actors—has become a cornerstone in healthcare research due to its explanatory power in complex, high-stakes clinical environments (Gittell, 2002). Simultaneously, the widespread deployment of health information systems (HIS) such as Electronic Medical Records (EMRs), Computerized Physician Order Entry (CPOE), and Tele-ICU technologies has fundamentally transformed coordination processes within and across institutional boundaries.

Yet, the interplay between RC and HIS remains insufficiently understood. Some studies suggest that relationally designed systems can strengthen RC by enhancing knowledge sharing and workflow transparency (e.g., Cramm & Nieboer, 2012; Tang et al., 2019), while others argue that strong RC is a prerequisite for effective system adoption, especially when digital tools mediate communication across physical distance (Ott-Trojel et al., 2017).

More recent work (e.g., Bolton et al., 2021) posits a dynamic, bidirectional, and co-evolutionary relationship—whereby RC shapes how systems are adopted and used, and those systems, in turn, reshape relational structures over time. Despite this recognition, the field still lacks a systematic review of the mechanisms, contingencies, and outcomes underpinning this relationship. This study aims to address that gap by conducting a comprehensive systematic literature review.

Context. The review focuses on the healthcare sector, where RC theory was originally developed and has been most widely applied. Healthcare delivery is marked by high task interdependence and intensive collaboration among professionals—doctors, nurses, social workers, and others—both within and across institutional boundaries (e.g., between hospitals and community care providers). In such fragmented systems, effective coordination is vital for patient safety and integrated care. Despite significant investments in HIS, many implementations fall short (Boonstra & Broekhuis, 2010), often due to a lack of relational foundations (Gittell et al., 2000; Cresswell & Sheikh, 2009). Understanding the RC–HIS interface is thus critical to advancing both digital and relational capabilities in healthcare.

Method. This study conducts a systematic review of empirical research published in the past 10–15 years on the relationship between RC and HIS in healthcare settings. Peer-reviewed studies were identified through PsycINFO, PubMed, and Web of Science across the domains of health management, informatics, and interprofessional collaboration. Studies were categorized by system type (e.g., EMR, CPOE, Tele-ICU) and coordination context. The review maps how HIS influence RC dimensions—such as communication frequency, shared goals, and mutual respect—and examines which relational preconditions, like trust and shared understanding, are necessary for successful HIS integration.

Expected Findings. Preliminary findings indicate that health information systems may indeed support the development of RC—but only when a baseline level of mutual trust, shared goals, and relationship quality is already present. Absent such conditions, digital implementations may trigger resistance, reinforce silos, or even degrade coordination quality.

Implications. The study contributes to theory by proposing a relational–technological lens for understanding digital transformation in healthcare. For practitioners and policymakers, the findings stress the importance of assessing relational readiness and designing HIS to complement, not replace, collaborative norms.

Author: Ben Kragen (Veterans Health Administration Boston)

Background: Secure messaging (patient-provider text-based communication) has been associated with improved management of type 2 diabetes, one of the most prevalent and costly chronic diseases in the United States. Prior research has found that secure messaging facilitates improved clinical outcomes through its ability to support care coordination. However, studies on secure message use in primary care are limited to internal medicine practices. Research is needed to understand the impact of secure messaging on care coordination in community health centers, where secure messaging remains “virtually unstudied”.

Methods: We used a cross-sectional patient-level survey combined with longitudinal patient-level clinical data to study (1) the association between secure messaging and patient experience of relational coordination of care with their PCP, and (2) the impact of secure messaging on HbA1c control (<7.5%). The sample consists of patients with type 2 diabetes who have a PCP listed at Massachusetts General Hospital (MGH). Treatment was observed in two settings: MGH affiliated community health centers, and MGH affiliated internal medicine practices. The relational coordination survey instrument was used to measure patient experience of coordination of care. Clinical and demographic data was collected from patient electronic health records and merged with survey data. Associative hypotheses were tested using logistic and ordinary least squares regression models, and causal hypotheses were tested using mediation and moderation analysis.

Results: 128 patients completed our survey, representing a 44.0% response rate. Patients attended community health centers (58.6%) and internal medicine practices (41.4%). Unadjusted models found that secure messaging was associated with improved relational coordination (Β = 0.15, p = .009). Adjusted models found that secure messaging was more strongly associated with relational coordination in community health centers as compared to internal medicine practices (Β = 0.28, p = .014). Secure messaging was found to impact HbA1c control in adjusted models (Β = 2.08, p = .050), however results indicate that this relationship was not mediated by relational coordination.

Author: Charlotte Notaras (National Center on Education and the Economy)

As policymakers and practitioners seek to expand work-based learning (WBL) opportunities that bridge education and employment, workforce intermediaries have emerged as critical actors in aligning systems and fostering cross-sector collaboration. Despite the recognized importance of intermediaries, there is limited comparative analysis of their roles across states.

This project draws on relational coordination theory to present a comparative policy analysis of all 50 U.S. states, examining how workforce intermediaries are positioned within state-level education and workforce development strategies to support WBL (including registered apprenticeships, internships, externships, and other career exploration and development initiatives) and advance scalable and equitable outcomes. We explore the extent to which intermediaries enable shared goals, mutual respect, and frequent communication among stakeholders across education, labor, and industry. Our method involves a systematic review of publicly available information on state education and workforce development agency websites, analyzing documentation on WBL-related grant programs, intermediary partnerships, and strategic plans to identify the presence and function of workforce intermediaries in each state.

Through this analysis, we will identify up to five distinct typologies of intermediary engagement, ranging from fully embedded intermediaries with formal state-level roles and dedicated funding streams, to states where intermediaries operate independently with limited systemic support. These typologies will be presented through a set of visualizations that highlight patterns of coordination, governance structures, and policy supports across states.

Preliminary findings suggest that states with formalized intermediary roles tend to offer more consistent access to WBL experiences, especially for underserved populations. Conversely, states lacking structural support for intermediaries often face challenges in scale and quality of implementation. These patterns have implications for equity, sustainability, and the effectiveness of WBL programs.

By illuminating how intermediaries function within or adjacent to state systems, this project offers actionable insights for state leaders, funders, and practitioners seeking to strengthen coordination across sectors. Our comparative analysis and typologies will support collaborative efforts to design state-level partnership structures and funding streams that foster more efficient, coherent, and responsive WBL systems, ultimately leading to stronger outcomes for students.

Author: Ansoumane Camara (CORHIS Laboratory University of Montpellier)

This study explores how the concepts of collective mind and relational coordination can be mobilized to address persistent coordination challenges within inter-organisational collaborations, using the case of Guinea’s interministerial committee against human trafficking. While collaboration across organisations is widely promoted as a strategy to address complex social problems, achieving effective coordination remains a significant hurdle. In Guinea, a national committee bringing together various ministries was created to improve institutional responses to human trafficking, but it struggled to align actions and share information effectively. To understand and address these limitations, the study introduced the theoretical frameworks of collective mind—as a performance criterion assessing shared understanding and alignment—and relational coordination—as a means to enhance communication and mutual respect among actors. Over a two-year period, from 2020 to 2022, a longitudinal observation of the committee’s functioning was carried out. This analysis revealed that despite formal collaboration structures, coordination was weak, especially in terms of joint attention, shared goals, and mutual trust—core elements of the collective mind. These findings were validated in a stakeholder workshop, confirming the gap between intended interministerial collaboration and actual practice. In response, an intervention was designed to reinforce the committee’s collective mind through the targeted development of relational coordination, aiming to improve the quality of communication, accountability, and relationships among members. The study illustrates how conceptual tools can be practically applied to diagnose and address coordination deficits in public inter-organisational settings, particularly in low-resource and high-stakes environments. It also highlights the need for ongoing attention to the relational and cognitive dimensions of collaboration to move beyond symbolic partnerships toward more effective collective action.

Facilitator: Tamara Stenn (Suffolk University)

How can organizations shift from competition to cooperation to help solve pressing problems - whether it’s healthcare, education, or community development – and become stronger and more resilient? How can we see the whole together, strengthen relationships across differences, and engage diverse voices to create win-win solutions? This workshop guides participants to answer these questions through the interactive, research-based Sustainability Lens Game.

This workshop invites participants to a hands-on experience using a game-based approach to build innovative, resilient, and fun organizations that elevate communities, providing balanced collaboration and relational coordination. The game simulates real-world challenges, encouraging players to meet economic, environmental, and social goals while building a sustainable organization. The game creates opportunities for integrative thinking, system mapping, and dialogue across stakeholder perspectives - critical elements in fostering a relational society.
Keeping with the theme of the roundtable, this workshop takes an organizational approach to building relational capacity. Through gameplay, participants see how strong relationships, different perspectives, and teamwork can lead to better problem-solving and new ideas. Using the Sustainability Lens with the Sustainable Development Goals, a framework of community engagement, shared relationships, and winning solutions emerge.

This workshop is relevant for researchers and practitioners working in cross-sector collaborations, team-based environments, and change-oriented organizations. It offers a dynamic, experiential approach to building collaborations and resilience as organizations move from competition to cooperation.

Learning Objectives
1. Understand how organizations play a pivotal role in relational coordination to drive systems-level sustainable development.
2. Experience the dynamics of gameplay that models multi-stakeholder problem-solving and innovation.
3. Explore how the Sustainability Lens Game can be used as a teaching, training, or consulting tool to engage diverse teams in applied systems thinking and collaborative leadership.
4. Reflect on one’s own experience and learn new approaches to co-creating integrative solutions within organizations and the community.

Interactive Elements
• Introduction: Introduce the Sustainability Lens and Sustainable Development Goals (SDGs). Short presentation of the concept and elements of the game, plus a modeling of the gameplay.
• Game Play: Participants, in teams, play a round of the Sustainability Lens Game, engaging in strategy, negotiation, and reflection around an SDG-aligned Sustainability Project. Roles include entrepreneurs, community members, policy advocates, and funders, simulating real-world interdependence and competing interests. Role-play cards will be provided. The Sustainability Project will reflect the interests of the players/roundtable.
• Gallery Walk: Using sticky notes, teams create a relational Business Model Canvas (BMC) to reflect on their gameplay experience and identify new areas of coordination, communication, and impact. Relational canvases are hung on the wall for other teams to walk around and see, learning from each other’s experiences.
• Debrief and Discussion: Facilitated discussion connects gameplay to real-world contexts participants bring from healthcare, education, public administration, nonprofit leadership, or business. We will reflect on how relationships shaped outcomes and what organizational solutions emerged.
• Summary and Conclusion: Next steps and action points identified. Participants are free to bring their BMCs home with them.

For more on the game and its foundations, visit: www.sustainabilitylensgame.com.

Facilitator: Julie Gordon (University of Oklahoma Health Sciences)

The session begins with a concise overview of recent research on the relational coordination and the Relational Model of Change and the relevance to academic institutions. Participants will then engage in a structured case study analysis in small groups. The case will highlight common relational and cultural challenges that affect engagement and psychological safety. Using the model as a lens, participants will identify key dynamics and evaluate opportunities for improvement.

Building on this analysis, participants will take part in a strategy design sprint. Working collaboratively, they will develop actionable plans to strengthen relational practices. A guided template will support the design of targeted interventions, including goals, stakeholders, timelines, and success metrics. The session concludes with a facilitated discussion to share insights, refine strategies, and reflect on implementation challenges.

Learning Objectives
By participating in this workshop, attendees will:
1. Integrate the Relational Model of Change with their professional knowledge and institutional context.
2. Critically evaluate a case study to prioritize evidence-based tactics aligned with desired cultural outcomes.
3. Design a strategic intervention to enhance employee engagement and psychological safety in academic environments.

Interactive Elements
• Small-Group Case Study Analysis: Participants will work in teams to analyze a real-world academic scenario using the Relational Model of Change. They will identify relational challenges and propose targeted improvements.
• Strategy Design Sprint: Using a structured template, participants will co-create a draft action plan to address engagement and psychological safety issues in their own settings. This includes defining goals, identifying stakeholders, and outlining implementation steps.
• Facilitated Discussion and Peer Feedback: Participants will share their strategies in a collaborative format, receive peer input, and refine their plans based on group insights.

Facilitators: Carolyn Ordowich (Sociotechnical Systems Associates), Douglas Austrom (Indiana University) & Erik Nicholson (Pandion Strategy)

Learning Objectives of the Workshop
1. Explore the convergence of a relational model of change and contemporary thinking on open sociotechnical systems (OST), Dynamic Deliberation Designing (3D), grounded in three diverse cases with wide applicability: a manufacturing site (GE Aviation Bromont), a government agency (Indiana Department of Revenue/DOR), and cross-sector coordination in agriculture (Semillero de Ideas).
2. Identify the key synergies between relational models of change and OST/3D designing for the future of work and our workplaces.
Interactive Elements of the Workshop: After an overview of OST/3D designing and the first case, the DOR cultural transformation (20m), participants will engage in the first round of breakout group discussions on common themes and implications for their work on relational models of change (25m). This will be followed with the Bromont and cross-sector collaboration cases (20m) and a second round of breakout group discussions and whole group discussion of the common themes and implications for research and practice (25m).

Conceptual Foundation of the Workshop: The goals of relational coordination and sociotechnical systems designing are to achieve a healthy balance between humanity and technology, making organizations more sustainable, efficient, and innovative while ensuring high quality of working life for all participants in the system. Given the ever-increasing complexity and velocity of change coupled with the changing nature of work from routine, manual labor to non-routine, knowledge work across virtually all industries, we propose an interactive exploration of the relational model of change and a model and process of work design based on OST first principles and dynamic deliberation designing.

A pre-requisite for a dramatic cultural transformation is an organizational mindset shift (Schein, 2010). To that end, we have identified OST first principles as the foundational mindset for the humanity-centered design of work systems (Austrom and Ordowich, 2024). This mindset shift was evident in the dramatic cultural transformation of the Indiana Department of Revenue, in GE Aviation Bromont’s alternative work system of self-managing teams in a participative governance structure and in Semillero de Ideas engagement of agricultural workers across the US and Mexico as knowledge workers. Furthermore, these OST first principles serve as the foundation for the numerous STS design principles that reorient enterprises toward trust, respect, and care for workers and a move from top-down, transactional coordination to relational coordination systems (Gittell, 2009), especially the foundational principle of respecting people as people and not viewing them instrumentally.

Recognizing the structural shift from predominantly routine manual work to nonroutine knowledge or cognitive work, Cal Pava astutely identified deliberations as the fundamental unit of knowledge work analysis, which he defined as: reflective and communicative behaviors concerning a particular topic. They are patterns of exchange and communication in which people engage with themselves or others to reduce the equivocality of a problematic issue (Pava, 1983 ). As such, knowledge advancement fundamentally occurs via relational and deliberative interaction.

Facilitators: Glenn Omanio (Bavarian Nordic) & Lauren Hajjar (Suffolk University)

Facilitators: Lorinda Visnick (UMass Boston) & Jim Best (Independent Consultant)

Facilitator: Jody Hoffer Gittell (Brandeis University)