Relational Coordination: An Imperative Influencing our Capacity to Reach the Core

Purpose:
There was absence of quantifiable relational coordination (RC) and intentional steps to achieve it, influencing patient and system outcomes. The purpose was to adopt evidence-based key practices influencing RC, nursing work efficiency and effectiveness across the nursing enterprise

Significance:
The core of nursing quality is relationship where nursing serves as the boundary spanner ensuring efficient and effective care delivery. Ineffective communication is the root of most patient care error. Accuracy, frequency & timeliness of communication demands excellence in RC.

Strategy and Implementation:
The innovation was to adapt the work that has been accomplished through relational coordination in other industries and apply it to the healthcare setting. RC is defined as a mutually reinforcing process of communicating and relating for the purpose of task integration. Evidence suggested 12 key steps influence RC and include: 1) select for team; 2) measure team performance; 3) reward team performance; 4) resolve conflicts proactively; 5) invest in frontline leadership; 6) design jobs for focus; 7) make job boundaries flexible; 8) create boundary spanners; 9) connect through pathways; 10) broaden participation in patient rounds; 11) develop shared information systems; and 12) partner with suppliers. The presentation will highlight adoption of the key practices within the perioperative environment, medical-surgical environment, and bariatric specialty services that have positively influenced nursing efficiency and effectiveness including nurse-sensitive outcomes.

Evaluation:
Outcomes include: on-time starts from 30% to 91%; room turnover from 60 minutes to < 30 minutes, and nursing satisfaction resulting in the elimination of traveler nurses. Outcomes achieved in the medical-surgical include: 3-day decrease in LOS, benchmark performance in fall and pressure.

Implications for Practice:
1.Explore interprofessional opportunities to adopt RC as a key process indicator influencing team performance for patient care. 2.Describe the link between evidence-based key practices and relational coordination beyond acute care to long term and ambulatory care practice settings.