Jody Hoffer Gittell

A Relational Model of How High-Performance Work Systems Work

In this paper we explore a causal mechanism through which high-performance work systems contribute to performance outcomes. We propose that high-performance work systems can improve organizational performance by strengthening relationships among employees who perform distinct functions, a pathway that is expected to be particularly important in settings characterized by highly interdependent work. In a nine-hospital study of patient care, we identify high-performance work practices that positively predict the strength of relational coordination among doctors, nurses, physical therapists, social workers, and case managers, in turn predicting quality and efficiency outcomes for their patients. Relational coordination mediates the association between these high-performance work practices and outcomes, suggesting a relational pathway through which high-performance work systems work.

Organizing work to support relational co-ordination

Service operations that are highly uncertain, interdependent and time constrained require a competency that I call relational co-ordination – co-ordination that is carried out by front-line workers with an awareness of their relationship to the overall work process and to other participants in that process. Relational co-ordination is characterized by frequent, timely, problem solving communication, and by helping, shared goals, shared knowledge and mutual respect. Previous work reports significant positive effects of relational co-ordination on performance in such settings. This paper addresses how organizations achieve, or fail to achieve, high levels of relational coordination. I find significant correlations between relational co-ordination and the use of cross-functional liaisons, IT, supervisors, cross-functional performance measurement, employee selection, conflict resolution and flexible work roles. I explore the implications for team effectiveness and organization design, and for the theory of organizational social capital.

Relationships, Layoffs, and Organizational Resilience Airline Industry Responses to September 11

The terrorist attacks of September 11, 2001, affected the U.S. airline industry more than almost any other industry. Certain airlines emerged successful and demonstrated remarkable resilience while others languished. This investigation identifies reasons why some airline companies recovered successfully after the attacks while others struggled. Evidence is provided that layoffs after the crisis, although intended to foster recovery, instead inhibited recovery throughout the 4 years after the crisis. But, layoffs after the crisis were strongly correlated with lack of financial reserves and lack of a viable business model prior to the crisis. Digging deeper, the authors find that having a viable business model itself depended on the development and preservation of relational reserves over time. Our model shows that the maintenance of adequate financial reserves enables the preservation of relational reserves and vice versa, contributing to organizational resilience in times of crisis.

Relationships between Service Providers and Their Impact on Customers

Relationships between service providers and customers are important for achieving high levels of customer satisfaction and loyalty, service management scholars have shown. Building from existing theories, the author proposes that relationships between service providers are another important contributor to customer outcomes. When service processes are highly interdependent, uncertain, and time constrained, relationships between service providers are integral to the process of coordination and therefore are an important contributor to customer outcomes. In a study of postsurgical care in nine hospitals, the author finds that strong provider-provider relationships directly increase customer satisfaction and loyalty because the overall service experience is more effectively coordinated. Second, strong provider-provider relationships help service providers to develop more effective relationships with their customers, which further increases customer satisfaction and loyalty. Managers should therefore select, train, and reward service providers in a way that supports the formation of strong working relationships between them.

Relational coordination among nurses and other providers: impact on the quality of patient care

AIM The present study examined nurse reports of relational coordination between nurses and other providers and the impact of relational coordination on patient care quality. BACKGROUND While communication between providers has been traditionally considered important to improve quality, relational coordination extends this view, emphasising the value of high-quality relationships exemplified by shared goals, shared knowledge and mutual respect; and high-quality communication that is timely, frequent, accurate and problem-solving. METHODS Direct care registered nurses (RNs) (n=747) completed surveys to assess relational coordination across five provider functions and six types of patient care units. Nurses also reported perceptions about patient care quality. RESULTS In all analyses, relational coordination between nurses and other providers was significantly related to overall quality, in the expected directions. As relational coordination increased, nurses reported decreases in adverse events such as hospital-acquired infections and medication errors. CONCLUSIONS Enhancing relational coordination between nurses and other providers is central to improving the quality of patient care. IMPLICATIONS FOR NURSE MANAGERS AND NEW KNOWLEDGE: The emerging theory of relational coordination provides a useful new research-based framework for managers to use to improve provider relationships, communication and the quality of care.

Paradox of Coordination and Control

This article describes the contrasting systems of coordination and control at American and Southwest Airlines. Contrary to popular belief, the best way to achieve coordination in high velocity settings like the airline industry is not to create a flat organization based on performance measurement and little supervision. Rather it is better to build an organization based on cross-functional accountability to diffuse blame, with adequate supervisory staffing to provide coaching and feedback. Coordination benefits from strengthening this role of supervisors while weakening the role of accountability and performance measurement.

Contextualizing Patterns of Work Group Interaction: Toward a Nested Theory of Structuration

The focus of this article is the patterns of interaction that arise within work groups, and how organizational and institutional factors play a role in shaping these patterns. Based on an ethnographic study of groups across three national contexts, we describe the variation in patterns of interaction that we observed. We further suggest how different patterns of interaction form mutually reinforcing systems with aspects of the organizational context. In addition, we suggest how these mutually reinforcing systems are perpetuated by aspects of the broader institutional context. Our findings point toward a nested theory of structuration, expanding structuration theory to multiple levels simultaneously. In turn our findings have theoretical and practical implications for better understanding and managing interaction patterns among group members.

Interprofessional collaborative practice and relational coordination: Improving healthcare through relationships

Interprofessional collaborative practice (IPCP) and relational coordination (RC) are two concepts with much in common. IPCP is a concept that is familiar to many readers of this journal but the def...

Mutual Gains or Zero Sum? Labor Relations and Firm Performance in the Airline Industry

The authors examine competing theoretical arguments regarding whether union representation, shared governance, wage levels, and two features of the quality of labor relations—workplace culture and conflict in negotiations—lead to better or worse outcomes for airlines, and they test these interpretations using a mix of historical and quantitative data from major U.S. airlines. Both the qualitative and quantitative results suggest that relational factors—conflict and workplace culture—are more important determinants of performance than the structural factors of unionization, shared governance, and wages. The authors conclude that efforts to recover from the current crisis in the airline industry that depend primarily on reductions in wages or union power will at best bring only short-term relief from immediate financial pressures. Sustained improvement in service quality and financial performance will require more fundamental improvements in the quality of labor relations.

Relationships and Resilience: Care Provider Responses to Pressures From Managed Care

Organizations in the health care industry and beyond face pressures to lower their costs while maintaining quality, resulting in high levels of stress for their workers. In a nine-hospital study, this article explores the role that relationships play in enabling resilient responses to external pressures and the organizational practices that enable workers to respond in a resilient way when organizational change is required. The article argues that relational coordination—communicating and relating for the purpose of task integration—is a resilient response to external threats that require a coordinated collective response across multiple functions or roles. Findings suggest that workers engage in higher levels of relational coordination when they perceive this type of threat but that the presence of a particular type of high performance work system—a relational work system—greatly strengthens this resilient response.