High Performance Healthcare: Using the Power of Relationships to Achieve Quality, Efficiency and Resilience

We've learned from the Institute of Medicine that fragmentation (lack of coordination) is a major culprit in the errors and waste that plague our healthcare system, but this problem does not seem to be getting sufficient attention in the current policy debates. In High Performance Healthcare, I show that relational coordination – coordinating work through relationships of shared goals, shared knowledge and mutual respect among care providers – can connect care providers with each other to produce substantial gains in both the quality and efficiency of care.

Building relational coordination is not rocket science but it does require investments in organizational practices with a cross-functional focus, for example 1) selection and training of care providers for cross-functional teamwork, 2) cross-functional performance measurement, 3) cross-functional rewards, 4) cross-functional conflict resolution, 5) cross-functional clinical pathways, 6) cross-functional information systems and 7) cross-functional boundary spanners, to name some of the key elements. Together these practices form a high performance work system that breaks down the silos that separate care providers to create a better-integrated, more patient-centered system of care.

Policy makers can’t repair our fragmented healthcare system on their own – it's a job that requires healthcare leaders to work in partnership with their care providers. But policy makers can focus attention on the problem of fragmentation and encourage healthcare leaders and care providers to work together adopt the high performance work practices that are needed to move the industry forward. Bundled payments would be a step in the right direction. How do we get these issues on the policy agenda to get a better shot at achieving the quality and efficiency outcomes that we desperately need?