APHCRI International Visiting Fellowship

Prof. Jody Hoffer Gittell is a Professor of Management at Brandeis University's Heller School for Social Policy and Management, and Acting Faculty Director of the MIT Leadership MIT Leadership Centre. http://www.jodyhoffergittell.info/content/gittellcv.html. Her research has explored how coordination by front-line workers contributes to quality and efficiency outcomes in service settings, with a particular focus on the airline and health care industries. She has developed a theory of Relational Coordination, proposing that work is most effectively coordinated through relationships of shared goals, shared knowledge and mutual respect, and demonstrating how organisations can support relational coordination through the design of high performance work systems.

Prof. Gittell is the author of dozens of articles and chapters, as well as books titled The Southwest Airlines Way: Using the Power of Relationships to Achieve High Performance, Up In the Air: How the Airlines Can Improve Performance by Engaging Their Employees, andSociology of Organisations: Structures and Relationships. Her book titled High Performance Healthcare: Using the Power of Relationships to Achieve Quality, Efficiency and Resilience presents her findings from ten years of research in the healthcare industry. Prof. Gittell has won the Best Book Award from the Alfred P. Sloan Foundation, a Best Paper award from the Human Resource Division of the Academy of Management, the Douglas McGregor Memorial Award for Best Paper of the Year in the Journal of Applied Behavioral Science, and an Honorable Mention for the Douglas McGregor Memorial Award for Best Paper on Organisational Change

Relational coordination is an emerging theory for understanding the relational dynamics of coordinating work. Other theorists have argued for the importance of relationships for coordinating work, based on the argument that coordination is the management of task interdependence and is therefore a fundamentally relational process. According to the theory of relational coordination, coordination that occurs through frequent, high quality communication supported by relationships of shared goals, shared knowledge and mutual respect enables organisations to better achieve their desired outcomes. Specifically, "relational coordination is a mutually reinforcing process of interaction between communication and relationships carried out for the purpose of task integration." According to this theory, three dimensions of relationships are integral to the process of coordination: shared knowledge, shared goals and mutual respect. Developed and tested in the context of air travel, surgical care and long term care, relational coordination theory is expected to generalise to work processes in which multiple providers are engaged in carrying out highly interdependent tasks under conditions of uncertainty and time constraints. Within the healthcare context, relational coordination has a significant positive impact on key measures of performance, including both quality and efficiency.

Prof. Gittell is currently working on launching a Center for Relational Coordination, to facilitate the use of this concept in Australia as well as in other countries (US, Denmark, Belgium, Netherlands, Canada, UK, Italy, Norway) where there is quite a bit of interest in relational coordination as applied to healthcare system improvements.

Prof. Gittell's work and research experience has direct relevance to the Australian PHC service system, which is facing pressures due to increasing demands from an ageing population, increasing chronic disease, increasing co-morbidities, workforce shortages, and increasing health system complexity and fragmentation. To improve access to care, to enhance local service coordination, population health planning and service integration, the Australian Government is establishing a network of independent PHC organisations (PHCOs/ Medicare Locals) National Health and Hospitals Reform Commission (NHHRC) http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/nhhrc-report). However, Dr Gittell's work has clearly shown that policy changes and increased access to care will not alone address these pressures. Timely, accurate, problem-solving communication that crosses all organisational boundaries is required to build a high performing work system that foster relational coordination across multidisciplinary primary health care team.

Prof. Gittell's visit will

• contribute to APHCRI's understanding of how to build high performing work systems that foster relational coordination across multidisciplinary primary health care team approaches
• provide advice to APHCRI on how to facilitate the uptake of new evidence about high performing work PHC systems into PHC policy;
• provide advice to the hosting organisations (Australian Health Workforce Institute at Melbourne University, Department of Management at Monash University, and Affinity Organisational Development) about of the use of theory of relational coordination in teaching and research
• provide international leadership on the use of the theory of relational coordination to inform Australia's PHC workforce policy

Prof. Gittell's program will comprise of seminars and roundtable discussion which will focus on ways to build and facilitate the uptake of evidence about relational coordination for future multi-professional PHC team workforce policy and practices.

Key round-table discussion questions will include:

• What are the current key gaps in the relational coordination evidence base related to the PHC systems?
• What challenges exist to the use of the theory of relational coordination in primary health care workforce research?
• What opportunities exist to strengthen the relational coordination evidence base within PHC?
• What needs to change (policy stakeholders, researchers) to facilitate the uptake of evidence about relational coordination within PHC?
• What are the systems implications of seeking to embed relational coordination principles within Medicare Locals/PHC organisations in a consistent way?