Ghaffari, Affan (2017-05). Relational Coordination Application to Patient-Provider, Inter-Organizational, and Inter-Professional Relationships. Doctoral Dissertation.
Fragmentation of healthcare in the United States has contributed significantly to the skyrocketing cost of care, poorer health outcomes, and higher rates of preventable hospitalizations compared to other industrialized nations. Addressing fragmentation requires improved coordination between patients and providers of care, across healthcare organizations, and across professionals. However, the issue with this proposed solution concerns the uncertainty surrounding how these different groups coordinate in achieving desirable outcomes for patients. Gittell's theory of Relational Coordination asserts that effective coordination is achieved through communication that is frequent, timely, and accurate involving shared goals, shared knowledge, and mutual respect. The Relational Coordination (RC) instrument is based upon this theory and has been applied to examine coordination between individuals in various healthcare settings. However, very few studies to date have directly applied RC to capture both perspectives of patient-professional relationships, relationships requiring coordination between individuals of different organizations, and relationships requiring coordination between two types of medical professionals. These three perspectives form the basis for the applications of RC for the purposes of the proposed study. All three study contexts take place within some aspect of the broader Texas Medicaid Waiver, each illustrating a different component of intra-agency or inter-agency relationships: the first paper applies RC to the intra-agency relationship between patients and professionals, the second paper applies RC to inter-organizational relationships between professionals and their partner organizations, while the final paper applies RC to inter-professional relationships in the context of primary care and mental health integration. Overall, these papers will combine to provide a picture of how RC can be applied to coordination across a variety of healthcare related settings.