Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay - A nine-hospital study of surgical patients

BACKGROUND. Health care organizations face pressures from patients to impro ve the quality of care and clinical outcomes, as well as pressures from man aged care to do so more efficiently. Coordination, the management of task i nterdependencies, is one way that health care organizations have attempted to meet these conflicting demands. OBJECTIVES. The objectives of this study were to introduce the concept of r elational coordination and to determine its impact on the quality of care, postoperative pain and functioning; and the length of stay for patients und ergoing an elective surgical procedure. Relational coordination comprises f requent, timely, accurate communication, as well as problem-solving, shared goals, shared knowledge, and mutual respect among health care providers. RESEARCH DESIGN. Relational coordination was measured by a cross-sectional questionnaire of health care providers. Quality of care was measured by a c ross-sectional postoperative questionnaire of total hip and knee arthroplas ty patients. On the same questionnaire, postoperative pain and functioning were measured by the WOMAC osteoarthritis instrument. Length of stay was me asured from individual patient hospital records. SUBJECTS. The subjects for this study were 338 care providers and 878 patie nts who completed questionnaires from 9 hospitals in Boston, MA, New York, NY, and Dallas, TX, between July and December 1997. MEASURES. Quality of care, postoperative pain and functioning, and length o f acute hospital stay. RESULTS. Relational coordination varied significantly between sites, rangin g from 3.86 to 4.22 (P <0.001). Quality of care was significantly improved by relational coordination (P <0.001) and each of its dimensions. Postopera tive pain was significantly reduced by relational coordination (P = 0.041), whereas postoperative functioning was significantly improved by several di mensions of relational coordination, including the frequency of communicati on (P = 0.044), the strength of shared goals (P = 0.035), and the degree of mutual respect (P = 0.030) among care providers. Length of stay was signif icantly shortened (53.77%, P <0.001) by relational coordination and each of its dimensions. CONCLUSIONS. Relational coordination across health care providers is associ ated with improved quality of care, reduced postoperative pain, and decreas ed lengths of hospital stay for patients undergoing total joint arthroplast y. These findings support the design of formal practices to strengthen comm unication and relationships among key caregivers on surgical units.