High Performance Healthcare: Using the power of relationships to achieve quality, efficiency, and resilience

In an earlier book, The Southwest Airlines Way: Using the Power of Relationships to Achieve High Performance (2003), Jody Hoffer Gittell described the relational coordination amongst employees of different functional groups (i.e., ticketing agents, baggage transfer agents, ramp agents, operations agents, gate agents and all the other functional groups who serviced and flew the planes) that characterized the corporate work culture. This culture has made Southwest Airlines a consistently high performing and profitable business amidst the tumultuous ups and downs of the US airline industry. In High Performance Health Care, Professor Gittell applies what she learned in the Southwest Airlines study to the delivery of health care. In a highly readable account based on data gathered in her organizational research program, she convincingly argues that efforts by health care delivery organizations to improve relational coordination can result in substantial improvements in the efficiency, quality and costs of health care delivery. Care coordination is the availability of relevant patient care information to the right person at the right time so as to maximize the ability to deliver the care needed: ‘‘communication [that is] frequent, timely, accurate, and focused on problem-solving’’ (p. 6). Care coordination is relevant across the spectrum of health care delivery from nurses’ shift changes to continuity of care across time and settings of care. Poor care coordination has been identified as a key source of medical error and poor quality care (Institute of Medicine [IOM], 2001), and is one of the US top 20 areas targeted for health care improvement (IOM, 2003). Among the 20, it is one of only two ‘‘crosscutting’’ areas, where improvements would be of benefit to large numbers and diverse groups of patients (IOM, 2003). But, as Gittell notes, care coordination ‘‘is not a problem that is unique to the US healthcare system’’ (p. 5), making most of the contents of this book broadly relevant to an international audience. Innovations pointed to by Gittell as part of the systems improvement needed, such as specialized care coordinator roles, the electronic medical record, and the use of clinical pathways can assist multiple care providers in managing information flow and planning appropriate coordinated care. But, it is the interdependent set of care providers themselves in different functional roles who generate, access, and use that information with patients and families who ‘‘make or break’’ effective care coordination. As Gittell points out, if you don’t value the information or respect its [functional] source you are not likely to pay attention to it. Fostering shared goals, shared knowledge, and shared respect between the persons who occupy diverse functional roles, then, forms the heart of relational coordination. This is a very important book from an interprofessional perspective. Professor Gittell provides compelling evidence from her extended research program of the importance of the quality of interprofessional relationships and practices, such as Journal of Interprofessional Care, May 2010; 24(3): 327–330