Evaluating the Relational Coordination instrument

Relational coordination rests on the idea that coordination is a central issue in all work and that coordination happens through communication, which in turn is shaped by relations. Relational coordination is quite interesting because it has been shown to correlate with on-time flight departures and surgical performance. This has prompted the attention of both practitioners and politicians some of who perceive relational coordination as a means to attain better performance.
The relational coordination instrument has been validated as a measure of teamwork from the following perspectives: internal consistency, interrater agreement and reliability, structural validity, content validity. However as relational coordination is being used as a diagnostics tool it is important to examine further if the instrument can measure changes. Indeed we need to know how precise and sensitive the instrument is when organizations are changed.
This paper reports findings from 15 healthcare organizational change projects. The projects received some guidance from external consultants but followed different methodologies and can be considered natural experiments. The projects were measured before and after the change using the relational coordination instrument. Managers were interviewed before the projects and a chronicle workshop (structured group interview) were performed after the project. This design allows us to compare the qualitative descriptions of change in the wards, with the measured change in relational coordination. We distinguish between statistical and clinical significance. Statistical significance is calculated using T-test. Clinical significance is the minimal amount of change in relational coordination score that is not considered noise. Sensitivity of the instrument i.e. the ability of the instrument to measure changes in relational coordination is analysed by evaluating the scope and depth of changes in work processes and relations. Sensitivity of the relational coordination instrument is surprisingly low and event significant changes e.g. introducing a new role in a work process only show small changes in relational coordination scores.