IHP 505 Module 4 Teamwork Paper Example

Working Hard, Working Apart: Teamwork and Relational Coordination at Northgate

[Student Name]

Southern New Hampshire University

IHP 505: Leadership in Clinical Microsystems

Module Four Paper

[Instructor Name]

[Date]

Working Hard, Working Apart: Teamwork and Relational Coordination at Northgate

Nobody at Northgate Family Medicine is lazy. Front-desk staff juggle phones and check-ins, medical assistants room patients back to back, the nurse care manager chases lab results and clinicians chart late into the evening. Yet the clinic's access problem is partly a coordination problem. A clinician blocks an afternoon for a meeting without telling the front desk, so patients are booked and then rescheduled. A medical assistant does not know a patient needs a foot exam, so the supplies are not ready. This paper uses research on teamwork and relational coordination to understand these seams and proposes ways to strengthen them.

What Makes Teams Effective

Salas et al. (2008) reviewed decades of research on teams across industries, including health care, aviation and the military. They described teamwork as a set of interrelated behaviors and attitudes, including shared mental models, meaning a common understanding of the task and each member's role; closed-loop communication, in which messages are confirmed; mutual performance monitoring, in which members notice and help when others are struggling; adaptability; and leadership that coordinates and supports. They concluded that teamwork can be taught and measured, and that teams whose members understand each other's roles and share goals perform better, especially under pressure.

Relational Coordination

Gittell et al. (2000) studied care of patients undergoing joint replacement at nine hospitals and introduced the concept of relational coordination. They measured how often and how well different roles communicated, whether communication was frequent, timely, accurate and focused on solving problems rather than blaming, and the quality of relationships underlying it, whether roles shared goals, understood each other's work and treated one another with respect. Higher relational coordination was associated with better patient-reported quality of care, less postoperative pain, better functioning and shorter lengths of stay. The concept is useful because it focuses on the connections between roles rather than on individuals.

Applying Teamwork Concepts to Northgate

Measured against these ideas, Northgate's team lacks shared mental models of the daily schedule; each role sees its own piece. Communication is often one-way: messages are left in the electronic inbox and not confirmed, as when schedule blocks are entered without a call to the front desk. Mutual monitoring is limited because roles are physically separated, with the front desk at the entrance and medical assistants in pods. Relationships are cordial but thin; several front-desk staff said they do not know what medical assistants actually do between rooming patients, and some clinicians admitted they did not know front-desk staff by name.

A Relational Coordination Snapshot

To go beyond anecdotes, the practice manager asked staff to complete a brief relational coordination survey rating communication and relationships between their role and each other role on a five-point scale. Ties between clinicians and medical assistants scored relatively well, reflecting daily work in pods. Ties between the front desk and every other role scored lowest, especially on timeliness of communication and shared knowledge. The care manager's ties with clinicians were strong but her ties with medical assistants were weak, which may explain missed opportunities to prepare patients with diabetes.

Table 1. Relational Coordination Scores (1 to 5)

Note. Scores are illustrative for the composite clinic.

What Team Training Achieves

Weaver et al. (2014) reviewed studies of team training in health care. Training programs, often built on principles like those Salas and colleagues describe, generally improved teamwork knowledge, attitudes and observed behaviors, and some studies reported better patient outcomes and fewer errors. The authors emphasized that training works best when it is part of a broader organizational effort, with leadership support, opportunities to practice skills in real work and reinforcement over time. Training delivered once and never revisited tends to fade.

Strengthening the Seams

Four actions follow. First, a ten-minute morning huddle for the whole team, including front desk, reviewing the day's schedule, open slots, patients needing special preparation and staffing gaps, creating a shared mental model of the day. Second, a rule that schedule changes are communicated in person or by phone to the front desk and confirmed, not only entered in the system. Third, pairing each clinician with the same medical assistant and linking them to a named front-desk contact, forming small teamlets that know each other. Fourth, a half-day team training session using clinic scenarios, followed by monthly practice in huddles.

Leadership's Role

The practice manager and lead physician must model the behaviors they ask for: attending huddles, confirming messages and learning everyone's name and role. Early in the change, they should make it safe for front-desk staff to speak up when a clinician's schedule creates problems, since those staff sit lowest in the clinic's informal hierarchy and have the weakest ties.

Including Patients

Patients are members of the microsystem too, and they often carry information between roles when the team does not. At Northgate, patients reported telling the front desk, the medical assistant and the clinician the same story because no one passed it along. A simple pre-visit call by a medical assistant two days before chronic care visits, asking what the patient most wants to address and whether labs are due, would let the team prepare together and signal to patients that the clinic works as one. The patient advisory group the health system already runs could also review changes to scheduling rules before they take effect, since patients experience the seams most directly.

Measuring Progress

The relational coordination survey will be repeated at six months, with the goal of raising front-desk ties above 3.5. Operational measures will include the number of unplanned reschedules caused by schedule changes, rooming time and the share of patients whose preparation needs were identified at huddle. These measures link teamwork directly to access.

Conclusion

Northgate's staff work hard but apart. Teamwork research explains what effective teams do, relational coordination pinpoints where the clinic's connections are weakest and evidence on team training shows how to strengthen them if leaders support and reinforce the change. Stronger seams between roles are a prerequisite for better access.

References

Gittell, J. H., Fairfield, K. M., Bierbaum, B., Head, W., Jackson, R., Kelly, M., Laskin, R., Lipson, S., Siliski, J., Thornhill, T., & Zuckerman, J. (2000). Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay: A nine-hospital study of surgical patients. Medical Care, 38(8), 807-819. https://doi.org/10.1097/00005650-200008000-00005

Salas, E., Cooke, N. J., & Rosen, M. A. (2008). On teams, teamwork, and team performance: Discoveries and developments. Human Factors, 50(3), 540-547. https://doi.org/10.1518/001872008X288457

Weaver, S. J., Dy, S. M., & Rosen, M. A. (2014). Team-training in healthcare: A narrative synthesis of the literature. BMJ Quality & Safety, 23(5), 359-372. https://doi.org/10.1136/bmjqs-2013-001848