A Relational Model of Organizational Change: A Wholistic View of Patient Experience

“Patient experience” while often perceived as an isolated metric emerging from the need to assess quality from the patient perspective, transformative health-care leaders recognize the value of a more integrated approach to ensuring high-quality experiences. As we seek opportunities to enhance patient experience outcomes, we must broaden our lens toward a systems perspective by recognizing the complexity of relationships across the care continuum. The Agency for Healthcare Research and Quality states that “Patient experience encompasses the range of interactions that patients have with the health care system, including their care from health plans, and from doctors, nurses, and staff in hospitals, physician practices, and other health care facilities.”¹ The emphasis on the range of interactions within the health-care system supports the obvious need to develop interventions to address patient experience from a systems perspective. Focusing on the interdependent relationships between people (the patients, families, clinicians, staff, leaders) and process (the work performed within and between departments, teams, units, systems) enables a more wholistic approach toward improving the entire health-care culture experience, not just “patient experience” metrics.

Shifting from traditional health care silos toward a more integrated systems perspective represents complexity and can seem daunting to leaders already faced with immense pressure and change. While adopting a systems perspective requires attentive leadership, there is a growing body of evidence supporting change models and tested practices. For example, the “Relational Coordination” model provides a straightforward approach as a “mutually reinforcing process of communicating and relating for the purpose of task integration.” In other words, how can we deliberately intervene to change both organizational structures and relational dynamics in order to produce sustainable, cost-effective, high-quality outcomes? To address these questions, Professor Jody Hoffer Gittell worked with Professors Edgar Schein and Amy Edmondson, influenced by colleagues in a variety of fields, to develop the Relational Model of Organizational Change.² This model has the following components:

• Relational Interventions to build new relational dynamics based on shared goals, shared knowledge, and mutual respect.

• Work Process Interventions that use the new relational dynamics to improve the work itself.

• Structural Interventions to support the changes with crosscutting organizational structures.

The current issue of The Journal of Patient Experience includes a diverse list of patient-experience topics. As we consider “Relational” interventions, we encourage readers to explore volume 6.4 for themes such as: communication, assessing perspectives, decision-making, teaching, and role clarity. Readers with an interest in interventions for “Work Process and Structure” may notice volume 6.4 articles with themes such as: transparency, health equity, information access, and telehealth.

By focusing on the interdependency of relational, work process, and structural dynamics, patient experience leaders might partner with colleagues from departments of quality, workforce engagement, clinical operations, and beyond. Synergistic improvement efforts, while complex, represent meaningful opportunities to improve patient experience by elevating the overall culture.

ON THE COVER

“I Want To Be Free”. This artwork is inspired by my ten year old female patient struggling with depression. This artwork represents the thoughts she felt trapped in her mind. She had suffered physical abuse by her father. Whenever her father beat her she detached herself from the pain and drifted to a beautiful world of scented flowers.

Laura Cooley, PhD
Academy of Communication in Healthcare

Bio

Dr Cooley leads education and outreach efforts on behalf of The Academy of Communication in Healthcare. She serves as Editor-in-Chief for The Journal of Patient Experience. She also holds an appointment as Assistant Clinical Professor in the Department of Medicine, Vanderbilt University School of Medicine.