Coordination Strategies for Team-Based Care, Explained

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Coordination Strategies for Team-Based Care

Healthcare Organization and Management · Chapter 7: Team Dynamics and Communication in Healthcare SettingsSection 7.5 · lesson 46 of 1059 min · free with a free account

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In this lesson

Matching coordination mechanisms to the way care teams depend on each other.

  • Classify interdependence as pooled, sequential, or reciprocal
  • Compare six coordination mechanisms and their failure modes
  • Match a coordination mechanism to the type of interdependence
  • Explain relational coordination and the costs of over-coordination

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Transcript

Everything said in the video, section by section (1,173 words). Read along, or search it.

Opening Case

A Lost Day After Joint Replacement

Patients who've had a joint replacement at Larkfield are going home a day later than planned. Three departments are asked to review their own work: surgery, physical therapy, and case management. Each reports back that it met its own standard. All three are telling the truth. So where's the delay?

Interdependence Types

Pooled, Sequential, and Reciprocal Work

Coordination is the management of interdependence, and the sociologist James Thompson, in nineteen sixty-seven, described three types. Pooled: units draw on a common resource, such as a shared budget, and affect each other only through what they use. Sequential: one unit's output is the next unit's input, in a fixed order, like referral, then assessment, then treatment. Reciprocal: units pass work back and forth, and must keep adjusting to each other. Each type demands more coordination than the last.

Common Error

Sequential Tools on Reciprocal Work

The practical point: a mechanism that's good enough for one type fails at the next. And in health care, the commonest coordination error is running a reciprocal relationship on mechanisms built for sequential work.

Quick Check

Nurses and Therapists Adjusting Together

Quick check. In the ICU, respiratory therapists and nurses adjust a ventilated patient's plan together. Each one's latest finding changes what the other does next. Which type of interdependence is this? Pause, and decide. Reciprocal. The work flows both ways, and neither side can finish its part without reacting to the other. Sequential is tempting, because one finding comes before the next step. But in sequential work the downstream unit depends on the upstream one, and not the reverse.

Standardization

Standardizing Work, Output, and Skills

Organizations have six main ways to coordinate. The first three are standardization, ideas Henry Mintzberg set out in nineteen seventy-nine. Standardize the work: a protocol that says how. It's cheap and scales, but it needs predictable work, and it breaks on the exception. Standardize the output: what the result must look like, not how to get there. The risk is a form filled in, with the meaning missing. Standardize skills, through training. Two people trained alike can predict each other. It's slow to build, and it erodes as practice drifts.

More Mechanisms

Plans, Mutual Adjustment, and Liaison Roles

Fourth, plans and schedules: timing agreed in advance. Cheap and visible, but they fail whenever conditions change faster than the plan. Fifth, mutual adjustment: direct communication between the people doing the work, adapting as they go. It handles anything, but it eats attention and doesn't scale. Sixth, liaison roles: positions created to connect units. The risk is that both sides hand the relationship to the liaison, and stop talking.

Matching Mechanisms

Fitting the Tool to the Interdependence

So match the mechanism to the interdependence. Pooled work is coordinated well by rules and plans: who may use the shared resource, when, and within what limit. Sequential work needs standardized output and schedules, so the next unit gets a predictable input at a predictable time. Reciprocal work can't be coordinated by standardization alone, because what the other side will do isn't known in advance. It needs mutual adjustment, backed by shared skills and often a liaison. The classic mistake is answering a reciprocal problem with a more detailed protocol.

Tracing a Pathway

Where the Day Goes Missing

Back to Larkfield's joint-replacement patients. Trace one pathway, and read the links, not the boxes. Surgery to physical therapy is sequential, and a standard handoff note covers it. That link works. Physical therapy and case management are reciprocal. The therapy assessment decides what equipment the patient needs, and the home situation changes what therapy must assess. That link runs on a daily list, a schedule. Each side waits for the other's output. That's where the day goes.

Integrating Roles

Three Conditions for Coordinator Roles

Health care also creates roles whose whole job is coordination: case managers, care coordinators, clinical nurse leaders, discharge coordinators. They work under three conditions. A remit covering the whole process, not a slice smaller than the problem. Enough authority to convene people and require a response, since a coordinator who can only ask depends on goodwill. And it must never replace the units talking to each other. The usual decay: the coordinator becomes a message carrier, and the hospital has added a post and a delay.

Cross-Organization Handoffs

Designing for Weaker Coordination

Handoffs between organizations, such as to a home health agency, are the weakest link of most pathways. No shared manager, often no shared record, no way to require a response. What's available is narrower: agreed standards for what travels with the patient, named contacts on both sides, and a few measures both can see. So design the transition assuming coordination will be weaker. Don't assume goodwill will substitute for structure.

Information Systems

What a Shared Record Can't Do

A shared information system is a powerful coordinator, with specific limits. It's excellent at standardized output, at sharing information across a boundary, and at recording what was done. So it handles pooled and sequential work well. What it can't do is mutual adjustment. A record isn't a conversation. People working reciprocally need to exchange judgment, uncertainty, and intention, and a chart entry carries none of them. Chapter ten returns to information systems.

Quick Check

Lab and ED Clash Over Add-On Tests

Quick check. Larkfield's lab and the ED keep clashing over add-on tests. Each result changes what the ED orders next, and each new order changes the lab's work. Leaders want it fixed for good. What would work better? Pause, and decide. Direct, routine contact: a quick daily exchange between people who can commit their own service. That's mutual adjustment, the mechanism reciprocal work needs. A stricter protocol is tempting, since it feels thorough. But no protocol can predict what the other side will need next.

Relational Coordination

Shared Goals, Knowledge, and Respect

Why do two units with the same protocol, meetings, and software perform differently? Jody Hoffer Gittell's answer is relational coordination. Communication between interdependent workers works in proportion to three relationships: shared goals, shared knowledge of each other's work, and mutual respect. Those support communication that's frequent, timely, accurate, and focused on solving problems, not blame. The levers are unglamorous: induction across the boundary, so people know what happens on the other side, shared measures, and solving problems jointly, not by email.

Coordination Costs

Too Little and Too Much

Coordination costs time that isn't spent on the work, and more isn't better. Under-coordination looks like work falling between units, duplication, and delays at handoffs. Over-coordination is less often noticed: meetings whose members can't say what decision they support, approval chains where each approver trusts another checked, and reports nobody reads. When the burden gets heavy enough, staff route around it, and the original problem returns, invisibly. So ask of every mechanism: what would fail if it stopped? If nobody can answer, stop it, and find out.

Case Resolved

A Five-Minute Morning Call

Back to Larkfield's lost day. The answer isn't a third protocol. It's a five-minute call each morning between the physical therapy lead and the case manager, each with authority to commit their own service. It costs ten minutes of two people's time a day, and it's the first thing that will get dropped under pressure. In three months, they'll ask what would fail if it stopped.

Key Takeaways

Match the Mechanism to the Work

To recap. Coordination manages interdependence: pooled, sequential, or reciprocal. Six mechanisms each fit a type, and each has a cost and a failure mode. Reciprocal work needs mutual adjustment, not a longer protocol. Integrating roles need the whole process, real authority, and direct contact kept alive. And test every mechanism by asking what would fail if it stopped.

About Healthcare Organization and Management at UPI Study

Healthcare Organization and Management (Health 302) is a self-paced online course of 105 video lessons in 18 chapters, from health systems and the law to ethics, leadership, teams, strategy, informatics, finance, quality, human resources, marketing and evidence-based practice. It carries a NCCRS credit recommendation for 3 semester credits.

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Why students take Healthcare Organization and Management with UPI Study

How hospitals and clinics are runHealthcare Organization and Management covers how care organizations are led and run: health law and ethics, leadership and teams, strategic planning, health informatics, budgets, quality improvement, staffing and marketing. It is a core course in healthcare administration and health management degrees.
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130,000+students helped with college creditsACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

Where the credit goes

Universities that work with NCCRS

Healthcare Organization and Management carries a NCCRS credit recommendation. These universities work with NCCRS; some are UPI Study's signed partners. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

Thomas Edison State UniversityThomas Edison State UniversitySigned partnerUniversity of the PeopleUniversity of the PeopleSigned partnerCharter Oak State CollegeCharter Oak State CollegeSigned partnerStrayer UniversityStrayer UniversitySigned partnerColumbia Southern UniversityColumbia Southern UniversitySigned partnerIndiana TechIndiana TechSigned partnerPenn StatePenn StateWorks with NCCRSSouthern New Hampshire UniversitySouthern New Hampshire UniversityWorks with NCCRSSUNYSUNYWorks with NCCRS +many more cooperating universitiesFind my college →

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FAQ

Questions students ask us

About Coordination Strategies for Team-Based Care

What are pooled, sequential, and reciprocal interdependence?
They are three types of interdependence described by the sociologist James Thompson in 1967. Pooled units share a common resource, such as a budget. Sequential units work in a fixed order, so one unit's output is the next unit's input. Reciprocal units pass work back and forth and keep adjusting to each other. Each type demands more coordination than the one before it.
Why doesn't a more detailed protocol fix reciprocal work between departments?
Reciprocal work depends on what the other side will need next, which cannot be known in advance, so standardization alone cannot coordinate it. It needs mutual adjustment, meaning direct communication between the people doing the work, often backed by shared training and sometimes a liaison. Answering a reciprocal problem with a longer protocol is a classic coordination mistake.
What is relational coordination in healthcare?
Relational coordination, developed by Jody Hoffer Gittell, holds that communication between interdependent workers works in proportion to three relationships: shared goals, shared knowledge of each other's work, and mutual respect. These support communication that is frequent, timely, accurate, and focused on solving problems rather than blame. Practical levers include cross-boundary induction, shared measures, and solving problems jointly instead of by email.
How can a manager tell if a team is over-coordinated?
Signs of over-coordination include meetings whose members cannot say what decision they support, approval chains where each approver assumes another one checked, and reports nobody reads. A useful test is to ask of each mechanism what would fail if it stopped. If nobody can answer, stopping it and watching the result is reasonable, since heavy coordination burdens push staff to route around them.

About the Healthcare Organization and Management course

How many college credits is Healthcare Organization and Management?
Healthcare Organization and Management (Health 302) carries a NCCRS credit recommendation for 3 semester credits. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.
How much does Healthcare Organization and Management cost and what is included?
$250, paid once, with lifetime access: all 105 video lessons, a practice quiz after each, the graded work and final exam, and an official transcript when you finish. Students who want several courses choose UPI Study PRO instead.
Which universities accept UPI Study credits?
UPI Study has signed partner agreements with universities such as Thomas Edison State University, University of the People and Charter Oak State College, and works with universities such as Penn State, SNHU and SUNY. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities. Use "Find my college" on this page to check yours.
How long does Healthcare Organization and Management take?
It is self-paced with no deadlines. The 105 lessons total about 17 hours of video; most students add reading and practice time and finish in a few weeks to a few months, on their own schedule.
How are the exams done?
Quizzes and assignments are online in the course. The final exam is taken online with proctoring; a person on the UPI Study team checks assignments, usually within two days.
How do my credits reach my college?
When the course shows 100% complete, request the official transcript from your dashboard. It is sent to the college you name, and you can send it to more than one. Check your college first with "Find my college" on this page, or ask Athena.

Ready for the full course? Earn 3 credits in Healthcare Organization and Management.

105 video lessons, a quiz after each one, and the graded work that earns the credit. Recommended for credit by NCCRS.

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