Customizing the RC Survey

As described previously, the RC Survey was used to measure communication and relationships across the workgroups performing orthopedic surgical procedures in the OR, as based on a dual purpose. First, the measures should be shared with the participants in the change team in order to allow them to reflect on current patterns of relational coordination and thereby allow them to help design the intervention, as recommended by Gittell (2016). In this way, the measurement of relational coordination should be used in a prioritization process guiding the development and design of Intervention I and Intervention II. Using the measures of relational coordination in this way is presented as a relational intervention in the Relational Model of Organizational Change, and it is described in the principles of relational coordination as tools for change (Box 1, p 28). Second, the measurement of relational coordination should be used in PHASE III as a baseline measurement.

The customizing process was conducted at a change team meeting in which the participants in the change team reflected on the definition of the focal work process and the functional workgroups involved. A work process for which tasks, procedures, and outcomes were well understood by all the involved health professionals in the orthopedic surgical unit was chosen and, articulated in the following way:

“Tasks associated with preparing, performing, and completing surgical procedures in patients undergoing orthopedic surgery in the OR at the university hospital”.

Several functional workgroups of health care providers were involved in carrying out this work process: surgeons (SUR), surgeon assistants (SURASS), coordinating surgeons (COORSU), anesthesiologists (ANE), operating room nurses (OR nurses), nurse anesthetists (AN nurses), coordinating nurses (COORNU), and nurse assistants (NURASS). The network of workgroups surrounding the defined work process is shown in Figure 24.

Figure 24 Network of workgroups involved in the work process

Several workgroups that were involved more peripherally in the work process, such as orderlies, secretaries, laboratory technicians, and other technicians, were omitted from the survey. This limitation was adopted to reduce the workgroups involved in the survey, with the aim being to only include those workgroups in direct contact with the patients undergoing surgical procedures in the operating room. However, an exception was made with regard to this limitation, since there was a great desire on the part of the change team to measure relational coordination between the functional workgroups in direct contact with the patients undergoing surgical procedures in the operating room and the nurses in the orthopedic wards. This desire derived from the experienced challenges in relation to the collaboration between nurses in the operating room (OR nurses and AN nurses) and nurses in the orthopedic wards, which could result in delays. Therefore, nurses in the orthopedic wards were included in the survey in the sense that respondents of the survey were asked to answer each of the

questions regarding their coordination with nurses in the orthopedic ward, although the nurses in the orthopedic wards themselves were not respondents to the survey, which resulted in one-way measures of relational coordination between nurses in the orthopedic wards and all the other workgroups. After having defined the work process and selected nine functional groups in the customizing workshop, a customized RC Survey was completed using the survey tool available from the analytics company Relational Coordination Analytics, Inc.¹⁶ (RCA, 2018). The template for the customized survey including the questions, response options, and converted values for response options, as are shown in Table 17.

RC Dimension Survey Question

Frequent communication

How frequently do people in each of these groups communicate with you about tasks associated with preparing, performing, and completing surgical procedures in patients undergoing orthopedic surgery in the OR at the university hospital?

1 = not nearly enough, 3 = not enough, 5 = just the right amount, 4 = too often, 2=much too often

Timely communication

Do they communicate with you in a timely way about tasks associated with preparing, performing, and completing surgical procedures in patients undergoing orthopedic surgery in the OR at the university hospital?

1 = never, 2 = rarely, 3 = sometimes, 4 = often, 5 = always

Accurate communication

Do they communication with you about tasks associated with preparing, performing, and completing surgical procedures in patients undergoing orthopedic surgery in the OR at the university hospital?

1 = never, 2 = rarely, 3 = sometimes, 4 = often, 5=always

Problem-solving communication

When there is a problem with tasks associated with preparing, performing, and completing surgical procedures in patients undergoing orthopedic surgery in the OR at the university hospital, do people each of these groups blame others or work with you to solve the problem?

1 = always blame, 2 = mostly blame, 3 = neither blame nor solve, 4 = mostly solve, 5=always solve

Shared goals

Do people in each of these groups share your goals for tasks associated with preparing, performing, and completing surgical procedures in patients undergoing orthopedic surgery in the OR at the university hospital?

1 = not at all, 2 = a little, 3 = somewhat, 4 = a lot, 5 = completely

Shared knowledge

Do people in each of these groups know about the work you do with tasks associated with preparing, performing, and completing surgical procedures in patients undergoing orthopedic surgery in the OR at the university hospital?

1 = nothing, 2 = a little, 3 = some, 4 = a lot, 5 = everything

Mutual respect

Do people in these groups respect the work you do with tasks associated with preparing, performing and completing surgical procedures in patients undergoing orthopedic surgery in OR at the University Hospital?

1=not at all, 2= rarely, 3=occasionally, 4= often, 5=constantly

Table 17 Customized RC-Survey with work process inserted.

16 Relational Coordination Analytics, Inc. (RCA) is an analytics company founded to support the measurement of relational coordination. RCA is closely connected to the Relational Coordination Research Collaborative, an international network of researchers, practitioners, and consultants working with improvement processes across industries using the theory of relational coordination as a framework. The use of the measurement tool requires certification, which I acquired by attending a workshop (two days) and the subsequent completion of an examination process in 2013.

The RC Survey was distributed to a total of 150 health professionals. Afterward, Intervention I was launched, as shown in the timeline (Figure 22, p. 131).