Relational Coordination Scale (RCS)

Submitted by National Center... on Oct 11, 2016 - 1:45pm CDT

Instrument

Authors:

Relational Coordination Analytics

Overview:

The RCS is a 7-item instrument completed by interdependent work groups with a critical role in carrrying out a work process. It diagnoses four dimensions of communication and three dimensions of relationship quality. In the 2000 study by Gittell, et al., reported below, the work process of interest was surgical care of orthopedic patients, and the workgroups with a critical role in providing care and services to those patients were members of five core disciplines: physicians, nurses, physical therapists, social workers, and case managers. The purpose of the study was to explore the impact of positive provider coordination on patient outcomes, namely patient reported quality of care, post-operative pain and functioning; and length of hospital stay. After controlling for patient comorbidies and other variables, RCS scores were significantly predictive of all four outcomes. A published peer review of this instrument by the AAMC MedEdPortal reported that it has been used successfully in multiple settings ranging from medical and surgical care to the criminal justice system. Because it analyzes working relationships between the respondent and interdependent members of a team (bounded and unbounded), it can be used to diagnose where professional relationships are weak and need support. It can also be used in the evaluation of training or other interventions designed to improve care coordination.

Link to Resources

Resource links:

RCS is a proprietary instrumented owned by Relational Coordination Analytics. Please visit the Relational Coordination Analytics website for permission to use it, and for information on measuring relational coordination and accessing the RC tool. Visit the Relational Coordination Analytics Research Collaborative website for the most current research on relational coordination and additional resources.

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. Med Care, 38(8): 807-819.

Gittell, J.H., Beswick, J., Goldmann, D., Wallack, S. (2014). Teamwork methods for accountable care: Relational coordination and TeamSTEPPS. Health management Review, doi: 10.1097/HMR.0000000000000021. Available online ahead of print.

Gittell, J.H., Weinberg, D., Pfefferly, S., & Bishop, C. (2008). Impact of relational coordination on job satisfaction and quality of outcomes: A study of nursing homes. Human Resource Management Journal, 18(2): 154-170.

To read a peer review critique of the RCS, go to the AAMC MedEdPortal. Type in "Relational Coordination Scale" in the home page search box to find the tool and the critique. Registration and login are required but free.

Descriptive Elements

Who is Being Assessed or Evaluated?:

Individuals

Instrument Type:

Self-report (e.g., survey, questionnaire, self-rating)

Notes for Type:

In the study reported here, idividual providers assessed their working relationships with 5 provider groups. Other tools were used in this study, including a patient survey that assessed quality of care received and reported their levels of post-operative pain and functioning, and hospital records for their length of hospital stay.

Source of Data:

Health care providers, staff

Notes for Data Sources:

In the study reported here, providers from 5 core disciplines (medicine, nursing, physical therapy, social workers, and case managers) were asked to evaluate their working relationships with members from the five disciplines in the team. Core disciplines were based on the care received by orthopedic patients designated for the study.

Instrument Content:

Reported perceptions, experiences of working relationships, teamwork

Notes for Content:

As described by Relational Coordination Analytics, the Relational Coordination Scale (RCS) "measures the quality of communication and relationships in bounded and unbounded teams. A mutually reinforcing process of communication (frequent, timely, accurate, and problem-solving) and relationships (shared goals, shared knowledge, and mutual respect) characterize the strength of coordination ties amongst interdependent team members."

"Relational coordination" is considered a unitary construct with two aspects: communication and relationships. Four items related to communication assess frequency, timeliness, accuracy, and the extent to which communication is focused on problem-solving rather than blame. Three items related to relationship assess shared goals, shared knowledge (the extent to which members of the other disciplines understand what the respondent does for patiet care), and mutual respect.

Instrument Length:

7 items (dimensions), with each dimension rated separately for collective members from five provider groups, plus 5 demographic items. Estimated time to complete is 10 minutes.

Item Format:

The RCS uses a 5-point Likert-typ[e response scale for each of the 7 items to assess the quality of communication and relationships. Frequency of communication is measured from a low of "not nearly enough," to a high of "much too often." Timely communication and accurate communication are both measured with the same scale, from a low of "never" to a high of "always." Response options for problem-solving are: "always blame," "mostly blame," "neither blame nor solve," "mostly solve," and "always solve." Response options for shared goals range from "not at all" to "completely." Response options for shared knowledge (how much others know about the work you do) range from "nothing" to "everything." The options for mutual respect range from "not at all" to "completely."

Administration:

Mailed surveys were used in the study, but a web-based format is also available.

Scoring:

Additive index of the 7 dimensions. Scores can also be aggregated and reported by dimension and by work group.

Language:

English, although translations have been also reported in the literature.

Norms:

None.

Access:

License required

Notes on Access:

In addition to the Relational Coordination Analytics website (see Resouce Links above), the RCS can also be found on the AAMC MedEdPortal website, along with the peer-review critique of this instrument. The complete "Critical Synthesis Package" also includes excellent support materials on how to interpret local validity data, and guidelines using the instrument for evaluation purposes. Note: as a licensed, commerical tool, users will pay fees for usage and also for other services (e.g., reporting), if desired. Disclaimer: the National Center does not benefit financially or in any other way from including the RCS on this website.

Psychometric Elements: Evidence of Validity

Content:

The study references theoretical underpinnings, and the MedEdPortal states that the items were based on "field research," but the content validity of the instrument is not described in this study.

Response Process:

A total of 878 patients (64% response rate) completed patient survey items, and n=338 (51%) provider completed the RCS. Provider response rates varied by profession and by hospital.

Internal Structure:

Cronbach's alpha for the 7 dimensions ranged from 0.717 to 0.840 and 0.849 for the total instrument, which is adequate for formative evaluation or low-stakes assessment purposes.

Relation to Other Variables:

See below, which describes significant patient benefits of positive relational coordination.

Consequential:

Patient reports of care quality were significantly related to overall relational coordination (p <0.001) and for each of the 7 separate dimensions. Post-operative pain was reduced, and post-operative functioning were both significantly related to the frequency of communication (p = 0.044), the strength of communication (p = 0.035), and the degree of mutual respect among care providers (p = 0.030). Length of stay was shortened by 53.8% in teams reporting high relational coordination; LOS was also significantly related to each of the 7 dimensions.

Assessment & Evaluation

Relational Coordination Scale (RCS)

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