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    Contributions of relational coordination to care management in accountable care organizations: Views of managerial and clinical leaders.
    Health Care Manage Rev 2016 Apr-Jun;41(2):88-100
    Thomas G. Rundall, PhD, is Henry J. Kaiser Professor of Organized Delivery Systems, Emeritus School of Public Health, University of California, Berkeley. E-mail: Frances M. Wu, PhD, is Postdoctoral Fellow in Health Services Research, Center for Innovation to Implementation, VA Palo Alto Health Care System, Center for Primary Care and Outcomes Research, Stanford University, California. Valerie A. Lewis, PhD, is Assistant Professor, Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire. Karen E. Schoenherr, BA, is Primary Care Medical Home Coordinator, Codman Square Health Center, Boston, Massachusetts. Stephen M. Shortell, PhD, MBA, MPH, is Blue Cross of California Distinguished Professor of Health Policy and Management and Director, Center for Healthcare Organizational and Innovation Research, School of Public Health, University of California, Berkeley.
    Background: The accountable care organization (ACO) is a new type of health care organization incentivized to improve quality of care, improve population health, and reduce the cost of care. An ACO's success in meeting these objectives depends greatly upon its ability to improve patient care management. Numerous studies have found relational coordination to be positively associated with key measures of organizational performance in health care organizations, including quality and efficiency.

    Purpose: The purpose of this paper is twofold: (a) identify the extent to which ACO leaders are aware of the dimensions of relational coordination, and (b) identify the ways these leaders believe the dimensions influenced care management practices in their organization.

    Methodology/approach: We performed content analysis of interviews with managerial and clinical leaders from a diverse group of 11 ACOs to assess awareness of relational coordination and identify the ways that dimensions of relational coordination were perceived to influence development of care management practices.

    Findings: ACO leaders mentioned four relational coordination dimensions: shared goals, frequency of communication, timeliness of communication, and problem solving communication. Three dimensions - shared knowledge of team members' tasks, mutual respect, and accuracy of communication - were not mentioned. Our analysis identified numerous ways leaders believed the four mentioned dimensions contributed to the development of care management, including contributions to standardization of care, patient engagement, coordination of care, and care planning.

    Discussion: We propose two hypotheses for future research on relational coordination and care management.

    Practice Implications: If relational coordination is to have a beneficial influence on ACO performance, organizational leaders must become more aware of relational coordination and its various dimensions and become cognizant of relational coordination's influence on care management in their ACO. We suggest a number of means by which ACO leaders could become more aware of relational coordination and its potential effects.

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