Increasing Performance with More Effective Coordination

NRSA Trainees Research Conference Slide Presentation (Text Version)

By Farbod N. Hagigi, M.P.H., Ph.D. Candidate

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On June 2, 2007, Farbod N. Hagigi made a slide presentation on Increasing Performance with More Effective Coordination at the 13th Annual National Research Service Award (NRSA) Trainees Research Conference. This is the text version of the slide presentation. Select to access the (PowerPoint® File, 260 KB).

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Slide 1

Increasing Performance with More Effective Coordination

Farbod N. Hagigi, M.P.H., Ph.D. Candidate
Schneider Institute for Health Policy
The Heller School for Social Policy and Management
Brandeis University

Slide 2

Research Question

Can organizations increase their performance by improving coordination?

Slide 3

Coordination

• Managing dependencies between activities (Malone and Crowston 1994).
• Two views:
  • Information processing: (Galbraith 1972; Tushman 1978; Argote 1982; March & Simon 1958).
  • Relational: (Gittell 2002; 2003; 2004; 2005; Faraj 2006).

Slide 4

Coordination

• Importance in health care:
  • Fragmented providers and facilities.
  • Difficult because of complexities of service.
  • Poor coordination results in: (IOM 2001; Miranda 2002; Halm 2003; Gittell 2000, 2005; Young 1998; Strauss 1989):
    • Low quality and efficiency.
    • Errors in medication and treatment.
    • Conflicting information.

Slide 5

Coordination & Performance

• Increased performance: (Granovetter 1985; Uzzi 1996):
  • Trust.
  • Fine-grained information transfer.
  • Facilitate problem solving arrangements.
• Mitigating cost/quality tradeoff with improved management practices.

Slide 6

Model

The diagram describes a three-faceted model focusing on dimensions of Clinic Design, Relational Coordination and Performance, each depicted in a rectangle. Dimensions of Clinic Design include Human Resources and Coordination Mechanisms, each depicted in a separate square.

These in turn influence dimensions of Relational Coordination, which are presented in a circle. Relational Coordination is comprised of three dimensions including those pertaining to:

• Communication, measured in terms of frequency, timeliness, and problem solving);
• Relationships, measured in terms of shared knowledge, shared goals and mutual respect; and
• Influence.

The three dimensions of Relational Coordination are also depicted as influencing each other. Relational Coordination is then shown to influence performance, measured in terms of quality and cost, presented as two rectangles.

Patient characteristics are represented as an additional factor with influences both Relational Coordination and Performance dimensions.

Slide 7

Study Site

• 16 primary care clinics.
• 3 hospitals.
• Complex patient population.
• Decentralized management of clinics.
• EMR [electronic medical record] implementation.

Slide 8

Data

• Coordination Data:
  • Coordination surveys (Gittell; Weinberg).
  • Interviews.
• Performance Data:
  • Quality.
  • Costs.
  • Risk adjustment: demographic and health.

Slide 9

Coordination & Performance

The essential purpose of clinics is to take a set of inputs, which are reflected in costs, or charges, and produce certain outputs which we can overall call quality.  The model is one that was presented in Chilingerian 2004 for a data envelopment analysis (DEA) model, a mathematical programming methodology which allows us to create a production frontier based on these inputs and outputs, and determine where certain clinics or primary care physicians are in relation to this frontier.

Slide 10

Coordination & Performance

This slide shows the performance frontier that the model in Slide 9 would have created.  Those units on the frontier are at maximum relative performance.  The unit shown with the arrow is a unit that is moving to increase quality without increasing costs.  This is the concept being tested in this research project—whether it’s possible to increase quality and not increase costs, or to decrease costs without decreasing quality.

Slide 11

Broader Goals

• Understanding relative importance of underlying factors that impact performance, focusing on coordination as a key factor.
• Using novel methodologies for performance measurement.
• Theoretical contributions to coordination literature.

Current as of October 2007

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Internet Citation:

Hagigi, FN. Increasing Performance with More Effective Coordination. Text Version of a Slide Presentation. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/fund/training/hagigitxt.htm

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