This article develops a relational perspective on the coordination of work. Existing theory suggests that relational forms of coordination should improve performance in settings that are highly interdependent, uncertain and time‐constrained. Going beyond previous work, we argue that relational coordination should also improve job satisfaction by helping employees to accomplish their work more effectively and by serving as a source of positive connection at work. Using a cross‐sectional sample of nursing aides and residents in 15 nursing homes, we investigate the impact of relational coordination on quality outcomes and job satisfaction.

The finding that greater job commitment of CNAs is associated with better quality of relationships and life for residents implies that better jobs lead to better care. Culture change transformation that increases CNA autonomy, knowledge input, and teamwork may not increase workers' commitment to jobs without improvements in basic supervision.

Background: The increased ''outsourcing'' of care-related tasks to patients and their informal caregivers is part of a broader trend in service industries toward engaging customers as ''coproducers'' of service outcomes. As both quasi-patients and quasi-providers, caregivers may play a critical role in successful coproduction, but they require coordination with care providers to play this role effectively. When tasks are highly interdependent, uncertain, and time constrained, as they often are in health care, relational forms of coordination are expected to be most effective.Purposes: This study explores the effects of coordination between formal providers and informal caregivers on caregiver preparation to provide care at home and the effect of caregiver preparation on patient outcomes. Gittell's theory of relational coordination posits that effective coordination occurs through frequent, high-quality communication that is supported by relationships of shared goals, shared knowledge, and mutual respect. We extend the relational coordination model, previously used to examine coordination between formal providers, to encompass coordination of care between formal providers and informal caregivers. Methodology: We surveyed patients before and 12 weeks after knee replacement surgery to assess outcomes. At 6 weeks postsurgery, we surveyed their caregivers regarding coordination with providers and preparation to provide care. Findings: We found that relational coordination between formal providers and caregivers improves caregiver preparation to provide care, which, in turn, is positively associated with patients' freedom from pain, functional status, and mental health. Implications: Providers should be encouraged to attend to the interpersonal aspects of their interactions with caregivers to promote relational coordination, which may ultimately benefit the patient's health. It is not enough, however, to urge providers to build shared goals, shared knowledge, and mutual respect with patients and caregivers. Dedicated resources and support are needed, given the context of constrained resources and brief encounters in which providers deliver care.

When designing jobs, the degree of specialization is a key consideration. Though functional specialization allows workers to develop deep areas of expertise, it also increases the challenge of coordinating their work. In this article, we propose the concepts of stage‐ and site‐based specialization and posit that together they can counteract the divisive effects of functional specialization. Taking advantage of a natural experiment in physician job design at a Massachusetts hospital, we explore the impact of stage‐ and site‐based specialization on coordination and performance outcomes. Building on recent interest in relational approaches to job design, this study is the first to link relational job design to relational outcomes such as coordination. Our findings have practical implications for job design in professional service settings such as education, consulting, and health care. © 2008 Wiley Periodicals, Inc.

Objectives. To investigate patients' experience with coordination of their postsurgical care across multiple settings and the effects on key outcomes. Data Sources. Primary data collected over 18 months from 222 unilateral kneereplacement patients at Brigham and Women's Hospital in Boston, MA. Study Design. Patients were surveyed about the coordination of their postdischarge care during the 6-week period postdischarge when they received care from rehabilitation facilities and/or home care agencies and follow-up care from the surgeon. Data Collection. Patients were surveyed before surgery and at 6 and 12 weeks postsurgery. Principal Findings. Patient reports highlight problems with coordination across settings and between providers and themselves. These problems, measured at 6 weeks, were associated with greater joint pain, lower functioning, and lower patient satisfaction at 6 weeks after surgery. At 12 weeks after surgery, coordination problems were associated with greater joint pain, but were not associated with functional status. Conclusion. Coordination across settings affects patients' clinical outcomes and satisfaction with their care. Although accountable for transfer to the next care setting, providers are neither accountable for nor supported to coordinate across the continuum. Addressing this system problem requires both introducing coordinating mechanisms and also supporting their use through changes in providers' incentives, resources, and time.

Objective. To examine the benefits of a high-performance work environment (HPWE) for employees, patients, and hospitals. Study Setting. Forty-five adult, medical-surgical units in nine hospitals in upstate New York. Study Design. Cross-sectional study. Data Collection. Surveys were collected from 1,527 unit-based hospital providers (68.5 percent response rate). Hospitals provided unit turnover and patient data (16,459 discharge records and 2,920 patient surveys). Principal Findings. HPWE, as perceived by multiple occupational groups on a unit, is significantly associated with desirable work processes, retention indicators, and care quality. Conclusion. Our findings underscore the potential benefits for providers, patients, and health care organizations of designing work environments that value and support a broad range of employees as having essential contributions to make to the care process and their organizations. Key Words. Acute inpatient care, quality of care/patient safety (measurement), patient assessment/satisfaction, health care organizations and systems, work environment, high performance work systems, management practices, organizational behavior Work environment, sometimes also called "work climate" or "culture," has become an important factor in health services research, shown in numerous studies to be associated with positive outcomes for workers, patients, and organizations. However, what do we mean when we say an organization has a good work environment or culture or climate? Does an organization have multiple cultures or work environments, for example, on different units or among different professions? If so, whose work environment matters for understanding what an organization does or how it performs? These [Correction statement added after first online publication 20 June 2012: The columns for Table 2 (page 9) were published in incorrect order. The table has been altered and is now correct.]

Given the strong doubts some residents expressed about nurses' cooperativeness and competence, the nursing profession should consider strengthening nursing education and clearly delineating nurses' roles and competencies.

Using qualitative data from 87 focus groups with CNAs in 16 nursing homes in Massachusetts, this study explores ways CNAs make meaning of their work despite devaluations such as lack of respect from management and residents, and the physical and emotional demands of such low status work. CNAs' meaning-making represents an effort to assert a positive identity rather than accept the stigmatization associated with their work. Assertions of the value help CNAs reconstitute their identities. Assertions of meaning, which depend upon providing good care to residents regardless of financial reward or management respect and support, make CNAs vulnerable to exploitation.