I n this paper we explore a causal mechanism through which high-performance work systems contribute to performance outcomes. We propose that high-performance work systems can improve organizational performance by strengthening relationships among employees who perform distinct functions, a pathway that is expected to be particularly important in settings characterized by highly interdependent work. In a nine-hospital study of patient care, we identify high-performance work practices that positively predict the strength of relational coordination among doctors, nurses, physical therapists, social workers, and case managers, in turn predicting quality and efficiency outcomes for their patients. Relational coordination mediates the association between these high-performance work practices and outcomes, suggesting a relational pathway through which high-performance work systems work.

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