Table Of ContentTRANSFORMING
RELATIONSHIPS FOR
HIGH PERFORMANCE
The Power of Relational Coordination
JODY HOFFER GITTELL
STANFORD BUSINESS BOOKS
An Imprint of Stanford University Press
Stanford, California
Stanford University Press
Stanford, California
© 2016 by the Board of Trustees of the Leland Stanford Junior University. All
rights reserved.
No part of this book may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying and recording, or in
any information storage or retrieval system without the prior written permission
of Stanford University Press.
Special discounts for bulk quantities of Stanford Business Books are available to
corporations, professional associations, and other organizations. For details and
discount information, contact the special sales department of Stanford Univer-
sity Press. Tel: (650) 736-1782, Fax: (650) 725-3457
Printed in the United States of America on acid-free, archival-quality paper
Library of Congress Cataloging-in-Publication Data
Names: Gittell, Jody Hoffer, author.
Title: Transforming relationships for high performance: the power of relational
coordination / )ody Hoffer Gittell.
Description: Stanford, California: Stanford Business Books, an imprint of Stan-
ford University Press, 2016. I Includes bibliographical references and index.
Identifiers: LCCN 2015050233 I ISBN 9780804787017 (cloth: alk. paper) I ISBN
9780804797047 (electronic)
Subjects: LCSH: Organizational change. I Interpersonal relations. I
Organizational behavior.
Classification: LCC HD58.8 .G575 2016 I DDC 658.4/06-<lc23
LC record available at http://lccn.loc.gov/2015050233
Typeset by Newgen in 10.5/ 15 Minion
CONTENTS
Preface VII
Acknowledgments ix
PART ONE RELATIONSHIPS AND PERFORMANCE 1
Chapter 1 Meeting Performance Pressures with a
Relational Response 3
Chapter 2 How Relational Coordination Drives
High Performance 13
Chapter 3 Engaging Clients in Relational Coproduction 31
Chapter 4 Engaging Co-Workers in Relational Leadership 45
Chapter 5 How Structures Support-or Undermine-
the Three Relational Dynamics 60
PART TWO GETTING FROM HERE TO THERE 77
Chapter 6 A Relational Model of Organizational Change 79
Chapter 7 Relational Coordination at Group Health 95
Chapter 8 Relational Coproduction in Yarde Municipality 118
Chapter 9 Relational Leadership at Dartmouth-Hitchcock 144
Chapter 10 Bringing It All Together at Billings Clinic 170
v i CONTENTS
PART THREE TOOLS FOR CHANGE 197
Chapter 11 Relational Interventions to Create New Ways
of Relating 199
Chapter 12 Work Process Interventions to Create New Ways
of Working 221
Chapter l3 Structural Interventions to Support and Sustain
the New Dynamics 243
Chapter 14 Bringing It All Together in Your Organization-
and Beyond 265
Notes 277
Index 299
PREFACE
As I began to observe organizational change in real time, I found many sur-
prises. For example, I realized that something needs to happen for people to
have different, more productive conversations, to be able to get past the bar-
riers of "you're in this role and I'm in this role, and I can't say what I think,"
and open up that path of communication to create new relational dynamics.
Another surprise was seeing people take the network measure of relational co-
ordination that I had invented as a research tool and use it instead as a mirror
to provide feedback and to notice "Oh, look, this isn't good communication
between us and this other group. We thought it was, but it wasn't." It was as
if they were using the measure as a boundary object, observing together what
was going on, then giving themselves and each other permission to communi-
cate and relate in different ways.
The cases presented in this book demonstrate the Relational Model of Or-
ganizational Change in action; they show that transformed relationships are at
the heart of sustainable positive change. This model took shape in early 2011,
when Ed Schein invited Amy Edmondson and me to regular meetings in his
living room overlooking the Charles River and the Boston Museum of Science.
Over the course of several months, he demonstrated what it means to create
a relational space-a space in which it is safe to admit what you don't know
and to learn from others-not so easily accomplished among academics, who
tend to have a fair amount of ego! My major insight from these conversa-
tions was that organizational change does not start with the adoption of new
structures, as my previous work had argued. Rather, it starts with participants
changing their patterns of relationships just as they change the way they do
viii PREFACE
the work. Structures cannot be overlooked-indeed, they are essential for sup-
porting and sustaining those new patterns. But by themselves they cannot cre-
ate those new patterns. Sustainable change is likely to require relational and
work process interventions, accompanied by structural interventions. These
conversations prompted me to observe change agents in action and helped me
to notice new things.
In this book, you will meet change agents-such as Tony Suchman, Marjorie
Godfrey, Curt Lindberg, Carsten Hornstrup, Diane Rawlins, Kim DeMacedo,
and their colleagues and clients-who turned the Relational Model of Organi-
zational Change into a living, breathing reality. You will see how theory meets
reality and helps to transform it, and vice versa: how reality meets theory and
helps to transform it. Our journey takes place amid tremendous performance
pressures we are facing in our world today-pressures that require a relational
response.
ACKNOWLEDGMENTS
Transforming Relationships for High Performance would not have been pos-
sible without the generosity and openness of many change agents in many
organizations-especially Group Health, Varde Municipality, Dartmouth-
Hitchcock, and Billings Clinic. There were others as well. In 2011, a series of
influential individuals, most of whom I had not known before, approached
me one by one with the idea that relational coordination could provide practi-
cal insights for organizational change. They included Tony Suchman of Rela-
tionship Centered Health Care; Dale Collins Vidal and Marjorie Godfrey of
Dartmouth-Hitchcock; Ken Milne, Nancy Whitelaw, and Margaret Nish of Sa-
lus Global; Thomas Huber of Kaiser Permanente; Gene Beyt of Indiana Uni-
versity Health; Kathryn McDonald of Stanford Health Policy; and Deborah
Ancona, John Carroll, and Edgar Schein of MIT Sloan School of Management.
I thank these individuals for inspiring me to establish the Relational Co-
ordination Research Collaborative, an international network of scholars and
practitioners headquartered in the Heller School of Brandeis University, and
for serving in many cases as its original board members. I thank the colleagues
who have staffed the Collaborative with me-Joanne Beswick, Megan Cun-
niff, Debbie DeWolfe, and Lynn Garvin-and those who have led the spin-off
we created to better serve clients around the world-Saleem a Moore, Michael
Noce, and Stan Wallack of Relational Coordination Analytics.
As always, I thank my family for providing me with inspiration and sup-
port throughout the long process of researching and writing this book. In this
book, more than my previous ones, they have contributed their insights as
well. Ross Gittell provides a macroperspective through his work on building
x ACKNOWLEDGMENTS
human capital and social capital for economic development. Our youngest,
Grace Hoffer Gittell, provides a microperspective, with her reflections on cre-
ating change through personal example. Our oldest, Rose Hoffer Gittell, links
micro and macro relational patterns through her study of neuroscience and
macroeconomics. My parents, John and Shirley Hoffer, have role modeled re-
lational coordination in their daily lives ever since I can remember. All of their
perspectives have informed this book, particularly the concluding chapter.
Now I invite you to read on, to become inspired by the many change agents
you will meet, and to inform your own journey of creating positive relational
change.
TRANSFORMING RELATIONSHIPS
FOR HIGH PERFORMANCE
