Relational coordination in inter-organizational settings. How does lack of proximity affect coordination between hospital-based and community-based healthcare providers?

Coordination among healthcare providers in intra- and inter-organizational networks is critical for the provision of seamless and efficient healthcare. Relational Coordination (RC) represents a type of coordination that enables network participants to manage interdependencies and has consistently been found to improve quality and efficiency of patient care. The majority of RC studies focuses on intra-organizational settings, while less is known about inter-organizational settings. This pilot study examined RC in relation to a collaboration between a hospital-based geriatric team and a community-based acute care team. The study focused especially on how structural challenges due to lack of technological, geographical and organizational proximity between the healthcare providers affected RC, drawing on literature on inter-organizational collaboration. We adopted a qualitative case design to gain an in-depth understanding of barriers and facilitators of interprofessional RC. Data included seven qualitative interviews with healthcare professionals and managers across the two provider teams and 16 hours of participant observations. Findings suggested that core tasks were coordinated through strong RC, while RC in non-core tasks were systematically hindered by structural challenges of the inter-organizational setting. Findings also indicated that RC in core tasks was partly dependent on formal coordination mechanisms to overcome frictions in inter-organizational structures.