Relational Coordination to improve inter-team dynamics in two pathways of care

‘Relational Coordination’ is used to measure the quality of relationships and communication involved in work processes. NHS Cumbria Clinical Commissioning Group applied this approach in a project to evaluate and compare two separate, poorly performing care pathways, for the first time in the NHS.

A Relational Coordination survey was used to test inter-team dynamics within the chemotherapy pathway at North Cumbria University Hospitals NHS Trust and the Multiagency Crisis Assessment Service (MACAS) for Cumbria, which draws together partners from across health, care and the police. The aim was to help teams to identify areas of poor performance and think about relational aspects of working in order to make improvements.

Although only around one third of the 113 staff who were emailed the survey completed it, data analysis gave sufficient insight for each pathway to generate ideas for ongoing improvement work.

Benefits seen in the MACAS pathway included less people detained under the Mental Health Act, a reduction in frequent attenders at A&E and a clear process for handling mental health crises. There was also a cultural shift towards recognising the importance of mental health and wellbeing.

Although work to improve communication within the chemotherapy service was planned, this has yet to be completed due to clinical pressures and staffing priorities. A key learning point was that increased engagement with senior leaders would have enabled better survey response rates and commitment to improvement.

Overall, using the survey to measure and enable discussion about relational working provided a valuable insight into the benefits of Relational Coordination and its potential application in the wider NHS.

Contact information

For more information about this project, please contact Rachel Fleming, Clinical Programme Manager, NHS Cumbria Clinical Commissioning Group.