Abstract

Relational coordination is an emerging HR-related concept based on the network of ties between task participants and is expected to produce favorable efficiency and quality outcome. The relational coordination-employee outcome is new research dimension in the relational coordination field. The objective of the study was to test if relational coordination leads to employee related outcomes. In terms of research methodology, we followed the positivism paradigm, used deductive approach, and quantitative method of data collection and analysis. Furthermore, we used the survey based on previously developed measures for data collection. Through stratified random sampling, data is collected from doctors, nurses, and support staff from five public and five private sector hospitals. The usable questionnaires were 978. Our findings show that relational coordination among staff positively influence the employee creative involvement (employee outcome). The findings have implications for the management of healthcare and a number of recommendations are made.

Key Words

Relational Coordination, Employee Outcome, Employee Creative Involvement, Healthcare,          Peshawar, Pakistan

Introduction

Relational coordination can be described as coordination which is carried out by the front line workers with an awareness of their relationship to the overall work process and to the other participants in that process and builds upon the concepts of communication and collaboration (Gittell, 2000, 2016). The theory of relational coordination emphasizes that the relational coordination bring improvement in efficiency and quality of services provided in the field of healthcare and produces favorable outcomes for organization and its stakeholders (Cramm & Nieboer, 2014; Gittell, 2009; Gittell, Weinberg, Pfefferle, & Bishop, 2008). Researchers in the field of relational coordination and its outcomes are based on various international contexts. These studies reported that relational coordination bringing efficiency and quality outcomes and additionally positively leading to other favorable customers, client and employee-related outcomes in various healthcare and non-healthcare settings (e.g. Naruse, Sakai, & Nagata, 2016; Lundstrom, 2014; Carmeli & Gittell, 2009; Hagigi, 2012). However, relational coordination-employee outcome is one of such research avenue which is not much explored by previous researches so far. 

Gittell (2011) suggested the five directions for future research in the field of relational coordination. The first direction is that the relational coordination theory may be investigated from a social-psychological perspective and putting the relational coordination in its social-psychological context. In other words, Gittell suggests investigation of relational coordination using the self-perspective. The second direction is that future researchers may include personal relationships in the relational coordination process. This thing needs to be kept in mind that at the moment, the relational coordination is based on task-based perspective only. The third future direction is that future researchers may investigate how non-core workers such as secondary or peripheral types of workers also contribute to the process of relational coordination process. By this means that future researcher may adopt approach which includes non-core workers such as support staff or technicians or even outside contractors. The fourth future direction is that researchers may include other possible outcomes of the relational coordination process. Currently, mostly, research only focused on efficiency and quality outcomes; however, client and employee outcomes are also emerging in more recent literature. Gittell, however, did not indicate much about the nature of other possible outcomes of relational coordination. The last and fifth future direction for future research is the non-linear process approach utilizing organizational change in future relational coordination related researches. In other words, this is about inclusion of relational coordination in organizational change enabler context. Keeping in view such literature gap and future directions as suggested by Gittell, in present work we proposed and test employee outcome of relational coordination and thus moving beyond efficiency and quality outcomes. We used employee creative involvement as an employment outcome of relational coordination and thus contributing the literature of relational coordination. 




Background of the Study

The outcomes of relational coordination include increases in efficiency and quality of services provided as indicated by its theory (Gittell, 2009; Cramm & Nieboer, 2014; Weinberg, Gittell, Lusenhop, Kautz, & Wright, 2007). As indicated in future directions, the other possible outcomes of relational coordination are employee and client/customer related. A limited number of studies focused on these outcomes, for example, HR-related outcomes of relational coordination investigated in previous studies include job satisfaction, motivation, professional efficacy, work engagement and proactive work behavior, job involvement, sense of social support, confidence in collaboration, and psychological safety (Naruse, et al., 2016; Havens, Vasey, Gittell, & Lin, 2010; Carmeli & Gittell, 2009). In present work, we extended the outcomes and included employee creative involvement as an employee-related outcome. 




Research Objective

• To measure the effects of relational coordination on employee creative involvement




Significance of Research

Moving beyond the efficiency and quality outcome and inclusion of employee-related outcome for relational coordination is a valid literature gap and this signifies the present work as it fills that literature gap. The significance of the study is that is also based on addressing future directions as suggested by Gittell (2011) by including employee related outcomes. Relational coordination and its outcomes-based studies are missing from Pakistani literature and the present study is one of the first studies investigating this concept in Pakistani healthcare system which is its contribution to the literature. The practical significance of the study is that it will provide management of organizations useful information for decision making regarding aspects of HRM such as training, promotions, placements, and so on. Similarly, the empirical knowledge of outcomes of relational coordination in this particular context can be used for putting a case for relational coordination. The findings can be used for improving the performance of healthcare organizations.

Literature Review

Relational Coordination

The importance of relational coordination is that it brought a new perspective to the coordination i.e. adding relational dimension in addition to the simple mechanistic and information processing perspective (Faraj & Xiao, 2006). Application of this relational perspective to the coordination means now coordination is considered as the management of interdependent tasks so it is relational in nature (Faraj &Xiao, 2006; Bechky, 2006). The relational dimensions include mutual respect, shared knowledge, and shared goals; while, the communication dimensions include problem-solving communication, accuracy, timeliness, and frequency (Weinberg, et al., 2007). Here, mutual respect is about participants carrying respect factor for each other’s role in the process. Shared knowledge is about participants possessing knowledge that how my role and other participants' role contribute to overall work completion. The shared goal is about sense of collective responsibility and goal sharing among participants. Problem-solving communication is about participants' engagement in communication-related to solving customer and work-related problems. Accuracy reflects how correct or valid the information is which is communicated by participants for the purpose of completing the task. Timeliness is about communication occurrence between participants in timely fashion for completing the task. Frequency is about how frequently the tasks participants communicate in order to get the work done. The theory of relational coordination suggests that both the relational and communication dimensions of relational coordination are simultaneously reinforcing each other (Gittell, 2009).




Relational Coordination and Employee Outcomes

Relational coordination produces favorable outcomes including quality and efficiency as suggested by its theory (Gittell, 2009). The relational coordination-employee outcome connection is proposed and tested in different studies and initial empirical evidence suggests that such connection does exist (Gittell, 2009). The relational coordination-employee outcome connection is based on the notion that relational coordination is a kind of social capital, which if present, makes it easier for the task participants to easily access the required resources and complete tasks (Adler & Kwon, 2002). Furthermore, relational coordination also creates a source of wellbeing for people at work (Dutton & Heaphy, 2003). 

Findings of studies which investigated the relationship between relational coordination and some favorable employee-related outcome indicate that relational coordination is associated with proactive work behavior and engagement, professional efficacy, greater career satisfaction, identification with organizational values, and motivation (Naruse, et al., 2016; Cramm, & Nieboer, 2014; Havens, et al., 2010). Other outcomes of relational coordination include psychological safety (Carmeli & Gittell, 2009); job involvement and competence (Albertsen, Wiegman, Limborg, Thornfeldt, & Bjorner, 2014); and perceived justice and employee organizational commitment (Alvarez, 2014; Wright, 2015). Overall, results indicate that relational coordination also leads to a favorable employee-related outcome.




Employee Creative Involvement

Employee creativity involvement is a difficult concept because of its very nature. A starting point is definition of creativity which may be described as employee display of workplace creativity for introducing new and improved ways of doing things and can be related to organizational products, processes, and outcomes (Anderson, Potocnik, & Zhou, 2014). One aspect of employee creativity is his/her personality; while, research also supports this notion that it is influenced partially by work environmental-related factors (Alvarez, 2014; Amabile, 2013; Amabile & Steven, 2011; Carmeli, Gelbard, & Gefen, 2010; Wright, 2015). We can treat relational coordination as an environmental factor that has the capability to provide employees a sense of psychological safety and suitable work environment and thus foster employee creativity. If relational coordination among task participants is strong, it will give employees a sense of cooperation, freedom, and shared psychological safety. These characteristics are likely to lead to higher employee creativity or creative involvement from employees. Empirical evidence also shows a positive relationship between support from work group and employee creativity (Amabile & Steven, 2011; Binnewies, Ohly, & Sonnetag, 2007). A study also reported that employee work engagement and proactive behavior is predicted by relational coordination (Warshawsky, Havens, & Knafl, 2012). These variables are technically closely related to employee creative behavior. 




Theoretical Framework and the Hypothesis of the Study

The connection of the relational coordination-employee outcome is theoretically grounded on the social capital theory. According to Nahapiet & Ghoshal, (1998), social capital is various relationships embedded in social structure which give strength to the social structure. Such embeddedness of special relationships as trust enables smooth interrelationship and functioning of the social structure (Nahapiet & Ghoshal, 1998; Gianvito, 2007). Based on the social capital theory, relational coordination can be conceptualized as a kind of social capital that makes smooth task integration possible (Adler & Kwon, 2002; Gittell & Weiss, 2004). 

H1= Relational coordination is significantly related to the employee creative involvement (Employee outcome)

Research Methodology

In terms of research methodology, the design is explanatory and cross-sectional in nature. This means that the study is about the explanation of a dependent variable using an independent variable and data collection is based on one-time data collection from participants (Creswell, 2012; Sekaran & Bougie, 2016). 




Population and Sampling Approach

All public and private hospitals make the population for our study as it is focused on the healthcare sector in the city of Peshawar. We used the sampling approach because of larger size of actual population. For sampling frame, we selected five public and five private sector hospitals. We utilized stratified sampling which is a sub-type of probability sampling for data collection from the participants.




Survey Measure

Relational Coordination is measured based on two dimensions having total of 7 items adopted from Gittell (2000). The two dimensions are communicational and relational which are measured by 4 items and 3 items respectively. Employee creative involvement is measured on single dimension having 9 items and adopted from Carmeli and Schaubroeck (2007).




Validity and Reliability

Asika (2005) describe validity as to how well an instrument measures its intended variable. The validity of the current study and its measures are established by construct validity using the confirmatory factor analysis which establishes the convergent and construct validity for measures adopted (Field, 2013; Sekaran & Bougie, 2016). Asika (2005) defined reliability as the consistency between independent measurements of the same phenomenon. We used Cronbach alpha and Composite Reliability (CR) for establishing reliability and found satisfactory results. 

Results and Discussions

This section provides results followed by discussion. 

Table 1. Demographic Information of the Survey Participants

Demographic Frequency Percentage (%)

Gender

Male 541 55.3%

Female 437 44.7%

Age

18 to 25 Years 142 14.5%

25 to 45 Years 563 57.6%

45 to 60 Years 255 26.1%

Above 60 Years 18 1.8%

Staff Profession

Doctors 289 29.6%

Nurses 346 35.4%

Support Staff 343 35%

Nature of Hospital

Public 646 66.1%

Private 332 33.9%

n for staff=978




A total of 978 usable surveys were returned from the staff of selected hospitals. In the staff category, there is a total of 541 males (55.3%) and 437 females (44.7%). In terms of the age of survey participants from the healthcare staff, 142 participants were 18 to 25 years of age category (14.5%); 563 participants were in category of 25 to 45 years (57.6%); 255 participants were in 45 to 60 years age category (26.1%); and 18 participants were in above 60 years category (1.8%). Profession wise, there were total of 289 doctors (29.6%); 346 nurses (35.4%); and 343 support staff (35%). A total of 646 participants belonged to the public hospitals' category (66.1%), and 332 participants belonged to the private hospitals' category (33.9%). The descriptive statistics are given below. 

Table 2. Descriptive Statistics

Minimum Maximum Mean Std. Deviation

Frequent Communication-Staff 1.00 5.00 3.32 0.98

Timely Communication-Staff 1.00 5.00 3.33 1.05

Accurate Communication-Staff 1.00 4.75 3.29 0.96

Problem Solving –Staff 1.00 5.00 3.25 0.94

Shared Goals-Staff 1.00 5.00 3.39 0.86

Shared Knowledge-Staff 1.00 5.00 3.34 0.85

Mutual Respect-Staff 1.00 5.00 3.27 0.93

Relational Coordination-Staff Overall 1.25 4.46 3.31 0.82

Employee Creative Involvement 1.11 4.89 3.04 0.86

Descriptive statistics for the dimensions of relational coordination suggest that in staff sample, the frequency of communication (M=3.32, SD=.98); timely communication (M=3.33, SD=1.05); accurate communication (M=3.29, SD=.96); and problem-solving communication is above average level (M=3.25, SD=.94). Similarly, shared goals (M=3.39, SD=.86); shared knowledge (M=3.34, SD=.85); and mutual respect is also about average level (M=3.27, SD=.93). The relational coordination among staff on aggregate basis is also just slightly above the medium level (M=3.31, SD=.82). Employee creative involvement is used as an employment outcome and data is collected from the staff. On average, the employee's creative involvement among the staff was also just medium level (M=3.04, SD=.86).

The main method of analysis was regression and we also tested its assumptions (Gujarati & Porter, 2009). We checked these four assumptions based on the guideline and tests suggested by Gujarati and Porter (2009), and Field (2013), and found satisfactory results for all the assumptions. In regression model, we used relational coordination as an independent variable and the employee creative involvement as dependent variables. 

Table 3. Regression Analysis for the Relationship between Relational Coordination and the Employee Outcome (Employee Creative Involvement)

Variables Model 1 Model 2

(Constant) 3.065*** 1.442***

Gender Staff Dummy .027 .005

Age Dummy 18-25 -.095 -.084

Age Dummy 25-45 -.010 .009

Profession Dummy-Doctor -.056 -.056

Profession Dummy- Nurse -.036 -.021

Hospital Nature Dummy- Public .017 -.016

Relational Coordination .502***

R .050 .448

Rsquare .002 .201

Adjusted RSquare -.004 .195

? RSquare .199

FStat .405 34.861***

?FStat 240.997

DWStatistics 1.989

Model 1 only contained control variables that had small influence on staff creative involvement (Rsquare=.002). Model 2 also included relational coordination along with control variables as independent variables. Results indicate that relational coordination can explain 20.1% variation in employee creative involvement (Rsquare=.201). The F-statistics showed that overall model is fit and significant (Fstat=34.861, P<.05).  The DW statistics is also within acceptable limit (DWstat=1.989). Results suggest positive change in employee creative involvement which is our employee outcome of relational coordination in the present study (?=.502, P<0.05). The result supports the hypothesis.

Discussion

The testing of relational coordination-employee related outcome which is beyond the traditional efficiency and quality outcome was the main purpose of the study. It was based on selected hospitals from the city of Peshawar. For data collection, task participants from different functions (doctor, nursing, and support staff) that contribute to delivering healthcare service delivery were included in the study. The main finding based on regression analysis suggests that relational coordination leads to the favorable employee outcome while employee creative involvement was used as an indicator of employee outcome in this study. Previous research work on the relational coordination-employee outcome also establishes that relational coordination among task participants leads to various outcomes such as job satisfaction, identification with organizational values, reduced burnout, professional efficacy, and motivation (Havens, et al., 2010; Cramm & Nieboer, 2014)

Work engagement and proactive work behavior which is theoretically closely aligned with employee proactive behavior is found to be predicted by relational coordination as in previous work (Warshawsky, et al., 2012; Naruse, et al., 2016). The relational coordination-employee outcomes link is explainable using the theoretical lens of social capital theory as it enables us to view relational coordination as a special type of social capital that enable achievement of favorable employee outcomes (Gianvito, 2007; Nahapiet & Ghoshal, 1998). Furthermore, environmental factors influence employee creativity other than employee own personality is also supported by employee creativity theory (Amabile & Steven, 2011; Alvarez, 2014; Wright, 2015). Overall, our findings match well with findings of previous work and add to the literature of relational coordination as well as employee creativity. 

Conclusion

The conclusion of the present study is that relational coordination is a highly important concept and if relational coordination among task participants is present, it is likely to lead to favorable employee outcomes. Thus, we can conclude that relational coordination favorable outcomes are not limited to efficiency or quality alone; rather, different multilevel outcomes hypothesis is supported based on our study. It may also be useful to view relational coordination as a special type of capital (Social capital theory) or special type of resource (Resource-based view) since it is associated with favorable outcomes. 

Recommendations

• A recommendation for the healthcare organizations is that they should give importance to the relational coordination capacities of staff.  For this purpose, the organization should give attention to the personality characteristics during the recruitment and selection process.

• A recommendation for the management of the healthcare organizations is that relational coordination is found to be producing favorable efficiency, quality, employee and customer related outcome; therefore, it may be given prime importance that relational coordination among task participants is increased using various mechanisms. 

• For the HR function, the recommendation is that there may be focus on relational coordination in various HR practices such as recruitment and selection, training and development, job design, and so on. Utilization of such cross-functional HR policies and practices is useful which promotes relational coordination among task participants and between different departments or units. 

Limitations and Direction for Future Researchers

The first limitation is related to the research approach and design as we only utilized quantitative research and did not include qualitative research design in our methodology. Another limitation is that the study was based on cross-sectional design. A limitation is related to the data collection. The geographical limitation of data collection is that we only collected data from ten hospitals located in a single city which is Peshawar. A future researcher may investigate relational coordination and employee outcomes using some mediating and moderating variables. Special focus may be given to how relational coordination can benefit non-core workers, customers, and even suppliers. 

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