Relationships and resilience: Care provider responses to pressures from managed care

Abstract

Organizations in the health care industry and beyond face pressures to lower their costs while maintaining quality, resulting in high levels of stress for their workers. In a nine-hospital study, this article explores the role that relationships play in enabling resilient responses to external pressures and the organizational practices that enable workers to respond in a resilient way when organizational change is required. The article argues that relational coordination-communicating and relating for the purpose of task integration-is a resilient response to external threats that require a coordinated collective response across multiple functions or roles. Findings suggest that workers engage in higher levels of relational coordination when they perceive this type of threat but that the presence of a particular type of high performance work system-a relational work system-greatly strengthens this resilient response. © 2008 NTL Institute.