| Summary: | <p> Relational capacity within cross-functional groups is increasingly understood to mediate a variety of performance outcomes. Relational coordination, a specific measure and theory of organizational performance in interdependent cross-functional groups with integrated tasks, has been associated with better performance outcomes especially under conditions of uncertainty and time pressure (Gittell, 2016). Understanding underlying factors and processes that contribute to increased relational coordination in terms of opportunity tension (Lichtenstein, 2014), focus theory (Feld, 1981), and positive organizational scholarship (Dutton & Ragins, 2007) from a multilevel research perspective (Kozlowski & Klein, 2000) may extend the theory and offers the possibility of designing more effective change interventions. </p><p> This single exploratory case study focused on a hospital Intensive Care Unit (ICU) that had demonstrated increased relational coordination as a result of change interventions. Case study method was suited to this “how” and “why” research question. During a single week, 15 ICU participants were interviewed on-site. Video interviews of 8 consultants, expert in relational coordination interventions from a variety of settings, situated the case in a larger context. </p><p> Transcripts were coded producing 35 descriptors that were ranked by frequency. The following 5 analytic categories of significant factors and processes emerged: (a) opportunity tension, (b) relational factors, (c) sensemaking, (d) focal activity, and (e) contextual factors. Additionally, 2 emergent themes developed: (a) factors and processes are causally linked in a mesh of interdependency, and (b) occur at multiple levels and multiple scales. </p><p> The major contribution of this study was an interoperability model of the 5 analytic categories of factors as a multilevel causal mesh to increase relational coordination. Contextual factors help create the container for focal activities that build relationships and the safety for continuous learning and sensemaking. At every point in the process, opportunity tension stimulated action. The analytic category model led to 22 recommendations that inform future change intervention designs. More specific research into each of the 5 analytic categories is needed to validate the findings and increase the resolution of how the factors are involved in the processes. Exciting future directions include leveraging positive organizational scholarship and harvesting relational coordination field practices to deepen theory.</p><p>
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