• Heather M Gilmartin, Catherine Battaglia, Theodore Warsavage, Brigid Connelly, and Robert E Burke.
• Heather M. Gilmartin, PhD, NP, is Investigator, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration Eastern Colorado Healthcare System, Aurora, and Health Systems, Management and Policy, University of Colorado School of Public Health, Aurora. E-mail: Heather.gilmartin@va.gov. Catherine Battaglia, PhD, RN, is Investigator, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration Eastern Colorado Healthcare System, Aurora, and Health Systems, Management and Policy, University of Colorado School of Public Health, Aurora. Theodore Warsavage, MS, is Statistician, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration Eastern Colorado Healthcare System, Aurora. Brigid Connelly, BA, is Research Assistant, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration Eastern Colorado Healthcare System, Aurora. Robert E. Burke, MD, MS, is Investigator, Center for Health Equity Research and Promotion, Corporal Crescenz Veterans Health Administration Medical Center, Philadelphia, Pennsylvania, and Hospital Medicine Section-Division of General Internal Medicine, University of Pennsylvania Perelmann School of Medicine, Philadelphia.
• Health Care Manage Rev. 2020 Nov 11.

BackgroundEnsuring safe transitions of care around hospital discharge requires effective relationships and communication between health care teams. Relational coordination (RC) is a process of communicating and relating for the purpose of task integration that predicts desirable outcomes for patients and providers. RC can be measured using a validated survey.PurposeThe aim of the study was to demonstrate the application of RC practices within the rural Transitions Nurse Program (TNP), a nationwide transitions of care intervention for Veterans, and assess relationships and mechanisms for developing RC in teams.Methodology/ApproachTNP implemented practices expected to support RC. These included creation of a transition nurse role, preimplementation site visits, process mapping to understand workflow, creation of standardized communication templates and protocols, and inclusion of teamwork and shared accountability in job descriptions and annual reviews. We used the RC Survey to measure RC for TNP health care teams. Associations between the months each site participated in TNP, number of Veterans enrolled, and adherence to the TNP intervention were assessed as possible mechanisms for developing high RC using Spearman (rs) correlations.ResultsThe RC Survey was completed by 44 providers from 11 Veterans Health Administration medical centers. RC scores were high across sites (mean = 4.19; 1-5 Likert scale) and were positively correlated with months participating in TNP (rs = .66) and number of enrollees (rs = .63), but not with adherence to the TNP intervention (rs = .12).Practice ImplicationsThe impact of practices to support RC can be assessed using the RC Survey. Our findings suggest scale-up time is a likely mechanism to the development of high-quality relationships and communication within teams.

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