Relational Coordination and Relational Systems: how teams navigate transformation and crisis in UK General Practice, a multi-method qualitative case study analysis

This paper presents findings from a multi-method case study of UK general practice. Empirically, this case study examined influences on teams’ ability to navigate crisis and change in the context of UK general practice. Theoretically, we explored the significance of relationships and their enabling structures or mechanisms during such navigation.

Our results highlight the importance of complementary organisational structures of relational advocacy and relational coordination in GP practice teams, given the complexity and interdependency of modern general practice work and the environmental context of persistent crisis and change. Our findings indicate that these structures support the development of adaptable teams that protect individual and organisational resilience. In turn, ensuring the team's resilience helps stabilise the system's relational advocacy and maintain an organisational culture of relational coordination.

Significant crisis events can disturb this cycle, sometimes so severely that the system can no longer be attentive to relational advocacy, and slips into indifference. Critically, there is the capacity for future work to facilitate movement into relational advocacy by establishing the conditions for positive change and supporting teams to build the critical structures and processes that support relational coordination, psychological safety, and attentive infrastructures.