Relational Leadership Institute
The Relational Leadership Institute (RLI) at Oregon Health and Science University is a three-month leadership learning collaborative that combines executive leadership skills (focused on the “what” and the “how” of work) with relational leadership skills (focused on the “who” and the “why”). A relational approach to leadership emphasizes emotional intelligence, strength-based engagement with others, and cultivation of trust and psychological safety on teams. It runs counter to the prevailing hierarchical model of leadership in healthcare, favoring practices that are collaborative, nurturing, and optimally engage all team members in a trustful environment. Evidence has shown that relational leadership practices are what characterize the highest performing teams in health care, leading to improved quality of care, patient satisfaction, and provider satisfaction.
RLI’s 10-session curriculum utilizes a mixed methods process to engage all learning styles, including: large group didactics, small group activities, one-on-one skill practice, opportunities for reflection, assigned readings, and the application of skills in participants’ professional settings. Each participant is assigned to a small group (6-8) that remains intact throughout the course and is facilitated by two prior RLI participants. Session trainers (subject matter experts) and small group facilitators actively model RL practices to engender trust and psychological safety. Participant feedback is regularly elicited and acted upon, with each session concluding with a group discussion of takeaways and opportunities for program improvement. A leadership pathway from participant to small group facilitator to session trainer has been developed, and participants are supported through curricula focused on relational facilitation skills and group activities to foster a sense of “community within a community.” The pathway provides a mechanism for participants to continue developing their RL skills by applying and teaching newly learned RL skills in a safe and supportive learning environment. It also builds local capacity for accelerated spread of RL.
Proof of Concept:
We have completed a mixed-methods evaluation of the two pilot cohorts of RLI (RLI 1 and 2), including assessments post-program and six months post-program. In evaluating the overall course, 100% of participants of both RLI 1 and 2 agreed or strongly agreed with the statements, “I’ve learned practical skills that will help me in my work” and “I plan to use skills I have learned in the future.” At six months post-program, 50% of participants of both RLI 1 and 2 agreed or strongly agreed with the statement, “I have reached out and connected with members of my RLI learning collaborative.” Participants reported a significant increase in self-assessed competence for all 11 competencies, many of which connect to trust, in the four course domains (p-value range: 0.013 to <0.001).
Participants also reported a significant positive shift in their level of agreement with eight of nine statements reflective of RL attitudes (p-value range: 0.041 to <0.001). The most marked shifts occurred in attitudes related to working in teams and supporting others. The proportion of participants who agreed or strongly agreed with the following statements shifted from 50% pre-RLI to 95% post-RLI: “I am confident that I can help launch a team and handle difficulties when they arise” and “I am confident I can support the growth and development of my colleagues.” Participants seemed to retain these skills and mindsets long term; six months post-course, approximately 50% of participants reported that they were “moderately” or “fully” applying skills.
The results of our RLI pilot demonstrate that RL skills and practices can be successfully learned, retained, and applied by its participants. Our experience also suggests that a local community of practice can be fostered, creating a powerful force to help spread the practices and deepen participants engagement in the material.
The RLI content and curriculum is optimally positioned to be scaled and reproduced in other settings. Based on its early successes, plans are already underway for PCP and OHSU to support the University of North Carolina, the University of Utah, and the University of Colorado in integrating RLI within their institutions. A RLI National Collaborative team has formed with representative stakeholders from each of these institutions participating to identify how to most effectively scale and spread RLI across the country. Due to interest from existing, intact clinical care teams, PCP and OHSU are developing and piloting a program that would bring RL skills learning to their clinical settings. Key insights and evaluations from this clinical team pilot will enhance our understanding of other ways to effectively scale and disseminate RLI in other settings.