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Intervention Database Project Summary Form
Instructions: Thank you for taking the time to complete the Relational Coordination Research Collaborative
intervention database project summary. Please complete the form below as completely as possible. You will be
asked to answer a number of descriptive questions and then to provide a narrative and a summary of key
learnings from your project. The information provided will help develop shared learning around the methods
and tools for effective and positive organizational change. Once this form has been completed the form, please
submit it to [email protected]
1)
2)
3)
4)
5)
Form Completed by:
Project Lead:
Project Title:
Start Date:
End Date:
Date completed:
6) Funding/Funder (internal, external – govt, external – foundation, other):
7) Is there a public report available or expected?
8) If yes, please include information on how it can be retrieved:
-Contact Name:
-Email address:
-Phone Number:
-URL:
Project Description
9) Background: how did the need for the project become apparent? How did the idea originate?
10) Goals: What was the intended outcome for the intervention?
 For a research project, please also describe the research question(s) to be answered:
 What was the time frame for conducting this project?
Setting
11) Identify the location of the project
• Country, city (region):
• Urban, suburban, rural:
12) Identify the setting in which the project intervention occurred:
☐Healthcare
☐Hospital
☐Physician or other independent professional practice
Please specify clinical discipline and specialty: _Family Medicine_________________
Practice group size (number of practitioners): _Approx 4 physicians_
☐Integrated Delivery System
☐Non-healthcare (Industry:________________)
☐ Service Delivery
☐ Manufacturing
☐ Consulting
☐ Academic and/or Research Institution
☐ Other: _____________________
13) How many intervention sites were involved in this project?
Intervention Description
14) Briefly describe the theoretical basis/logic model for your intervention. What led you to believe the
intervention(s) being tested would potentially produce the intended outcomes?
15) Briefly summarize the intervention (including subcomponents) and, if applicable, the strategy for
introducing and implementing the intervention.
16) Identify the unit of analysis (those targeted by the intervention):
☐Individuals (e.g. workers, patients, etc)
☐Workgroups/Teams (e.g. managers, nurses, clinical teams, consulting team)
☐Units/Departments (e.g. obstetrics, customer support, emergency department)
☐Other: __________________________
17) For the focal workgroup or unit of analysis identified, describe the primary members involved. Be sure to
include any information you can provide on the characteristics of the unit.
18) Select the total number of project participants (number of unique individuals, groups or units depending on
the unit of analysis): For just the first leadership group:
☐<10
☐251-500
☐10-20
☐501-1000
☐21-50
☐1001-5000
☐51-100
☐>5000
☐101-250
19) When did collection of baseline data take place?
20) How many subsequent rounds of data collection were there?
21) What was the time interval between each round of data collection?
22) For research projects, please describe the study design:
☐Cluster Randomized Control Trial
☐ Stepped Wedge
☐Individual Randomized Control Trial
☐Interrupted Time Series
☐Controlled Before After
☐Simple Before After
☐Observational Study
☐Other: ____________________
23) Was there a comparison group (used to compare against the intervention group)?
24) If yes, please describe the characteristics of the comparison group:
25) Were Relational Coordination measures used? If so, how were they data collected?
Outcomes
26) RC interventions should be designed to improve both RC and associated performance outcomes. Please
indicate the types of outcomes you tracked or measured. Check all that apply:
☐Health outcomes
☐Process outcomes
☐Client/patient experience outcomes
☐Worker experience/satisfaction outcomes
☐Economic outcomes
27) What changes were observed on each measure? (Please list the performance outcome and associated
results including statistical information)
 Health Outcomes
o 1.
o 2.
o 3.
 Process Outcomes
o 1.
o 2.
o 3.
 Client/Patient Experience Outcomes
o 1.
o 2.
o 3.
 Worker experience/satisfaction outcomes
o 1.
o 2.
o 3.
 Economic Outcomes
o 1.
o 2.
28) Relational Coordination (RC) Survey
o Did survey respondents rate individuals, workgroups or both?
o
What patterns did you observe in the RC results?
o
How did the RC results change over time? (please include quantitative data and statistics)
29) If any other survey instruments were used please describe them and describe the results.
30) Please provide a 1-3 paragraphs narrative summary the results of the intervention. Be specific—include
information about whether or not the intervention affected the targeted outcomes; what were some of the
realized successes, unintended consequences, and contextual barriers or enablers of success or failure; and
what are ongoing open-questions or next steps:
31) For research projects, what were the principal research findings?
Other Learnings
32) What did you learn from this project about the process of planning and/or conducting interventions?
33) What did you learn from this project about research methods?
34) What other comments about the project would you like to record?
35) Has information about this project been shared in any public forum, such as a conference, webinar or a
journal article? If so, please indicate the dissemination method and how this information can be accessed.
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